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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Blood Pressure Variability and Atrial Fibrillation in Patients with Acute ST Segment Elevation Myocardial Infarction:
Ragab A Mahfouz1, Mohamed El-Shetry1, Abdelfattah Frere1
1Cardiology Department, Zagazig University Hospital, Zagazig, Egypt.
Insights
High blood pressure variability (BPV) is linked to new-onset atrial fibrillation (NOAF) in ST-segment elevation myocardial infarction (STEMI) patients. Increased BPV also correlates with atrial electromechanical delay (EMD), suggesting BPV may predict NOAF.
Area of Science:
- Cardiology
- Electrophysiology
- Hypertension Research
Background:
- New-onset atrial fibrillation (NOAF) is a common complication in ST-segment elevation myocardial infarction (STEMI) patients.
- Blood pressure variability (BPV) and atrial electromechanical delay (EMD) are emerging factors influencing cardiovascular outcomes.
- The relationship between short-term BPV and NOAF in STEMI patients requires further investigation.
Purpose of the Study:
- To investigate the association between 24-h blood pressure variability (BPV) and atrial electromechanical delay (EMD).
- To assess the predictive value of BPV for new-onset atrial fibrillation (NOAF) in patients with ST-segment elevation myocardial infarction (STEMI).
Main Methods:
- 175 STEMI patients undergoing primary percutaneous coronary intervention were enrolled.
- 24-h ambulatory blood pressure monitoring was performed to assess BPV parameters, including SDdn.
- Echocardiography and atrial EMD assessments were conducted; patients were stratified into low and high BPV groups.
Main Results:
- Patients with high BPV (SDdn: 13.5 ± 2.9 mm Hg) had a significantly higher incidence of NOAF (28.9%) compared to those with low BPV (3.5%; p < 0.001).
- High BPV was associated with increased left atrial volume index, E/e' ratio, and significantly prolonged inter- and intra-atrial EMD (p < 0.001).
- SDdn and intra-atrial EMD were identified as independent predictors of NOAF in STEMI patients (OR = 3.75 and 2.72, respectively; p < 0.001).
Conclusions:
- Short-term 24-h blood pressure variability is significantly associated with new-onset atrial fibrillation in STEMI patients.
- Blood pressure variability demonstrates a significant correlation with atrial electromechanical delay.
- BPV emerges as a potential early predictor for NOAF in the STEMI population.
Purpose:
To investigate the association between 24-h blood pressure variability (BPV) and atrial electromechanical delay (EMD) in patients with ST segment elevation myocardial infarction (STEMI) who developed new-onset atrial fibrillation (NOAF).
Materials And Methods:
A total of 175 STEMI patients (age 56.6 ± 10.5 years) who underwent primary percutaneous coronary intervention were subjected to in-hospital 24-h ambulatory BP monitoring, comprehensive echocardiography, and assessment of atrial EMD. The parameters of BPV analyzed were: (a) 24-h standard deviation (SD), (b) the coefficient of variation, and (c) the average of the daytime and nighttime SDs weighted for the duration of the daytime and nighttime interval (SDdn ).
Results:
Based on the median of BPV index (SDdn) = 9.5 mm Hg of all participants, patients were stratified into low and high variability groups (SDdn: 7.1 ± 1.5 vs.13.5 ± 2.9; p < 0.001). Of the 175 patients with STEMI, 29 (16.7%) patients developed NOAF; 26 (28.9%) were in the high variability group and 3.5% were in the low variability group (p < 0.001). Echocardiographic data showed that the left atrial volume index (p < 0.01) and E/e' ratio (p < 0.001) were significantly higher in patients with high BPV. Inter and intra-atrial EMD were significantly increased in the high variability group compared to the low variability group (p < 0.001). With multiple linear analysis, there was significant correlation between SDdn and intra-left atrial and inter-atrial EMD (p < 0.001 and <0.01, respectively). Cox regression analysis revealed that SDdn and intra-atrial EMD were independent predictors for NOAF in patients with STEMI (OR = 3.75 and 02.72, respectively; p < 0.001). ROC analysis revealed that SDdn ≥12.8 was the optimal cut-off value for predicting NOAF during follow-up.
Conclusions:
Short-term BPV was associated with NOAF during the 1-year follow-up in patients with STEMI. In addition, BPV was correlated significantly with atrial EMD. Herein, BPV was predicted to be an early predictor of NOAF in patients with STEMI.
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