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Published on: July 20, 2022
The impact of the right heart cavities echocardiographic features on atrial-high rate episodes
Inanc Artac1, Muammer Karakayali2, Timor Omar2
1Department of Cardiology KARS, Faculty of Medicine, Kafkas University, Kars, Turkey. inancartac@hotmail.com.
Insights
Right atrial volume index (RAVI) and E/Em tricuspid ratio are key predictors of atrial high-rate episodes (AHRE) in patients with cardiac implantable electronic devices and reduced ejection fraction. These echocardiographic measures can help identify individuals at higher risk for adverse cardiovascular outcomes.
Area of Science:
- Cardiology
- Echocardiography
- Electrophysiology
Background:
- Atrial high-rate episodes (AHRE) detected by cardiac implantable electronic devices (CIEDs) are linked to increased risks of atrial fibrillation, thromboembolism, cardiovascular events, and mortality.
- Predictive factors for AHRE are actively researched to improve patient management and risk stratification.
- Impaired left ventricular ejection fraction (LVEF) is a common comorbidity in patients with CIEDs, potentially influencing atrial arrhythmogenesis.
Purpose of the Study:
- To evaluate the association between right-heart structural and functional echocardiographic parameters and the occurrence of AHRE in patients with CIEDs and impaired LVEF.
- To identify specific echocardiographic variables that can independently predict AHRE in this patient population.
- To assess the diagnostic performance of identified echocardiographic predictors for AHRE detection.
Main Methods:
- Prospective study including 194 patients with CIEDs and impaired LVEF.
- Patients were divided into two groups: those with AHRE (+) and those without AHRE (-).
- Multivariate analysis and Receiver Operating Characteristic (ROC) curve analysis were performed to identify independent predictors and assess their predictive accuracy.
Main Results:
- Multivariate analysis identified Age, Left Atrial Volume Index (LAVI), E/Em tricuspid ratio, and Right Atrial Volume Index (RAVI) as independent predictors of AHRE.
- ROC curve analysis demonstrated that RAVI (AUC: 0.707) and E/Em tricuspid ratio (AUC: 0.611) significantly predicted AHRE.
- Optimal cut-off values were determined for RAVI (29.5 mL/m²) and E/Em tricuspid ratio (6.28), with associated sensitivity and specificity values.
Conclusions:
- Right atrial volume index (RAVI) and E/Em tricuspid ratio are significantly associated with the presence of AHRE in patients with CIEDs and impaired LVEF.
- These echocardiographic parameters serve as independent predictors for AHRE, offering valuable insights for risk stratification.
- The findings suggest that integrating RAVI and E/Em tricuspid ratio into echocardiographic assessments may enhance the prediction and management of AHRE in at-risk populations.
Abstract:
Atrial high-rate episodes (AHRE) defined as atrial tachy-arrhythmias, detected through continuous monitoring with a cardiac implantable electronic device (CIED). AHRE's have been associated with increased risks of developing clinically manifested atrial fibrillation, thromboembolism, cardiovascular events, and mortality. Several variables have been researched and identified to predict AHRE existence. The present study evaluated the association between right-heart structural and functional echocardiographic parameters and AHRE in patients with CIEDs and impaired LVEF. This prospective design study included 194 patients with CIED's. The study population was divided into two groups according to presence of AHRE and analyzed the echocardiographic variables which may able to be a predictor of AHRE. Patients was divided into two groups: patients with AHRE (+) and without AHRE (-). The distribution of patients' characteristics according to presence of AHRE was analyzed. The multivariate analysis revealed Age, LAVI, E/Em tricuspid (HR: 1.106, 1.015-1.205% 95 CI; p = 0.022) and RAVI (HR: 1.035, 1.003-1.069 95% CI; p = 0.033) as independent predictors of AHREs. ROC curve analysis indicated that an E/Em tricuspid (AUC: 0.611, 95% CI 0.538-0.680 p: 0.009) and RAVI (AUC = AUC: 0.707, 95% CI 0.637-0.770 p < 0.001) predicted AHREs with a cut-off value of 6.28 and a sensitivity of 53.2% and specificity of 66.7% and a cut-off value of 29.5 mL/m2 with a sensitivity of 72.7% and a specificity of 65.9%, respectively. The main finding of this study was "RAVI" and "E/Emtricuspid ratio" is associated with AHRE. Additionally, "RAVI" and "E/Emtricuspid ratio" is an independent predictor of AHRE existence.
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