title: Are transthoracic echocardiographic parameters associated with atrial fibrillation recurrence or stroke? Results from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the associations of transthoracic echocardiographic parameters with recurrent atrial fibrillation (AF) and/or stroke.
  
  
  BACKGROUND
  The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study, an evaluation of elderly patients with AF at risk for stroke, provided an opportunity to evaluate the implications of echocardiographic parameters in patients with AF.
  
  
  METHODS
  Transthoracic echocardiographic measures of mitral regurgitation (MR), left atrial (LA) diameter, and left ventricular (LV) function were evaluated in the AFFIRM rate- and rhythm-control patients who had sinus rhythm resume and had these data available. Risk for recurrent AF or stroke was evaluated with respect to transthoracic echocardiographic measures.
  
  
  RESULTS
  Of 2,474 patients studied, 457 had > or =2(+)/4(+) MR, and 726 had a LA diameter >4.5 cm. The LV ejection fraction was abnormal in 543 patients. The cumulative probabilities of at least one AF recurrence/stroke were 46%/1% after 1 year and 84%/5% by the end of the trial (> 5 years), respectively. Multivariate analysis showed that randomization to the rhythm-control arm (hazard ratio [HR] = 0.64; p < 0.0001) and a qualifying episode of AF being the first known episode (HR = 0.70; p < 0.0001) were associated with decreased risk. Duration of qualifying AF episode >48 h (HR = 1.55; p < 0.0001) and LA diameter (p = 0.008) were associated with an increased risk of recurrent AF. Recurrent AF was more likely with larger LA diameters (HR = 1.21, 1.16, and 1.32 for mild, moderate, and severe enlargement, respectively). No transthoracic echocardiographic measures were associated with risk of stroke.
  
  
  CONCLUSIONS
  In the AFFIRM study, large transthoracic echocardiographic LA diameters were associated with recurrent AF, but no measured echocardiographic parameter was associated with stroke.
authors.affiliation: University of Iowa Hospitals, 200 Hawkins Drive, Iowa City, IA 52242, USA. brian-olshansky@uiowa.edu
authors.forename: Brian
authors.initials: B
authors.lastname: Olshansky
authors.forename: Eliot N
authors.initials: EN
authors.lastname: Heller
authors.forename: L Brent
authors.initials: LB
authors.lastname: Mitchell
authors.forename: Mary
authors.initials: M
authors.lastname: Chandler
authors.forename: William
authors.initials: W
authors.lastname: Slater
authors.forename: Martin
authors.initials: M
authors.lastname: Green
authors.forename: Michael
authors.initials: M
authors.lastname: Brodsky
authors.forename: Patrick
authors.initials: P
authors.lastname: Barrell
authors.forename: H Leon
authors.initials: HL
authors.lastname: Greene
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D013318:Stroke Volume / Q000502:physiology*