title: Augmentation of pulmonary vein backflow velocity during left atrial contraction: a novel phenomenon responsible for progression of atrial fibrillation in hypertensive patients.
abstract: BACKGROUND
  Atrial fibrillation (AF) is a common arrhythmia showing disease progression. However, echocardiographic prediction of such progression remains incomplete. This study aimed to identify echocardiographic predictors of AF progression in hypertensive patients.
  
  
  METHODS
  Hypertensive patients with paroxysmal AF were divided into two groups: patients with AF which became permanent (group A; n = 13) and those with AF which remained paroxysmal (group B; n = 46) during the same follow-up period (8.0 +/- 2.4 years). Clinical baselines showed no significant differences except for age. Transthoracic echocardiography was recorded 1-2 weeks after termination of the first-detected paroxysms of AF.
  
  
  RESULTS
  Echocardiography showed greater left atrial (LA) dimension (p = 0.023) and late diastolic pulmonary vein (PV) backflow velocity (p < 0.001), and a lower LA fractional shortening (p = 0.008) in group A than in group B. Multilogistic regression analysis demonstrated that augmented PV backflow (p = 0.007) and reduced LA fractional shortening (p = 0.032) were independent predictors of the progression of AF. The receiver-operating characteristic curve demonstrated that PV backflow augmentation is the best predictor of future AF perpetuation.
  
  
  CONCLUSIONS
  PV backflow leading to cyclic stretching of PV musculature contributes to AF progression.
authors.affiliation: Department of Medicine, Kyushu University, Fukuoka, Japan. maruyama@ihs.kyushu-u.ac.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Maruyama
authors.forename: Toshisuke
authors.initials: T
authors.lastname: Kishikawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ito
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kaji
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ishihara
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D016279:Atrial Function, Left / Q000502:physiology*; D001783:Blood Flow Velocity / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology*