Prediction of transition to chronic atrial fibrillation in elderly patients with nonvalvular paroxysmal atrial fibrillation by transthoracic Doppler echocardiography.
BACKGROUND
It is well known that paroxysmal atrial fibrillation (PAF) often precedes the development of chronic atrial fibrillation (CAF).


OBJECTIVE
The purpose of this study was to determine prospectively whether transthoracic echocardiography is useful for the prediction of the transition to CAF in elderly patients with nonvalvular PAF.


METHODS
Forty-two consecutive elderly patients (> or =65 years) with nonvalvular PAF were prospectively evaluated after undergoing transthoracic echocardiography. The study endpoint was the transition to CAF (AF; > or = 6 mo).


RESULTS
During a follow-up period of 32 +/- 24 mo, 12 patients developed CAF. Patients with CAF had a significantly lower peak A velocity (A) and a higher E/A ratio of the transmitral inflow (TMF) such as a pseudonormalization pattern, and a lower peak atrial reversal wave velocity, higher peak diastolic wave velocity (D), and lower peak systolic/diastolic wave velocity ratio (S/D ratio) of the pulmonary venous flow (PVF). Kaplan-Meier analysis revealed that the transition to CAF was observed more often when A was < or = 70 cm/sec and E/A ratio was > or = 1.07 of TMF, and D was > or = 44 cm/sec and the S/D ratio was < or = 1.34 of PVF. All patients developed CAF when the E/A ratio was > or = 1.15 or the S/D ratio was < or = 0.75.


CONCLUSIONS
This prospective study suggests that elderly patients at high risk for transition to CAF have a pseudonormalization pattern of TMF and a diastolic dominant pattern of PVF, and that transthoracic Doppler estimation of TMF and PVF may be useful in identifying elderly patients at high risk for the transition from nonvalvular PAF to CAF.
Sakabe
Koichi
K
Department of Cardiology and Clinical Research, National Hospital Organization, Zentsuji National Hospital, 2-1-1, Senyu-cho, Zentsuji, Kagawa 765-0001, Japan. ksakabe@jun.ncvc.go.jp
Fukuda
Nobuo
N
Fukuda
Yamato
Y
Morishita
Satofumi
S
Shinohara
Hisanori
H
Tamura
Yoshiyuki
Y
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D002908:Chronic Disease; D018450:Disease Progression; D018572:Disease-Free Survival; D018619:Echocardiography, Doppler, Pulsed; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors