Predictive value of total atrial conduction time estimated with tissue Doppler imaging for the development of new-onset atrial fibrillation after acute myocardial infarction.
Patients who develop new-onset atrial fibrillation (AF) after acute myocardial infarction (AMI) show an increased risk for adverse events and mortality during follow-up. Recently, a novel noninvasive echocardiographic method has been validated for the estimation of total atrial activation time using tissue Doppler imaging of the atria (PA-TDI duration). PA-TDI duration has shown to be independently predictive of new-onset AF. However, whether PA-TDI duration provides predictive value for new-onset AF in patients after AMI has not been evaluated. Consecutive patients admitted with AMIs and treated with primary percutaneous coronary intervention underwent echocardiography <48 hours after admission. All patients were followed at the outpatient clinic for > or =1 year. During follow-up, 12-lead electrocardiography and Holter monitoring were performed regularly, and the development of new-onset AF was noted. Baseline echocardiography was performed to assess left ventricular and left atrial (LA) function. LA performance was quantified with LA volumes, function, and PA-TDI duration. A total of 613 patients were evaluated. LA maximal volume (hazard ratio 1.07, 95% confidence interval 1.04 to 1.11), the total LA ejection fraction (hazard ratio 0.96, 95% confidence interval 0.93 to 0.99) and PA-TDI duration (hazard ratio 1.05, 95% confidence interval 1.04 to 1.06) were univariate predictors of new-onset AF. After multivariate analysis, LA maximal volume and PA-TDI duration independently predicted new-onset AF. Furthermore, PA-TDI duration provided incremental prognostic value to traditional clinical and echocardiographic parameters for the prediction of new-onset AF. In conclusion, PA-TDI duration is a simple measurement that provides important value for the prediction of new-onset AF in patients after AMI.
Antoni
M Louisa
ML
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Bertini
Matteo
M
Atary
Jael Z
JZ
Delgado
V
V
ten Brinke
Ellen A
EA
Boersma
Eric
E
Holman
Eduard R
ER
van der Wall
Ernst E
EE
Schalij
Martin J
MJ
Bax
Jeroen J
JJ
van de Veire
Nico R L
NR
D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000209:etiology*; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006329:Heart Conduction System; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011237:Predictive Value of Tests