title: A new tissue doppler index in predicting future atrial fibrillation in patients with heart failure.
abstract: BACKGROUND
  Onset of atrial fibrillation (AF) in patients with heart failure (HF) is usually associated with a high occurrence of cardiovascular complications. E/(E'×S') ratio (E=early diastolic transmitral velocity, E'=early mitral annular diastolic velocity and S'=systolic mitral annulus velocity) has been shown to reflect left ventricular filling pressure.
  
  
  OBJECTIVE
  We investigate whether E/(E'×S') could be a predictor of new-onset AF in patients with HF.
  
  
  METHODS
  We analyzed 113 consecutive hospitalized patients with HF, in sinus rhythm, after appropriate medical treatment. Patients with histories of AF, inadequate echocardiographic images, congenital heart disease, paced rhythm, significant primary valvular disease, acute coronary syndrome, coronary revascularization during follow-up, severe pulmonary disease or renal failure were not included. E/(E'×S') was determined using the average of septal and lateral mitral annular velocities. The primary study end-point was the new-onset AF.
  
  
  RESULTS
  During the follow-up period (35.7±11.2 months), 33 patients (29.2%) developed AF. Mean E/(E'×S') was 3.09±1.12 in these patients, while it was 1.72±1.34 in the other patients (p<0.001). The optimal E/(E'×S') cut-off to predict new-onset AF was 2.2 (88% sensitivity, 77% specificity). There were 64 patients (56.6%) with E/(E'×S')<2.2 and 49 (43.4%) with E/(E'×S')>2.2. New-onset AF was higher in patients with E/(E'×S')>2.2 than in patients with E/(E'×S')<2.2 [29 (59.1%) versus 4 (6.2%), p<0.001]. On multivariate Cox analysis including the variables that predicted AF on univariate analysis, E/(E'×S') was the only independent predictor of new-onset AF (hazard ratio=2.26, 95% confidence interval=1.25-4.09, p=0.007).
  
  
  CONCLUSIONS
  In patients with HF, E/(E'×S') seems to be a good predictor of new-onset AF.
authors: Institute of Cardiovascular Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, România. mornoscristi@yahoo.com
authors: Cristian
authors: C
authors: Mornos
authors: Lucian
authors: L
authors: Petrescu
authors: Dragos
authors: D
authors: Cozma
authors: Adina
authors: A
authors: Ionac
authors: Sorin
authors: S
authors: Pescariu
authors: Stefan Iosif
authors: SI
authors: Dragulescu
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001783:Blood Flow Velocity / Q000502:physiology; D003971:Diastole; D015150:Echocardiography, Doppler; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D013599:Systole