Factors associated with atrial fibrillation in rheumatic mitral stenosis.
BACKGROUND
Atrial fibrillation is a complication of mitral valve stenosis that causes several adverse neurologic outcomes. Our objective was to establish a mathematical model to predict the risk of atrial fibrillation in patients with mitral stenosis.


METHODS
Of 819 patients with mitral stenosis who were screened, 603 were enrolled in the study and grouped according to whether they were in sinus rhythm or atrial fibrillation. Demographic, echocardiographic, and hemodynamic data were recorded. Logistic regression models were constructed to identify the relative risks for each contributing factor and calculate the probability of developing atrial fibrillation. Receiver operating characteristic curves were plotted.


RESULTS
Two hundred (33%) patients had atrial fibrillation; this group was older, in a higher functional class, more likely to have suffered previous thromboembolic events, and had significantly larger left atrial diameters, lower ejection fractions, and lower left atrial appendage emptying flow velocity. The factors independently associated with atrial fibrillation were left atrial strain (odds ratio = 7.53 [4.47-12.69], p < 0.001), right atrial pressure (odds ratio = 1.09 [1.02-1.17], p = 0.01), age (odds ratio = 1.14 [1.05-1.25], p = 0.002), and ejection fraction (odds ratio = 0.92 [0.87-0.97], p = 0.003). The area under the curve for the combined receiver operating characteristic for this model was 0.90 ± 0.12.


CONCLUSIONS
Age, right atrial pressure, ejection fraction, and left atrial strain can be used to construct a mathematical model to predict the development of atrial fibrillation in rheumatic mitral stenosis.
Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Leili
L
Pourafkari
Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Samad
S
Ghaffari
Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA.
George R
GR
Bancroft
Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Arezou
A
Tajlil
Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA nnader@buffalo.edu.
Nader D
ND
Nader
D000328:Adult; D000367:Age Factors; D019540:Area Under Curve; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016279:Atrial Function, Left; D016280:Atrial Function, Right; D062185:Atrial Pressure; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008954:Models, Biological; D016017:Odds Ratio; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D016277:Ventricular Function, Left
Atrial fibrillation; Logistic models; Mitral valve stenosis; Rheumatic heart disease; Risk factors