title: Echocardiographic Predictors of Progression to Persistent or Permanent Atrial Fibrillation in Patients with Paroxysmal Atrial Fibrillation (E6P Study).
abstract: BACKGROUND
  Paroxysmal atrial fibrillation (AF) frequently, but not always, progresses to persistent/permanent AF. The aim of this study was to evaluate the echocardiographic predictors of AF progression in patients with paroxysmal AF.
  
  
  METHODS
  A multicenter, prospective, observational study was conducted that included 313 patients with paroxysmal AF who underwent two-dimensional speckle-tracking echocardiography. The diameter, volume, and mechanical function of the left atrium, including global strain (ε) and ε rate, were measured.
  
  
  RESULTS
  Progression to persistent or permanent AF occurred in 52 patients (16.6%) during a median follow-up period of 26 months. Echocardiographic measure of left atrial (LA) diameter, volume, and function (E velocity, E/A and E/e' ratio, LA expansion index, active emptying fraction, global longitudinal ε and ε rate) were associated with AF progression. LA ε ≤ 30.9% was the strongest predictor of AF progression, which was associated with a more than fourfold hazard increase for AF progression (hazard ratio, 4.224; P = .001). LA diameter > 39 mm and maximal LA volume index > 34.2 mL/m(2) were associated with about a twofold hazard increase for AF progression (hazard ratios, 1.994 and 2.649; P = .016 and P = .001, respectively). When adjusted for a model combining maximal LA volume index, E velocity, LA expansion index, and active emptying fraction, LA ε ≤ 30.9% maintained a more than threefold hazard increase for AF progression (adjusted hazard ratio, 3.970; P = .003).
  
  
  CONCLUSIONS
  Echocardiographic measures of LA diameter, volume, and mechanical function, including LA ε, were associated with AF progression. LA ε was the strongest independent predictor of AF progression and is expected to serve as a valuable predictor of AF progression.
authors.affiliation: Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Yeonyee E
authors.initials: YE
authors.lastname: Yoon
authors.affiliation: Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Il-Young
authors.initials: IY
authors.lastname: Oh
authors.affiliation: Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Seoul, Korea.
authors.forename: Sung-Ai
authors.initials: SA
authors.lastname: Kim
authors.affiliation: Cardiovascular Division, Department of Internal Medicine, Hallym University Medical Center, Seoul, Korea.
authors.forename: Kyoung-Ha
authors.initials: KH
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Korean University Medical Center, Seoul, Korea.
authors.forename: Seong Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Cardiovascular Division, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Jae-Hyeong
authors.initials: JH
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jeong-Eun
authors.initials: JE
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Seung-Pyo
authors.initials: SP
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyung-Kwan
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Dae-Won
authors.initials: DW
authors.lastname: Sohn
authors.affiliation: Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea. Electronic address: cardioch@snu.ac.kr.
authors.forename: Goo-Yeong
authors.initials: GY
authors.lastname: Cho
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging*; D002908:Chronic Disease; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: Atrial fibrillation; Left atrium; Strain