title: Echo-Doppler-derived indexes of ventricular stiffness and ventriculo-arterial interaction as predictors of new-onset atrial fibrillation in patients with heart failure.
abstract: BACKGROUND
  Atrial fibrillation (AF) is common in patients with heart failure (HF) and worsens their prognosis. Vulnerability to changes in loading is an important factor in the development of AF and is strongly influenced by ventricular stiffness and ventriculo-arterial interaction. The aim of this study was to investigate predictors of AF development in patients with HF.
  
  
  METHODS
  We studied 349 patients with stable HF. The following parameters of ventricular stiffness and ventriculo-arterial interaction were derived from echo-Doppler measurements: left ventricular (LV) diastolic elastance (Ed), effective arterial elastance (Ea), LV end-systolic elastance (Ees) and ventricular-vascular coupling index (VVI).
  
  
  RESULTS
  AF occurred in 57 (16.3%) patients over a median follow up of 30.3 months. Echo-Doppler-derived parameters of ventricular stiffness and ventriculo-arterial interaction were closely associated with HF severity. Ed was independently associated with AF after adjustment for age, hypertension, diabetes mellitus, and left atrial volume index (hazard ratio [HR] 5.49, p = 0.018). Ea and VVI were also associated with new-onset AF (HR 1.66, p = 0.027, and HR 1.06, p = 0.001, respectively).
  
  
  CONCLUSIONS
  Echo-Doppler indexes of ventricular stiffness are closely associated with HF severity. LV diastolic elastance (Ed) is the strongest predictor of new-onset AF in HF patients.
authors: Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
authors: Ji Hyun
authors: JH
authors: Yoon
authors: Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
authors: Myung-Hyun
authors: MH
authors: Kim
authors: Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
authors: Hyemoon
authors: H
authors: Chung
authors: Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
authors: Eui-Young
authors: EY
authors: Choi
authors: Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
authors: Pil-Ki
authors: PK
authors: Min
authors: Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
authors: Young Won
authors: YW
authors: Yoon
authors: Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
authors: Byoung Kwon
authors: BK
authors: Lee
authors: Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
authors: Bum-Kee
authors: BK
authors: Hong
authors: Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
authors: Se-Joong
authors: SJ
authors: Rim
authors: Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
authors: Hyuck Moon
authors: HM
authors: Kwon
authors: Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea. jykim0706@yuhs.ac.
authors: Jong-Youn
authors: JY
authors: Kim
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D015984:Causality; D015897:Comorbidity; D015150:Echocardiography, Doppler / Q000706:statistics & numerical data*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology