title: A Novel Index Combining Diastolic and Systolic Tissue Doppler Parameters for Prediction of Atrial Fibrillation Recurrence.
abstract: OBJECTIVE
  Identification of patients at risk for atrial fibrillation (AF) recurrence with using simple and objective parameters may be helpful in tailoring the treatment. In this study, we investigated whether E/(Ea×Sa) and Ea/(Aa×Sa) could be a predictor of AF recurrence after cardioversion. (E = early diastolic transmitral velocity, Ea = early diastolic mitral annular velocity, Aa = late diastolic mitral annular velocity, Sa = systolic mitral annular velocity).
  
  
  METHODS
  In total, 127 patients with persistent AF were evaluated for this study and 73 patients were included according to the study criteria. Sinus rhythm (SR) was achieved for 70 patients after electrical direct-current cardioversion. E, Sa, Ea, and Aa were determined at mitral medial and lateral site and average values obtained. E/(Ea×Sa) and Ea/(Aa×Sa) were calculated (medial, lateral, average). Heart rate and rhythm were followed with an electrocardiography (ECG) monitor and 12-lead ECG at first week and first month.
  
  
  RESULTS
  At one month, 53 patients (75.7%) were in SR, whereas 17 patients (24.3%) reverted to AF. According to precardioversion E/(Ea×Sa) lateral, E/(Ea×Sa) medial, E/(Ea×Sa) average (P ≤ 0.01 for all the indices), 24-hour echocardiographic evaluation E/(Ea×Sa) lateral, E/(Ea×Sa) medial, E/(Ea×Sa) average, Ea/(Aa×Sa) lateral, Ea/(Aa×Sa) medial, and Ea/(Aa×Sa) average (P ≤ 0.01 for all the indices), indices were significantly higher in the AF recurrence group than in the SR group. Furthermore, the ROC analysis showed that all the E/(Ea×Sa) and Ea/(Aa×Sa) parameters predict the AF recurrence. The AUC values range from 70% to 81% (P ≤ 0.01 for all the parameters). In subgroup analysis of the patients, precardioversion mitral medial E/Ea ratio was between 8 and 15, and the ROC analysis showed that the novel indices predict the AF recurrence. The AUC values range from 72% to 86% (P ≤ 0.02 for all the parameters).
  
  
  CONCLUSIONS
  We found that E/(Ea×Sa) and Ea/(Aa×Sa) indices are novel predictors of AF recurrence.
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Ari
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: Selma
authors.initials: S
authors.lastname: Ari
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: O Yaşar
authors.initials: OY
authors.lastname: Sarigül
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: Selvi
authors.initials: S
authors.lastname: Coşar
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: Kübra
authors.initials: K
authors.lastname: Doğanay
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: Nadir
authors.initials: N
authors.lastname: Emlek
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Tütüncü
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: Eylem
authors.initials: E
authors.lastname: Kivanç
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: Sencer
authors.initials: S
authors.lastname: Çamci
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Aktaş
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Karakuş
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: Ismet
authors.initials: I
authors.lastname: Zengin
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: Tahsin
authors.initials: T
authors.lastname: Bozat
authors.affiliation: Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Melek
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume
keywords: atrial fibrillation; cardioversion; mitral annular velocity; recurrence; tissue Doppler imaging