title: Evaluating functional capacity, and mortality effects in the presence of atrial electromechanical conduction delay in patients with systolic heart failure.
abstract: OBJECTIVE
  Atrial functions are relatively suppressed in heart failure (HF). We aimed to investigate the associations of intra- and inter-atrial electromechanical conduction delay (EMCD) with functional class and mortality over a 12-month follow-up period.
  
  
  METHODS
  The prospective study included 65 patients with systolic HF and 65 healthy subjects with normal sinus rhythm. Left ventricular (LV) systolic functions and left atrial (LA) dimensions and volumes were evaluated by transthoracic echocardiography. Tissue Doppler imaging (TDI) signals at the lateral border of the mitral annulus (lateral PA'), septal mitral annulus (septal PA'), and tricuspid annulus (tricuspid PA') were measured. Intra- and inter-atrial EMCD were calculated.
  
  
  RESULTS
  Mitral inflow velocities were studied using pulsed-wave Doppler after placing the sample volume at the leaflets' tips. The peak early (E wave) and late (A wave) velocities were measured. The septal annular E/E' ratio was relatively higher and lateral, septal, and right ventricular S, E', and A' waves were significantly lower in the HF group than in the control group (12.49±6.03 - 7.16±1.75, pE/E' <0.0001). Intra-atrial EMCD was detected as 117.5 ms and inter-atrial EMCD as 127.5 ms in patients with prolonged atrial EMCD. A significant increase was found in prolonged intraand inter-atrial EMCD according to functional capacity increase (p=0.012 and p=0.031, respectively). The incidence of mortality was significantly higher in patients with prolonged atrial EMCD (p=0.025), and 5 patients in the HF group died during the study over the 12-month follow-up period.
  
  
  CONCLUSIONS
  In this study, we found a relationship between prolonged atrial conduction time and increased functional class and mortality in patients with systolic HF.
authors.affiliation: Department of Cardiology, Ankara Dışkapı Training and Research Hospital, Ankara-Turkey. drbilginmurat@hotmail.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Bilgin
authors.affiliation: Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli-Turkey.
authors.forename: Bekir Serhat
authors.initials: BS
authors.lastname: Yıldız
authors.affiliation: Department of Cardiology, İzmir Karşıyaka State Hospital, İzmir-Turkey.
authors.forename: Kamil
authors.initials: K
authors.lastname: Tülüce
authors.affiliation: Department of Cardiology, Faculty of Medicine, İzmir Şifa University, İzmir-Turkey.
authors.forename: İlker
authors.initials: İ
authors.lastname: Gül
authors.affiliation: Department of Cardiology, Faculty of Medicine, Ege University, İzmir-Turkey.
authors.forename: Mustafa Beyazıt
authors.initials: MB
authors.lastname: Alkan
authors.affiliation: Department of Cardiology, İzmir Tepecik Training and Research Hospital, İzmir-Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Sayın
authors.affiliation: Department of Cardiology, Faculty of Medicine, Ege University, İzmir-Turkey.
authors.forename: Aysel
authors.initials: A
authors.lastname: İslamlı
authors.affiliation: Department of Cardiology, Ankara Dışkapı Training and Research Hospital, Ankara-Turkey.
authors.forename: Tolga Han
authors.initials: TH
authors.lastname: Efe
authors.affiliation: Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli-Turkey.
authors.forename: Yusuf İzzettin
authors.initials: Yİ
authors.lastname: Alihanoğlu
authors.affiliation: Department of Cardiology, Faculty of Medicine, Ege University, İzmir-Turkey.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Zoghi
authors.affiliation: Department of Cardiology, Faculty of Medicine, Ege University, İzmir-Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Akın