title: Systolic and Diastolic Function by Tissue Doppler Imaging Predicts Mortality in Patients with Atrial Fibrillation.
abstract: OBJECTIVE
  Tissue Doppler Imaging (TDI) detects early signs of left ventricular dysfunction. The prognostic potential of TDI in patients with atrial fibrillation (AF) has, however, not yet been clarified. This study evaluates the prognostic value of TDI in patients with atrial fibrillation.
  
  
  RESULTS
  In total, echocardiograms from 313 patients with AF during examination were analyzed offline. Longitudinal systolic velocity (s'), early diastolic velocity (e') and longitudinal displacement (LD) were measured by color TDI. During a median follow-up of 891 days, 64 patients (20%) died. TDI was significantly associated with all-cause mortality, and the risk of dying increased significantly per 1 cm/s decrease in s' (HR of 1.31, 95% CI 1.05-1.63; p=0.018) and e' (HR of 1.17, 95% CI 1.01-1.35; p=0.038) respectively, even after adjustment for age, gender, heart rate, aortic stenosis, DM and LVEF quartiles. LD also proved to be a significant predictor of outcome after multivariate adjustment (HR 1.23; 95% CI 1.05-1.44; p=0.012). The population was stratified according to high or low s' and e'. Patients with low s' and e' had more than three times the risk of mortality compared to the patients with high s' and e' (HR 3.64; 95% CI 1.83-7.26; p<0.001) and remained in significantly higher risk after adjustment for various risk factors.
  
  
  CONCLUSIONS
  Both systolic and diastolic performance, as assessed by TDI, are strong predictors of mortality in patients with atrial fibrillation, and especially the combination of systolic and diastolic dysfunction is a significant prognostic marker.
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Maria
authors.initials: M
authors.lastname: Dons
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark; Clinical Institute, Faculty of Health Sciences, University of Copenhagen, Denmark.
authors.forename: Tor
authors.initials: T
authors.lastname: BieringSørensen
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark; Clinical Institute, Faculty of Health Sciences, University of Copenhagen, Denmark.
authors.forename: Jan Skov
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fritz-Hansen
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Bech
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Martina Chantal
authors.initials: MC
authors.lastname: de Knegt
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Sivertsen
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Flemming Javier
authors.initials: FJ
authors.lastname: Olsen
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Mogelvang
keywords: Atrial Fibrillation; Echocardiography; Mortality; Outcome; Tissue Doppler Imaging