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Taniguchi N, Miyasaka Y, Suwa Y, Nakai E, Harada S, Otagaki H, Shiojima I. Incremental value of diastolic wall strain in predicting heart failure events in patients with atrial fibrillation. Heart Vessels 2024:10.1007/s00380-024-02401-w. [PMID: 38625395 DOI: 10.1007/s00380-024-02401-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/28/2024] [Indexed: 04/17/2024]
Abstract
Diastolic wall strain (DWS), an echocardiographic index based on linear elasticity theory, has been identified as a predictor of heart failure (HF) in patients with sinus rhythm. However, its effectiveness in atrial fibrillation (AF) patients remains uncertain. This study aims to assess DWS as a predictor of HF in AF patients with preserved ejection fraction. We analysed a prospective database of AF patients undergoing transthoracic echocardiography. AF patients with reduced left ventricular ejection fraction (< 50%), posterior wall motion abnormality, hypertrophic cardiomyopathy, valvular heart disease, pericardial disease, congenital heart disease, or history of pacemaker/implantable cardioverter-defibrillator implantation or cardiac surgery were excluded. The study followed patients until HF development, death, or last visit. Follow-up for patients who underwent catheter ablation was censored on the date of their procedure. HF was ascertained based on the Framingham criteria. DWS was calculated using a validated formula: DWS = (PWs -PWd)/PWs, where PWs is the posterior wall thickness at end-systole and PWd is the posterior wall thickness at end-diastole. Among 411 study patients (mean age 69.6 years, 66% men), 20 (5%) was underwent catheter ablation and 57 (14%) developed HF during a mean follow-up of 82 months. Cox-proportional hazards demonstrated that low DWS (≤ 0.33) significantly predicted HF events (hazard ratio [HR] 3.28, 95% confidence interval [CI]) 1.81-5.94, P < 0.0001), independent of age (per 10 years; HR 1.99, 95% CI 1.35-2.93, P < 0.001), indexed left ventricular mass (per 10 g/m2; HR 1.16, 95% CI 1.05-1.27, P < 0.01), and indexed left atrial volume (per 10 mL/m2; HR 1.14, 95% CI 1.04-1.24, P < 0.01). Additionally, global log-likelihood ratio chi-square statistics indicated that DWS incrementally predicts HF development beyond age, indexed left ventricular mass, and left atrial volume (P < 0.001).
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Affiliation(s)
- Naoki Taniguchi
- Division of Cardiology, Department of Medicine II, Kansai Medical University, 2-5-1, Shin- machi, Hirakata, 573-1010, Osaka, Japan
| | - Yoko Miyasaka
- Division of Cardiology, Department of Medicine II, Kansai Medical University, 2-5-1, Shin- machi, Hirakata, 573-1010, Osaka, Japan.
| | - Yoshinobu Suwa
- Division of Cardiology, Department of Medicine II, Kansai Medical University, 2-5-1, Shin- machi, Hirakata, 573-1010, Osaka, Japan
| | - Eri Nakai
- Division of Cardiology, Department of Medicine II, Kansai Medical University, 2-5-1, Shin- machi, Hirakata, 573-1010, Osaka, Japan
| | - Shoko Harada
- Division of Cardiology, Department of Medicine II, Kansai Medical University, 2-5-1, Shin- machi, Hirakata, 573-1010, Osaka, Japan
| | - Hiromi Otagaki
- Division of Cardiology, Department of Medicine II, Kansai Medical University, 2-5-1, Shin- machi, Hirakata, 573-1010, Osaka, Japan
| | - Ichiro Shiojima
- Division of Cardiology, Department of Medicine II, Kansai Medical University, 2-5-1, Shin- machi, Hirakata, 573-1010, Osaka, Japan
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Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and associated with increased morbidity and mortality resulting from thromboembolism and heart failure. AF often presents initially as paroxysmal and may progress to a sustained form over time. Sustained forms of AF may be associated with increased symptoms and cardiovascular morbidity, and AF progression may be associated with increased risk of clinically adverse events and outcomes. The present review discusses the clinical factors of arrhythmia progression and risk stratification available to assess the probability of AF progression. Furthermore, currently available treatment options for preventing AF progression are explored and evaluated.
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Affiliation(s)
- Hisashi Ogawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
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Kishima H, Mine T, Fukuhara E, Ishihara M. Left ventricular stiffness assessed by diastolic Wall strain predicts asymptomatic atrial high-rate episodes in patients with pacemaker implantation. J Cardiol 2020; 77:195-200. [PMID: 32888831 DOI: 10.1016/j.jjcc.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/22/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cardiac implantable electronic device-detected atrial high-rate episodes (AHREs) have been reported to be associated with thromboembolic risks. The present study aimed to investigate the association of echocardiographic and clinical parameters with the occurrence of AHREs in patients with a dual-chamber pacemaker (PMI). METHODS One hundred forty-seven patients (76 males, 75.2 ± 8.9 years) who did not show atrial tachyarrhythmia before the implantation of the PMI were studied. Diastolic wall strain (DWS) and other measurements were assessed during sinus rhythm using transthoracic echocardiography before the PMI. DWS was calculated from the M-mode echocardiographic measurement of the left ventricular (LV) posterior wall thickness at end-systole (PWs) and end-diastole (PWd), and DWS was defined as (PWs-PWd) / PWs. RESULTS AHREs (defined as AHREs duration >6 min and atrial rate >180 bpm) were detected in 50 / 147 patients during follow up (38.3 ± 13.8 months). Patients in the AHREs group had reduced DWS (0.29 ± 0.07 vs. 0.39 ± 0.06, p < 0.0001), larger left atrial volume index, thicker LV posterior diameter, higher rate of patients taking β-blocker / diuretics, and higher prevalence of sinus node dysfunction. On multivariable analysis, only DWS was independently associated with AHREs. Patients with reduced DWS (<0.33) had a higher risk of incidences of AHREs. CONCLUSION LV stiffness assessed by DWS was associated with AHREs in patients with a PMI.
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Affiliation(s)
- Hideyuki Kishima
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan.
| | - Takanao Mine
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
| | - Eiji Fukuhara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
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