Coronary artery disease
Predictive Value of Total Atrial Conduction Time Estimated With Tissue Doppler Imaging for the Development of New-Onset Atrial Fibrillation After Acute Myocardial Infarction

https://doi.org/10.1016/j.amjcard.2010.02.030Get rights and content

Patients who develop new-onset atrial fibrillation (AF) after acute myocardial infarction (AMI) show an increased risk for adverse events and mortality during follow-up. Recently, a novel noninvasive echocardiographic method has been validated for the estimation of total atrial activation time using tissue Doppler imaging of the atria (PA-TDI duration). PA-TDI duration has shown to be independently predictive of new-onset AF. However, whether PA-TDI duration provides predictive value for new-onset AF in patients after AMI has not been evaluated. Consecutive patients admitted with AMIs and treated with primary percutaneous coronary intervention underwent echocardiography <48 hours after admission. All patients were followed at the outpatient clinic for ≥1 year. During follow-up, 12-lead electrocardiography and Holter monitoring were performed regularly, and the development of new-onset AF was noted. Baseline echocardiography was performed to assess left ventricular and left atrial (LA) function. LA performance was quantified with LA volumes, function, and PA-TDI duration. A total of 613 patients were evaluated. LA maximal volume (hazard ratio 1.07, 95% confidence interval 1.04 to 1.11), the total LA ejection fraction (hazard ratio 0.96, 95% confidence interval 0.93 to 0.99) and PA-TDI duration (hazard ratio 1.05, 95% confidence interval 1.04 to 1.06) were univariate predictors of new-onset AF. After multivariate analysis, LA maximal volume and PA-TDI duration independently predicted new-onset AF. Furthermore, PA-TDI duration provided incremental prognostic value to traditional clinical and echocardiographic parameters for the prediction of new-onset AF. In conclusion, PA-TDI duration is a simple measurement that provides important value for the prediction of new-onset AF in patients after AMI.

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Methods

Beginning in February 2004, consecutive patients admitted with AMIs treated with primary percutaneous coronary intervention were included in an ongoing registry. All patients were treated according to the institutional AMI protocol. This protocol, designed to improve care around AMI, includes structured medical therapy and standardized follow-up at the outpatient clinic, as described previously.15 In addition, 2-dimensional echocardiography was performed <48 hours after admission. All patients

Results

A total of 726 patients were included. Nine patients (1.2%) died during hospitalization before echocardiographic assessment could be performed, and in 22 patients (3.0%), echocardiographic assessment was not available within 48 hours of admission for logistic reasons. An additional 35 patients (4.8%) were excluded because 1-year follow-up was not completed. From the remaining 660 patients, 47 patients were excluded with previous AF or AF during baseline echocardiography. The final patient

Discussion

The major findings of the present study can be summarized as follows. (1) The incidence of new-onset AF after AMI during mean follow-up of 21 months was 7%, despite optimal contemporary treatments. (2) After adjusting for the strongest clinical and echocardiographic predictors, moderate or severe mitral regurgitation, LA max, and PA-TDI duration were independent predictors of the development of new-onset AF in patients after AMI. (3) PA-TDI duration provided incremental value for the prediction

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Dr. Schalij received grants from Biotronik, Berlin, Germany; Boston Scientific Corporation, Natick, Massachusetts; and Medtronic, Inc., Minneapolis, Minnesota. Dr. Bax received grants from Biotronik; BMS Medical Imaging, North Billerica, Massachusetts; Boston Scientific Corporation; Edwards Lifesciences, Irvine, California; GE Healthcare, Buckinghamshire, United Kingdom; Medtronic, Inc.; and St. Jude Medical, St. Paul, Minnesota.

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