Abstract
Background: The ratio of early transmitral filling velocity to early diastolic strain rate (E/e’sr) has been proposed as a new measurement of left ventricular filling pressure. We aimed to investigate the ability of E/e’sr to predict atrial fibrillation (AF) after ST-elevation myocardial infarction (STEMI). Methods: This was a prospective cohort study of patients with STEMI treated with primary percutaneous coronary intervention (pPCI). Patients underwent an echocardiographic examination a median of two days after pPCI. By echocardiography, transmittal early filling velocity (E) was measured by pulsed-wave Doppler, and early diastolic strain rate (e’sr) was measured by speckle tracking of the left ventricular. The E was indexed to e’sr to obtain the E/e’sr as well as to the early myocardial relaxation velocity to obtain the E/e’. The endpoint was new-onset AF. Results: During follow-up (median 5.6 years, IQR:5.0-6.1), 23 of the 369 patients developed AF. In unadjusted analyses, both E/e’sr and E/e’ were significantly associated with AF [E/e’sr: HR=1.06; (1.03-1.10); p<0.001, per 0.1 increase] and [E/e’: HR=1.11 (1.05-1.17); p<0.001, per 1 increase] and had equal Harrell’s C-statistic of 0.71. However, only E/e’sr remained an independent predictor after multivariable adjustments for clinical and echocardiographic parameters [E/e’sr: HR=1.06 (1.00-1.11); p=0.042, per 0.1 increase] and patients with high E/e’s compared to those with a low E/e’sr had and almost four-fold risk of AF during follow up (HR=3.85 (1.43-10.35), p<0.02) (figure). These findings were unchanged in competing risk analyses accounting for death as a competing event. E/e’sr was also significantly associated with AF in patients with normal filling pressure by E/e’ (HR=1.07 (1.01-1.17); p=0.030, per 0.1 increase). Conclusion E/e’sr is an independent predictor of AF in STEMI patients, even in subjects with seemingly normal filling pressure.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
