Echo-Doppler-derived indexes of ventricular stiffness and ventriculo-arterial interaction as predictors of new-onset atrial fibrillation in patients with heart failure.

Ji Hyun Yoon,Pil-Ki Min,Bum-Kee Hong,Hyuck Moon Kwon,Hyemoon Chung,Myung-Hyun Kim,Eui-Young Choi,Young Won Yoon,Jong-Youn Kim,Byoung Kwon Lee,Se-Joong Rim

doi:10.1186/s12947-016-0050-y

Abstract

BackgroundAtrial fibrillation (AF) is common in patients with heart failure (HF) and worsens their prognosis. Vulnerability to changes in loading is an important factor in the development of AF and is strongly influenced by ventricular stiffness and ventriculo-arterial interaction. The aim of this study was to investigate predictors of AF development in patients with HF.MethodsWe studied 349 patients with stable HF. The following parameters of ventricular stiffness and ventriculo-arterial interaction were derived from echo-Doppler measurements: left ventricular (LV) diastolic elastance (Ed), effective arterial elastance (Ea), LV end-systolic elastance (Ees) and ventricular–vascular coupling index (VVI).ResultsAF occurred in 57 (16.3 %) patients over a median follow up of 30.3 months. Echo-Doppler–derived parameters of ventricular stiffness and ventriculo-arterial interaction were closely associated with HF severity. Ed was independently associated with AF after adjustment for age, hypertension, diabetes mellitus, and left atrial volume index (hazard ratio [HR] 5.49, p = 0.018). Ea and VVI were also associated with new-onset AF (HR 1.66, p = 0.027, and HR 1.06, p = 0.001, respectively).ConclusionsEcho-Doppler indexes of ventricular stiffness are closely associated with HF severity. LV diastolic elastance (Ed) is the strongest predictor of new-onset AF in HF patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12947-016-0050-y) contains supplementary material, which is available to authorized users.

Highlights

Atrial fibrillation (AF) is common in patients with heart failure (HF) and worsens their prognosis
The principle findings of this study are as follows: (1) Ventricular stiffness and ventriculo-arterial interaction could be measured by echo Doppler, and (2) Ed, Ea and ventricular–vascular coupling index (VVI) were closely correlated with new-onset AF in patients with HF
While left ventricular (LV) systolic function was similar between the two groups, patients with new-onset AF had significantly higher LAVI, E/e’, and Ed. These findings suggest that atrial dilation and reduced LV relaxation are related to the development of AF and could be explained by diastolic dysfunction

Summary

Introduction

Atrial fibrillation (AF) is common in patients with heart failure (HF) and worsens their prognosis. Vulnerability to changes in loading is an important factor in the development of AF and is strongly influenced by ventricular stiffness and ventriculo-arterial interaction. The heart’s vulnerability to changes in loading affects the prognosis of HF and the development of AF. As this vulnerability is affected by ventricular stiffness and ventriculo-arterial interaction [8, 9], it is reasonable to hypothesize that those factors are closely associated with the development of AF.

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