Abstract
BackgroundEchocardiographic parameters representing impaired left atrial (LA) function and remodeling are of high value to predict atrial fibrillation (AF). This study aimed to develop a prediction model for AF easily to apply in clinical routine containing echocardiographic parameters associated with LA remodeling and—function.Methods and ResultsThis monocentric, semi-blinded, controlled analysis included 235 patients to derive a prediction model. This prediction model was tested in a validation cohort encompassing 290 cardiovascular inpatients. The derivation and validation cohort included 54 (23%) and 66 (23%) patients with AF, respectively. Transthoracic echocardiography, comprising parameters indicating left atrial remodeling [septal/lateral total atrial conduction time (s/l PA-TDI)] and left atrial volume indexed to a' (LAVI/a') was performed in each patient. Based on multivariable regressions analysis, four variables were enclosed into the EAHsy (Echocardiography, Age, Hypertension)-AF risk score for AF prediction: Hypertension, Age, LAVI/a‘ and septal PA-TDI. In the validation cohort discrimination was strong (C-statistic 0.987, 95%CI 0.974–0.991) with an adequately performed calibration. The EAHsy-AF risk score was associated with a more precise prediction of AF in comparison to commonly used AF-scores (CHADS2-, ATLAS-, ARIC-, CHARGE-AF score).ConclusionThe EAHsy-AF-Score containing age, hypertension and echocardiographic parameters of atrial dysfunction and remodeling precisely predicts the incidence of AF in a general population of patients with cardiovascular disease. The EAHsy-AF risk score may enable more selective rhythm monitoring in specific patients at high risk for AF.
Highlights
Detection of atrial fibrillation (AF) is highly relevant to prevent cardio-embolic stroke and preclude death and disability (1)
Atrial fibrillation is a main cause of cardio-embolic events and in particular strokes, subsequently provoking functional limitations and death
The determined EAHsy-AF risk score seems to be of high value for the discrimination of patients with and without AF in a general population of patients with cardiovascular disease and may enable more selective rhythm monitoring in specific patients at high risk for AF
Summary
Detection of atrial fibrillation (AF) is highly relevant to prevent cardio-embolic stroke and preclude death and disability (1). There is a debate to extend rhythm monitoring in patients after stroke even beyond 72 h as currently recommended by the European Society of. Due to the importance of AF detection several prediction models have been previously published with different limitations. These risk models are based upon previously collected parameters for AF-prediction or strong associations with AF. The CHADS2 and CHA2DS2VASc scores were designed to assess stroke events in AF. Both scores were associated with a known risk of AF and predictive for AF (12). This study aimed to develop a prediction model for AF to apply in clinical routine containing echocardiographic parameters associated with LA remodeling and—function
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