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

• Published in: The American journal of cardiology Vol. 106; no. 2; pp. 198 - 203
• Main Authors: Antoni, M. Louisa, MD, Bertini, Matteo, MD, Atary, Jael Z., MD, Delgado, V., MD, ten Brinke, Ellen A., MD, Boersma, Eric, PhD, Holman, Eduard R., MD, PhD, van der Wall, Ernst E., MD, PhD, Schalij, Martin J., MD, PhD, Bax, Jeroen J., MD, PhD, van de Veire, Nico R.L., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-07-2010; Elsevier; Elsevier Limited
• Subjects: Aged; Angioplasty; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - etiology; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology; Cardiology. Vascular system; Cardiovascular; Clinical outcomes; Coronary heart disease; Coronary vessels; Echocardiography, Doppler - methods; Female; Heart; Heart Atria - diagnostic imaging; Heart attacks; Heart Conduction System; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocarditis. Cardiomyopathies; Predictive Value of Tests; Risk factors; Ultrasonic imaging; Sonography; Myocardial infarction; Conduction; Arrhythmia; Acute; Atrial fibrillation; Tissue doppler; Cardiovascular disease; Time; Coronary heart disease; Myocardial disease; Excitability disorder; Total; Development; Predictive value; Medical imagery; Circulatory system; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2010.02.030

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.