Abstract 720: Transthoracic Echocardiographic Parameters as Predictors of Atrial Fibrillation Recurrence: Data From the GISSI-AF Echocardiographic Study
Objective: The identification of echocardiographic predictors of recurrence of atrial fibrillation (AF) may represent a valuable step towards its prevention. This study was undertaken in an effort to evaluate the role of echocardiographic data as independent risk markers of AF recurrence in the framework of a large multicenter clinical trial.
Methods: Transthoracic echocardiographic measurements of left atrial (LA) diameters, maximum and minimum LA volumes [Simpson’s biplane method, indexed by body surface area (BSA)], LA ejection fraction (LAEF), left ventricular (LV) ejection fraction (LVEF) </>=40%, LV end diastolic wall thickness, LV mass/BSA, E/e’ and mitral valve regurgitation grades were evaluated at randomization in 340 patients included in GISSI-AF, with reading in a central core laboratory. A multivariable Cox regression model was used to identify the variables associated with first recurrence of AF over a 12 month follow up. Covariates included in the model were age, sex, >2 episodes of AF in the 6 months before enrollment and successful cardioversion in the 2 weeks before randomization.
Results: The mean±SD age of patients was 68±9 years, 64% were men, 85% had a history of hypertension, 11% had documented coronary artery disease and 14%, diabetes. Incidence of first recurrence of atrial fibrillation was 54.4%. Patients with LVEF <40% were 7.8% and 85% had normal LV mass index. Mean values for LAD was 2,4±0.4 cm/m2, for maximum and minimum LAV, 44±15 and 26±13 mL/m2 respectively; LAEF, 47±13 %. Independent predictors of AF recurrence were: LA minimum volume, LAEF, LVEF<40% and severe mitral valve regurgitation (Table⇓). LA diameters were not predictive.
Conclusion: Echocardiograpic predictors of AF recurrence in patients in sinus rhythm with a history of AF were related to LA ejection fraction and LA minimum volume. In addition, the predictive roles of depressed LVEF and of mitral regurgitation are confirmed.