Abstract 13857: Increase of Left Ventricular Filling Pressure Predicts New-Onset of Atrial Fibrillation and Stratifies the Risk of Embolic Event in Patients with Reduced Left Ventricular Contractility
Background: The objective of this study is to determine whether left ventricular (LV) filling pressure is associated with an increased risk of new-onset atrial fibrillation (AF) in patients with reduced LV contractility with no history of atrial arrhythmia. Few data exist regarding the relationship between LV filling pressure and new-onset AF, and the relative risk of cerebrovascular accident (CVA) under low LV contractility conditions.
Methods: The clinical and echocardiographic characteristics of 350 patients with reduced LV contractility who had an echocardiogram performed in 2007 and 2008 were reviewed. Exclusion criteria were history of atrial arrhythmia, muscular dystrophy, valvular heart disease and history of valvular operation. Patients were followed up in their medical records until the last clinical visit or development of an adverse event (documentation of first AF or the occurrence of cerebrovascular accident (CVA)).
Results: Of 350 patients (68% men; mean (±SD) age, 62.9 (± 15.2) years), in 57 (16.3%) AF occurred and in 13 (3.7%) CVA developed over a mean (±SD) follow-up of 25.60 (± 18.99) months. The optimal cutoff value using receiver operating characteristic (ROC) curve for prediction of new-onset AF in early mitral inflow/ early diastolic mitral ratio (E/E’) was 15.7. After a number of adjustments, elevated LV filling pressure (E/E’ ≥15) remained as an independent predicting factor for new-onset AF. The odds ratio (OR) of CVA in elevated LV filling pressure and the AF development composite group was 9.722 (p<0.002) compared to normal LV filling and sinus rhythm group.
Conclusion(s): The presence and severity of an increase in LV filling pressure are independently predictive of new-onset of AF in reduced LV contractility. Risk stratification and anticoagulation guidelines are needed to prevent thromboembolic events for these patients.
- Atrial fibrillation
- Diastolic function
- Heart failure
- Left ventricular filling pressure
- Reduced left ventricular contractility
- © 2012 by American Heart Association, Inc.