Abstract 10642: A New Echocardiographic Parameter is a Strong Predictor of New-onset Atrial Fibrillation: Results From a Prospective Study in 566 Elderly Subjects Followed-up for 4 Years
Background: The incidence of new-onset atrial fibrillation (AF) is increasing with age. However, the specific causes of new-onset AF are not well known. We reported that pulmonary capillary wedge pressure (ePCWP) estimated by the combination of left atrial volume (LAV) and emptying function (EF) had a strong correlation with PCWP measured by catheterization (r=0.9). We sought to examine the association between echocardiographic parameters and the risk of AF in the elderly and elucidate the most useful predictors of new-onset AF.
Methods: We measured left ventricular (LV) mass, ejection fraction, E/A and E/e’ in 663 consecutive elderly subjects without a history of AF. We examined LAV, EF, strain, strain rate (SR), ePCWP and LA stiffness measured by speckle tracking echocardiography (STE). ePCWP was determined as 10.7 - 12.4 x log (LA active EF / minimum LAV), and LA stiffness was defined as ePCWP / LA strain. Data from 566 subjects (age 72±6) were analyzed.
Results: During a mean follow-up of 50 months, 63 subjects (age 73±6, 39 men) developed electrocardiographically-confirmed AF. Subjects with new-onset AF had lower phasic LAEF (total EF: 35±8 vs 43±8%; active EF: 18±7 vs 28±8%), lower strain (19±6 vs 25±8) and lower SR (SR at systole: 0.9±0.3 vs 1.2±0.4S-1; SR at atrial contraction: -1.0±0.3 vs -1.4±0.5 S-1), but larger phasic LAV (maximum: 57±16 vs 47±16 ml/m2; pre-atrial contraction: 46±14 vs 38±14 ml/m2; minimum: 38±13 vs 27±11 ml/m2) compared with subjects without AF. E/e’, ePCWP and LA stiffness were significantly elevated in subjects with than without AF (9.6±1.8 vs 8.5±1.7, 15±4 vs 10±3 mmHg, 0.92±0.66 vs 0.48±0.26, respectively). In multivariate regression analysis, ePCWP was the strongest independent predictor of AF. Using an ePCWP cutoff of 13 mmHg, the sensitivity and specificity for new-onset AF were 75 and 83%, and the positive and negative predictive value were 35 and 96%, respectively (area under the curve of 0.84).
Conclusions: ePCWP estimated by STE was the strongest predictor of new-onset AF, suggesting that elevated PCWP caused LA remodeling and increased LA stiffness that led to AF. Estimation of ePCWP by STE may have incremental value for assessing the risk of new-onset AF in the elderly.
- © 2013 by American Heart Association, Inc.