Tissue Doppler Imaging as a Prognostic Marker for Cardiovascular Events in Heart Failure with Preserved Ejection Fraction and Atrial Fibrillation

Background

Although atrial fibrillation (AF) is associated with adverse cardiovascular (CV) outcomes, the prognosis of heart failure (HF) with preserved ejection fraction (HFPEF) with AF is still uncertain. This study was designed to evaluate whether the occurrence of CV events in patients with HFPEF and AF could be predicted by tissue Doppler imaging (TDI) of mitral annular velocity.

Methods

Clinical and echocardiographic data from January 2004 to December 2005 in patients with HFPEF and AF were investigated in this retrospective study. The development of CV events was defined as the composite of CV death, recurrent HF, and ischemic stroke.

Results

Of 148 patients (mean age 68 ± 10 years; 64% were men), 35 clinical events, including 2 cardiac deaths, 22 recurrent HFs, and 11 ischemic strokes, were identified during a median follow-up of 27 months. In univariate analyses, age, ejection fraction, left atrial dimension, systolic (s'), and early diastolic (e') mitral annular velocities were correlated with clinical events. Multivariate analyses revealed that old age, enlarged left atrial dimension, and lower s' and e' remained independent predictors of outcomes. Furthermore, patients with both s' < 5 cm/s and e' < 7 cm/s experienced more frequent clinical events (hazard ratio 12.2; 95% confidence interval, 1.62-92.5; P = .015).

Conclusion

s' and e', particularly their combination, seem to be useful predictors of CV events in patients with HFPEF with AF.

Keywords: Atrial fibrillation, Echocardiography, Heart failure, Tissue Doppler imaging

Abbreviations: AF, Atrial fibrillation, AUC, Area under the curve, CHF, Congestive heart failure, CV, Cardiovascular, EF, Ejection fraction, HF, Heart failure, HFPEF, Heart failure preserved ejection fraction, LA, Left atrial, LV, Left ventricular, LVEF, Left ventricular ejection fraction, ROC, Receiver operating characteristics, TDI, Tissue Doppler imaging