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Clinical and prognostic association of total atrial and conduction time in patients with heart failure: a report from Studies Investigating Co-morbidities Aggravating Heart Failure

Nuzzi, Vincenzo; Pellicori, Pierpaolo; Nikolaidou, Theodora; Kallvikbacka-Bennett, Anna; Torromeo, Concetta; Barilla, Francesco; Salekin, Damien; Kaur, Kuldeep; Monzo, Luca; Cleland, John G F; Clark, Andrew

Authors

Vincenzo Nuzzi

Pierpaolo Pellicori

Theodora Nikolaidou

Anna Kallvikbacka-Bennett

Concetta Torromeo

Francesco Barilla

Damien Salekin

Kuldeep Kaur

Luca Monzo

John G F Cleland

Andrew Clark



Abstract

Background The total atrial conduction time can be measured as the time from the onset of the P wave on the ECG to the peak of the A wave recorded at the mitral annulus using tissue Doppler imaging (A′; P-A′TDI); when prolonged, it might predict incident atrial fibrillation.

Methods We measured P-A′TDI in outpatients with heart failure and sinus rhythm enrolled in the SICA-HF programme.

Results P-A′TDI measured at the lateral mitral annulus was longer in patients with HF with reduced [LVEF50% and NT-proBNP > 125 ng/l, N = 71; 128 (108–145) ms; P = 0.026] compared to controls [N = 117; 120 (106–135) ms]. Increasing age, left atrial volume and PR interval were independently associated with prolonged P-A′TDI. During a median follow-up of 1251 (956–1602) days, 73 patients with heart failure died (N = 42) or developed atrial fibrillation (N = 31). In univariable analysis, P-A′TDI was associated with an increased risk of the composite outcome of death or atrial fibrillation, but only increasing log [NT-proBNP], age and more severe symptoms (NYHA III vs. I/II) were independently related to this outcome. Patients in whom both P-A′TDI and left atrial volume were above the median (127 ms and 64 ml, respectively) had the highest incidence of atrial fibrillation (hazard ratio 6.61, 95% CI 2.27–19.31; P < 0.001 compared with those with both P-A′TDI and LA volume below the median).

Conclusion Measuring P-A′TDI interval identifies patients with chronic heart failure at higher risk of dying or developing atrial fibrillation during follow-up.

Journal Article Type Article
Publication Date 2019-07
Journal European journal of heart failure
Print ISSN 1388-9842
Electronic ISSN 1879-0844
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 20
Issue 7
Pages 442–449
APA6 Citation Nuzzi, V., Pellicori, P., Nikolaidou, T., Kallvikbacka-Bennett, A., Torromeo, C., Barilla, F., …Clark, A. (2019). Clinical and prognostic association of total atrial and conduction time in patients with heart failure: a report from Studies Investigating Co-morbidities Aggravating Heart Failure. European journal of heart failure, 20(7), 442–449. https://doi.org/10.2459/JCM.0000000000000802
DOI https://doi.org/10.2459/JCM.0000000000000802
Keywords Atrial fibrillation; PA-TDI; Heart failure; Echocardiography; SICA-HF
Publisher URL https://journals.lww.com/jcardiovascularmedicine/Abstract/2019/07000/Clinical_and_prognostic_association_of_total.6.aspx

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