Clinical and prognostic association of total atrial 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 L.

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 [LVEF<50%, N = 141; 126 (112–146) ms; P = 0.005] or preserved left ventricular ejection fraction [LVEF>50% 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 (127ms and 64ml, 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.

Citation

Nuzzi, V., Pellicori, P., Nikolaidou, T., Kallvikbacka-Bennett, A., Torromeo, C., Barilla, F., Salekin, D., Kaur, K., Monzo, L., Cleland, J. G. F., & Clark, A. L. (2019). Clinical and prognostic association of total atrial conduction time in patients with heart failure: A report from studies investigating co-morbidities aggravating heart failure. Journal of Cardiovascular Medicine, 20(7), 442-449. https://doi.org/10.2459/JCM.0000000000000802

• Journal Article Type: Article
• Acceptance Date: Mar 12, 2019
• Online Publication Date: Apr 9, 2019
• Publication Date: Jul 1, 2019
• Deposit Date: Mar 14, 2019
• Publicly Available Date: Apr 10, 2020
• Journal: Journal of Cardiovascular Medicine
• Print ISSN: 1558-2027
• Electronic ISSN: 1558-2035
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Volume: 20
• Issue: 7
• Pages: 442-449
• DOI: https://doi.org/10.2459/JCM.0000000000000802
• Keywords: Atrial fibrillation; PA-TDI; Heart failure; Echocardiography; SICA-HF
• Public URL: https://hull-repository.worktribe.com/output/1378393
• Publisher URL: https://journals.lww.com/jcardiovascularmedicine/Abstract/2019/07000/Clinical_and_prognostic_association_of_total.6.aspx
• Contract Date: Mar 14, 2019