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Echocardiographically Derived Pulse Wave Velocity and Diastolic Dysfunction Are Associated with an Increased Incidence of Atrial Fibrillation in Patients with Systolic Heart Failure
Author(s) -
Bonapace Stefano,
Rossi Andrea,
Cicoira Mariantonietta,
Targher Giovanni,
Marino Paolo,
Benfari Giovanni,
Mugnai Giacomo,
Arcaro Guido,
Vassanelli Corrado
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13230
Subject(s) - medicine , cardiology , atrial fibrillation , heart failure , ejection fraction , pulse wave velocity , diastole , population , blood pressure , environmental health
Background Chronic heart failure ( CHF ) is an established risk factor of atrial fibrillation ( AF ), but the prognostic value of cardiac and hemodynamic parameters in assessing the risk of developing AF among patients with CHF is less defined. Methods and results We followed an outpatients cohort of CHF patients secondary to left ventricular ( LV ) systolic dysfunction, who were free of AF at baseline. All patients underwent clinical evaluation, comprehensive echocardiography, and blood drawing in the same morning. Aortic pulse wave velocity ( aPWV ), a measure of aortic stiffness, was determined by Doppler echocardiography. A total of 77 patients (age 63 ± 9 years; 79% male) with mean LVEF (34 ± 8%) formed the study population. Fifteen patients developed incidental AF . At baseline, CHF patients who developed AF during follow‐up had higher E‐wave velocity (75 ± 2 cm/sec vs. 60 ± 2 cm/sec; P = 0.02), higher difference duration between mitral and pulmonary vein A velocity (A′–A), (10 ± 35 msec vs. 43 ± 44 msec P = 0.02), aPWV (7.1 ± 2.6 vs. 5.3 ± 1.9 m/sec P = 0.004), and furosemide dosage (110 ± 145 mg vs. 49 ± 48 mg P = 0.01) than those remaining free from AF . The two groups of patients did not significantly differ in terms of NYHA , LV volumes, ejection fraction, left atrial volume, creatinine, hemoglobin, renin, epinephrine, amino‐terminal propeptide of type III and I procollagens, ACE inhibitor, and β‐blocker dose (P > 0.1 for all). Notably, higher aPWV (P = 0.01) and longer A–A′ duration (P = 0.04) were associated with an increased incidence of AF , independently of potential confounders. Conclusions Increased aortic stiffness and LV diastolic dysfunction are strong predictors of new onset of AF among patients with systolic CHF .