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Tissue Doppler‐derived atrial dyssynchrony predicts new‐onset atrial fibrillation during hospitalization for ST ‐elevation myocardial infarction
Author(s) -
Mohamed Ibrahim Ismail,
Taha Hassanin Mesbah,
El Zaki Manar Moustafa
Publication year - 2019
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.14486
Subject(s) - medicine , cardiology , atrial fibrillation , conventional pci , myocardial infarction , doppler imaging , percutaneous coronary intervention , diastole , blood pressure
Background Atrial dyssynchrony, but not atrial enlargement/dysfunction, reflects acute atrial histopathological changes. It has been shown to be associated with new‐onset atrial fibrillation ( NOAF ) in various clinical conditions but was not studied in the acute phase of ST ‐elevation myocardial infarction ( STEMI ) which is the aim of the current study. Methods A total of 440 STEMI patients underwent primary percutaneous coronary intervention ( PCI ) and were monitored for NOAF during hospitalization. Immediately after primary PCI , P‐wave dispersion was calculated and conventional/tissue Doppler echocardiography was done. Results During a median hospitalization period of 3 days, 80 (18.2%) patients developed NOAF . The group with NOAF showed significantly higher prevalence of hypertension ( P = .049), higher P‐wave dispersion ( P = .018), higher post– PCI ‐corrected TIMI frame count ( P < .001), and lower incidence of post‐ PCI myocardial blush grade 2–3 ( P = .031). Indexed left atrial maximum volume ( LAVI max ), left atrial dyssynchrony, and inter‐atrial dyssynchrony were significantly higher in NOAF group ( P < .001, each). Using ROC curve analysis, inter‐atrial dyssynchrony showed the highest diagnostic performance ( AUC 85%, 95% CI : 0.77–0.94, P < .001). A cutoff value at 23.8 ms showed a good validity for predicting NOAF with a sensitivity of 93.8% and a specificity of 68.1%. Using binary logistic regression analysis, history of hypertension ( OR = 10.72, P = .03), LAVI max ( OR = 7.47, P = .04), and inter‐atrial dyssynchrony ( OR = 45.58, P = .001) were independent determinants of NOAF . Conclusions In the acute phase after STEMI , history of hypertension, LAVI max, and inter‐atrial dyssynchrony were independent determinants of inhospital NOAF , with the latter being the strongest.