Echocardiographic Predictors of Progression to Persistent or Permanent Atrial Fibrillation in Patients with Paroxysmal Atrial Fibrillation (E6P Study)

• Published in: Journal of the American Society of Echocardiography Vol. 28; no. 6; pp. 709 - 717
• Main Authors: Yoon, Yeonyee E., MD, Oh, Il-Young, MD, Kim, Sung-Ai, MD, Park, Kyoung-Ha, MD, Kim, Seong Hwan, MD, Park, Jae-Hyeong, MD, Kim, Jeong-Eun, MD, Lee, Seung-Pyo, MD, Kim, Hyung-Kwan, MD, Kim, Yong-Jin, MD, Sohn, Dae-Won, MD, Cho, Goo-Yeong, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2015
• Subjects: Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnostic imaging; Cardiovascular; Chronic Disease; Disease Progression; Echocardiography - methods; Female; Heart Atria - diagnostic imaging; Humans; Image Interpretation, Computer-Assisted - methods; Left atrium; Male; Middle Aged; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Strain; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Minimal LA volume index (after atrial contraction); A-P; Maximal LA volume index (before mitral valve opening); Left ventricular; Two-dimensional; LAVI max; HR; LV; Left atrium; Hazard ratio; AUC; 2D; Anterior-posterior; Pre-A LA volume index (before atrial contraction); AF; Atrial fibrillation; ROC; LAVI pre-A; Strain; Area under the receiver operating characteristic curve; Receiver operating characteristic; ε; LA; Left atrial; LAVI min; LAVImin; LAVIpre-A; LAVImax
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2015.01.017

Backgrounds Paroxysmal atrial fibrillation (AF) frequently, but not always, progresses to persistent/permanent AF. The aim of this study was to evaluate the echocardiographic predictors of AF progression in patients with paroxysmal AF. Methods A multicenter, prospective, observational study was conducted that included 313 patients with paroxysmal AF who underwent two-dimensional speckle-tracking echocardiography. The diameter, volume, and mechanical function of the left atrium, including global strain (ε) and ε rate, were measured. Results Progression to persistent or permanent AF occurred in 52 patients (16.6%) during a median follow-up period of 26 months. Echocardiographic measure of left atrial (LA) diameter, volume, and function (E velocity, E/A and E/e′ ratio, LA expansion index, active emptying fraction, global longitudinal ε and ε rate) were associated with AF progression. LA ε ≤ 30.9% was the strongest predictor of AF progression, which was associated with a more than fourfold hazard increase for AF progression (hazard ratio, 4.224; P  = .001). LA diameter > 39 mm and maximal LA volume index > 34.2 mL/m2 were associated with about a twofold hazard increase for AF progression (hazard ratios, 1.994 and 2.649; P  = .016 and P  = .001, respectively). When adjusted for a model combining maximal LA volume index, E velocity, LA expansion index, and active emptying fraction, LA ε ≤ 30.9% maintained a more than threefold hazard increase for AF progression (adjusted hazard ratio, 3.970; P  = .003). Conclusions Echocardiographic measures of LA diameter, volume, and mechanical function, including LA ε, were associated with AF progression. LA ε was the strongest independent predictor of AF progression and is expected to serve as a valuable predictor of AF progression.