Echocardiographic predictors of progression to persistent or permanent atrial fibrillation in patients with paroxysmal atrial fibrillation (E6P Study)

Yeonyee E. Yoon, Il Young Oh, Sung Ai Kim, Kyoung Ha Park, Seong Hwan Kim, Jae Hyeong Park, Jeong Eun Kim, Seung Pyo Lee, Hyung Kwan Kim, Yong Jin Kim, Dae Won Sohn, Goo Yeong Cho

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

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/m 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.

Original languageEnglish
Pages (from-to)709-717
Number of pages9
JournalJournal of the American Society of Echocardiography
Volume28
Issue number6
DOIs
Publication statusPublished - 2015 Jan 1

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Atrial Fibrillation
Left Atrial Function
Heart Atria
Observational Studies
Echocardiography
Prospective Studies

Keywords

  • Atrial fibrillation
  • Left atrium
  • Strain

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Echocardiographic predictors of progression to persistent or permanent atrial fibrillation in patients with paroxysmal atrial fibrillation (E6P Study). / Yoon, Yeonyee E.; Oh, Il Young; Kim, Sung Ai; Park, Kyoung Ha; Kim, Seong Hwan; Park, Jae Hyeong; Kim, Jeong Eun; Lee, Seung Pyo; Kim, Hyung Kwan; Kim, Yong Jin; Sohn, Dae Won; Cho, Goo Yeong.

In: Journal of the American Society of Echocardiography, Vol. 28, No. 6, 01.01.2015, p. 709-717.

Research output: Contribution to journalArticle

Yoon, Yeonyee E. ; Oh, Il Young ; Kim, Sung Ai ; Park, Kyoung Ha ; Kim, Seong Hwan ; Park, Jae Hyeong ; Kim, Jeong Eun ; Lee, Seung Pyo ; Kim, Hyung Kwan ; Kim, Yong Jin ; Sohn, Dae Won ; Cho, Goo Yeong. / Echocardiographic predictors of progression to persistent or permanent atrial fibrillation in patients with paroxysmal atrial fibrillation (E6P Study). In: Journal of the American Society of Echocardiography. 2015 ; Vol. 28, No. 6. pp. 709-717.
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abstract = "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/m 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.",
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AU - Yoon, Yeonyee E.

AU - Oh, Il Young

AU - Kim, Sung Ai

AU - Park, Kyoung Ha

AU - Kim, Seong Hwan

AU - Park, Jae Hyeong

AU - Kim, Jeong Eun

AU - Lee, Seung Pyo

AU - Kim, Hyung Kwan

AU - Kim, Yong Jin

AU - Sohn, Dae Won

AU - Cho, Goo Yeong

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N2 - 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/m 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.

AB - 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/m 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.

KW - Atrial fibrillation

KW - Left atrium

KW - Strain

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