Aims: Tissue Doppler Imaging (TDI) detects early signs of left ventricular
dysfunction. The prognostic potential of TDI in patients with atrial
fibrillation (AF) has, however, not yet been clarified. This study evaluates the prognostic value of TDI
in patients with atrial
fibrillation.
Methods and results: In total, echocardiograms from 313 patients with AF during examination
were analyzed offline. Longitudinal
systolic velocity (s\'), early diastolic velocity (e\') and longitudinal
displacement (LD) were measured by color TDI. During a median follow-up of 891
days, 64 patients (20%)
died.
TDI was significantly associated with all-cause
mortality, and the risk of dying increased significantly per 1 cm/s decrease in
s\' (HR of 1.31, 95% CI 1.05-1.63; p=0.018) and e\' (HR of 1.17, 95% CI
1.01-1.35; p=0.038) respectively, even after adjustment for age, gender, heart
rate, aortic stenosis, DM and LVEF quartiles.
LD also proved to be a significant predictor of outcome after
multivariate adjustment (HR 1.23; 95% CI 1.05-1.44; p=0.012).
The population was stratified according to high or low s’ and e’. Patients
with low s’ and e’ had more than three times the risk of mortality compared to
the patients with high s’ and e’ (HR 3.64; 95% CI 1.83-7.26; p<0.001) and
remained in significantly higher risk after adjustment for various risk
factors.
Conclusion: Both systolic and diastolic performance, as assessed by TDI, are strong
predictors of mortality in patients with atrial fibrillation, and especially
the combination of systolic and
diastolic dysfunction is a significant prognostic marker.
Credits: Maria Dons, MB; Tor Biering-Sørensen, MD, PhD; Jan Skov Jensen, MD, PhD, DMSc; Thomas Fritz-Hansen, MD; Jan Bech, MD, PhD; Martina Chantal de Knegt, MD; Jacob Sivertsen, MD; Flemming Javier Olsen, MB; Rasmus Mogelvang, MD, PhD