Ratio of early transmitral inflow velocity to early diastolic strain rate predicts atrial fibrillation following acute myocardial infarction

Caroline Løkke Bjerregaard*, Flemming Javier Olsen, Mats Christian Højbjerg Lassen, Anne-Sophie Winther Svartstein, Thomas Fritz Hansen, Søren Galatius, Allan Iversen, Sune Pedersen, Tor Biering-Sørensen

*Corresponding author for this work

Abstract

The ratio of early transmitral filling velocity to early diastolic strain rate (E/SRe) has been proposed as a new non-invasive measurement of left ventricular filling pressure. We aimed to investigate the ability of E/SRe to predict atrial fibrillation (AF) after ST-elevation myocardial infarction (STEMI). This was a prospective cohort study of patients (n = 369) with STEMI. Patients underwent an echocardiographic examination a median of two days after pPCI. By echocardiography, transmitral early filling velocity (E) was measured by pulsed-wave Doppler, and early diastolic strain rate (SRe) was measured by speckle tracking of the left ventricle. E was indexed to SRe and the early myocardial relaxation velocity (e') to obtain the E/SRe and E/e', respectively. The endpoint was new-onset AF. During follow-up (median 5.6 years, IQR: 5.0-6.1 years), 23 (6%) of the 369 patients developed AF. In unadjusted analyses, both E/SRe and E/e' were significantly associated with AF [E/SRe: HR = 1.06; (1.03-1.10); p < 0.001, per 10 increase] and [E/e': HR = 1.11 (1.05-1.17); p < 0.001, per 1 increase] and had equal Harrell's C-statistic of 0.71. However, only E/SRe remained an independent predictor after multivariable adjustments for clinical and echocardiographic parameters [E/SRe: HR = 1.06 (1.00-1.11); p = 0.044, per 10 increase]. E/SRe was further significantly associated with AF in patients with E/e' < 14 HR = 1.09 (1.01-1.17); p = 0.030, per 10 increase), also after multivariable adjustments. E/SRe is an independent predictor of AF in STEMI patients, even in subjects with seemingly normal filling pressure.

Original languageEnglish
JournalThe international journal of cardiovascular imaging
Volume40
Issue number2
Pages (from-to)331-340
Number of pages10
ISSN1569-5794
DOIs
Publication statusPublished - Feb 2024

Keywords

  • Atrial Fibrillation/diagnostic imaging
  • Humans
  • Myocardial Infarction
  • Predictive Value of Tests
  • Prospective Studies
  • ST Elevation Myocardial Infarction/diagnostic imaging
  • Ventricular Dysfunction, Left

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