Abstract
This prospective study aimed to identify the relation of gender and interatrial dyssynchrony on tissue Doppler imaging (TDI) to the prediction of the progression to chronic atrial fibrillation (CAF) in nonvalvular paroxysmal AF (PAF) patients. Nineteen consecutive men and 19 women with nonvalvular PAF were prospectively followed after echocardiography. We measured the interval of time from initiation of the P wave on the electrocardiogram until the beginning of the late diastolic TDI signal at the lateral border of the mitral (P-A′(M)) and the tricuspid annulus (P-A′(T)). Interatrial dyssynchrony was defined as the difference between the P-A′(M) and P-A′(T) intervals (A′(M)-A′(T)). The study endpoint was the onset of CAF (>6 months). Six men developed CAF during a follow-up of 32 ± 26 months, and 3 women developed CAF during a follow-up of 25 ± 19 months. Compared to those without CAF, the patients with CAF had significantly longer A′(M)- A′(T) intervals (men: 41 ± 10 vs 27 ± 12 ms, women: 64 ± 4 vs 23 ± 9 ms; P < 0.01) in both genders. Kaplan-Meier analysis, using cutoff values determined by analysis of receiveroperating characteristics curves, revealed that the progression to CAF was significantly observed more often when A′(M)-A′(T) interval was >34 ms in men and >43 ms in women. This prospective study suggests that nonvalvular PAF men and women with a high risk of developing CAF have “interatrial dyssynchrony” on atrial TDI, whose cutoff values are shorter and may affect the vulnerability of AF in men.
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References
Nishimura RA, Abel MD, Hatle LK, Tajik AJ (1989) Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part II. Clinical studies. Mayo Clin Proc 64:181–204
Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114: e257–e354
Jahangir A, Lee V, Friedman PA, Trusty JM, Hodge DO, Kopecky SL, Packer DL, Hammill SC, Shen WK, Gersh BJ (2007) Longterm progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study. Circulation 115: 3050–3056
Kerr CR, Humphries KH, Talajic M, Klein GJ, Connolly SJ, Green M, Boone J, Sheldon R, Dorian P, Newman D (2005) Progression to chronic atrial fibrillation after the initial diagnosis of paroxysmal atrial fibrillation: results from the Canadian Registry of Atrial Fibrillation. Am Heart J 149:489–496
Tsang TS, Gersh BJ, Appleton CP, Tajik AJ, Barnes ME, Bailey KR, Oh JK, Leibson C, Montgomery SC, Seward JB (2002) Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol 40:1636–1644
Lindgren KS, Pekka Raatikainen MJ, Juhani Airaksinen KE, Huikuri HV (2003) Relationship between the frequency of paroxysmal episodes of atrial fibrillation and pulmonary venous flow pattern. Europace 5:17–23
Yamada H, Donal E, Kim YJ, Agler DA, Zhang Y, Greenberg NL, Mazgalev TN, Thomas JD, Grimm RA (2004) The pseudorestrictive pattern of transmitral Doppler flow pattern after conversion of atrial fibrillation to sinus rhythm: is atrial or ventricular dysfunction to blame? J Am Soc Echocardiogr 17:813–818
Verma A, Kilicaslan F, Adams JR, Hao S, Beheiry S, Minor S, Ozduran V, Claude Elayi S, Martin DO, Schweikert RA, Saliba W, Thomas JD, Garcia M, Klein A, Natale A (2006) Extensive ablation during pulmonary vein antrum isolation has no adverse impact on left atrial function: an echocardiography and cine computed tomography analysis. J Cardiovasc Electrophysiol 17:741–746
Fukunami M, Yamada T, Ohmori M, Kumagai K, Umemoto K, Sakai A, Kondoh N, Minamino T, Hoki N (1991) Detection of patients at risk for paroxysmal atrial fibrillation during sinus rhythm by P wave-triggered signal-averaged electrocardiogram. Circulation 83:162–169
Kiès P, Leclercq C, Bleeker GB, Crocq C, Molhoek SG, Poulain C, van Erven L, Bootsma M, Zeppenfeld K, van der Wall EE, Daubert JC, Schalij MJ, Bax JJ (2006) Cardiac resynchronization therapy in chronic atrial fibrillation: impact on left atrial size and reversal to sinus rhythm. Heart 92:490–494
Brodsky MA, Allen BJ, Capparelli EV, Luckett CR, Morton R, Henry WL (1989) Factors determining maintenance of sinus rhythm after chronic atrial fibrillation with left atrial dilatation. Am J Cardiol 63:1065–1068
Hakala T, Hedman A (2003) Predicting the risk of atrial fibrillation after coronary artery bypass surgery. Scand Cardiovasc J 37: 309–315
Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG (1995) Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med 155:469–473
Fuenmayor AJ, Ramírez L, Fuenmayor AM (2002) Validation of inter-atrial conduction time measurement by means of echo-Doppler. Arch Cardiol Mex 72:125–128
Chen MC, Guo GB, Chang HW (2002) Atrial electrophysiological properties evaluated by right and left atrial pacing in patients with or without atrial fibrillation. Jpn Heart J 43:231–240
Rein AJ, O’Donnell CP, Colan SD, Marx GR (2003) Tissue velocity Doppler assessment of atrial and ventricular electromechanical coupling and atrioventricular time intervals in normal subjects. Am J Cardiol 92:1347–1350
Daubert JC, Pavin D, Jauvert G, Mabo P (2004) Intra- and interatrial conduction delay: implications for cardiac pacing. Pacing Clin Electrophysiol 27:507–525
Merckx KL, De Vos CB, Palmans A, Habets J, Cheriex EC, Crijns HJ, Tieleman RG (2005) Atrial activation time determined by transthoracic Doppler tissue imaging can be used as an estimate of the total duration of atrial electrical activation. J Am Soc Echocardiogr 18:940–944
Ozer N, Yavuz B, Can I, Atalar E, Aksöyek S, Ovünç K, Ozmen F, Kes S (2005) Doppler tissue evaluation of intra-atrial and interatrial electromechanical delay and comparison with P-wave dispersion in patients with mitral stenosis. J Am Soc Echocardiogr 18:945–948
Roshanali F, Mandegar MH, Yousefnia MA, Rayatzadeh H, Alaeddini F, Amouzadeh F (2007) Prediction of atrial fibrillation via atrial electromechanical interval after coronary artery bypass grafting. Circulation 116:2012–2017
Cui QQ, Zhang W, Wang H, Sun X, Wang R, Yang HY, Meng XQ, Zhang Y, Wang H (2008) Assessment of atrial electromechanical coupling and influential factors in nonrheumatic paroxysmal atrial fibrillation. Clin Cardiol 31:74–78
Can I, Onat AM, Aytemir K, Akdogan A, Ureten K, Kiraz S, Ertenli I, Ozer N, Tokgozoglu L, Oto A (2007) Assessment of atrial conduction in patients with scleroderma by tissue Doppler echocardiography and P wave dispersion. Cardiology 108:317–321
Garcia MJ, Rodriguez L, Ares M, Griffin BP, Klein AL, Stewart WJ, Thomas JD (1996) Myocardial wall velocity assessment by pulsed Doppler tissue imaging: characteristic findings in normal subjects. Am Heart J 132:648–656
Edvardsen T, Urheim S, Skulstad H, Steine K, Ihlen H, Smiseth OA (2002) Quantification of left ventricular systolic function by tissue Doppler echocardiography: added value of measuring pre- and postejection velocities in ischemic myocardium. Circulation 105: 2071–2077
Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA (1994) Independent risk factors for atrial fibrillation in a population based cohort. The Framingham Heart Study. JAMA 271:840–844
Larsen JA, Kadish AH (1999) Effects of gender on cardiac arrhythmias. J Cardiovasc Electrophysiol 9:655–664
Tada H, Sticherling C, Chough SP, Baker RL, Wasmer K, Daoud EG, Oral H, Pelosi F Jr, Knight BP, Strickberger SA, Morady F (2001) Gender and age differences in induced atrial fibrillation. Am J Cardiol 88:436–438
Tse HF, Oral H, Pelosi F, Knight BP, Strickberger SA, Morady F (2001) Effect of gender on atrial electrophysiologic changes induced by rapid atrial pacing and elevation of atrial pressure. J Cardiovasc Electrophysiol 12:986–989
Khan IA (2003) Atrial stunning: basics and clinical considerations. Int J Cardiol 92:113–128
Henry WL, DeMaria A, Gramiak R, King DL, Kisslo JA, Popp RL, Sahn DJ, Schiller NB, Tajik A, Teichholz LE, Weyman AE (1980) Report of the American Society of Echocardiography Committee on nomenclature and standards in two-dimensional echocardiography. Circulation 62:212–217
Sahn DJ, DeMaria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58: 1072–1082
Severino S, Caso P, Galderisi M, De Simone L, Petrocelli A, de Divitiis O, Mininni N (1998) Use of pulsed Doppler tissue imaging to assess regional left ventricular diastolic dysfunction in hypertrophic cardiomyopathy. Am J Cardiol 82:1394–1398
Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA (2002) Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 15:167–184
Hirono K, Konishi T, Origasa H, Ichida F, Miyawaki T (2009) Echocardiographic and electrocardiographic analyses of patients with severe motor and intellectual disabilities. Heart Vessels 24: 46–53
Paraskevaidis IA, Theodorakis GN, Katritsis DG, Tsiapras DP, Livanis EG, Kremastinos DT (1999) Pulmonary vein flow analysis by transoesophageal echocardiography in patients with chronic atrial fibrillation; 1 year follow-up after cardioversion. Eur Heart J 20:375–385
Suzuki S, Yamashita T, Otsuka T, Sagara K, Uejima T, Oikawa Y, Yajima J, Koike A, Nagashima K, Kirigaya H, Ogasawara K, Sawada H, Yamazaki T, Aizawa T (2009) Treatment strategy and clinical outcome in Japanese patients with atrial fibrillation. Heart Vessels 24:287–293
Budeus M, Felix O, Hennersdorf M, Wieneke H, Erbel R, Sack S (2007) Prediction of conversion from paroxysmal to permanent atrial fibrillation. Pacing Clin Electrophysiol 30:243–252
Van Beeumen K, Duytschaever M, Tavernier R, Van de Veire N, De Sutter J (2007) Intra- and interatrial asynchrony in patients with heart failure. Am J Cardiol 99:79–83
Omi W, Nagai H, Takamura M, Okura S, Okajima M, Furusho H, Maruyama M, Sakagami S, Takata S, Kaneko S (2005) Doppler tissue analysis of atrial electromechanical coupling in paroxysmal atrial fibrillation. J Am Soc Echocardiogr 18:39–44
Fleg JL, Shapiro EP, O’Connor F, Taube J, Goldberg AP, Lakatta EG (1995) Left ventricular diastolic filling performance in older male athletes. JAMA 273:1371–1375
Allessie M, Ausma J, Schotten U (2002) Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res 54:230–246
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Sakabe, K., Fukuda, N., Fukuda, Y. et al. Relation of gender and interatrial dyssynchrony on tissue Doppler imaging to the prediction of the progression to chronic atrial fibrillation in patients with nonvalvular paroxysmal atrial fibrillation. Heart Vessels 25, 410–416 (2010). https://doi.org/10.1007/s00380-009-1211-9
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DOI: https://doi.org/10.1007/s00380-009-1211-9