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The Predictive Value of Tissue Doppler Indices for Early Recurrence of Atrial Fibrillation After Electrical Cardioversion

Authors Karaliute R, Jureviciute J, Jurgaityte J, Rimkute A, Mizariene V, Baksyte G, Kazakevicius T, Urboniene D, Kavoliuniene A

Received 28 May 2020

Accepted for publication 19 July 2020

Published 7 October 2020 Volume 2020:15 Pages 1917—1925


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Richard Walker

Rasa Karaliute,1,2 Justina Jureviciute,2 Julija Jurgaityte,2 Agne Rimkute,2 Vaida Mizariene,2 Giedre Baksyte,2 Tomas Kazakevicius,2 Daiva Urboniene,3 Ausra Kavoliuniene2

1Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania; 2Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania; 3Department of Laboratory Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania

Correspondence: Rasa Karaliute
Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Eiveniu St. 4, Kaunas LT-50161, Lithuania
Tel +37067766157

Purpose: Spectral tissue Doppler-derived E/e’ ratio has been proposed as the best parameter for prediction of atrial fibrillation (AF). Relaxation and contraction are equivalent parts of a continuous cardiac cycle, where systolic and diastolic abnormalities have a variable contribution to the left ventricle (LV) failure. The aim of this study was to investigate whether the E/(e’xs’) ratio is a better index than E/e‘ to predict AF recurrence and to determine the changes of spectral tissue Doppler indices 1 month after the electrical cardioversion (ECV).
Patients and Methods: The study included 77 persistent AF patients with restored sinus rhythm (SR) after ECV. Only patients with normal LV ejection fraction (EF) were included. Echocardiography and NT-proBNP laboratory findings were performed. A primary outcome was the early (within 1 month) recurrence of AF.
Results: After a 1 month follow-up period, 39 patients (50.6%) were in SR. E/e′ (HR=1.74, P=0.001) and E/(e’×s’) ratios (HR=8.17, P=0.01) were significant predictors of AF recurrence. E/(e’×s’) in combination with LV end-diastolic diameter > 49.3 mm and NT-proBNP > 2000 ng/L demonstrated a higher contribution in the model to predict AF recurrence compared to the E/e’ ratio (18.94, P=0.005 vs 1.95, P=0.001). On ROC analysis, E/(e’×s’) and E/e′ showed similar diagnostic accuracy (E/(e’×s’), AUC=0.71, P=0.002 and E/e′, AUC=0.75, P< 0.0001). Average e‘ value significantly decreased after 1 month in SR (from 10.76± 1.24 to 8.96± 1.47 cm/s, P=0.01), E wave did not change significantly and E/e′ ratio tended to improve. A decrease of average e‘ and an increase of average s‘ values led to significant improvement of E/(e’xs’) ratio.
Conclusion: E/(e’xs’) and E/e’ ratios are comparable to predict early AF recurrence after ECV in patients with persistent AF. The e’ value decreased significantly after 1 month follow-up period after ECV for persistent AF patients.

Keywords: diastolic function, E/(e‘xs‘), E/e‘, NT-proBNP, left ventricular end-diastolic diameter

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