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- Title
Doppler-Derived Indexes and B-Type Natriuretic Peptide in Prediction of Paroxysmal Atrial Fibrillation in Essential Hypertension: A Prospective Study.
- Authors
Badran, Hala Mahfouz; Eid, Manal Abd Elwahed; Michael, Atef
- Abstract
Background: Onset of atrial fibrillation in hypertensive patients is usually associated with a high occurrence of cardiovascular complications. Despite its leading importance as a highly prevalent and modifiable risk factor, only a few data are available regarding the predictors of paroxysmal atrial fibrillation (PAF) in hypertensive patients. Objectives: This study was undertaken to determine if PAF could be predicted in hypertensive patients while in sinus rhythm using Doppler-derived indexes and the plasma B-type natriuretic peptide (BNP) concentration. Methods: We prospectively evaluated 165 consecutive patients with hypertension and no known history of PAF or cardiovascular events who attended the cardiology outpatient clinic. Their mean age was 62 ± 12, 94 male, 71 female. The conventional echocardiographic parameters were measured including: left atrial (LA) volume, mitral regurgitation (MR), left ventricular (LV) function, LV mass. The ratio of transmitral peak E-wave velocity to flow propagation velocity (E/Vp), ratio of E-wave to mitral annular early diastolic velocity (E/Ea) obtained by Doppler tissue at the lateral and septal corners of the mitral annulus were calculated. The plasma BNP was measured at the study entry. Results: After a mean follow-up of 15 ± 3 months, PAF (symptomatic attacks or documented on the ECG) occurred in 36 (21.8%) of 165 patients. The patients with PAF had significant higher BNP levels than those with sinus rhythm (160 ± 109.8 vs. 87.9 ± 57.7 pg/ml, P < 0.001) Also, E/Ea and E/Vp ratios were significantly higher in hypertensives with PAF (15.1 ± 2.8 vs. 8.39 ± 1.33, P < 0.001), and (1.65 ± 1.29 vs. 1.19 ± 1.06, P < 0.001) respectively. In univariate analysis, E/Vp, E/Ea, and BNP and LV hypertrophy were significant predictors of PAF. Barely E/Vp and E/Ea remained independently significant after adjustment of clinical and other echocardiographic variables by multivariate logistic regression analysis (odd ratio: 3.36, P < 0.001 and 4.93, P < 0.001 respectively). A cutoff value of ≥1.7 for E/Vp predicted PAF with 91% sensitivity and 88% specificity; E/Ea >12 has sensitivity 98%, specificity 89%, while BNP>170 pg/ml has 83% and 72% specificity, respectively, for prediction of PAF in hypertensive patients. Conclusion: Paroxysmal atrial fibrillation could be predicted in hypertensive patients while in sinus rhythm using Doppler-derived indexes. Increased E/Vp, E/Ea ratios and elevated BNP appear to be useful parameters to identify patients at heightened risk. They may reflect early left ventricular dysfunction and atrial hypertension in this population.
- Subjects
DOPPLER effect; COLLISION broadening; DOPPLER echocardiography; ECHOCARDIOGRAPHY; ATRIAL natriuretic peptides; ATRIAL fibrillation; HYPERTENSION
- Publication
Echocardiography, 2007, Vol 24, Issue 9, p911
- ISSN
0742-2822
- Publication type
Article
- DOI
10.1111/j.1540-8175.2007.00493.x