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Left Ventricular Filling Pressure as Assessed by the E/e’ Ratio Is a Determinant of Atrial Fibrillation Recurrence after Cardioversion

Authors
 Hyemoon Chung  ;  Byoung Kwon Lee  ;  Pil-Ki Min  ;  Eui-Young Choi  ;  Young Won Yoon  ;  Bum-Kee Hong  ;  Se-Joong Rim  ;  Hyuck Moon Kwon  ;  Jong-Youn Kim 
Citation
 Yonsei Medical Journal, Vol.57(1) : 64-71, 2016 
Journal Title
 Yonsei Medical Journal 
ISSN
 0513-5796 
Issue Date
2016
MeSH
Aged ; Atrial Fibrillation/physiopathology* ; Electric Countershock ; Female ; Follow-Up Studies ; Heart Atria/pathology ; Heart Atria/physiopathology ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Proportional Hazards Models ; ROC Curve ; Recurrence ; Regression Analysis ; Retrospective Studies ; Sensitivity and Specificity ; Survival Rate ; Ventricular Dysfunction, Left/physiopathology*
Keywords
Diastolic dysfunction ; atrial fibrillation ; cardioversion ; left ventricular filling pressure
Abstract
PURPOSE: Left ventricular (LV) filling pressure affects atrial fibrillation (AF) recurrence. We investigated the relationship between diastolic dysfunction and AF recurrence after cardioversion, and whether LV filling pressure was predictive of AF recurrence. MATERIALS AND METHODS: Sixty-six patients (mean 58±12 years) with newly diagnosed persistent AF were retrospectively enrolled. We excluded patients with left atrial (LA) diameters larger than 50 mm, thereby isolating the effect of LV filling pressure. We evaluated the differences between the patients with (group 1) and without AF recurrence (group 2). RESULTS: Group 1 showed increased LA volume index (LAVI) and E/e' compared to group 2 (p<0.05). During a mean follow-up period of 25±19 months, AF recurrence after cardioversion was 60.6% (40/66). The area under the receiver operating characteristics curve of E/e' for AF recurrence was 0.780 [95% confidence interval (CI): 0.657-0.903], and the optimal cut-off value of the E/e' was 9.15 with 75.0% of sensitivity and 73.1% of specificity. A Kaplan-Meier survival curve showed that the cumulative recurrence-free survival rate was significantly lower in patients with higher LV filling pressure (E/e'>9.15) compared with patients with lower LV filling pressure (E/e'≤9.15) (log rank p=0.008). Cox regression analysis revealed that E/e' [hazards ratio (HR): 1.100, 95% CI: 1.017-1.190] and LAVI (HR: 1.042, 95% CI: 1.002-1.084) were independent predictors for AF recurrence after cardioversion. CONCLUSION: LV filling pressure predicts the risk of AF recurrence in persistent AF patients after cardioversion.
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DOI
10.3349/ymj.2016.57.1.64
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
권혁문(Kwon, Hyuck Moon) ORCID logo https://orcid.org/0000-0001-9901-5015
김종윤(Kim, Jong Youn) ORCID logo https://orcid.org/0000-0001-7040-8771
민필기(Min, Pil Ki) ORCID logo https://orcid.org/0000-0001-7033-7651
윤영원(Yoon, Young Won) ORCID logo https://orcid.org/0000-0002-0907-0350
이병권(Lee, Byoung Kwon) ORCID logo https://orcid.org/0000-0001-9259-2776
임세중(Rim, Se Joong) ORCID logo https://orcid.org/0000-0002-7631-5581
최의영(Choi, Eui Young) ORCID logo https://orcid.org/0000-0003-3732-0190
홍범기(Hong, Bum Kee) ORCID logo https://orcid.org/0000-0002-6456-0184
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146244
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