Patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation: advanced echocardiographic evaluation of the left atrium combined with non-invasive P-wave analysis

The maintenance of sinus rhythm is crucial for the functional capacity of patients with hypertrophic cardiomyopathy (HCM). Using a multimodality approach, we attempted to identify potential predictors of paroxysmal atrial fibrillation (PAF) in HCM patients. Thirty HCM patients (17 males, mean age 57...

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Published in:European heart journal cardiovascular imaging 2013-05, Vol.14 (5), p.425-434
Main Authors: Girasis, Chrysafios, Vassilikos, Vassilios, Efthimiadis, Georgios K, Papadopoulou, Stella-Lida, Dakos, Georgios, Dalamaga, Emmanuela G, Chouvarda, Ioanna, Giannakoulas, Georgios, Kamperidis, Vassilios, Paraskevaidis, Stylianos, Maglaveras, Nicos, Karvounis, Haralambos I, Parcharidis, Georgios E, Styliadis, Ioannis H
Format: Article
Language:English
Subjects:
Age Factors
Aged
Analysis of Variance
Atrial Fibrillation - complications
Atrial Fibrillation - diagnosis
Cardiomyopathy, Hypertrophic - complications
Cardiomyopathy, Hypertrophic - diagnosis
Case-Control Studies
Disease Progression
Echocardiography - methods
Electrocardiography - methods
Female
Heart Atria - diagnostic imaging
Heart Atria - physiopathology
Humans
Male
Middle Aged
Multivariate Analysis
Observer Variation
Prognosis
Reference Values
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Sex Factors
Tachycardia, Paroxysmal - complications
Tachycardia, Paroxysmal - diagnosis
Ultrasonography, Doppler, Color - methods
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Summary:The maintenance of sinus rhythm is crucial for the functional capacity of patients with hypertrophic cardiomyopathy (HCM). Using a multimodality approach, we attempted to identify potential predictors of paroxysmal atrial fibrillation (PAF) in HCM patients. Thirty HCM patients (17 males, mean age 57.9 ± 13.6) with at least one documented PAF episode and 32 age- and sex-matched HCM control patients as well as 25 healthy volunteers were studied in sinus rhythm. Study subjects underwent 2D echocardiography including a colour Doppler myocardial imaging evaluation of the left atrium (LA). Additionally, an orthogonal electrocardiogram was acquired; P-wave duration, maximum, and mean energies were calculated for each subject at each orthogonal lead and the composite vector axis using the Morlet wavelet analysis. Compared with HCM controls, in HCM-PAF patients, LA antero-posterior diameter was significantly enlarged (LADAP: 46.1 ± 5.9 vs. 40.0 ± 4.7 mm, P < 0.001), peak strain rate of the LA lateral wall in the reservoir phase was significantly decreased (LAT peak SR-S: 1.93 ± 0.51 vs. 2.55 ± 0.83 s(-1), P < 0.01), and P-wave duration in the Z-lead was significantly prolonged (P-durZ: 106.9 ± 24.6 vs. 86.2 ± 14.3 ms, P < 0.001). Cut-off values and areas under the curve (AUCs) for individual parameters were 42.0 mm, 2.32 s(-1), and 98.8 ms and 0.81, 0.74, and 0.78, respectively. A multivariable model combining LADAP, LAT peak SR-S and P-durZ had an AUC of 0.90, a sensitivity of 0.87, and a specificity of 0.91 for identifying PAF patients. P-wave duration combined with LA antero-posterior diameter and myocardial deformation indices resulted in a higher power for discriminating HCM-PAF patients, when compared with individual parameters derived from either wavelet analysis or 2D echocardiography.
ISSN:2047-2404
2047-2412
DOI:10.1093/ehjci/jes172