Prevalence of Atrial Fibrillation in Systolic Heart Failure, Pulsed and Tissue Doppler Echocardiographic Abnormalities ()
Affiliation(s)
College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain;
2Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain.
College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain;
Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain.
ABSTRACT
Background: Heart failure (HF) is a common clinical syndrome mostly due to the impaired ability of the Left Ventricle (LV) to eject blood
with reduced cardiac output. Heart failure is called systolic (SHF) if left
ventricle ejection fraction on echo-cardiogram is low (LVEF of ≤50%). Aim: To
assess the echocardiographic characteristics of patients with SHF with Atrial
Fibrillation (AF) and compare with those with Sinus Rhythm (SR) on 12 leads ECG. Furthermore,
to evaluate the clinical and biochemical markers for the prediction of AF in
SHF. Method: Over two years duration, each patient diagnosed with SHF
was enrolled in the study (n = 354) based on admission code. AF or sinus rhythm
on 12 leads ECG was documented on each patient. Multiple logistic regression
analysis was applied to assess the risk ratio of different clinical and Doppler
derived variables for the development of AF in SHF. Results: Out of the
total hospital medical admissions of 14,674 patients, there were 354 patients
with diagnosis of SHF, a prevalence
of 2.4%. The incidence of AF on ECG was 109 (31%) patients in the whole study population and 245 (69%) in SR. M Mode echocardiogram
in patients with SHF and AF compared with those in SR showed significant
dilation of LV cavity in systole with LVESD of 5.72 ± 0.63 vs. 5.23 ± 0.76 cm,
P < 0.001 and in Diastole LVEDD of 6.83 ± 0.51 vs. 6.58 ± 0.63 cm, P <
0.001. Pulsed
Doppler echocardiogram showed a severe restrictive-pattern with shorter
Decellration Time (DT) of 163.73 ± 7.42 vs. 214.9 ± 31.81msec, P < 0.001 and higher Pulse to Tissue Doppler ratio
of E/Em of 14.26 ± 1.34 vs. 9.99 ± 1.27, P < 0.001, and the serum level of Brain
Natriuretic Peptide (BNP)
hormone of 723.72 ± 13.45 vs. 686.98 ± 72.57 pg/ml, P < 0.001. The
predictive risks (odd ratio) of different clinical variables for the development of AF in SHF were positive for high BNP >
500 pg/ml of 2.8, history of hypertension of 1.8, history of DM of 1.7, BMI
> 28 of 1.4, LV hypertrophy on ECG of 1.3. Conclusions: The
prevalence of Systolic Heart Failure in the study population was 2.4%. The
prevalence of AF in the study population was 31%. The best predictors of AF in SHF were high BNP > 500 pg/ml,
history of hypertension, Diabete Mellitus and LV Hypertrophy on ECG.
Share and Cite:
S. Gabani, T. Garadah, A. Hassan, A. Jaradat, M. Al Alawi and Z. Hasan, "Prevalence of Atrial Fibrillation in Systolic Heart Failure, Pulsed and Tissue Doppler Echocardiographic Abnormalities,"
International Journal of Clinical Medicine, Vol. 4 No. 11, 2013, pp. 504-509. doi:
10.4236/ijcm.2013.411089.