TITLE:
Pulsed and Tissue Doppler Echocardiographic Abnormalities in Patients with Diastolic Heart Failure with and without Atrial Fibrillation
AUTHORS:
Taysir Said Garadah, Najat Hassan Mahdi, Mohamed Ahmed Al Alwai, Ahmed Abdulkareem Jaradat, Zuheir Ahmed Hasan
KEYWORDS:
Diastolic Heart Failure; Atrial Fibrillation; Tissue Doppler; Bahrain
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.3 No.7,
December
31,
2012
ABSTRACT: Background: Symptoms of heart failure (HF) are identical in
both systolic (SHF) and diastolic hear failure (DHF). The prevalence of atrial
fibrillation (AF) in heart failure varies in different studies depending on the
criteria of enrollment and the use of echocardiographic parameters in the
definition of HF. Aim: To assess the clinical characteristic of pa- tients with DHF
complicated by AF and compare with those with SHF in regard of
echocardiographic abnormalities and causative agents. Furthermore, evaluate the
clinical and biochemical markers for the prediction of AF in HF. Method: Over the duration of 12 months, each patient
diagnosed as HF based on admission code was enrolled in the study. Patients
were classified into two groups: group 1: DHF, with preserved LVPEF% > 50%,
n = 204 (60%), and group 2,
with SHF, with LVREF% ≤ 50%, n = 140 (40%). The presence or absence of AF on ECG was recorded. The
predictive value of different clinical and biochemical variables for the
development of AF was evaluated using logistic multiple regression analysis. Results: Three hundred and forty four eligible patients
were admitted to hospital with heart failure out of 7650 who had other medical
problems. The prevalence of HF in this population was 4.5%, those with DHF were
2.7% and SHF of 1.8%. The incidence of AF on ECG was 35% in the whole study
population and 65% were in sinus rhythm (SR). The occurrence of AF was twice
higher in DHF patients of 22% compared with 11% in SHF. Echo pulsed Doppler in DHF
and AF compared with those in SR showed a severe restrictive pattern with
significantly thick septum wall, higher LV mass index, shorter DT and higher
E/e? ratio of 12.4 vs. 9.73, P 0.05. The predictive risk (odd ratio) of different
clinical variables for development of AF in HF was positive for LV hypertrophy
on ECG of 2.4, history of hypertension of 1.6, history
of DM of 1.4, BMI > 28 of 1.7. Conclusions: The prevalence of HF was 4.5% in the study population, with SHF of 1.8%
and DHF of 2.7%. Patients with DHF and AF were older with a higher female ratio
with severe restrictive pattern compared with those of SHF. The incidence of AF in the whole study was
35%. The best predictor of AF in HF was left ventricle hypertrophy followed by
history of hypertension and DM.