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ATRIAL EMPTYING FRACTION PREDICTS MAINTENANCE OF SINUS RHYTHM POST DIRECT CURRENT CARDIOVERSION FOR ATRIAL FIBRILLATION
1662 JACC April 5, 2016 Volume 67, Issue 13
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) ATRIAL EMPTYING FRACTION PREDICTS MAINTENANCE OF SINUS RHYTHM POST DIRECT CURRENT CARDIOVERSION FOR ATRIAL FIBRILLATION Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m. Session Title: New Technologies in Echocardiography Abstract Category: 29. Non Invasive Imaging: Echo Presentation Number: 1149-268 Authors: Christina Luong, Darby Thompson, Kenneth Gin, John Jue, Parvathy Nair, Marion Barnes, P.K. Lee, Matthew Bennett, Teresa Tsang, University of British Columbia, Vancouver, Canada
Background: Atrial volumes indexed to body surface area (AVI) are robust predictors of non-valvular atrial fibrillation (AF) recurrence post direct current cardioversion (DCCV). The incremental value of atrial emptying fraction, an index of atrial function, compared to atrial volumes as a predictor for AF recurrence following DCCV has not been evaluated. We sought to compare the predictive ability of baseline left atrial emptying fraction (LA EMF), RA EMF, LAVI, and RAVI for post DCCV AF recurrence at 6 months.
Methods: Pre-specified data was collected for patients enrolled in the AF Clinic Registry. The first 95 patients enrolled constituted the study cohort. Echocardiogram was performed within 6 months pre-cardioversion. Maximal LAVI and RAVI, LA EMF, and RA EMF were performed offline using 4-chamber single plane Simpson’s method, averaged over 5 cycles. ECG was performed at baseline, precardioversion, and at each clinic visit. Results: Of the 95 patients who underwent DCCV 28 (29%) remained in sinus rhythm by 6 months - of the remainder, 11 underwent ablation 9 underwent re-cardioversion, and 57 (60%) had AF recurrence. Mean age was 63 years and 67% were male. A history of hypertension, diabetes mellitus, and heart failure was identified in 63%, 15%, and 28% of patients, respectively. The overall performance for prediction of AF recurrence at 6 months was greatest for RA EMF, area under the receiver operator characteristic curve (AUC): RA EMF 0.92, LA EMF 0.89, RAVI 0.76 and LAVI 0.63. For prediction of AF recurrence at 6 months, RA EMF of 52% was associated with 73% sensitivity and 89% specificity, with a positive predictive valve of 95% and a negative predictive value of 76%. Overall accuracy of RA EMF > 52% was 88.5% for prediction of AF recurrence. LA EMF had similar, but lower predictive value at a cut point of 42%, though all were superior to those for RAVI or LAVI. Atrial EMF AUCs were significantly higher than for LAVI or RAVI (max p = 0.01). Conclusions: While RAVI and LAVI are robust predictors of AF recurrence post DCCV, RA and LA EMF outperformed atrial volume in this cohort.
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) ATRIAL EMPTYING FRACTION PREDICTS MAINTENANCE OF SINUS RHYTHM POST DIRECT CURRENT CARDIOVERSION FOR ATRIAL FIBRILLATION Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m. Session Title: New Technologies in Echocardiography Abstract Category: 29. Non Invasive Imaging: Echo Presentation Number: 1149-268 Authors: Christina Luong, Darby Thompson, Kenneth Gin, John Jue, Parvathy Nair, Marion Barnes, P.K. Lee, Matthew Bennett, Teresa Tsang, University of British Columbia, Vancouver, Canada
Background: Atrial volumes indexed to body surface area (AVI) are robust predictors of non-valvular atrial fibrillation (AF) recurrence post direct current cardioversion (DCCV). The incremental value of atrial emptying fraction, an index of atrial function, compared to atrial volumes as a predictor for AF recurrence following DCCV has not been evaluated. We sought to compare the predictive ability of baseline left atrial emptying fraction (LA EMF), RA EMF, LAVI, and RAVI for post DCCV AF recurrence at 6 months.
Methods: Pre-specified data was collected for patients enrolled in the AF Clinic Registry. The first 95 patients enrolled constituted the study cohort. Echocardiogram was performed within 6 months pre-cardioversion. Maximal LAVI and RAVI, LA EMF, and RA EMF were performed offline using 4-chamber single plane Simpson’s method, averaged over 5 cycles. ECG was performed at baseline, precardioversion, and at each clinic visit. Results: Of the 95 patients who underwent DCCV 28 (29%) remained in sinus rhythm by 6 months - of the remainder, 11 underwent ablation 9 underwent re-cardioversion, and 57 (60%) had AF recurrence. Mean age was 63 years and 67% were male. A history of hypertension, diabetes mellitus, and heart failure was identified in 63%, 15%, and 28% of patients, respectively. The overall performance for prediction of AF recurrence at 6 months was greatest for RA EMF, area under the receiver operator characteristic curve (AUC): RA EMF 0.92, LA EMF 0.89, RAVI 0.76 and LAVI 0.63. For prediction of AF recurrence at 6 months, RA EMF of 52% was associated with 73% sensitivity and 89% specificity, with a positive predictive valve of 95% and a negative predictive value of 76%. Overall accuracy of RA EMF > 52% was 88.5% for prediction of AF recurrence. LA EMF had similar, but lower predictive value at a cut point of 42%, though all were superior to those for RAVI or LAVI. Atrial EMF AUCs were significantly higher than for LAVI or RAVI (max p = 0.01). Conclusions: While RAVI and LAVI are robust predictors of AF recurrence post DCCV, RA and LA EMF outperformed atrial volume in this cohort.