Altered trans-mitral flow velocity pattern after exercise predicts development of new-onset atrial fibrillation in elderly patients with impaired left ventricular relaxation at rest: Prognostic value of diastolic stress echocardiography

作者：Takagi Tsutomu^*; Takagi Atsushi; Yoshikawa Junichi

来源：Journal of Cardiology, 2012, 59(2): 225-234.

DOI：10.1016/j.jjcc.2011.11.004

• Doppler echocardiography
• Exercise stress echocardiography
• Diastolic function
• Atrial fibrillation

Objective: This study attempted to determine whether exercise induced left ventricular (LV) diastolic dysfunction estimated by altered trans-mitral flow (TMF) velocity pattern after exercise is associated with increased risk of cardiac events including new-onset atrial fibrillation (AF) in elderly patients with impaired LV relaxation at rest. %26lt;br%26gt;Background: Diastolic stress echocardiography has been applied to evaluate LV diastolic function during and post-exercise. Prognostic importance of exercise-induced diastolic dysfunction remains uncertain. %26lt;br%26gt;Patients and methods: We studied 126 patients (70 +/- 5 years; 70 males) who underwent treadmill stress echocardiography. Doppler measurements were done before exercise and immediately after the post-stress image acquisition, and the ratio between early (E) and atrial (A) TMF velocities was measured. Patients with impaired LV relaxation (E/A %26lt; 1.0) at rest were studied. Altered TMF velocity pattern was present when patients with E/A %26lt; 1.0 at rest developed E/A %26gt;= 1.0 after exercise. %26lt;br%26gt;Primary endpoints for follow-up were combination of major cardiac events and new-onset AF. %26lt;br%26gt;Results: There were 42 patients with altered TMF velocity pattern after exercise. During the 5-year follow-up period, there were 30 cardiac events including 13 new-onset AF. Kaplan-Meier survival plot demonstrated that altered TMF velocity pattern after exercise is associated with increased risk of cardiac events (p %26lt; 0.0001) including development of new-onset AF (p = 0.0003). Cox hazard ratio analysis demonstrated that altered TMF velocity pattern after exercise was the best predictor of cardiac events (hazard ratio 3.939; 95%confidence interval 1.662-9.337; p = 0.0018). %26lt;br%26gt;Conclusions: Altered TMF velocity pattern after exercise provides significant prognostic information for predicting cardiac events including new-onset AF in elderly patients with impaired left ventricular relaxation at rest.

• 出版日期2012-3