Document Detail


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.
MedLine Citation:
PMID:  22218325     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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. 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. PATIENTS AND METHODS: We studied 126 patients (70±5years; 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<1.0) at rest were studied. Altered TMF velocity pattern was present when patients with E/A<1.0 at rest developed E/A≥1.0 after exercise. Primary endpoints for follow-up were combination of major cardiac events and new-onset AF. 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<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). 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.
Authors:
Tsutomu Takagi; Atsushi Takagi; Junichi Yoshikawa
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-2
Journal Detail:
Title:  Journal of cardiology     Volume:  -     ISSN:  1876-4738     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804703     Medline TA:  J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Affiliation:
Takagi Cardiology Clinic, Kyoto, Japan.
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