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Incremental value of diastolic wall strain in predicting heart failure events in patients with atrial fibrillation

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Abstract

Diastolic wall strain (DWS), an echocardiographic index based on linear elasticity theory, has been identified as a predictor of heart failure (HF) in patients with sinus rhythm. However, its effectiveness in atrial fibrillation (AF) patients remains uncertain. This study aims to assess DWS as a predictor of HF in AF patients with preserved ejection fraction. We analysed a prospective database of AF patients undergoing transthoracic echocardiography. AF patients with reduced left ventricular ejection fraction (< 50%), posterior wall motion abnormality, hypertrophic cardiomyopathy, valvular heart disease, pericardial disease, congenital heart disease, or history of pacemaker/implantable cardioverter-defibrillator implantation or cardiac surgery were excluded. The study followed patients until HF development, death, or last visit. Follow-up for patients who underwent catheter ablation was censored on the date of their procedure. HF was ascertained based on the Framingham criteria. DWS was calculated using a validated formula: DWS = (PWs -PWd)/PWs, where PWs is the posterior wall thickness at end-systole and PWd is the posterior wall thickness at end-diastole. Among 411 study patients (mean age 69.6 years, 66% men), 20 (5%) was underwent catheter ablation and 57 (14%) developed HF during a mean follow-up of 82 months. Cox-proportional hazards demonstrated that low DWS (≤ 0.33) significantly predicted HF events (hazard ratio [HR] 3.28, 95% confidence interval [CI]) 1.81–5.94, P < 0.0001), independent of age (per 10 years; HR 1.99, 95% CI 1.35–2.93, P < 0.001), indexed left ventricular mass (per 10 g/m2; HR 1.16, 95% CI 1.05–1.27, P < 0.01), and indexed left atrial volume (per 10 mL/m2; HR 1.14, 95% CI 1.04–1.24, P < 0.01). Additionally, global log-likelihood ratio chi-square statistics indicated that DWS incrementally predicts HF development beyond age, indexed left ventricular mass, and left atrial volume (P < 0.001).

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Funding

This study was supported in part by Grant-in-Aid for Scientific Research ©, 26461096, from the Ministry of Education, Culture, Sports, Science and Technology of Japan (Tokyo Japan).

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine II, Kansai Medical University, 2-5-1, Shin- machi, Hirakata, 573-1010, Osaka, Japan

    Naoki Taniguchi, Yoko Miyasaka, Yoshinobu Suwa, Eri Nakai, Shoko Harada, Hiromi Otagaki & Ichiro Shiojima

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  1. Naoki Taniguchi
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Contributions

Study concept and design: Yoko Miyasaka, Naoki Taniguchi. Acquisition of data: Naoki Taniguchi, Yoshinobu Suwa, Eri Nakai. Analysis and interpretation of data: Naoki Taniguchi, Yoko Miyasaka. Drafting of the manuscript: Naoki Taniguchi, Yoko Miyasaka, Ichiro Shiojima. Critical revision of the manuscript for important intellectual content: Yoko Miyasaka, Naoki Taniguchi, Yoshinobu Suwa, Shoko Harada, Eri Nakai, Hiromi Otagaki, Ichiro Shiojima. Obtained funding: Yoko Miyasaka.

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Correspondence to Yoko Miyasaka.

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Taniguchi, N., Miyasaka, Y., Suwa, Y. et al. Incremental value of diastolic wall strain in predicting heart failure events in patients with atrial fibrillation. Heart Vessels (2024). https://doi.org/10.1007/s00380-024-02401-w

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