Bunting, KV;
Gill, SK;
Sitch, A;
Mehta, S;
O'Connor, K;
Lip, GY;
Kirchhof, P;
Strauss, VY;
Rahimi, K;
Camm, AJ;
et al.
Bunting, KV; Gill, SK; Sitch, A; Mehta, S; O'Connor, K; Lip, GY; Kirchhof, P; Strauss, VY; Rahimi, K; Camm, AJ; Stanbury, M; Griffith, M; Townend, JN; Gkoutos, GV; Karwath, A; Steeds, RP; Kotecha, D; RAte control Therapy Evaluation in permanent Atrial Fibrillation
(2021)
Improving the diagnosis of heart failure in patients with atrial fibrillation.
Heart, 107 (11).
pp. 902-908.
ISSN 1468-201X
https://doi.org/10.1136/heartjnl-2020-318557
SGUL Authors: Camm, Alan John
Abstract
OBJECTIVE: To improve the echocardiographic assessment of heart failure in patients with atrial fibrillation (AF) by comparing conventional averaging of consecutive beats with an index-beat approach, whereby measurements are taken after two cycles with similar R-R interval. METHODS: Transthoracic echocardiography was performed using a standardised and blinded protocol in patients enrolled in the RATE-AF (RAte control Therapy Evaluation in permanent Atrial Fibrillation) randomised trial. We compared reproducibility of the index-beat and conventional consecutive-beat methods to calculate left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and E/e' (mitral E wave max/average diastolic tissue Doppler velocity), and assessed intraoperator/interoperator variability, time efficiency and validity against natriuretic peptides. RESULTS: 160 patients were included, 46% of whom were women, with a median age of 75 years (IQR 69-82) and a median heart rate of 100 beats per minute (IQR 86-112). The index-beat had the lowest within-beat coefficient of variation for LVEF (32%, vs 51% for 5 consecutive beats and 53% for 10 consecutive beats), GLS (26%, vs 43% and 42%) and E/e' (25%, vs 41% and 41%). Intraoperator (n=50) and interoperator (n=18) reproducibility were both superior for index-beats and this method was quicker to perform (p<0.001): 35.4 s to measure E/e' (95% CI 33.1 to 37.8) compared with 44.7 s for 5-beat (95% CI 41.8 to 47.5) and 98.1 s for 10-beat (95% CI 91.7 to 104.4) analyses. Using a single index-beat did not compromise the association of LVEF, GLS or E/e' with natriuretic peptide levels. CONCLUSIONS: Compared with averaging of multiple beats in patients with AF, the index-beat approach improves reproducibility and saves time without a negative impact on validity, potentially improving the diagnosis and classification of heart failure in patients with AF.
Item Type: |
Article
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Additional Information: |
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
Keywords: |
atrial fibrillation, diastolic, echocardiography, heart failure, systolic, 1102 Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology |
SGUL Research Institute / Research Centre: |
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) |
Journal or Publication Title: |
Heart |
ISSN: |
1468-201X |
Language: |
eng |
Dates: |
Date | Event |
---|
12 May 2021 | Published | 10 March 2021 | Published Online | 25 January 2021 | Accepted |
|
Publisher License: |
Creative Commons: Attribution 4.0 |
Projects: |
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PubMed ID: |
33692093 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/113063 |
Publisher's version: |
https://doi.org/10.1136/heartjnl-2020-318557 |
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