Evaluation of P wave Dispersion and Tissue Doppler Imaging for Predicting Paroxysmal Atrial Fibrillation in Patients with Hypertension
DOI:
https://doi.org/10.1532/hsf.1831Keywords:
Hypertension, Atrial fibrillation, Tissue Doppler echocardiography, Tissue Doppler imaging, Electromechanical delayAbstract
Background: There are no previous studies dealing with paroxysmal atrial fibrillation (AF) and hypertension using electrocardiogram and tissue doppler imaging (TDI). The aim of this study was to investigate and identify the predictive indicators for paroxysmal AF in hypertensive patients using
P wave dispersion (Pd) and TDI.
Methods: Patients with hypertension were enrolled. Patients with paroxysmal AF were classified as the PAF group, and patients without a history of paroxysmal AF were classified as the NAF group. The clinical data, P wave indicators and TDI indicators were collected and compared between the two groups.
Results: A total of 120 patients were enrolled into the study with 40 cases in the PAF group and 80 cases in the NAF group. Compared with NAF group, Pd, maximum P wave duration (Pmax), left ventricular end-diastolic dimension (LVEDd) and left atrial dimension (LAD) were significantly longer (P < .05) in the PAF group. PAL, PAI, PAR, LR, LI and IR were significantly longer (P < .05) in the PAF group than in the NAF group. As for ROC analysis, Pd and PAL had the greatest area under the curve. The best diagnostic value of Pd and PAL was 40ms and 78ms, respectively. The combination of Pd ≥40ms with Pmax ≥ 110ms showed higher specificity and positive predictive value but decreased sensitivity and negative predictive value for paroxysmal AF.
Conclusions: The PAF group had significantly longer atrial electromechanical time and higher Pd compared with NAF group. The combination of Pd and TDI may be helpful to predict the onset of paroxysmal AF in patients
with hypertension.
References
Andrade J, Khairy P, Dobrev D, Nattel S. 2014. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circ Res 114:1453-1468.
Andrikopoulos GK, Dilaveris PE, Richter DJ, et al. 2000. Increased variance of P wave duration on the electrocardiogram distinguishes patients with idiopathic paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 23:1127-1132.
Association EHR, Fuster V, Rydén LE, et al. 2007. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Commi. Eur Heart J 59:1231-1265.
Buxton AE, Josephson ME. 1981. The role of P wave duration as a predictor of postoperative atrial arrhythmias. Chest 80:68-73.
Chugh SS, Havmoeller R, Narayanan K, et al. 2014. Worldwide Epidemiology of Atrial Fibrillation A Global Burden of Disease 2010 Study. Circulation 129:837-847.
Ciaroni S, Cuenoud L, Bloch A. 2000. Clinical study to investigate the predictive parameters for the onset of atrial fibrillation in patients with essential hypertension. Am Heart J 139:814-819.
de Vos CB, Pisters R, Nieuwlaat R, et al. 2010. Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. J Am Coll Cardiol 55:725-731.
Dilaveris PE, Gialafos EJ, Sideris SK, et al. 1998. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 135:733-738.
Dilaveris PE, Gialafos EJ, Andrikopoulos GK, et al. 2000. Clinical and Electrocardiographic Predictors of Recurrent Atrial Fibrillation. Pacing Clin Electrophysiol 23:352-358.
Guo JH. 1999. P wave dispersion. J Clin Electrocardiol 189-192.
Guo YP. Fang WH, Cheng S-T. 2007. Analyzing effects of P wave dispersion on paroxysmal atrial fibrillation. Chin J Prim Med Pharm 14:411-412.
Healey JS, Connolly SJ. 2003. Atrial fibrillation: hypertension as a causative agent, risk factor for complications, and potential therapeutic target. American Journal of Cardiology 91:9-14.
Hijazi Z, Oldgren J, Siegbahn A, Granger CB, Wallentin L. 2013. Biomarkers in atrial fibrillation: a clinical review. Eur Heart J 34:1475-1480.
Huxley RR. 2011. Absolute and Attributable Risks of Atrial Fibrillation in Relation to Optimal and Borderline Risk Factors The Atherosclerosis Risk in Communities (ARIC) Study. Circulation 123:1501-1508.
Khaji A, Kowey PR. 2017. Update on atrial fibrillation. Trends Cardiovasc Med 27:14-25.
Li D, Shinagawa K, Pang L, et al. 2001. Effects of Angiotensin-Converting Enzyme Inhibition on the Development of the Atrial Fibrillation Substrate in Dogs With Ventricular Tachypacing induced Congestive Heart Failure. Circulation 104:2608-2614.
Mori K, Hayabuchi Y, Inoue M, et al. 2007. Myocardial strain imaging for early detection of cardiac involvement in patients with Duchenne’s progressive muscular dystrophy. Echocardiography 24:598-608.
Ozer N, Aytemir K, Atalar E, et al. 2000. P wave dispersion in hypertensive patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 23:1859-1862.
Piccini JP, Fauchier L. 2016. Rhythm control in atrial fibrillation. The Lancet 388:829-840.
Pieruzzi F, Antolini L, Salerno FR, et al. 2015. The role of blood pressure, body weight and fat distribution on left ventricular mass, diastolic function and cardiac geometry in children. J Hypertens 33:1182-1192.
Rein A, O’Donnell C, Colan S, Sear-Brent L, Marx G. editors. 2000. Right and left atrial contraction time and electromechanical coupling using tissue velocity imaging. Circulation 383.
Rein AJ, O’Donnell CP, Colan SD, Marx GR. 2003. Tissue velocity Doppler assessment of atrial and ventricular electromechanical coupling and atrioventricular time intervals in normal subjects. Am J Cardiol 92:1347-1350.
Schneider MP, Hua TA, Böhm M, et al. 2010. Prevention of Atrial Fibrillation by Renin-Angiotensin System Inhibition : A Meta-Analysis. J Am Coll Cardiol 55:2299-2307.
Takahashi S, Katayama K, Watanabe M, et al. 2016. Preoperative Tissue Doppler Imaging-Derived Atrial Conduction Time Predicts Postoperative Atrial Fibrillation in Patients Undergoing Mitral Valve Surgery for Mitral Valve Regurgitation. Circ J 80:101-109.
Tenekecioglu E, Karabulut A, Yilmaz M. 2010. Comparison of tissue Doppler dynamics with Doppler flow in evaluating left atrial appendage function by transesophageal echocardiography in prehypertensive and hypertensive patients. Echocardiography 27:677-686.
Tong D. 2013. The relation between P wave dispersion and primary hypertension complicated with paroxysmal atrial fibrillation. Prevention and Treatment of Cardio-Cerebral-Vascular Disease 13:376-378.
Wang CQ, Zhou M, Zhan ZQ, et al. 2005. Predictive value of P wave dispersion on paroxysmal atrial fibrillation in primary hypertensive patients. Clinical Focus 245-7.
Yuan YQ, Liu HL, Ma YX. 2003. The effect of the inhibitors of angiotensin converting enzyme on P wave dispersion in patients with organic heart disease and paroxysmal atrial fibrillation. J Clin Cardiol 690-691.
Zhang H, Xin-Zheng LU. 2012. Hypertension and Atrial Fibrillation:Diagnostic Approach,Prevention and Treatment. Position Paper of the Working Group ‘Hypertension Arrhythmias and Thrombosis’ of the European Society of Hypertension. Adv Cardiovasc Dis 30:239-252.
Zhou ZQ, Hu DY, Chen J, et al. 2004. [An epidemiological survey of atrial fibrillation in China]. Zhonghua Nei Ke Za Zhi 43:491-494.
