A multivariable model combining left atrial antero-posterior diameter, myocardial deformation indices, and P-wave duration identified paroxysmal atrial fibrillation in HCM patients with an AUC of 0.90.
Case-Control (n=87)
Does combining advanced echocardiography of the left atrium with non-invasive P-wave analysis improve the identification of paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy?
Combining P-wave duration with left atrial antero-posterior diameter and myocardial deformation indices provides high discriminatory power for identifying paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy.
Effect estimate: AUC 0.90
AIMS: The maintenance of sinus rhythm is crucial for the functional capacity of patients with hypertrophic cardiomyopathy (HCM). Using a multimodality approach, we attempted to identify potential predictors of paroxysmal atrial fibrillation (PAF) in HCM patients. METHODS AND RESULTS: Thirty HCM patients (17 males, mean age 57.9 ± 13.6) with at least one documented PAF episode and 32 age- and sex-matched HCM control patients as well as 25 healthy volunteers were studied in sinus rhythm. Study subjects underwent 2D echocardiography including a colour Doppler myocardial imaging evaluation of the left atrium (LA). Additionally, an orthogonal electrocardiogram was acquired; P-wave duration, maximum, and mean energies were calculated for each subject at each orthogonal lead and the composite vector axis using the Morlet wavelet analysis. Compared with HCM controls, in HCM-PAF patients, LA antero-posterior diameter was significantly enlarged (LADAP: 46.1 ± 5.9 vs. 40.0 ± 4.7 mm, P < 0.001), peak strain rate of the LA lateral wall in the reservoir phase was significantly decreased (LAT peak SR-S: 1.93 ± 0.51 vs. 2.55 ± 0.83 s(-1), P < 0.01), and P-wave duration in the Z-lead was significantly prolonged (P-durZ: 106.9 ± 24.6 vs. 86.2 ± 14.3 ms, P < 0.001). Cut-off values and areas under the curve (AUCs) for individual parameters were 42.0 mm, 2.32 s(-1), and 98.8 ms and 0.81, 0.74, and 0.78, respectively. A multivariable model combining LADAP, LAT peak SR-S and P-durZ had an AUC of 0.90, a sensitivity of 0.87, and a specificity of 0.91 for identifying PAF patients. CONCLUSION: P-wave duration combined with LA antero-posterior diameter and myocardial deformation indices resulted in a higher power for discriminating HCM-PAF patients, when compared with individual parameters derived from either wavelet analysis or 2D echocardiography.
Girasis et al. (Fri,) conducted a case-control in Hypertrophic cardiomyopathy (n=87). Advanced echocardiographic evaluation of the left atrium combined with non-invasive P-wave analysis vs. Individual parameters derived from either wavelet analysis or 2D echocardiography was evaluated on Discrimination of HCM-PAF patients using a multivariable model combining LADAP, LAT peak SR-S and P-durZ (AUC 0.90). A multivariable model combining left atrial antero-posterior diameter, myocardial deformation indices, and P-wave duration identified paroxysmal atrial fibrillation in HCM patients with an AUC of 0.90.