Key result
The E/(e’×s’) ratio (HR 8.17, P=0.01) and E/e′ ratio (HR 1.74, P=0.001) were significant predictors of early atrial fibrillation recurrence 1 month after electrical cardioversion.
Why the study?
The study investigated whether the E/(e'xs') ratio better predicts AF recurrence than the E/e' ratio, and evaluated changes in spectral tissue Doppler indices 1 month after electrical cardioversion.
Does the E/(e'xs') ratio predict early recurrence of atrial fibrillation better than the E/e' ratio in patients with persistent AF after electrical cardioversion?
Cohort (n=77)
Does the E/(e'xs') ratio predict early recurrence of atrial fibrillation better than the E/e' ratio in patients with persistent AF after electrical cardioversion?
Hazard Ratio: 8.17
p-value: p=0.01
Both E/(e'xs') and E/e' ratios are comparable and significant predictors of early atrial fibrillation recurrence after electrical cardioversion in patients with persistent AF and normal LVEF.
E/(e’×s’) and E/e′ ratios may predict early AF recurrence after cardioversion; hypothesis-generating and requires prospective validation before clinical use.
Purpose: Spectral tissue Doppler-derived E/e’ ratio has been proposed as the best parameter for prediction of atrial fibrillation (AF). Relaxation and contraction are equivalent parts of a continuous cardiac cycle, where systolic and diastolic abnormalities have a variable contribution to the left ventricle (LV) failure. The aim of this study was to investigate whether the E/(e’xs’) ratio is a better index than E/e‘ to predict AF recurrence and to determine the changes of spectral tissue Doppler indices 1 month after the electrical cardioversion (ECV). Patients and Methods: The study included 77 persistent AF patients with restored sinus rhythm (SR) after ECV. Only patients with normal LV ejection fraction (EF) were included. Echocardiography and NT-proBNP laboratory findings were performed. A primary outcome was the early (within 1 month) recurrence of AF. Results: After a 1 month follow-up period, 39 patients (50.6%) were in SR. E/e′ (HR=1.74, P =0.001) and E/(e’×s’) ratios (HR=8.17, P =0.01) were significant predictors of AF recurrence. E/(e’×s’) in combination with LV end-diastolic diameter > 49.3 mm and NT-proBNP > 2000 ng/L demonstrated a higher contribution in the model to predict AF recurrence compared to the E/e’ ratio (18.94, P =0.005 vs 1.95, P =0.001). On ROC analysis, E/(e’×s’) and E/e′ showed similar diagnostic accuracy (E/(e’×s’), AUC=0.71, P =0.002 and E/e′, AUC=0.75, P < 0.0001). Average e‘ value significantly decreased after 1 month in SR (from 10.76± 1.24 to 8.96± 1.47 cm/s, P =0.01), E wave did not change significantly and E/e′ ratio tended to improve. A decrease of average e‘ and an increase of average s‘ values led to significant improvement of E/(e’xs’) ratio. Conclusion: E/(e’xs’) and E/e’ ratios are comparable to predict early AF recurrence after ECV in patients with persistent AF. The e’ value decreased significantly after 1 month follow-up period after ECV for persistent AF patients.
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Karaliūtė et al. (2020) conducted a cohort in persistent atrial fibrillation (n=77). E/(e’×s’) ratio vs. E/e' ratio was evaluated on early (within 1 month) recurrence of AF (HR 8.17, p=0.01). The E/(e’×s’) ratio (HR 8.17, P=0.01) and E/e′ ratio (HR 1.74, P=0.001) were significant predictors of early atrial fibrillation recurrence 1 month after electrical cardioversion.
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