Improving the diagnosis of heart failure in patients with atrial fibrillation

Bunting, Karina V, Gill, Simrat K, Sitch, Alice, Mehta, Samir, O'Connor, Kieran, Lip, Gregory YH ORCID: 0000-0002-7566-1626, Kirchhof, Paulus, Strauss, Victoria Y, Rahimi, Kazem, Camm, A John
et al (show 7 more authors) (2021) Improving the diagnosis of heart failure in patients with atrial fibrillation. HEART, 107 (11). pp. 902-908.

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<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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
Uncontrolled Keywords: atrial fibrillation, echocardiography, heart failure, diastolic, systolic
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 30 Jun 2021 13:58
Last Modified: 18 Jan 2023 21:37
DOI: 10.1136/heartjnl-2020-318557
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