The online version of this article (doi:10.1186/1476-7120-10-28) contains supplementary material, which is available to authorized users.
TK and NT carried out subject recruitment and analyzed data. MK analyzed data and wrote the manuscript. HI, YI, MO, ST and HS performed integrated backscatter ultrasound analysis. KN, GT and SM analyzed data. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
It is recognized that one of the causes of atrial fibrillation (AF) is pathological degeneration of the left atrium (LA). However, prospective study that elucidated the relationship between the incidence of persistent AF and pathological degeneration has not been performed. The purpose of this study was to elucidate the usefulness of integrated backscatter (IBS) values for the prediction of progression from paroxysmal AF (PAF) to persistent AF.
We measured IBS values of the entire LA wall at 5 mm intervals (except the posterior wall) in 27 patients with paroxysmal AF and evaluated progression to persistent AF for three years. IBS values were acquired with transesophageal echocardiography (TEE) using a 4–7 MHz transducer. IBS values were calculated as the average power of the backscattered signal from regions of interest (ROI). Each IBS value was color-coded to construct three dimensional maps.
Average IBS values of total voxels in color-coded maps in the persistent AF group were significantly greater than those in the non-persistent AF group (25.8 ± 5.0 dB vs. 17.4 ± 10.2 dB, p = 0.047), whereas there was no significant difference in LA diameter between the persistent AF and the non-persistent AF group. There was significant difference in persistent AF-free survival after the baseline measurements in the subjects stratified by IBS value (<20 dB versus ≥20 dB) (univariate Cox regression analysis: hazard ratio: 8.74, p =0.046).
Using IBS values measured by TEE, we can identify an increase in atrial degeneration that may predict the occurrence of persistent AF before LA dilation.
Tsang TS, Gersh BJ, Appleton CP, Tajik AJ, Barnes ME, Bailey KR, Oh JK, Leibson C, Montgomery SC, Seward JB: Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol. 2002, 40: 1636-1644. 10.1016/S0735-1097(02)02373-2 CrossRefPubMed
Bharati S, Lev M: Histology of the normal and diseased atrium. Atrial Fibrillation and Management. Edited by: Falk HE, Podrid PJ. Raven Press, Ltd, NY, 1992, 15-39.
Kubota T, Kawasaki M, Takasugi N, Takeyama U, Ishihara Y, Okubo M, Yamaki T, Ojio S, Aoyama T, Nishigaki K, et al.: Evaluation of the left atrial degeneration using integrated backscatter transesophageal echocardiography for the prediction of atrial fibrillation. J Am Coll Cardiol Img. 2009, 2: 1039-1047. CrossRef
Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, et al.: American College of Cardiology Foundation/American Heart Association Task Force. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2011, 123: e269-e367. 10.1161/CIR.0b013e318214876d CrossRefPubMed
Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, et al.: Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, 2010, 12: 1360-1420. CrossRefPubMed
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, et al.: American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for Chamber Quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardior. 2005, 18: 1440-1463. 10.1016/j.echo.2005.10.005. CrossRef
Okubo M, Kawasaki M, Ishihara Y, Takeyama U, Kubota T, Yamaki T, Ojio S, Nishigaki K, Takemura G, Saio M, et al.: Development of integrated backscatter intravascular ultrasound for tissue characterization of coronary plaques. Ultrasound Med Biol. 2008, 34: 655-663. 10.1016/j.ultrasmedbio.2007.09.015 CrossRefPubMed
Ono K, Kawasaki M, Tanaka R, Segawa T, Matsuo H, Watanabe S, Takemura G, Minatoguchi S: Integrated backscatter and intima-media thickness of the thoracic aorta evaluated by transesophageal echocardiography in hypercholesterolemic patients: Effect of pitavastatin therapy. Ultrasound Med Biol. 2009, 35: 193-200. 10.1016/j.ultrasmedbio.2008.08.011 CrossRefPubMed
Hirose T, Kawasaki M, Tanaka R, Ono K, Watanabe T, Iwama M, Noda T, Watanabe S, Takemura G, Minatoguchi S: Left atrial function assessed by speckle tracking echocardiography as a predictor of new-onset nonvalvular atrial fibrillation: Results from a prospective study in 580 adults. Eur Heart J Cardiovasc Imaging. 2012, 13: 243-250. 10.1093/ejechocard/jer251 CrossRefPubMed
Vermes E, Tradif JC, Bourassa MG, Racine N, Levesque S, White M, Guerra PG, Ducharme A: Enarapril decrease the incidence of atrial fibrillation in patients with left ventricular dysfunction. Insight from the studies of left ventricular dysfunction (SOLVD) trials. Circulation. 2003, 107: 2926-2931. 10.1161/01.CIR.0000072793.81076.D4 CrossRefPubMed
Wachtell K, Lehto M, Gerdts E, Olsen MH, Hornestam B, Dahlöf B, Dahlöf B, Ibsen H, Julius S, Kjeldsen SE, Lindholm LH: Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke complication to atenolol. J Am Coll Cardiol. 2005, 45: 712-719. 10.1016/j.jacc.2004.10.068 CrossRefPubMed
Maggioni AP, Latini R, Carson PE, Singh SN, Barlera S, Glazer R, Masson S, Cerè E, Tognoni G, Cohn JN: Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: Results from the valsartan heart failure trial (Val-HeFT). Am Heart J. 2005, 149: 548-557. 10.1016/j.ahj.2004.09.033 CrossRefPubMed
- Left atrial pathological degeneration assessed by integrated backscatter transesophageal echocardiography as a predictor of progression to persistent atrial fibrillation: Results from a prospective study of three-years follow-up
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II