Clinical InvestigationLeft Ventricular Strain Mechanics: Clinical ApplicationEchocardiographic Predictors of Progression to Persistent or Permanent Atrial Fibrillation in Patients with Paroxysmal Atrial Fibrillation (E6P Study)
Section snippets
Methods
The Echocardiographic Predictors of Progression to Persistent or Permanent Atrial Fibrillation in Patients with Paroxysmal Atrial Fibrillation (E6P) study was designed as a multicenter, prospective, observational study and was conducted at four sites in Korea (Seoul National University Bundang Hospital, Seongnam; Hallym University Medical Center, Anyang; Korea University Medical Center, Seoul; and Chungnam University Hospital, Daejeon). The study protocol was approved by the institutional
Results
A total of 313 patients (194 men; mean age, 57 ± 14 years) were included. During follow-up (median, 26 months; interquartile range, 16–37 months), progression to either persistent or permanent AF (28 and 24, respectively) was observed in 52 patients (16.6%), resulting in an annualized AF progression rate of 5.7% (Figure 1). Clinical characteristics, including the CHADS2, CHA2DS2-VASc, and HATCH scores, were similar between patients with and without AF progression (Table 1). However, patients
Discussion
The present investigation is the first and largest multicenter observational study evaluating the echocardiographic predictors of AF progression in patients with paroxysmal AF. We found that 16.6% of patients with first paroxysmal AF progressed to persistent or permanent AF during a median follow-up period of 26 months, resulting in an annualized event rate of 5.7%, even though those with congestive heart failure symptoms, LV dysfunction, valvular heart disease, and secondary causes of AF were
Conclusions
In this study, many patients with paroxysmal AF progressed to persistent or permanent AF, despite the exclusion of those with underlying heart disease. Echocardiographic measures of LA diameter, volume, and mechanical function, including LA global ε, were found to be associated with AF progression. In particular, LA global ε was the strongest and independent predictor of AF progression and is expected to serve as a valuable predictor of AF progression.
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