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Are transthoracic echocardiographic parameters associated with atrial fibrillation recurrence or stroke? Results from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study.
J Am Coll Cardiol. 2005 Jun 21; 45(12):2026-33.JACC

Abstract

OBJECTIVES

The purpose of this study was to evaluate the associations of transthoracic echocardiographic parameters with recurrent atrial fibrillation (AF) and/or stroke.

BACKGROUND

The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study, an evaluation of elderly patients with AF at risk for stroke, provided an opportunity to evaluate the implications of echocardiographic parameters in patients with AF.

METHODS

Transthoracic echocardiographic measures of mitral regurgitation (MR), left atrial (LA) diameter, and left ventricular (LV) function were evaluated in the AFFIRM rate- and rhythm-control patients who had sinus rhythm resume and had these data available. Risk for recurrent AF or stroke was evaluated with respect to transthoracic echocardiographic measures.

RESULTS

Of 2,474 patients studied, 457 had > or =2(+)/4(+) MR, and 726 had a LA diameter >4.5 cm. The LV ejection fraction was abnormal in 543 patients. The cumulative probabilities of at least one AF recurrence/stroke were 46%/1% after 1 year and 84%/5% by the end of the trial (> 5 years), respectively. Multivariate analysis showed that randomization to the rhythm-control arm (hazard ratio [HR] = 0.64; p < 0.0001) and a qualifying episode of AF being the first known episode (HR = 0.70; p < 0.0001) were associated with decreased risk. Duration of qualifying AF episode >48 h (HR = 1.55; p < 0.0001) and LA diameter (p = 0.008) were associated with an increased risk of recurrent AF. Recurrent AF was more likely with larger LA diameters (HR = 1.21, 1.16, and 1.32 for mild, moderate, and severe enlargement, respectively). No transthoracic echocardiographic measures were associated with risk of stroke.

CONCLUSIONS

In the AFFIRM study, large transthoracic echocardiographic LA diameters were associated with recurrent AF, but no measured echocardiographic parameter was associated with stroke.

Authors+Show Affiliations

University of Iowa Hospitals, 200 Hawkins Drive, Iowa City, IA 52242, USA. brian-olshansky@uiowa.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15963405

Citation

Olshansky, Brian, et al. "Are Transthoracic Echocardiographic Parameters Associated With Atrial Fibrillation Recurrence or Stroke? Results From the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study." Journal of the American College of Cardiology, vol. 45, no. 12, 2005, pp. 2026-33.
Olshansky B, Heller EN, Mitchell LB, et al. Are transthoracic echocardiographic parameters associated with atrial fibrillation recurrence or stroke? Results from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study. J Am Coll Cardiol. 2005;45(12):2026-33.
Olshansky, B., Heller, E. N., Mitchell, L. B., Chandler, M., Slater, W., Green, M., Brodsky, M., Barrell, P., & Greene, H. L. (2005). Are transthoracic echocardiographic parameters associated with atrial fibrillation recurrence or stroke? Results from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study. Journal of the American College of Cardiology, 45(12), 2026-33.
Olshansky B, et al. Are Transthoracic Echocardiographic Parameters Associated With Atrial Fibrillation Recurrence or Stroke? Results From the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. J Am Coll Cardiol. 2005 Jun 21;45(12):2026-33. PubMed PMID: 15963405.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are transthoracic echocardiographic parameters associated with atrial fibrillation recurrence or stroke? Results from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study. AU - Olshansky,Brian, AU - Heller,Eliot N, AU - Mitchell,L Brent, AU - Chandler,Mary, AU - Slater,William, AU - Green,Martin, AU - Brodsky,Michael, AU - Barrell,Patrick, AU - Greene,H Leon, PY - 2004/11/23/received PY - 2005/01/25/revised PY - 2005/03/01/accepted PY - 2005/6/21/pubmed PY - 2005/7/15/medline PY - 2005/6/21/entrez SP - 2026 EP - 33 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 45 IS - 12 N2 - OBJECTIVES: The purpose of this study was to evaluate the associations of transthoracic echocardiographic parameters with recurrent atrial fibrillation (AF) and/or stroke. BACKGROUND: The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study, an evaluation of elderly patients with AF at risk for stroke, provided an opportunity to evaluate the implications of echocardiographic parameters in patients with AF. METHODS: Transthoracic echocardiographic measures of mitral regurgitation (MR), left atrial (LA) diameter, and left ventricular (LV) function were evaluated in the AFFIRM rate- and rhythm-control patients who had sinus rhythm resume and had these data available. Risk for recurrent AF or stroke was evaluated with respect to transthoracic echocardiographic measures. RESULTS: Of 2,474 patients studied, 457 had > or =2(+)/4(+) MR, and 726 had a LA diameter >4.5 cm. The LV ejection fraction was abnormal in 543 patients. The cumulative probabilities of at least one AF recurrence/stroke were 46%/1% after 1 year and 84%/5% by the end of the trial (> 5 years), respectively. Multivariate analysis showed that randomization to the rhythm-control arm (hazard ratio [HR] = 0.64; p < 0.0001) and a qualifying episode of AF being the first known episode (HR = 0.70; p < 0.0001) were associated with decreased risk. Duration of qualifying AF episode >48 h (HR = 1.55; p < 0.0001) and LA diameter (p = 0.008) were associated with an increased risk of recurrent AF. Recurrent AF was more likely with larger LA diameters (HR = 1.21, 1.16, and 1.32 for mild, moderate, and severe enlargement, respectively). No transthoracic echocardiographic measures were associated with risk of stroke. CONCLUSIONS: In the AFFIRM study, large transthoracic echocardiographic LA diameters were associated with recurrent AF, but no measured echocardiographic parameter was associated with stroke. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/15963405/Are_transthoracic_echocardiographic_parameters_associated_with_atrial_fibrillation_recurrence_or_stroke_Results_from_the_Atrial_Fibrillation_Follow_Up_Investigation_of_Rhythm_Management__AFFIRM__study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(05)00671-6 DB - PRIME DP - Unbound Medicine ER -