Improving the diagnosis of heart failure in patients with atrial fibrillation
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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; Kirchhof, Paulus; Strauss, Victoria Y; Rahimi, Kazem; Camm, A John; Stanbury, Mary; Griffith, Michael; Townend, Jonathan N; Gkoutos, Georgios V; Karwath, Andreas; Steeds, Richard P; Kotecha, Dipak; RAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) trial group.
In: HEART, Vol. 107, No. 11, 06.2021, p. 902-908.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Improving the diagnosis of heart failure in patients with atrial fibrillation
AU - Bunting, Karina V
AU - Gill, Simrat K
AU - Sitch, Alice
AU - Mehta, Samir
AU - O'Connor, Kieran
AU - Lip, Gregory Yh
AU - Kirchhof, Paulus
AU - Strauss, Victoria Y
AU - Rahimi, Kazem
AU - Camm, A John
AU - Stanbury, Mary
AU - Griffith, Michael
AU - Townend, Jonathan N
AU - Gkoutos, Georgios V
AU - Karwath, Andreas
AU - Steeds, Richard P
AU - Kotecha, Dipak
AU - RAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) trial group
N1 - © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
PY - 2021/6
Y1 - 2021/6
N2 - OBJECTIVE: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.
AB - OBJECTIVE: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.
KW - Aged
KW - Aged, 80 and over
KW - Atrial Fibrillation/physiopathology
KW - Biomarkers/blood
KW - Diastole/physiology
KW - Echocardiography, Doppler, Pulsed
KW - Female
KW - Heart Failure/diagnosis
KW - Humans
KW - Male
KW - Natriuretic Peptide, Brain/blood
KW - Peptide Fragments/blood
KW - Reproducibility of Results
KW - Stroke Volume/physiology
KW - Systole/physiology
KW - Ventricular Function, Left/physiology
U2 - 10.1136/heartjnl-2020-318557
DO - 10.1136/heartjnl-2020-318557
M3 - SCORING: Journal article
C2 - 33692093
VL - 107
SP - 902
EP - 908
JO - HEART
JF - HEART
SN - 1355-6037
IS - 11
ER -
