Tissue Doppler‐derived atrial dyssynchrony predicts new‐onset atrial fibrillation during hospitalization for ST ST ‐elevation myocardial infarction

摘要

Abstract Background Atrial dyssynchrony, but not atrial enlargement/dysfunction, reflects acute atrial histopathological changes. It has been shown to be associated with new‐onset atrial fibrillation ( NOAF ) in various clinical conditions but was not studied in the acute phase of ST ‐elevation myocardial infarction ( STEMI ) which is the aim of the current study. Methods A total of 440 STEMI patients underwent primary percutaneous coronary intervention ( PCI ) and were monitored for NOAF during hospitalization. Immediately after primary PCI , P‐wave dispersion was calculated and conventional/tissue Doppler echocardiography was done. Results During a median hospitalization period of 3?days, 80 (18.2%) patients developed NOAF . The group with NOAF showed significantly higher prevalence of hypertension ( P ?=?.049), higher P‐wave dispersion ( P ?=?.018), higher post– PCI ‐corrected TIMI frame count ( P ??.001), and lower incidence of post‐ PCI myocardial blush grade 2–3 ( P ?=?.031). Indexed left atrial maximum volume ( LAVI max ), left atrial dyssynchrony, and inter‐atrial dyssynchrony were significantly higher in NOAF group ( P ??.001, each). Using ROC curve analysis, inter‐atrial dyssynchrony showed the highest diagnostic performance ( AUC 85%, 95% CI : 0.77–0.94, P ??.001). A cutoff value at 23.8?ms showed a good validity for predicting NOAF with a sensitivity of 93.8% and a specificity of 68.1%. Using binary logistic regression analysis, history of hypertension ( OR ?=?10.72, P ?=?.03), LAVI max ( OR ?=?7.47, P ?=?.04), and inter‐atrial dyssynchrony ( OR ?=?45.58, P ?=?.001) were independent determinants of NOAF . Conclusions In the acute phase after STEMI , history of hypertension, LAVI max, and inter‐atrial dyssynchrony were independent determinants of inhospital NOAF , with the latter being the strongest.