Prognostic value of short-deceleration time of mitral inflow E velocity: implications in patients with atrial fibrillation and left-ventricular systolic dysfunction.

OBJECTIVE

The aim of this prospective study was to evaluate the contribution of an initially shortened deceleration time of mitral inflow E velocity (E-wave DT) to predict survival in patients with left-ventricular (LV) systolic dysfunction in atrial fibrillation (AF) and in sinus rhythm (SR).

BACKGROUND

To date, few data are available concerning the prognostic value of Doppler mitral profile in patients with AF, particularly in the presence of LV systolic dysfunction.

METHODS

We studied the outcome of 140 consecutive patients with LV ejection fraction less than 40%. Complete history, physical examination and echocardiography were performed.

RESULTS

Chronic AF was present in 40 (29%) patients. Over a mean follow-up of 25+/-11 months, 54 (39%) patients died, 18 in the AF group and 36 in the SR group. Ejection fraction was similar in the two groups (31% versus 32%, respectively). Survival curves indicated a significantly poorer prognosis for shortened E-wave DT less than 150 ms in the AF group and in the SR group (both p<or=0.01). Using multivariable Cox analysis, shortened E-wave DT was identified as an independent predictor of mortality in the AF group (exponential of coefficient: 0.97; chi-square: 5.82; p=0.01) and in the SR group (exponential of coefficient: 0.98; chi-square: 5.82; p=0.001).

CONCLUSION

In patients with LV systolic dysfunction, a shortened deceleration time E-wave on Doppler examination appears to predict a similar poor prognosis in patients with AF as with SR.