Department of Cardiology, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK.
Dipartimento di scienze cardiovascolari, respiratorie, nefrologiche, anestesiologiche e geriatriche, Sapienza University, Rome, Italy.
J Cardiovasc Med (Hagerstown). 2019 Jul;20(7):442-449. doi: 10.2459/JCM.0000000000000802.
The total atrial conduction time can be measured as the time from the onset of the P wave on the ECG to the peak of the A wave recorded at the mitral annulus using tissue Doppler imaging (A'; P-A'TDI); when prolonged, it might predict incident atrial fibrillation.
We measured P-A'TDI in outpatients with heart failure and sinus rhythm enrolled in the SICA-HF programme.
P-A'TDI measured at the lateral mitral annulus was longer in patients with HF with reduced [LVEF<50%, N = 141; 126 (112-146) ms; P = 0.005] or preserved left ventricular ejection fraction [LVEF>50% and NT-proBNP > 125 ng/l, N = 71; 128 (108-145) ms; P = 0.026] compared to controls [N = 117; 120 (106-135) ms]. Increasing age, left atrial volume and PR interval were independently associated with prolonged P-A'TDI. During a median follow-up of 1251 (956-1602) days, 73 patients with heart failure died (N = 42) or developed atrial fibrillation (N = 31). In univariable analysis, P-A'TDI was associated with an increased risk of the composite outcome of death or atrial fibrillation, but only increasing log [NT-proBNP], age and more severe symptoms (NYHA III vs. I/II) were independently related to this outcome. Patients in whom both P-A'TDI and left atrial volume were above the median (127 ms and 64 ml, respectively) had the highest incidence of atrial fibrillation (hazard ratio 6.61, 95% CI 2.27-19.31; P < 0.001 compared with those with both P-A'TDI and LA volume below the median).
Measuring P-A'TDI interval identifies patients with chronic heart failure at higher risk of dying or developing atrial fibrillation during follow-up.
总心房传导时间可以通过组织多普勒成像（TDI）从心电图上 P 波起始到二尖瓣环记录的 A 波峰值（A'；P-A'TDI）来测量；当延长时，它可能预测心房颤动的发生。
我们在 SICA-HF 项目中测量了心力衰竭和窦性节律门诊患者的 P-A'TDI。
在左心室射血分数降低（LVEF<50%，N=141；126（112-146）ms；P=0.005）或左心室射血分数保留（LVEF>50%和 NT-proBNP>125ng/l，N=71；128（108-145）ms；P=0.026）的心力衰竭患者中，外侧二尖瓣环的 P-A'TDI 比对照组（N=117；120（106-135）ms）更长。年龄增长、左心房容积和 PR 间期与 P-A'TDI 延长独立相关。在中位数为 1251（956-1602）天的随访期间，73 例心力衰竭患者死亡（N=42）或发生心房颤动（N=31）。在单变量分析中，P-A'TDI 与死亡或心房颤动的复合结局风险增加相关，但只有增加的 log[NT-proBNP]、年龄和更严重的症状（NYHA III 比 I/II）与该结局独立相关。P-A'TDI 和左心房容积均高于中位数（分别为 127ms 和 64ml）的患者心房颤动发生率最高（风险比 6.61，95%CI 2.27-19.31；与 P-A'TDI 和 LA 容积均低于中位数的患者相比，P<0.001）。
测量 P-A'TDI 间期可识别出在随访期间死亡或发生心房颤动风险较高的慢性心力衰竭患者。
