Journal Article

Improving the diagnosis of heart failure in patients with atrial fibrillation

Stanbury, Mary, Kirchhof, Paulus, Rahimi, Kazem, Camm, A John, Lip, Gregory YH, Steeds, Richard P, Bunting, Karina V, Gill, Simrat K, Townend, Jonathan N, Karwath, Andreas, O'Connor, Kieran, Mehta, Samir, Sitch, Alice, Griffith, Michael, Gkoutos, Georgios V, Kotecha, Dipak, Strauss, Victoria Y

2021

Overview

ObjectiveTo 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.MethodsTransthoracic 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.Results160 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.ConclusionsCompared 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.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Aged / Aged, 80 and over / atrial fibrillation / Atrial Fibrillation - physiopathology / Bias / Biomarkers - blood / Cardiac arrhythmia / Diastole - physiology / diastolic / echocardiography / Echocardiography, Doppler, Pulsed / Ethnicity / Female / Heart failure / Heart Failure - diagnosis / Heart Failure and Cardiomyopathies / Heart rate / Humans / Male / Natriuretic Peptide, Brain - blood / Patients / Peptide Fragments - blood / Regression analysis / Reproducibility / Reproducibility of Results / Statistical analysis / Stroke Volume - physiology / Systole - physiology / systolic / Ultrasonic imaging / Ventricular Function, Left - physiology