1. A combination of P wave electrocardiography and plasma brain natriuretic peptide level for predicting the progression to persistent atrial fibrillation: comparisons of sympathetic activity and left atrial size.
- Author
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Akutsu Y, Kaneko K, Kodama Y, Miyoshi F, Li HL, Watanabe N, Asano T, Tanno K, Suyama J, Namiki A, Gokan T, and Kobayashi Y
- Subjects
- Aged, Atrial Fibrillation epidemiology, Biomarkers blood, Chronic Disease, Disease Progression, Disease-Free Survival, Echocardiography statistics & numerical data, Female, Follow-Up Studies, Humans, Incidence, Japan epidemiology, Male, Middle Aged, Organ Size, Prevalence, Reproducibility of Results, Risk Assessment, Sensitivity and Specificity, Atrial Fibrillation blood, Atrial Fibrillation diagnosis, Electrocardiography statistics & numerical data, Heart Atria diagnostic imaging, Natriuretic Peptide, Brain blood, Stroke Volume
- Abstract
Purpose: Development of atrial fibrillation (AF) is complexly associated with electrical and structural remodeling and other factors every stage of AF development. We hypothesized that P wave electrocardiography with an elevated brain natriuretic peptide (BNP) level would be associated with the progression to persistence from paroxysmal AF., Methods: P wave electrocardiography such as a maximum P wave duration (MPWD) and dispersion by 12-leads ECG, heart/mediastinum (H/M) ratio by delayed iodine-123 metaiodobenzylguanidine scintigraphic imaging, left ventricular ejection fraction (LVEF), and left atrial dimension (LAD) by echocardiography, and plasma BNP level were measured to evaluate the electrical and structural properties and sympathetic activity in 71 patients (mean ± standard deviation, age: 67 ± 13 years, 63.4 % males) with idiopathic paroxysmal AF., Results: Over a 12.9-year follow-up period, AF developed into persistent AF in 30 patients. A wider MPWD (>129 ms) (p = 0.001), wider P wave dispersion (>60 ms) (p = 0.001), LAD enlargement (>40 mm) (p = 0.001), higher BNP level (>72 pg/mL) (p = 0.002), lower H/M ratio (≤2.7) (p = 0.025), and lower LVEF (≤60 %) (p = 0.035) were associated with the progression to persistent AF, and the wide MPWD was an independently powerful predictor of the progression to persistent AF with a hazard ratio (HR) of 5.49 [95 % confidence interval (CI) 2.38-12.7, p < 0.0001] after adjusting for potential confounding variables, such as age and sex. The combination of wide MPWD and elevated BNP level was additive and incremental prognostic power with 13.3 [2.16-13, p < 0.0001]., Conclusion: The wide MPWD with elevated BNP level was associated with the progression to persistent AF.
- Published
- 2013
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