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 <= 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. (C) 2008 Published by Elsevier Masson SAS.