Prevalences of LA abnormalities by TOE (left) and LAA emptying velocity (right) according to the tertiles of the E/e? ratio in non-valvular AF patients. An increased tertile of E/e? was associated with a high prevalence of LA abnormalities (P = 0.00dos) and decreased LAA velocity (P < 0.001). Patients with the highest tertile of E/e? had a significantly higher prevalence of LA abnormalities by TOE (*P = 0.005; ** P = 0.023 vs. the highest tertile) and lower LAA velocity (*P < 0.001; **P < 0.001 vs. the highest tertile) than those with the intermediate or the lowest tertile of the E/e? ratio.
ROC bend from Elizabeth/e? ratio as predictor of your exposure off SBI. The suitable cut-out of worth of the fresh Elizabeth/e? was 12.4 to possess forecasting SBI (area according to the bend 0.72).
ROC curve out of E/e? ratio given that predictor of one’s presence away from SBI. The perfect slashed-out of worth of new https://datingranking.net/es/citas-sobrias/ E/e? is twelve.cuatro having forecasting SBI (city within the curve 0.72).
In the univariate logistic regression analysis, age (P < 0.001), hypertension (P = 0.008), CKD (P < 0.001), CHADS2 score ? 2 (P < 0.001), CHA2DS2-VASc score ? 2 (P < 0.001), and E/e? ratio ? 12.4 (OR 4.90, 95% CI 2.38–; P < 0.001) were strong non-invasive predictors of the presence of SBI (P < 0.01) (Table 3). E/e? ratio ?12.4 was significantly associated with SBI independent of hypertension status by binary logistic regression analysis (OR 4.92, 95% CI 2.24–; P < 0.001). Moreover, multivariate logistic regression analysis after adjustment for age, hypertension, CKD, and CHA2DS2-VASc score ?2 revealed E/e? ratio ?12.4 to be an independent predictor of SBI (OR 3.98, 95% CI 1.74–9.07; P = 0.001) (Table 3).
On the best of all of our studies, this is the earliest analysis indicating the relationship ranging from diastolic TDI research and you can silent coronary attack according to brain MRI inside people that have non-valvular AF
E/e? ratio was significantly higher in patients with SBI than in those without SBI in both persistent AF group (14.9 ± 6.4 vs. 11.0 ± 3.9; P < 0.001) and paroxysmal AF group (11.9 ± 3.9 vs. 9.6 ± 2.5; P = 0.002), and E/e? ?12.4 was associated with the presence of SBI in both groups (OR 5.38, 95% CI 1.93–; P = 0.001 and OR 3.50, 95% CI 1.13–; P = 0.031, respectively).
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In this study, we confirmed an increased E/e? ratio, as assessed by TDI, to be associated with a higher prevalence of LA abnormalities detected by TOE, and found that this parameter is independently associated with SBI on brain MRI after adjustment for significant risk factors including age and CHA2DS2-VASc score ?2.
TOE is a gold standard for detecting cardiogenic thromboembolic sources and the risks of thromboembolism such as LA abnormalities in AF patients. 12 , 24 As a non-invasive parameter determined by transthoracic echocardiography, the E/e? ratio not only reflects LV relaxation but also serves as a measure of LV filling pressure. 10 Previously, Iwakura et al. 8 showed the E/e? ratio to be negatively associated with LAA flow velocity and positively associated with the rate of SEC, as assessed by TOE, in patients with paroxysmal or persistent non-valvular AF, and showed the E/e? ratio ?13 to be an independent predictor of LAA thrombus in these patients. Very recently, Doukky et al. 9 prospectively demonstrated that the E/e? ratio and e? velocity can predict LAA thrombus or LAA sludge, as assessed by TOE, independently of clinical parameters including the CHA2DS2-VASc score. Our observation that the prevalence of LA abnormalities, detected by TOE, was significantly higher in patients with the highest tertile of the E/e? ratio is consistent with these findings in previous studies. This can be explained by the concept that an increased E/e? ratio represents elevated LV diastolic filling pressure and consequently LA blood stasis, which leads to the formation of SEC or LAA thrombus. 8 , 9