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Clinical and prognostic association of total atrial conduction time in patients with heart failure

a report from Studies Investigating Co-morbidities Aggravating Heart Failure

Nuzzi, Vincenzoa,b; Pellicori, Pierpaoloa,c; Nikolaidou, Theodoraa; Kallvikbacka-Bennett, Annaa; Torromeo, Concettab; Barilla’, Francescob; Salekin, Damiena; Kaur, Kuldeepa; Monzo, Lucab; Cleland, John G.F.c,d; Clark, Andrew L.a

Journal of Cardiovascular Medicine: July 2019 - Volume 20 - Issue 7 - p 442–449
doi: 10.2459/JCM.0000000000000802
Research articles: Heart failure

Background 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.

Methods We measured P-A′TDI in outpatients with heart failure and sinus rhythm enrolled in the SICA-HF programme.

Results 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).

Conclusion Measuring P-A′TDI interval identifies patients with chronic heart failure at higher risk of dying or developing atrial fibrillation during follow-up.

aDepartment of Cardiology, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK

bDipartimento di scienze cardiovascolari, respiratorie, nefrologiche, anestesiologiche e geriatriche, Sapienza University, Rome, Italy

cRobertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow

dNational Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield Hospitals, Imperial College, London, UK

Correspondence to Dr Pierpaolo Pellicori, MD, FESC, Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK Tel: +44 141 330 4744; fax: +44 141 330 5094; e-mail:

Received 3 December, 2018

Revised 13 February, 2019

Accepted 12 March, 2019

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