Absence of the presystolic wave was independently associated with a higher prevalence of cerebrovascular events (OR 1.881) in patients with paroxysmal atrial fibrillation.
Observational (n=380)
No
Is the absence or reduction of the presystolic wave associated with cerebrovascular events in patients with paroxysmal atrial fibrillation?
The absence or reduction of the presystolic wave on echocardiography is an independent predictor of cerebrovascular events in patients with paroxysmal atrial fibrillation.
Effect estimate: OR 1.881 (95% CI 1.220-2.961)
Absolute Event Rate: 45.8% vs 16.9%
p-value: p=0.004
Abstract Background The presystolic wave (PSW), a late-diastolic Doppler flow signal in the left ventricular outflow tract, reflects atrial contraction and atrioventricular coupling. Although its presence is considered a physiological finding in healthy individuals, alterations in PSW characteristics may indicate impaired atrial or ventricular compliance. This study aimed to evaluate the relationship between PSW and cerebrovascular events (CVE) in patients with paroxysmal atrial fibrillation (PAF). Methods In this retrospective study, 380 patients diagnosed with PAF by 24-hour Holter monitoring between January 2019 and January 2025 were analyzed. Transthoracic echocardiography was performed to assess PSW presence, left ventricular systolic and diastolic functions. Patients were divided according to PSW presence and history of CVE (stroke or transient ischemic attack). Clinical, laboratory, and echocardiographic variables were compared, and multivariate logistic regression was used to identify independent predictors of CVE. Results PSW was identified in 284 (74.7%) patients. Those without PSW were older, had greater left atrial volume index (LAVI) and left ventricular mass index (LVMI), and more frequently had previous CVE (45.8% vs. 16.9%, p < 0.001). In multivariate analysis, high CHA₂DS₂-VASc score, increased LAVI, and absence of PSW were independent predictors of CVE. ROC analysis showed that a PSW peak velocity < 0.30 m/s was associated with the presence of CVE, with 81% sensitivity and 67% specificity (AUC = 0.783, p < 0.001). Conclusion Absence or reduction of the PSW is independently associated with CVE in PAF patients. PSW assessment provides a simple, reproducible, and noninvasive measure of atrioventricular mechanical function that may be associated with increased thromboembolic vulnerability. Graphical Abstract
Bayam et al. (Thu,) conducted a observational in Paroxysmal atrial fibrillation (n=380). Absence of presystolic wave (PSW) vs. Presence of presystolic wave (PSW) was evaluated on Cerebrovascular events (CVE) (OR 1.881, 95% CI 1.220-2.961, p=0.004). Absence of the presystolic wave was independently associated with a higher prevalence of cerebrovascular events (OR 1.881) in patients with paroxysmal atrial fibrillation.