Ikorkin M. Diagnostic and prognostic value of transesophageal echocardiography in patients with persistent non-valvular atrial fibrillation

Dissertation is dedicated to defining structural and functional indices associated with clotting in LA appendage and AF relapses during 6 months after cardioversion, as well as developing a model of individual prognosis of arrhythmic events during 6 months observation after cardioversion, based on clinical and echocardiography signs, in patients with persistent non-valvular AF. Single factor analysis allowed to reveal structural and functional indices, associated with clotting in LA appendage, and to define their threshold values. Comparative analysis of baseline structural and functional indices of myocardial function by TEE showed worse results in the group of patients, who had AF relapses during 6 months after amiodarone cardioversion. Stright step-by-step discriminant analysis of main database defined independent clinical and EchoCG, associated with AF relapse during 6 months after cardioversion. Six-factor model of individual prognosis of AF flow during 6-months observation after cardioversion, based upon binary logistic regression, that takes into account duration of AF anamnesis, SC phenomenon, MR, LA appendage fibrosis, ejection peak velocity from LA appendage and maximum LA appendage filling velocity, was characterized by high indices of accuracy (86 %), sencitivity (89,2 %), specificity (80 %), PPV (89,2 %) and NPV (80 %). Model answers claster analysis in the main group allowed to define threshold levels of model significance: lower, intermediate and upper (<0,12, 0,12-0,74 and >0,74, respectively). Elaborated model of individual prognosis, realized in programmed module, can be widely used in clinical practice.