Prediction of AF in ACS Patients Using Different Antiplatelets by Tissue Doppler Derived Atrial Dyssynchrony

Abstract

Background: Acute coronary syndromes (ACS) are one of the major causes of mortality and morbidity worldwide. Current guidelines recommend dual antiplatelet therapy in patients with ACS. This study aimed to predict AF in ACS patients using ticagrelor or clopidogrel by tissue Doppler derived atrial Dyssynchrony and to assess the outcome morbidity and mortality in each group. Methods: This was an observational, case series, single center study, was carried out at coronary care unit at "Benha University hospital" on 200 patients with ACS (STEMI & NSTE-ACS), 100 of the patients used ticagrelor and the other 100 patients used clopidogrel, in the period from June 2022 to December 2022. Results: The incidence of AF was insignificantly different between the studied groups. LAVI max and Mitral regurgitation was significantly higher in New-onset AF patients (P value=0.024, 0.001 respectively). Tissue Doppler imaging data (Lateral mitral P-A' interval, septal mitral P-As interval, tricuspid P-A' interval, LA Dyssynchrony and Interatrial Dyssynchrony) were significantly higher in New-onset AF patients (P value<0.05). LA Dyssynchrony can significantly predict the incidence of AF with AUC 0.704 (95% CI: 0.636 -0.766) and P value = 0.008, at cut off value >7.792 ms, with 68.2 % sensitivity, 63.5 % specificity, 18.7 PPV and 94.2 NPV. LV GLS was significantly lower in New-onset AF patients (P value =0.035). Conclusion: Our study showed that there was no significant difference in electro-echocardiographic AF predictors such as PWD, LAVI max, left atrial dyssynchrony and interatrial dyssynchrony in ACS patients who received ticagrelor or clopidogrel.