Evidence map›Paper›PMID 33692093›Full record

ArticleHeart (British Cardiac Society)2021

Improving the diagnosis of heart failure in patients with atrial fibrillation.

Karina V Bunting, Simrat K Gill, Alice Sitch, Samir Mehta, Kieran O'Connor, Gregory Yh Lip, Paulus Kirchhof, Victoria Y Strauss, Kazem Rahimi, A John Camm and 8 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Heart (British Cardiac Society), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed.

  1. Trial
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  4. Perioperative atrial fibrillation after non-cardiac surgery - A narrative review.Clinical research in cardiology : official journal of the German Cardiac Society · 2026
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Karina V BuntingInstitute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.ORCID 0000-0003-4602-4377
Simrat K GillInstitute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Alice SitchNIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.
Samir MehtaUniversity of Birmingham Clinical Trials Unit, Birmingham, UK.
Kieran O'ConnorCardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Gregory Yh LipThrombosis Research Unit, Aalborg University, Aalborg, Denmark.ORCID 0000-0002-7566-1626
Paulus KirchhofInstitute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.ORCID 0000-0002-1881-0197
Victoria Y StraussMedical Sciences Division, University of Oxford, Oxford, UK.
Kazem RahimiDeep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
A John CammCardiology Clinical Academic Group - Molecular & Clinical Sciences Institute, St George's University of London, London, UK.ORCID 0000-0002-2536-2871
Mary StanburyPatient and Public Involvement Team, Birmingham, UK.
Michael GriffithCardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Jonathan N TownendInstitute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Georgios V GkoutosInstitute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
Andreas KarwathInstitute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
Richard P SteedsInstitute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.ORCID 0000-0001-5687-2535
Dipak KotechaInstitute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK d.kotecha@bham.ac.uk.ORCID 0000-0002-2570-9812
RAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) trial group

Funding

British Heart Foundation AA/18/2/34218Department of Health CDF-2015-08-074Medical Research Council MR/S003991/1
6 · The paper itself

Abstract

objectiveTo improve the echocardiographic assessment of heart failure in patients with atrial fibrillation (AF) by comparing conventional averaging of consecutive beats with an index-beat approach, whereby measurements are taken after two cycles with similar R-R interval.

methodsTransthoracic echocardiography was performed using a standardised and blinded protocol in patients enrolled in the RATE-AF (RAte control Therapy Evaluation in permanent Atrial Fibrillation) randomised trial. We compared reproducibility of the index-beat and conventional consecutive-beat methods to calculate left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and E/e' (mitral E wave max/average diastolic tissue Doppler velocity), and assessed intraoperator/interoperator variability, time efficiency and validity against natriuretic peptides.

results160 patients were included, 46% of whom were women, with a median age of 75 years (IQR 69-82) and a median heart rate of 100 beats per minute (IQR 86-112). The index-beat had the lowest within-beat coefficient of variation for LVEF (32%, vs 51% for 5 consecutive beats and 53% for 10 consecutive beats), GLS (26%, vs 43% and 42%) and E/e' (25%, vs 41% and 41%). Intraoperator (n=50) and interoperator (n=18) reproducibility were both superior for index-beats and this method was quicker to perform (p<0.001): 35.4 s to measure E/e' (95% CI 33.1 to 37.8) compared with 44.7 s for 5-beat (95% CI 41.8 to 47.5) and 98.1 s for 10-beat (95% CI 91.7 to 104.4) analyses. Using a single index-beat did not compromise the association of LVEF, GLS or E/e' with natriuretic peptide levels.

conclusionsCompared with averaging of multiple beats in patients with AF, the index-beat approach improves reproducibility and saves time without a negative impact on validity, potentially improving the diagnosis and classification of heart failure in patients with AF.

Indexed as

Echocardiography, Doppler, PulsedAgedAged, 80 and overAtrial FibrillationBiomarkersDiastoleFemaleHeart FailureHumansMaleNatriuretic Peptide, BrainPeptide FragmentsReproducibility of ResultsStroke VolumeSystoleVentricular Function, LeftBiomarkersNatriuretic Peptide, BrainPeptide Fragmentspro-brain natriuretic peptide (1-76)atrial fibrillationdiastolicechocardiographyheart failuresystolic

Identifiers

PMID33692093
PMCPMC8142420

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.