Clinical significance of presystolic wave attenuation in patients with paroxysmal atrial fibrillation

@article{bayam2026clinical,
  title = {{Clinical significance of presystolic wave attenuation in patients with paroxysmal atrial fibrillation}},
  author = {Emrah Bayam and Macit Kalçık and Ersin Yıldırım and Burak Öztürkeri and Muzaffer Kahyaoğlu and Ayhan Küp and Baver Bozan and Mustafa Kara and Abdullah Sarıhan and Tolga Aksu and Ramazan Kargın},
  journal = {Journal of Interventional Cardiac Electrophysiology},
  year = {2026},
  month = may,
  doi = {10.1007/s10840-026-02352-4},
  url = {https://doi.org/10.1007/s10840-026-02352-4},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Clinical significance of presystolic wave attenuation in patients with paroxysmal atrial fibrillation
AU  - Emrah Bayam
AU  - Macit Kalçık
AU  - Ersin Yıldırım
AU  - Burak Öztürkeri
AU  - Muzaffer Kahyaoğlu
AU  - Ayhan Küp
AU  - Baver Bozan
AU  - Mustafa Kara
AU  - Abdullah Sarıhan
AU  - Tolga Aksu
AU  - Ramazan Kargın
PY  - 2026
DA  - 2026/05/14
JO  - Journal of Interventional Cardiac Electrophysiology
DO  - 10.1007/s10840-026-02352-4
UR  - https://doi.org/10.1007/s10840-026-02352-4
AB  - 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: This study demonstrates that attenuation or absence of the presystolic wave (PSW) in the left ventricular outflow tract is associated with cerebrovascular events in patients with paroxysmal atrial fibrillation (PAF). PSW reduction reflects impaired atrioventricular coupling related to left ventricular hypertrophy, diastolic dysfunction, and reduced left atrial contractile function. Decreased PSW peak velocity and velocity–time integral (VTI) may indicate subclinical atrial mechanical dysfunction. PSW assessment by routine echocardiography may provide a simple and reproducible functional marker associated with cerebrovascular involvement in patients with PAF and may offer complementary information alongside conventional clinical risk assessment.
SN  - 1383-875X
SN  - 1572-8595
ER  -