Aims: Tissue Doppler Imaging (TDI) detects early signs of left ventricular dysfunction. The prognostic potential of TDI in patients with atrial fibrillation (AF) has, however, not yet been clarified. This study evaluates the prognostic value of TDI in patients with atrial fibrillation.

Methods and results: In total, echocardiograms from 313 patients with AF during examination were analyzed offline. Longitudinal systolic velocity (s\'), early diastolic velocity (e\') and longitudinal displacement (LD) were measured by color TDI. During a median follow-up of 891 days, 64 patients (20%) died.

TDI was significantly associated with all-cause mortality, and the risk of dying increased significantly per 1 cm/s decrease in s\' (HR of 1.31, 95% CI 1.05-1.63; p=0.018) and e\' (HR of 1.17, 95% CI 1.01-1.35; p=0.038) respectively, even after adjustment for age, gender, heart rate, aortic stenosis, DM and LVEF quartiles.

LD also proved to be a significant predictor of outcome after multivariate adjustment (HR 1.23; 95% CI 1.05-1.44; p=0.012).

The population was stratified according to high or low s’ and e’. Patients with low s’ and e’ had more than three times the risk of mortality compared to the patients with high s’ and e’ (HR 3.64; 95% CI 1.83-7.26; p<0.001) and remained in significantly higher risk after adjustment for various risk factors.

Conclusion: Both systolic and diastolic performance, as assessed by TDI, are strong predictors of mortality in patients with atrial fibrillation, and especially the combination of systolic and diastolic dysfunction is a significant prognostic marker.