Assessment of Left Atrial Function in Patients with Paroxysmal, Persistent, and Permanent Atrial Fibrillation Using Two-Dimensional Strain.

Abstract

Background and purpose: Atrial fibrillation (AF) has a progressive nature, leading to structural, functional, and electrical changes in the left atrium (LA). Enhanced response to treatment in patients with AF can be achieved through improved knowledge of atrial structure and a better understanding of its function. The aim of this study was to assess LA strain and its determinants in patients with paroxysmal (PAF), persistent (PsAF), and permanent AF (PmAF). Methods: Fifty-eight patients with registered non-valvular AF were divided into 3 groups depending on the type of AF. The participants underwent transthoracic echocardiography to assess the anatomy and function of heart chambers. Left atrial longitudinal strain (LALS) was measured in four-chamber projections using two-dimensional speckle tracking echocardiography. Results: Patients with PAF had higher LALS (15.7±12.0) when compared to those with PsAF (4.3±7.9) and PmAF (5.8±7.8, all P=0.003). Multiple linear regression showed that the independent predictors of LALS were diastolic blood pressure (β=0.95, R 2 =0.88) in the PAF group; left atrial area (β=-0.56) and creatinine (β=-0.63, R 2 =0.58) in the PsAF group; AF duration (β=0.89) in the PmAF group (R 2 =0.72). Conclusions: LA strain has different determinants depending on AF type. LA size, renal function, and AF duration determine LALS in longlasting AF. LA strain is a simple and accurate technique to estimate LA dysfunction in patients with long-lasting AF.

Recent-onset atrial fibrillation: a study exploring the elements of Virchow’s triad after cardioversion

“…A plausible explanation for the lower LAEF in patients with a prior AF history is a slower reverse remodeling which may be secondary to irreversible structural remodeling after their previous episodes of AF. These findings are consistent with another study reporting lower LAEF in patients with persistent or permanent AF as compared with paroxysmal AF and increased LAVI with the severity of AF type [21]. Moreover, LAEF seems to be significantly lower in persistent AF patients with arrhythmia recurrences after LA ablation versus those without, indicating that more extensive irreversible remodeling is an arrhythmia precursor [22].…”

Increased Levels of Platelets and Endothelial-Derived Microparticles in Patients With Non-Valvular Atrial Fibrillation During Rivaroxaban Therapy

“…Patients with unstable coronary artery disease (CAD), exacerbation of chronic heart failure, uncontrolled hypertension, recent (<3 months) thromboembolic events such as stroke/TIA or systemic embolism, neoplastic disease, connective tissue disease, uncontrolled thyroid disease and chronic kidney disease (CKD) stage 4 or higher, with an active infection or undergoing treatment with steroids were excluded from the study. 15 …”

“… 16 A standardized questionnaire was used to collect the patients’ demographics data, as well as information about their cardiovascular risk factors and current treatment. 15 The CHA 2 DS 2 -VASc score was used to evaluate their risk of stroke or systemic embolism. 17 We estimated the patients’ bleeding risk using the HAS-BLED score.…”

Atrial fibrosis and substrate based characterization in atrial fibrillation: Time to move forwards

“…In addition, quantification of LA longitudinal strain and strain rate have also been validated using CMR feature tracking from cine CMR images 81 . In patients with AF, lower LA strain has been linked to a higher burden of LA fibrosis 82,83 with regional LA strain significantly lower in LA areas with LGE observed on CMR, indicating areas of LA fibrosis compared to LA areas without LGE 84 while another retrospective study looking at n = 971 AF patients enrolled in the ENGAGE AF‐TIMI 48 trial, showed progressive reduction in LA emptying fraction and increase in LA volume index as AF subtype progresses from paroxysmal, to persistent and permanent, respectively. However, there are some limitations to the use of echo‐derived LA strain and strain rate as a fibrosis surrogate, and these include:…”