Correlations between left atrial strain and left atrial pressures values in patients undergoing atrial fibrillation ablation

Abstract

Background:We aimed to investigate the correlations between left atrial strain (LAS) assessed by speckle tracking echocardiography and directly measured left atrial pressures (LAP) values and to estimate the features of patients with lower LAS values. Methods:A prospective, observational study was performed on patients with atrial fibrillation (AF) undergoing ablation. Detailed transthoracic echocardiography with the speckle tracking method was used to estimate the LAS reservoir (LASr) and direct measurements of LAP during ablation in all patients.Results: A total of 172 patients were included (98 with sinus rhythm [SR] and 74 with AF). The patients with lower LASr (first tercile) compared to those with higher (third tercile), were older, more often female, presented with a larger left atrium (LA) (per the LA area and volume index), and had more impaired left ventricular (LV) diastolic function parameters (e' , E/e'). The correlation analysis of the echocardiographic parameters with the LAP revealed the most significant correlations in the SR group, where the E/e' ratio, LASr, and LAS contraction (LASct) values were all associated with LAP. The cut-off value of LASr estimating high elevated mean LAP (≥15 mm Hg) was 21.88 (Area Under Curve [AUC], 0.81; 95% confidence interval [CI], 0.72-0.90; P <0.0001) for the SR group and 11.25 (AUC, 0.66; 95% CI, 0.53-0.80; P = 0.016) for the AF group.Conclusions: AF patients with lower LASr are older, more often female, have a larger LA, and have more impaired LV diastolic function. Low LASr and LASct and high E/e' ratio values are associated with higher LAP in AF patients with SR.

From left atrial pressures to left atrial strain: The importance of diastolic dysfunction in patients with atrial fibrillation

“…In accordance with the above, in their recent article, Uziębło-Życzkowska et al [6] found a close correlation between LAP, measured during atrial fibrillation ablation, and LA reservoir strain. The authors enrolled 172 patients with atrial fibrillation undergoing ablation and divided them according to the LA strain reservoir value into three terciles; then they compared patients with lower values (first tercile) with those with higher values (third tercile) and found that the former were older and more often women, they had a larger LA and showed a more impaired LV diastolic function.…”

Predicting reduced left atrial appendage velocity from echocardiographic left atrial function parameters in patients with atrial fibrillation undergoing catheter ablation

“…There are reports that E′ value and E/e′ ratio, were also associated with decreased LAAV and can be useful parameters for the prediction of LAA blood stasis in patients with nonvalvular AF 24 , 25 . In addition, LASr, which has shown significant added value in many cardiac diseases 34 , was previously found to correlate negatively with left atrial pressures in AF patients with sinus rhythms during echocardiography 35 . It is currently being used increasingly in clinical practice, particularly in patients with AF and HFpEF.…”

Left atrial strain parameters to predicting elevated left atrial pressure in patients with atrial fibrillation

“…Low LASr value were associated with higher LAP in AF with sinus rhythm. The cut‐off value of LASr predicting high elevated LAP was 21.88% (AUC .81) for the patients with sinus rhythm in AF, while 11.25% (AUC .66) for the AF group 13 . Muka et al.…”