Left Atrial Longitudinal Strain Parameters Predict Postoperative Persistent Atrial Fibrillation Following Mitral Valve Surgery: A Speckle Tracking Echocardiography Study

Abstract

Postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with increased morbidity, mortality, and prolonged hospital stay. Speckle tracking echocardiography (STE) has been applied recently for evaluation of LA function. The purpose of this study was to examine whether left atrial longitudinal strain measured by STE is a predictor for the development of POAF following mitral valve surgery for severe mitral regurgitation. We studied 53 patients undergoing mitral valve surgery in sinus rhythm at the time of surgery. Echocardiography with evaluation of LA strain by STE was performed. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization. Patients who did not develop POAF were taken as group 1 and those who had POAF constituted group 2. The echocardiographic and clinical predictors of POAF were investigated. POAF occurred in 28.3% of subjects. Mean age, LAVi and BNP were found higher in group 2 while peak atrial longitudinal strain (PALS) (13.9 ± 3.8% vs. 24.8 ± 7.3%; P < 0.001), peak atrial contraction strain (PACS) (7.6 ± 1.95% vs. 11.3 ± 3.5%; P < 0.001) were significantly lower. By multivariate logistic regression analysis, PALS and LAVi were independent predictor of POAF development. LA longitudinal strain was found to predict POAF in patients undergoing mitral valve surgery. It could be used to better identify patients at greater risk of developing POAF, and thus to guide in risk stratification and to take appropriate intensive prophylactic therapy.

Can left atrial function guide atrial fibrillation ablation?

“…6 In this issue of HeartRhythm, Montserrat et al 7 evaluate markers of LA function using 2-dimensional echocardiographic speckle tracking to assess LA strain and strain rate as well as compare these markers in patients with or without recurrent AF after first or second ablation. Recently, there has been a growing literature on the evaluation of atrial strain that has demonstrated its predictive value (1) to identify the risk of AF after cardiac surgery, 8,9 (2) as an additive measure to the CHA 2 DS 2 -VASc score to predict thromboembolic risk in AF, 10,11 and (3) to help predict the success rates after ablation. 12,13 Other work has demonstrated that LA strain and strain rate correlate with LA structural remodeling seen on magnetic resonance imaging 14 and has also shown them to correlate with fibrosis seen on histopathology.…”

Evaluation of geometric, functional and mechanical parameters of left atrium remodeling after surgical treatment of isolated atrial fibrillation

“…В работе O. Candan et al обнаружено, что значение глобальной пиковой продольной деформации является независи-мым предиктором развития ФП у пациентов, перенесших операцию на митральном клапане [12]. Y.Y.…”

Echocardiographically derived effective valve opening area in mitral prostheses: a comparative analysis of various calculations using continuity equation and pressure half time method

“…As a consequence, in arrhythmia-especially AF-all gradients, velocities, velocity integrals, or their derivatives should not be used as parameters of first choice when investigating mitral valve prosthetic function [12,[31][32][33][34].…”

“…Selection of the formula to calculate VA (CE versus PHT) is recommended depending on rhythm [31][32][33]. The time consumption in case of applying the PHT 220 is minimal as it is included in every echo-system calculation module; the investigator only needs to reduce the value by 1 cm 2 to compare with CE VTI .…”