Left atrial strain: a new predictor of thrombotic risk and successful electrical cardioversion

Abstract

BackgroundLeft atrial deformation (LAD) parameters are new markers of atrial structural remodelling that seem to be affected in atrial fibrillation (AF) and atrial flutter (AFL). This study aimed to determine whether LAD can identify patients with a higher risk of thrombosis and unsuccessful electrical cardioversion (ECV).MethodsRetrospective study including 56 patients with AF or AFL undergoing ECV, with previous transthoracic (TTE) and transoesophageal echocardiography (TEE) studies. Echocardiographic parameters analysed were as follows: left ventricle function, left atrium (LA) dimensions, LAD parameters (positive and negative strain peaks), left atrial appendage (LAA) filling and emptying velocities and the presence of thrombi. Strain values were analysed according to thrombotic risk and success of ECV.ResultsLower mean values of peak-positive strain (PPS) in patients with prothrombotic velocities (<25 cm/s) and a higher incidence of thrombi in LAA were observed compared with those with normal velocities. Multivariate analysis revealed PPS normalised by LA maximum volume indexed by body surface area (BSA) to be associated with prothrombotic risk (odds ratio 0.000 (95% CI: 0.000–0.243), P 0.017), regardless of CHADs2VASC score. Peak-negative strain normalised by LA volumes indexed by BSA were associated with unsuccessful ECV.ConclusionsAtrial deformation parameters identify AF and AFL patients with a high risk of thrombosis and unsuccessful ECV. Therefore, these new parameters should be included in anticoagulation management and rhythm vs rate control strategies.

Diagnosis and Management of Left Atrium Appendage Thrombosis in Atrial Fibrillation Patients Undergoing Cardioversion

“…STE deformation analysis is highly correlated with the amount of LA interstitial fibrosis and remodeling process occurring in AF patients [28]. A reduced peak positive strain has been associated with lower LAA emptying velocities, with an LA prothrombotic state, and with higher incidence of LAA thrombosis [29,30].…”

Atrial Cardiomyopathy: An Unexplored Limb of Virchow's Triad for AF Stroke Prophylaxis

“…Furthermore, atrial strain can predict clinical course and response to treatment modalities. Reduced atrial strain is associated with LAA dysfunction, LAA thrombus, and stroke independent of the presence of AF (65)(66)(67). Patients with reduced atrial strain are more likely to have poor response to treatments including unsuccessful electrical cardioversion (65), and arrhythmia recurrence after ablation (68).…”

“…Reduced atrial strain is associated with LAA dysfunction, LAA thrombus, and stroke independent of the presence of AF (65)(66)(67). Patients with reduced atrial strain are more likely to have poor response to treatments including unsuccessful electrical cardioversion (65), and arrhythmia recurrence after ablation (68). Interestingly, reduced atrial strain is also associated with increased mortality after stroke, and new onset AF after stroke, supporting AC as a primary driver of stroke risk independent of arrhythmic burden (20,69).…”

Sympathetic Nervous System Activation in Pathogenesis of Development of Essential Hypertension and Its Role in Target-Organs Damage in Young and Middle Aged Adults: the Cardioprotective Capabilities of Bisoprolol

“…Кроме того, установлено, что стрейн ЛП служит прогностическим маркером возникновения фибрилляции предсердий после шунтирования коронарных артерий [38], на фоне перенесенного ишемического мозгового инсульта [39] и катетерной абляции [40], а у пациентов с фибрилляцией предсердий коррелирует с риском, рассчитанным по шкале CHADS 2 , и обладает прогностической значимостью с точки зрения развития у них мозгового инсульта и других ССО [41]. Кроме того, данный показатель имеет предиктивную ценность в отношении результатов электрической кардиоверсии и риска тробмообразования в сердце у пациентов с фибрилляций и трепетанием предсердий [42], а также поражения сердца при хронической почечной недостаточности [43].…”