Relation of Echocardiographic Markers of Left Atrial Fibrosis to Atrial Fibrillation Burden

Abstract

In patients with atrial fibrillation (AF), left atrial (LA) fibrosis is a major determinant of the progression to, and burden of AF. LA reservoir strain and total atrial conduction time (PA-TDI) reflect LA fibrotic content. We aimed to investigate the relation between LA reservoir strain and PA-TDI in AF patients and control subjects. Six-hundred two patients (mean age 56 years, 53% men) with first episode of AF and 342 controls (mean age 64 years, 71% men) without structural heart disease underwent echocardiography. LA volumes, PA-TDI, LA reservoir strain, and left ventricular global longitudinal strain (GLS) were compared. Compared with controls, patients with paroxysmal AF and patients with persistent AF had longer PA-TDI (128 ± 25 millisecond, 140 ± 31 millisecond, and 154 ± 33 millisecond, respectively; p <0.001) and a progressive decline in LA reservoir strain (36.9 ± 11.6%, 29.8 ± 13.4%, 24.2 ± 12.3%, respectively; p <0.001). LA reservoir strain was negatively correlated with PA-TDI (r = -0.43, p <0.001). On multivariate analyses, LA reservoir strain, diabetes mellitus, and burden of AF were independent correlates of PA-TDI (R = 0.23, p <0.001); whereas only PA-TDI was an independent correlate of LA reservoir strain (R = 0.43, p <0.001); controlling for age, hypertension, coronary artery disease, body mass index, severity of mitral regurgitation, left ventricular global longitudinal strain, and LA volume. In conclusion, PA-TDI and LA reservoir strain are negatively correlated in all subjects, irrespective of the presence or burden of AF. Patients with persistent AF have longer PA-TDI and impaired LA reservoir strain compared with paroxysmal AF and controls, suggesting increasing burden of fibrosis and LA structural remodeling in the progression of AF.

Left atrial strain - an early marker of left ventricular diastolic dysfunction in patients with hypertension and paroxysmal atrial fibrillation

“…These findings suggest that in hypertensive patients changes in the LA myocardium occur very early and support the role of LA strain imaging as an important and a very sensitive marker of hypertensive heart disease [ 22 ]. Recent data from Melissa Leung that links decreased LA reservoir strain with LA fibrosis, a fundamental component of hypertensive heart disease and AF, makes it even more valid and relevant in these conditions [ 23 ].…”

Correlations between left ventricular and left atrial function assessed by speckle tracking echocardiography in patients with treated well-controlled arterial hypertension

“…This atrial arrhythmia may itself lead to impaired LAS [16,17,18]. It was also suggested that the LASr value proved to be a strong parameter of LA brosis in patients with AF [19].…”

New Ultrasound Technologies for Ischemic Heart Disease Assessment and Monitoring in Cardiac Rehabilitation

“…For this purpose, LA works as reservoir during ventricular systole, when it receives blood from pulmonary veins and its volume increases, as conduit during early ventricular diastole, passively allowing the passage of blood into the ventricle, and as booster pump during late ventricular diastole, when it actively contracts to complete LV filling. During last years the application of 2DSTE to the LA has been largely investigated in several studies [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Longitudinal strain and SR curves are generated for each of the 6 atrial segments, obtained from apical 4- and 2-chamber views.…”