Atrial Myocardial Deformation Properties Predict Maintenance of Sinus Rhythm After External Cardioversion of Recent-Onset Lone Atrial Fibrillation

Abstract

Background-Accurate echocardiographic parameters to predict maintenance of sinus rhythm in patients with atrial fibrillation (AF) are poorly defined. This study was conducted to assess the atrial myocardial properties during AF through myocardial velocity, strain rate, and strain and to compare their prognostic value in maintaining sinus rhythm in patients with lone AF with standard transthoracic (TTE) and transesophageal echocardiography (TEE). Methods and Results-Sixty-five consecutive patients with lone AF for Յ3 months underwent TTE, TEE, and myocardial velocity and strain and strain rate imaging examinations before successful external cardioversion. Maintenance of sinus rhythm was assessed during a 9-month follow-up. Atrial myocardial velocity, strain, and strain rate values in AF patients were compared with those of age-and sex-matched referents. Moreover, clinical and echocardiographic parameters of patients with maintenance of sinus rhythm (MSR patients) over the 9-month follow-up period (nϭ25) were compared with those from patients with AF recurrence (AFR patients; nϭ40). Atrial myocardial properties assessed by myocardial velocity, strain rate, and strain were significantly reduced (PϽ0.0001) in patients (velocity, 3.2Ϯ1.4 cm/s; strain, 23.3Ϯ19%; strain rate, 2Ϯ0.9 seconds Ϫ1 ) compared with referents (velocity, 5.7Ϯ1.3 cm/s; strain, 92Ϯ26%; strain rate, 4.2Ϯ1.8 seconds

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

“…[385][386][387][388][389][390][391][392][393][394][395][396][397][398][399][400] Strain (S) and strain rate (SR) imaging provide data on myocardial deformation by estimating spatial gradients in myocardial velocities. 385,388,392,393,[401][402][403][404][405] This technique has been used as a surrogate of LA structural remodelling and fibrosis. [388][389][390][391][392][393] Interestingly, LA dysfunction with changes in strain and strain rate has been observed in patients with amyloidosis in the absence of other echocardiographic features of cardiac involvement.…”

Assessment of Left Atrial Function and Remodeling in Patients With Atrial Fibrillation by Performing Strain Echocardiography: A Prospective Study to Assess the Influence of Renin-Angiotensin System Inhibitors on Atrial Fibrillation

“…17)18) In a recent study, strain/rate imaging has been proposed as strong index of the atrial reservoir function, and the degree of the impairment in atrial compliance, as assessed by strain and the strain rate, seems to be strongly predictive of maintaining sinus rhythm in patients with AF. 19) In our previous study, the lower values of strain/rate in the AF patients suggest decreased passive lengthening (stretching) and shortening of the atrial walls, and this is possibly because of atrial remodeling with fibrosis and the reduced compliance. 13) Electrical and structural remodeling AF is characterized by atrial dilatation and shortening of the atrial effective refractory period 20)21) and this may act as perpetuators, ensuring the persistence of AF for a longer period.…”

“…The results of this investigation showed agreement with a previous study that reported patients with higher atrial strain and a higher strain rate appeared to have a greater likelihood of staying in sinus rhythm. 19) The atrial biopsy specimens of AF patients have demonstrated inflammatory changes and increased fibrosis, providing evidence of the possible role of inflammation in atrial structural remodeling.…”

Left atrial mechanical function and stiffness in patients with atrial septal aneurysm: A speckle tracking study

“…Recently, LA myocardial strain has been confirmed as a reliable index that represents the magnitude of atrial deformation [20]. E/e' ratio 10.0 ± 2.6 5.9 ± 1.8 < 0.001 E -peak early diastolic filling velocity; A -peak late diastolic filling velocity; e' -peak early diastolic velocity of the mitral annulus; a' -peak late diastolic velocity of the mitral annulus In previously published studies, global LA strain and strain rate were significantly reduced in patients with paroxysmal AF, compared with the normal control subjects [21,22].…”