Atrial Strain and Strain Rate: A Novel Method for the Evaluation of Atrial Stunning

Abstract

BackgroundAtrial fibrillation (AF) is the most common arrhythmia seen in adults. Atrial stunning is defined as the temporary mechanical dysfunction of the atrial appendage developing after AF has returned to sinus rhythm (SR).ObjectivesWe aimed to evaluate atrial contractile functions by strain and strain rate in patients with AF, following pharmacological and electrical cardioversion and to compare it with conventional methods.MethodsThis study included 41 patients with persistent AF and 35 age-matched control cases with SR. All the AF patients included in the study had transthoracic and transesophageal echocardiography performed before and after. Septum (SEPsSR), left atrium (LAsSR) and right atrium peak systolic strain rate (RAsSR) were defined as the maximum negative value during atrial contraction and septum (SEPε), left atrium (LAε) and right atrium peak systolic strain (RAε) was defined as the percentage of change. Parameters of two groups were compared.ResultsIn the AF group, 1st hour and 24th hour LAε, RAε, SEPε, LAsSR, RAsSR, SEPsSR found to be significantly lower than in the control group (LAε: 2.61%±0.13, 3.06%±0.19 vs 6.45%±0.27, p<0.0001; RAε: 4.03%±0.38, 4.50%±0.47 vs 10.12%±0.64, p<0.0001; SEPε: 3.0%±0.22, 3.19%±0.15 vs 6.23%±0.49, p<0.0001; LAsSR: 0.61±0.04s-1, 0.75±0.04s-1 vs 1.35±0.04s-1, p<0.0001; RAsSR: 1.13±0.06s-1, 1.23±0.07s-1 vs 2.10±0.08s- 1, p<0.0001; SEPsSR: 0.76±0.04s- 1, 0.78±0.04s- 1 vs 1.42±0.06 s- 1, p<0.0001).ConclusionAtrial strain and strain rate parameters are superior to conventional echocardiographic parameters for the evaluation of atrial stunning in AF cases where SR has been achieved.

Relationship of Natriuretic Peptides with Left Atrial Structure and Function within 1 Month after Electrical Cardioversion in Patients with Persistent Atrial Fibrillation

“…Some previous studies that used conventional echocardiographic parameters also showed that the maximum improvement in atrial function was observed at the end of the first month [20, 21]. Meanwhile Ozkan H et al used strain analysis and demonstrated that atrial stunning can last longer than 1 month and it depends on AF duration [22]. Several studies have proven elevated plasma NPs concentrations in most patients with AF and significant drop following SR restoration by ECV, radiofrequency catheter ablation, or pulmonary vein isolation.…”

Association Between the Left Atrial and Left Atrial Appendages Systole Strain Rate in Patients with Atrial Fibrillation

“…The damage incidence of LAA function is directly proportional to the incident rate of embolic diseases in AF patients [9], and the mechanical function of LAA is closely related to the therapeutic effect of treatments for AF [10]. In the ventricular systole, the active relaxation activities and stiffness of LA will affect the volume of circulating heart blood flow from the pulmonary vein to the LA [11]. The functions of LA and LAA associate with the therapeutic effect of treatments for AF, therefore, the accurate evaluation of LA and LAA possesses significant meanings to estimate the AF illness state, including helping clinical doctors make accurate judgment, formulate effective therapeutic plans and evaluate the therapeutic effect.…”

Effect of catheter ablation for atrial fibrillation on left and right atrial function

“…После восстановления синусового ритма любым способом (спонтанная, медикаментозная или электрическая кардиоверсия), развивается феномен "оглушения" или станинга, который представляет собой механическую дисфункцию миокарда обоих предсердий и может сохраняться от нескольких дней до 3-4 нед. и более в зависимости от продолжительности аритмии, структурного ремоделирования предсердий [11].…”