Left atrial strain, intervendor variability, and atrial fibrillation recurrence after catheter ablation: A systematic review and meta-analysis

Mouselimis, Dimitrios; Tsarouchas, Anastasios; Pagourelias, E; Bakogiannis, Constantinos; Theofilogiannakos, Efstratios K.; Loutradis, Charalampos; Fragakis, Nikolaos; Vassilikos, Vassilios; Papadopoulos, Christodoulos

doi:10.1016/j.hjc.2020.04.008

Cited by 27 publications

(14 citation statements)

References 48 publications

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“…In our study, baseline ℇR was significantly associated with AF recurrence in the multivariate analysis. This is in line with previous echocardiographic studies that showed an association between the baseline strain and AF recurrence following PVI or cardioversion [ 12 , 30 ]. We also found a significant association of post ablation LAVmin and expansion index with AF recurrence after PVI, however, the association was stronger with baseline ℇR than volumetric indices.…”

Section: Discussionsupporting

confidence: 92%

“…Some studies have reported that PVI leads to a positive change in LA anatomical and functional parameters which may correlate with AF recurrence [ 9 – 11 ]. CMR strain by tissue tracking is a novel, relatively simple and reproducible technique that is being investigated for assessment of atrial mechanics [ 5 , 12 – 15 ]. Standardized strain parameters include LA reservoir strain (ℇR), contractile strain (ℇCT), and conduit strain (ℇCD) [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Association of left atrial strain by cardiovascular magnetic resonance with recurrence of atrial fibrillation following catheter ablation

Benjamin

Moulki

Waqar

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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Background Atrial fibrillation (AF) is a progressive condition, which is characterized by inflammation/fibrosis of left atrial (LA) wall, an increase in the LA size/volumes, and decrease in LA function. We sought to investigate the relationship of anatomical and functional parameters obtained by cardiovascular magnetic resonance (CMR), with AF recurrence in paroxysmal AF (pAF) patients after catheter ablation. Methods We studied 80 consecutive pAF patients referred for ablation, between January 2014 and December 2019, who underwent pre- and post-ablation CMR while in sinus rhythm. LA volumes were measured using the area–length method and included maximum, minimum, and pre-atrial-contraction volumes. CMR-derived LA reservoir strain (ℇR), conduit strain (ℇCD), and contractile strain (ℇCT) were measured by computer assisted manual planimetry. We used a multivariate logistical regression to estimate the independent predictors of AF recurrence after ablation. Results Mean age was 58.6 ± 9.4 years, 75% men, mean CHA2DS2-VASc score was 1.7, 36% had prior cardioversion and 51% were taking antiarrhythmic drugs. Patients were followed for a median of 4 years (Q1–Q3 = 2.5–6.2 years). Of the 80 patients, 21 (26.3%) patients had AF recurrence after ablation. There were no significant differences between AF recurrence vs. no recurrence groups in age, gender, CHA2DS2-VASc score, or baseline comorbidities. At baseline, patients with AF recurrence compared to without recurrence had lower LV end systolic volume index (32 ± 7 vs 37 ± 11 mL/m2; p = 0.045) and lower ℇCT (7.1 ± 4.6 vs 9.1 ± 3.7; p = 0.05). Post-ablation, patients with AF recurrence had higher LA minimum volume (68 ± 32 vs 55 ± 23; p = 0.05), right atrial volume index (62 ± 20 vs 52 ± 19 mL/m2; p = 0.04) and lower LA active ejection fraction (24 ± 8 vs 29 ± 11; p = 0.05), LA total ejection fraction (39 ± 14 vs 46 ± 12; p = 0.02), LA expansion index (73.6 ± 37.5 vs 94.7 ± 37.1; p = 0.03) and ℇCT (6.2 ± 2.9 vs 7.3 ± 1.7; p = 0.04). Adjusting for clinical variables in the multivariate logistic regression model, post-ablation minimum LA volume (OR 1.09; CI 1.02–1.16), LA expansion index (OR 0.98; CI 0.96–0.99), and baseline ℇR (OR 0.92; CI 0.85–0.99) were independently associated with AF recurrence. Conclusion Significant changes in LA volumes and strain parameters occur after AF ablation. CMR derived baseline ℇR, post-ablation minimum LAV, and expansion index are independently associated with AF recurrence.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Association of left atrial strain by cardiovascular magnetic resonance with recurrence of atrial fibrillation following catheter ablation

Benjamin

Moulki

Waqar

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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“…Although recent publications have reported standardization of the technique as well as normal ranges of LA strain, considerable intervendor variability seems to exist and steps must be taken to underscore this limitation. 31 In this specific study, we used EchoPac software for LA strain analysis and our results should not be generalized and should be evaluated with caution.…”

Section: Study Limitationsmentioning

confidence: 99%

The impact of atrial mechanical function on age‐dependent presentation of neurocardiogenic syncope

Sotiriadou

Papadopoulos

Antoniadis

et al. 2021

Clinical Cardiology

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Background: The contribution of atrial and ventricular function in neurocardiogenic syncope (NCS) pathophysiology is elusive.Hypothesis: We assessed the influence of echocardiographic properties to the age of presentation and NCS recurrences. Methods:We assigned 124 patients with symptoms suggesting NCS, to those with syncope initiation at age <35 (group A, n = 56) and >35 years (group B, n = 68). Echocardiographic indices were measured before head-up tilt test (HUTT).Results: A total of 55 had positive HUTT (44%) with a trend favoring group A (p = .08). Group A exhibited lower left atrial (LA) volume index (17 ± 6 vs. 22 ± 11 ml/m 2 , p = .015), higher LA ejection fraction (69 ± 10 vs. 63 ± 11%, p = .008), LA peak strain (reservoir phase 41 ± 13 vs. 31 ± 14%, p = .001, contraction phase 27 ± 11 vs. 15 ± 10%, p < .001) and LA peak strain rate (reservoir phase 1.83 ± 1.04 vs. 1.36 ± 0.96 1/s, p = .012, conduit phase 2.36 ± 1.25 vs. 1.36 ± 0.78 1/s, p = .001). Group A showed smaller minimum right atrial (RA) volume, better RA systolic function, superior left ventricular diastolic indices, and lower filling pressures.Group A patients were more likely to have >3 recurrences (82.0% vs. 50.1%, p < .05).Conclusions: Patients with younger age of NCS onset and more syncopal recurrences manifest smaller LA and RA dimensions with distinct patterns of systolic and diastolic function and better LA reservoir and contraction properties. These findings may indicate an increased susceptibility to preload reduction, thereby triggering the NCS mechanism.

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“…Conventionally, atrial function is evaluated with diameter and volumetric analysis with echocardiography or cardiovascular magnetic resonance (CMR) ( 5 ). More recently, strain has been utilized to quantify atrial deformation and detect atrial dysfunction in various diseased conditions, such as hypertension ( 6 ), atrial fibrillation ( 7 ), myocardial infarction ( 8 ), non-ischemic cardiomyopathies ( 9 , 10 ) and heart failure ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Quantitative Assessment of Left and Right Atrial Strains Using Cardiovascular Magnetic Resonance Based Tissue Tracking

Buckert

et al. 2021

Front. Cardiovasc. Med.

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Background: Left and right atrium (LA and RA) exert an essential and dynamic role in ventricular filling and hence affect heart performance. Strain quantification has been reported as a novel parameter to assess function. However, the assessment of bi-atrial strains with cardiovascular magnetic resonance (CMR) based techniques is still limited and gender- and age-specific normal values in a healthy population are missing.Methods: One hundred and fifty healthy volunteers (49.8 ± 17.3 years, 75 males) undergoing 1.5 Tesla CMR examination were retrospectively and consecutively recruited. LA and RA free wall (RAFW) radial and longitudinal strains (RS and LS) associated with atrial reservoir, conduit and booster pump functions were evaluated with CMR based tissue tracking (CMR-TT) technique.Results: The reservoir, conduit and pump LS resulted as 30.7 ± 10.2%, 19.5 ± 8.2%, 10.9 ± 3.7% for LA, and 52.2 ± 17.6%, 33.3 ± 14.2%, 19.1 ± 8.5% for RAFW, respectively. The amplitude of RA strains was significantly larger than that of LA strains, except for conduit RS. With the increase of age, the decrement of majority of reservoir and conduit strains were observed, while pump strains remained unaffected. Females presented with significantly larger RAFW strains compared with males, especially in the elderly. In addition to the positive correlation between atrial strains and emptying fraction, the negative correlation between atrial strains and volume index was also confirmed. Intra-observer reproducibility of LA strains was superior to RAFW strains (coefficient of variation: 10.12–17.04% vs. 10.80–27.36%, respectively), and the measurement of reservoir and conduit strains was more reproducible in comparison with pump strain.Conclusion: CMR-TT is a feasible and reproducible technique to quantify LA and RA strains and determine atrial phasic functions. The existence of age- and gender-related difference of strains suggests the necessity to establish specific normal values for individual populations.

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Left atrial strain, intervendor variability, and atrial fibrillation recurrence after catheter ablation: A systematic review and meta-analysis

Cited by 27 publications

References 48 publications

Association of left atrial strain by cardiovascular magnetic resonance with recurrence of atrial fibrillation following catheter ablation

Association of left atrial strain by cardiovascular magnetic resonance with recurrence of atrial fibrillation following catheter ablation

The impact of atrial mechanical function on age‐dependent presentation of neurocardiogenic syncope

Quantitative Assessment of Left and Right Atrial Strains Using Cardiovascular Magnetic Resonance Based Tissue Tracking

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