Pre-operative left atrial strain predicts post-operative atrial fibrillation in patients undergoing aortic valve replacement for aortic stenosis

Abstract

Post-operative atrial fibrillation (AF) is a common and serious complication in patients undergoing aortic valve replacement (AVR). Speckle tracking echocardiography (STE) has recently enabled the quantification of longitudinal myocardial left atrial (LA) deformation dynamics. Our aim was to investigate LA preoperative mechanical function in patients undergoing AVR for aortic stenosis using STE and determine predictors of post-operative AF. 76 patients with aortic stenosis in sinus rhythm, undergoing AVR, were prospectively enrolled. Conventional echocardiographic parameters, and peak atrial longitudinal strain (PALS) were measured in all subjects the day before surgery. PALS values were obtained by averaging all segments in the 4- and 2-chamber views (global PALS). All patients received biological valve prostheses and a standard postoperative care. Postoperative AF occurred in 15 patients (19.7 %). On univariate analysis among all clinical and echocardiographic variables, global PALS showed the highest diagnostic accuracy (HR 6.55 p < 0.0001; AUC of 0.89) with a cut-off value <16.9 %, having sensitivity and specificity of 86 and 91 %, respectively, in predicting postoperative AF. LA volume indexed and E/e' ratio had lower diagnostic accuracy (AUC 0.76 and 0.51, respectively). On multivariate analysis global PALS remains a significant predictor of postoperative AF (p < 0.0001). STE analysis of LA myocardial deformation is considered a promising tool for the evaluation of LA subclinical dysfunction in patients undergoing AVR, giving a potentially better risk stratification for the occurrence of postoperative AF.

Preoperative Tissue Doppler Imaging-Derived Atrial Conduction Time Can Predict Postoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Replacement for Aortic Valve Stenosis

“…18 Cameli et al reported that in patients undergoing AVR for AS, LAVI and the peak LA longitudinal strain measured by STE were predictors of POAF in their univariate analysis. 19 Furthermore, in their multivariate regression analysis, age and peak LA longitudinal strain (but not LAVI) were independent predictors of POAF. Moreover, ROC curve analysis showed that the AUC of peak LA longitudinal strain (0.89) showed higher diagnostic accuracy than the AUC of LAVI (0.78).…”

Left atrial dimensions – Is left atrial volume calculation always necessary?

“…(12) Area-length method and biplane method of discs (modified Simpson's rule) were recommended recently as well as a 3D data set. (10) With the development of echocardiographic speckle tracking imaging, (18) left atrial function assessment became possible (19) with calculation of segmental and average peak left atrial strain, (20,21) but this is time consuming and needs off-line analysis. Echocardiographic 3D data sets are usually obtained from the apical approach using a multi-beat full volume acquisition.…”

Left Atrial Phasic Function and Its Association With Atrial Fibrillation in Patients After Transcatheter Aortic Valve Implantation

“…In patients with severe aortic stenosis (AS), left atrial (LA) enlargement and dysfunction are associated with the evolution of symptoms, the recurrence of heart failure after aortic valve replacement,(1) the development of early postoperative atrial fibrillation (AF) (2), and mortality. (3) Transcatheter aortic valve implantation (TAVI) is now considered the treatment of choice for patients with severe AS at high risk for open-heart surgery.…”

“…Patients were included if transthoracic echocardiograms obtained before and at medium-term follow-up (between 2 to 12 months) were available for review. Exclusion criteria were: (1) the presence of AF during the echo study (since atrial mechanics cannot be adequately assessed) or (2) inadequate endocardial definition of the LA walls, resulting in poor speckle-tracking. The control group consisted of 20 patients ≥ 75 years with no significant underlying heart disease (based on clinical and echo assessments).…”