Reduced left atrial strain can predict stroke in atrial fibrillation – A meta-analysis

Sachdeva, Sonali; Desai, Rupak; Andi, Kartik; Vyas, Ankit; Deliwala, Smit; Sachdeva, Rajesh; Kumar, Gautam

doi:10.1016/j.ijcha.2021.100859

Cited by 10 publications

(9 citation statements)

References 12 publications

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“…This was also unexpected because BAV AS patients generally were healthier compared with TAV AS patients. However, since impaired LA reservoir strain is associated with stroke in both patients with sinus rhythm 33 , 34 and AF, 35 this should also be considered a possible explanation behind this difference. We also excluded patients with coronary artery disease, which often coexists with general atherosclerotic burden.…”

Section: Discussionmentioning

confidence: 99%

Left atrial dysfunction in bicuspid aortic valve patients with severe aortic stenosis is associated with post-operative atrial fibrillation following aortic valve replacement

Wedin,

Rodin,

Flachskampf

et al. 2024

European Heart Journal Open

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Aims To investigate (i) the association between preoperative left atrial (LA) reservoir strain and postoperative atrial fibrillation (AF), and (ii) the incidence of postoperative ischemic stroke events separately in bicuspid (BAV) and tricuspid aortic valve (TAV) patients after surgical aortic valve replacement for isolated severe aortic stenosis (AS). Methods and results We prospectively enrolled 227 patients (n = 133 BAV and n = 94 TAV) with isolated severe AS scheduled for aortic valve replacement. A comprehensive intra- and interobserver validated preoperative echocardiogram with analysis of LA reservoir strain was performed. Postoperative AF was defined as a sustained (>30 s) episode of atrial fibrillation or atrial flutter. Timing of neurological events were defined in accordance with the Valve Academic Research Consortium (VARC)-3 criteria for stroke. Postoperative AF occurred in 114 of 227 patients (50.2%), with no difference between BAV and TAV patients (48.1% vs. 53.1%, P = 0.452). Persisting postoperative AF at discharge was more frequent in BAV patients (29.7% vs. 8.0%, P = 0.005). Preoperative LA reservoir strain was independently associated with postoperative AF (odds ratio [OR] = 1.064, 95% CI 1.032–1.095, P < 0.001), with a significant interaction between LA reservoir strain and aortic valve morphology (Pinteraction = 0.002). The cumulative TIA/stroke incidence during follow-up was significantly higher in BAV patients (19.1% vs. 5.8% at five years). Conclusion Preoperative LA function was associated with postoperative AF after aortic valve replacement in BAV AS patients, while postoperative AF in TAV AS patients likely depends on transient postoperative alterations and traditional cardiovascular risk factors. TIA/stroke during follow-up was more common in BAV AS patients.

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Section: Discussionmentioning

confidence: 99%

Left atrial dysfunction in bicuspid aortic valve patients with severe aortic stenosis is associated with post-operative atrial fibrillation following aortic valve replacement

Wedin,

Rodin,

Flachskampf

et al. 2024

European Heart Journal Open

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“…There is limited data on clinical application of LASr and specific thresholds to apply in the clinical practice. Several studies have shown that decreased LASr strain is a predictor of adverse AF outcomes such as stroke 20,21 . This is likely related to the fact that reduced LA function increases adverse AF outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that decreased LASr strain is a predictor of adverse AF outcomes such as stroke. 20,21 This is likely related to the fact that reduced LA function increases adverse AF outcomes. In patients above 50 years of age incrementally lower LASr was associated with a higher rate of cardiovascular events with an average difference of ~15% (35.4 ± 9.5% vs. 20.7 ± 9.8%).…”

Section: Comparison Of Baseline Clinical Characteristics Between the 68mentioning

confidence: 99%

Ablation of atrial fibrillation beyond pulmonary vein isolation: Do additional ablation lesions impact left atrial function?

Reynbakh

García

Romero

et al. 2022

Cardiovasc electrophysiol

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Introduction: Electrical isolation of pulmonary veins (PVI) is a cornerstone for atrial fibrillation (AF) ablation. The overall effect of AF ablation, and especially lesions beyond PVI, on left atrial (LA) function is currently poorly understood. Our aim was to determine if LA function is different in patients after extensive LA ablation compared to PVI only.We performed non-inferiority analysis of LA function after PVI with additional nonpulmonary vein ablation lesions in LA (PVI+) and PVI alone. Methods:We studied 68 patients consecutive patients who underwent AF ablation and who had complete transthoracic echocardiogram (TTE) within 12 months before AF ablation and 1−12 months after the procedure. Patients were stratified into two groups: PVI only and PVI+. Primary outcome was change in LA reservoir strain (LASr). Noninferiority margin was defined at 6%. Results:The PVI only group had a higher proportion of patients with paroxysmal AF (70% vs. 30%). The PVI+ group was observed to have a slightly higher increase in LASr compared to PVI alone (5.0% vs. 4.3%, p < .01 for noninferiority). LASr noninferiority was confirmed when adjusted for age, sex, coronary artery disease, hyperlipidemia, and AF type, rhythm at preprocedure TTE in a multivariable linear regression model, 90% CI (−5.46 to 2.04), p < .01. Conclusion:LA functional improvement evaluated by LASr was noninferior after PVI with additional LA ablation lesions compared to PVI alone. These findings were confirmed when adjusted for confounding clinical variables, suggesting that more extensive ablation does not negatively affect LA function.

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“…Most of the literature in this area involves cardiology patients. LAS has been shown to predict adverse outcomes in many cardiovascular conditions, namely heart failure [ 8 – 12 ], atrial fibrillation [ 13 – 16 ] and severe valvular defects [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of volume infusion on left atrial strain in acute circulatory failure

Cicetti,

Bagate,

Lapenta

et al. 2024

Ann. Intensive Care

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Background Left atrial strain (LAS) is a measure of atrial wall deformation during cardiac cycle and reflects atrial contribution to cardiovascular performance. Pathophysiological significance of LAS in critically ill patients with hemodynamic instability has never been explored. This study aimed at describing LAS and its variation during volume expansion and to assess the relationship between LAS components and fluid responsiveness. Methods This prospective observational study was performed in a French ICU and included patients with acute circulatory failure, for whom the treating physician decided to proceed to volume expansion (rapid infusion of 500 mL of crystalloid solution). Trans-thoracic echocardiography was performed before and after the fluid infusion. LAS analysis was performed offline. Fluid responsiveness was defined as an increase in velocity-time integral (VTI) of left ventricular outflow tract ≥ 10%. Results Thirty-eight patients were included in the final analysis. Seventeen (45%) patients were fluid responders. LAS analysis had a good feasibility and reproducibility. Overall, LAS was markedly reduced in all its components, with values of 19 [15 – 32], -9 [-19 – -7] and − 9 [-13 – -5] % for LAS reservoir (LASr), conduit (LAScd) and contraction (LASct), respectively. LASr, LAScd and LASct significantly increased during volume expansion in the entire population. Baseline value of LAS did not predict fluid responsiveness and the changes in LAS and VTI during volume expansion were not significantly correlated. Conclusions LAS is severely altered during acute circulatory failure. LAS components significantly increase during fluid administration, but cannot be used to predict or assess fluid responsiveness.

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Reduced left atrial strain can predict stroke in atrial fibrillation – A meta-analysis

Cited by 10 publications

References 12 publications

Left atrial dysfunction in bicuspid aortic valve patients with severe aortic stenosis is associated with post-operative atrial fibrillation following aortic valve replacement

Left atrial dysfunction in bicuspid aortic valve patients with severe aortic stenosis is associated with post-operative atrial fibrillation following aortic valve replacement

Ablation of atrial fibrillation beyond pulmonary vein isolation: Do additional ablation lesions impact left atrial function?

Effect of volume infusion on left atrial strain in acute circulatory failure

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