Three-Dimensional Speckle Tracking Imaging for Assessing Left Atrial Function in Hypertensive Patients With Paroxysmal Atrial Fibrillation

Abstract

SummaryHypertension (HT) is known to be the most prevalent risk factor for paroxysmal atrial fibrillation (PAF), however, its mechanisms have not been fully clarified. Our aim was to investigate the differences in left atrial (LA) function between healthy subjects, and hypertensive patients without PAF (HT-PAF(-)) and with PAF (HT-PAF(+)) using 3-dimensional (3D) speckle tracking imaging (STI). A total of 144 subjects were enrolled: 44 HT-PAF(+) (27 males; mean age 69 ± 10 years), 50 HT-PAF(-) (31 males; mean age 63 ± 11 years), and 50 controls (31 males; mean age 51 ± 14 years). All subjects were in sinus rhythm during the examination. LA volume, LA emptying fraction (LAEF), and LA wall strain were analyzed by 3D area tracking imaging. The maximal value of the global strain curve was defined as the peak global strain. The standard deviation of the time from the R-wave on the electrocardiogram to peak positive values of the segmental strain curves corrected by the R-R' interval in 6 mid LA segments (TP-SD) was calculated to assess LA dyssynchrony. LAEF and peak global strain were lower in HT-PAF(+) than in HT-PAF(-) (P < 0.01) and in the control (P < 0.01). Moreover, TP-SD was higher in HT-PAF(+) than in HT-PAF(-) (P < 0.05) and in the control (P < 0.01). Multivariate analysis revealed LA volume index, peak global strain, and TP-SD were independent determinants of HT-PAF(+). The presence of PAF is associated with diminished LA compliance and advanced mechanical dyssynchrony, as well as LA geometric deformation. (Int Heart J 2016; 57: 705-711) Key words: Three-dimensional echocardiography, Strain, Hypertension, Left atrium A trial fibrillation (AF) is the most common arrhythmia, and its frequency is increasing with the aging of populations. 1,2) Alterations in left atrial (LA) geometry and function, known as LA remodeling, often develop in AF. It is widely known that hypertension (HT) is a risk factor for developing AF and is often synergistically associated with it. Some large animal model studies have provided insights into atrial histological remodeling in HT.3,4) An enlargement of LA is a common finding in patients with HT, indicating hypertensive heart disease. 5,6) Furthermore, many studies have reported that LA enlargement is strongly associated with the incidence of cardiovascular outcomes including the incidence of AF, heart failure, or stroke. 7-9) A better understanding of atrial structure and function in patients with HT is crucial for predicting risk factors for and incidence of AF, as well as complications accompanying the disease.Speckle tracking imaging (STI) is a non-Doppler-based method for the objective quantification of regional myocardial function, independent of ultrasound beam direction. The feasibility of two-dimensional (2D-) STI for measuring LA deformation in patients with paroxysmal or persistent AF has been documented. [10][11][12] Three-dimensional (3D-) STI is thought to be preferable to 2D-STI because the ability of 3D-STI to track echo patterns in 3D-space would eliminate the prob...

Four-Dimensional Volume-Strain Expression in Asymptomatic Primary Hypertension Patients Presenting with Subclinical Left Atrium-Ventricle Dysfunction

“…LA reservoir, conduit and contractile functions during LV systole, early diastole and late diastole with increased LA volumes were significantly lower in LVH patients than in controls. It was in accordance with other speckle tracking echocardiographic studies on atrial function in hypertension patients [5, 8, 11, 18, 19]. Significantly reduced functions were determined by reservoir and contractile measurements in LV systolic and late diastolic phases, comparing LVH with NLVH.…”

“…In the context of systemic hypertension, a reduced 2-dimensional (2D) LA longitudinal strain has been demonstrated to differentiate between subjects with LV diastolic dysfunction from those who already suffer from cardiac events with preserved ejection fraction [6]. Studies have already shown early progressive reduction in 3-dimensional LA longitudinal strain in hypertensive patients with LV diastolic dysfunction even before the appearance of LA enlargement and other structural alteration [7, 8]. Other results show that the strongest echocardiagraphic predictor of LA component dysfunction determined by deformation values is the LV mass index, while LA strain positively correlated with LA reservoir, conduit and contractile functions, underlining the importance of LA-LV coupling [5].…”

Left atrial phasic function and heart rate variability in patients with systemic sclerosis: A new part of the old puzzle

“…25,26 Additionally, LA phasic function is associated with LV systolic and diastolic function 27,28 and represents a good predictor of atrial fibrillation occurrence or recurrence. [29][30][31] Previous investigations have shown that LA is enlarged and dysfunctional in SSc patients. [8][9][10] Using the volumetric method for assessment of LA phasic function, Aktoz et al 8 have shown that LA passive EF is reduced, whereas LA active EF is increased in SSc patients.…”

“…Introduction of LA volume determination in everyday clinical practice reveals a significant predictive value of LA volume and LA phasic function in general population . Additionally, LA phasic function is associated with LV systolic and diastolic function and represents a good predictor of atrial fibrillation occurrence or recurrence …”

Strain Values of Left Ventricular Segments Reduce Non-homogeneously in Dilated Cardiomyopathy with Moderately and Severely Deteriorated Heart Function Assessed by MRI Tissue Tracking Imaging

“…Until recently, ultrasonographic strain analysis has been the mainstay for assessing regional and global myocardial performance. [3][4][5] Matsumoto, et al 6) demonstrated that 3D global circumferential strain (GCS) below 2.71% with dobutamine stress assessed by echocardiography could predict cardiovascular events with 83% sensitivity and 80% specificity. Cardiac magnetic resonance (CMR) imaging based on steady-state free precession (SSFP) cine sequence has been successfully used to evaluate wall motion and strain changes.…”