Atrial Dispersion Predicts Atrial Fibrillation in Mitral Stenosis: A Five-Year Follow-Up SpeckleTracking Echocardiography Study

Abstract

Introduction: Atrial dispersion showing increased electrical heterogeneity may be associated with the occurence of atrial fibrillation (AF). In our study, it was aimed to investigate the effects of atrial dispersion evaluated by speckle tracking echocardiography on the occurence of AF on in patients with mild to moderate rheumatic mitral stenosis. Patients and Methods: Sixty-two patients with rheumatic mitral stenosis with sinus rhythm, asymptomatic or NYHA 1 symptoms were included in the study. The time to peak atrial strain was measured for each segment by speckle tracking echocardiography in two and four-chamber views. Atrial dispersion was calculated by taking the standard deviation of time to peak strain in 12 left atrial segments. Echocardiographic and clinical parameters of the patients were compared according to the development of AF. Results: During follow-up (mean follow-up duration, 49.9 ± 12.9 months), 19 patients (30%) developed AF. Compared to patients who did not develop AF at follow-up, patients with AF were older (46.8 ± 10.2 vs. 35.9 ± 12, p= 0.001), while mitral valve area (MVA) (1.38 ± 0.1 vs. ± 1.49 ± 0.18 vs. p= 0.02), PALS (13.7 ± 4 vs. 18.8 ± 5.5, p= 0.001) and PACS (6 ± 2.3 vs. 8.2 ± 3.8, p= 0.002) were found to be lower. Atrial dispersion was found to be increased in patients who developed AF (63.2 ± 13.5 vs. 46.1 ± 22.3, p= 0.003). Age, atrial dispersion and PALS were determined as independent predictors of AF development in Cox regression analysis. Conclusion: Atrial dispersion, a new parameter measured by STE, predicts the development of AF. Increased atrial dispersion may provide additional benefits in initiating prophylactic antiarrhythmic drug therapy or anticoagulants.