Abstract
The function of left atrium (LA) is closely related to LA remodeling and one of the most important mechanisms is an increased deposition of fibrous tissue that often is the basis for LA electro-mechanical changes before the onset of atrial fibrillation (AF). This study evaluated LA shape and function, by investigating standard and novel strain parameters calculated by a new approach based on homologous times derived from 3D speckle tracking echocardiography (3DSTE) in hypertensive (HT) and paroxysmal atrial fibrillation (PAF) patients with or without left ventricular hypertrophy (LVH), compared to control (C) subjects. LA function was assessed using homologous times to compare strain variables among different individuals, acquired at different physiological time periods. Standard global longitudinal (GLS) and circumferential (GCS) strains were measured at peak of atrial diastole, while longitudinal and circumferential strains (GLSh, GCSh), strain rate (GLSr, GCSr), volume (Vh) and volume rate (Vr) were measured during the atrial telediastolic phase (fifth homologous time) and atrial pre-active phase (tenth homologous time). Using ANOVA, we found an impaired LA deformation detected by standard, interpolated strains and strain rates in both HT and PAF groups compared to C. We also performed ROC analysis to identify different performances of each parameter to discriminate groups (GLSr10 + GCSr10: C vs PAF 0.935; C vs PAF_LVH 0.924; C vs HT_LVH 0.844; C vs HT 0.756). Our study showed anatomical and functional LA remodeling in patients with PAF and HT. 3D strains and strain rates derived from the homologous times approach provide more functional information with improved performance to identify among the explored groups, in particular PAF patients.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia in the general population
Among the entire left atrium (LA) cycle we focused on atrial diastole and pre-active time; at these times we investigated the relationship among HT and paroxysmal atrial fibrillation (PAF) with or without left ventricular hypertrophy (LVH) in terms of LA function and shape
Groups were composed of 82 normal subjects (Control), 9 patients with arterial hypertension (HT) and paroxysmal episodes of atrial fibrillation (AF), without left ventricular hypertrophy (LVH) (PAF group), 11 patients with PAF, HT and LVH (PAF_LVH group), 10 patients with HT and LVH (HT_LVH group) and 18 patients with HT without LVH (HT group)
Summary
Atrial fibrillation (AF) is the most common arrhythmia in the general population. The prevalence of AF is 1–2%1–3 and its complications have a very high socio-economic impact due to a close relationship with ischemic stroke, embolisms, heart failure, hospitalizations and death risk along with worse quality of life, lower exercise tolerance and impaired left ventricular (LV) function. The left atrial volume index (LAVi) calculated in 2D is one of the most used shape parameters for the ability to predict the likelihood of new AF onset or recurrence after cardioversion/ablation, in PAF patients, or to establish the severity of cardiac remodeling in patients with HT. It is usually evaluated at atrial diastole and it has a prognostic value with a high clinical impact. Among the entire LA cycle we focused on atrial diastole (fifth homologous time) and pre-active time (tenth homologous time); at these times we investigated the relationship among HT and PAF with or without left ventricular hypertrophy (LVH) in terms of LA function and shape
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