Left atrial strain measured by three-dimensional echocardiography predicts atrial fibrillation in the general population

Abstract

Abstract Background Left atrial (LA) strain is prognostic of adverse cardiovascular events. LA strain by three-dimensional echocardiography (3DE) has been proposed as a more accurate measure of LA function and provide incremental prognostic benefits than traditional two-dimensional approaches. Our aim was to evaluate the prognostic value of LA strain by 3DE in predicting incident atrial fibrillation (AF) in the general population. Methods The study included 4,466 participants from a prospective longitudinal cohort study in the general population, among these 2,082 participants underwent 3DE of the LA. After excluding participants with poor image quality (n=70), low volume rate (n=8) and AF at baseline (n=51) 1,956 participants were included in the final study. The endpoint was incident AF. Results Mean age was 54±17 years, 44% were male. During a median follow-up time of 4.8 years (interquartile range 4.3-5.5 years) 59 participants (3.0%) developed AF. At baseline, mean left atrial reservoir strain (LASr) was 29.3±6.7%, mean left atrial conduit strain (LAScd) was 16.5±6.7%, and mean left atrial contractile strain (LASct) was 12.8±4.8. The incidence of AF increased significantly with decreasing LA strain measures (p<0.001) (figure 1). In univariable analysis, all three parameters were associated with incident AF (p value for all <0.01). After multivariable adjustment for CHARGE-AF risk score (age, height, weight, systolic blood pressure, diastolic blood pressure, smoking, antihypertensive medication, diabetes, congestive heart failure and myocardial infarction), only LASr and LASct were associated with incident AF (LASr: HR 1.11 (1.07-1.17), p<0.001, per 1% decrease; LASct: HR 1.16 (1.09-1.24), p<0.001, per 1% decrease), whereas LAScd was not (HR 1.04 (0.98-1.10), p=0.17, per 1% decrease). Conclusion LA reservoir and contraction strain by 3DE are independently associated incident AF in the general population.