Prognostic value of left atrial longitudinal strain by cardiac MRI feature tracking in atrial fibrillation patients with mitral valve disease

Abstract

To evaluate the prognostic value of left atrial global longitudinal strain (LAGLS) in atrial fibrillation (AF) patients with mitral valve disease (MVD). In this single-centre retrospective study, 48 consecutive AF patients with MVD who underwent cardiac magnetic resonance imaging (CMRI) before surgery were enrolled. The LAGLS was assessed by cine-CMRI images and feature tracking (CMRI-FT) technique. Logistic regression and receiver operating characteristic (ROC) analysis were performed to identify the value of LAGLS in predicting atrial tachyarrhythmia recurrence after surgery. The LAGLS level of the total patients was 4.4% (interquartile range: 2.7-9.2%). LAGLS was significantly associated with many evaluated parameters of severity of disease including biventricular volumetric function, left atrial (LA) ejection fraction, and the European System for Cardiac Operative Risk Evaluation II score (all p<0.05). Multivariate Cox analysis showed that LAGLS (hazard ratio=0.52, 95% confidence interval [CI]: 0.31, 0.87; p=0.013) was an independent predictor of atrial tachyarrhythmia recurrence after adjustment for LA diameter, LA and biventricular ejection fraction, aetiology of MVD (rheumatic or degenerative), and surgical procedure (valve surgery alone or valve surgery combined with Maze IV). The optimal cut-off value of LAGLS was 4.1% for predicting recurrent atrial tachyarrhythmia (sensitivity 81.8%, specificity 78.4%) and the area under the ROC curve was 0.854 (95% CI: 0.711, 0.996, p<0.001). CMRI-FT-derived LAGLS may act as a novel non-invasive imaging biomarker with which to evaluate the severity of disease and offer independent prognostic information for atrial tachyarrhythmia recurrence after surgery in AF patients with MVD.