Thromboembolic risk in atrial fibrillation: association between left atrium mechanics and risk scales. A study based on 3DWMT

Abstract

Purpose: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a significantly high risk of stroke and systemic embolism. Thromboembolic risk is known to be related to abnormalities in left atrial (LA) flow and endocardium, as well as local and systemic humoral factors. Our objective is to describe the association between LA mechanics measured by 3D Wall motion tracking (3DWMT) technology and the most common thromboembolic risk scales (CHADS2, CHA2DS2VASc). Methods: 101 consecutive patients with AF underwent conventional transthoracic echocardiogram. We studied conventional bidimentional (2D) atrial parameters and mechanics with 3DWMT. Association between 2D and 3DWMT parameters of LA and both risk schemes was evaluated as well as its correlation with every component of the score individually. Results: Mean age of our cohort (n=101) was 78±10 years, and 47 (46.5%) were male. In regards to comorbidities, 28.7% were diabetic and 85.1% hipertensive. Mean CHADS2 was: 2.7±1.3 and mean CHA2DS2VASc was 4.4±1.7. Mean values of 2D and 3DWTM LA parameters were: area 26.4±9.7 cm2; volume index 49.4±10.1 ml/m2, left atrial ejection fraction (LAEF) 15.9±8.4% and global longitudinal strain 9.1±4.5%. Linear regression analysis showed significant correlation between global longitudinal strain and CHADS2 and CHA2DS2VASc. The latter had also association with LAEF. View this table: Table 1. Linear regression analysis (R value) Conclusions: Our results show that LA longitudinal strain and area strain have a correlation with both scales CHADS2 and CHA2DS2VASc, therefore these parameters might be considered as new predictors of also thromboembolic events in adition to the current scales.