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. 2014 Jan-Mar;24(1):10-17.
doi: 10.4103/2211-4122.131987.

External Cardioversion of Atrial Fibrillation Causes an Early Improvement of Cardiac Performance: A Longitudinal Strain Analysis Study

Stefano Fumagalli  1 , Debbie Gabbai  1 , Sara Francini  1 , Marta Casalone Rinaldi  1 , Stefano Pedri  2 , Samuele Baldasseroni  1 , Francesca Tarantini  1 , Claudia Di Serio  1 , Giuseppe Lonetto  1 , Mauro Di Bari  1 , Luigi Padeletti  3 , Harry J Crijns  4 , Niccolò Marchionni  1
Affiliations

External Cardioversion of Atrial Fibrillation Causes an Early Improvement of Cardiac Performance: A Longitudinal Strain Analysis Study

Stefano Fumagalli et al. J Cardiovasc Echogr. 2014 Jan-Mar.

Abstract

Introduction: Atrial fibrillation (AF) is often associated with heart failure. Several studies have demonstrated that resumption of sinus rhythm (SR) improves cardiac output in the long-term. Aims of this study were to evaluate the acute variations of left ventricular (LV) performance, following successful external cardioversion (ECV) of persistent AF using longitudinal strain (LSt) analysis, and the influence of inflammation.

Materials and methods: We enrolled 48 patients with AF (age: 73 ± 12 years, men: 83.3%). A standard transthoracic echocardiographic evaluation was performed before the procedure and 6 h later; this included the analysis of LV endocardial peak LSt, a measure of myocardial deformation. In the last 32 patients, plasma concentration of interleukin-6 (IL-6) was also determined.

Results: Restoration of SR led to the decrease of heart rate (HR) (74 ± 21 vs 64 ± 10 bpm, P < 0.001) and LV end-systolic volume (30 ± 16 vs 27 ± 17 mL/m2, P = 0.001), and to the increase of LV end-diastolic volume (LVEDV) (56 ± 20 vs 60 ± 21 mL/m2, P = 0.036) and ejection fraction (EF) (48 ± 10 vs 57 ± 11%, P < 0.001). Peak LSt improved in 43 (89.6%) patients (-12.9 ± 3.3 vs -18.0 ± 4.7%, P < 0.001). Multivariate analysis (R = 0.729, P < 0.001) showed that strain changes were directly correlated with basal HR and the appearance of atrial mechanical activity and inversely correlated with corrected thyroid dysfunction, LVEDV and the presence of a permanent pacemaker. Higher levels of IL-6 negatively affected LV performance improvement.

Conclusions: Effective ECV of AF determines a significant and fast improvement of LV performance, which is readily captured by LSt analysis. Inflammatory status may impact the response to SR restoration.

Keywords: Atrial fibrillation; external cardioversion; heart failure; inflammation; longitudinal strain analysis; speckle-tracking echocardiography.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Pre- (baseline) and post-external cardioversion (ECV) longitudinal strain analysis of left ventricular performance; the dotted line represents the overall value of the individual segments
Figure 2
Figure 2
Pre- and post-ECV values of peak longitudinal strain by segment explored. Restoration of sinus rhythm determines a significant improvement of peak longitudinal strain in any segment. Dotted lines indicate mean value at baseline and after the procedure
Figure 3
Figure 3
Correlation between pre- and post-ECV peak longitudinal strain (LSt) values (left panel) and between absolute changes of LSt (Δ) and pre-ECV LSt (right panel). In this last case, the dashed line indicates the “0” value
Figure 4
Figure 4
Scatterplots of the univariate linear association of changes of peak longitudinal strain (dependent variable) with age, baseline values of heart rate (HR), and left ventricular (LV) end-diastolic and end-systolic volumes
See this image and copyright information in PMC

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