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. 2017 Dec 31;10(4):1641.
doi: 10.4022/jafib.1641. eCollection 2017 Dec.

Left Atrial Strain Predicts Pro-Thrombotic State in Patients with Non-Valvular Atrial Fibrillation

Matteo Cameli  1 , Stefano Lunghetti  1 , Giulia Elena Mandoli  1 , Francesca Maria Righini  1 , Matteo Lisi  1 , Valeria Curci  1 , Cristina Di Tommaso  1 , Marco Solari  1 , Dan Nistor  2 , Annalaura Gismondi  2 , Marta Focardi  1 , Roberto Favilli  1 , Sergio Mondillo  1
Affiliations

Left Atrial Strain Predicts Pro-Thrombotic State in Patients with Non-Valvular Atrial Fibrillation

Matteo Cameli et al. J Atr Fibrillation. .

Abstract

Background and purpose: Atrial fibrillation (AF) has a high prevalence in the population and it is responsible for up to the 25% of the strokes in elderly people. The aim of our study was to assess the correlations of left atrial (LA) functional parameter, global peak atrial longitudinal strain (PALS), derived from speckle tracking echocardiography (STE), with transesophageal echocardiography (TEE) findings in patients with persistent AF undergoing TEE before electrical cardioversion or ablation procedures.

Methods: 79 patients (58 males, 21 females) with persistent AF waiting for cardioversion were included in the study. The patients underwent conventional two-dimensional (2D) and 2D speckle tracking echocardiogram. PALS were measured in all subjects. Patients were divided into two groups according to the presence of reduced LA appendage (LAA) emptying velocity (<25 cm/s) and/or thrombus in the LAA at TEE examination.

Results: Patients with reduced LAA emptying velocity and/or thrombus at TEE examination showed a significantly higher LA volume and increased E/E' ratio. 4-chamber, 2-chamber and global PALS were significantly lower in patients with reduced LAA emptying velocity and/or thrombus (6.8 ± 2.0% vs. 27.5 ± 5.4%, P < 0.0001; 8.6 ± 3.5% vs. 29.4 ± 7.1%, P < 0.0001; 7.9 ± 3.2% vs. 28.5 ± 6.1%, P <0.0001, respectively). Among all variables analyzed, global PALS demonstrated the highest diagnostic accuracy (AUC of 0.92) and, with a cut-off value less than 8.1%, good sensitivity and specificity of 87% and 94%, respectively, to predict LAA thrombus and/or reduced LAA emptying velocity.

Keywords: atrial fibrillation; left atrial strain; speckle tracking echocardiography.; transesophageal echocardiography.

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Figures

Figure 1.
Figure 1.. Differences of the values of 4-ch PALS, 2-ch PALS and Global PALS in patients with reduced LAA emptying velocity/thrombus or normal LAA emptying velocity/No thrombus.
Figure 2.
Figure 2.. Correlation between global peak atrial longitudinal strain (global PALS) and LAA emptying velocity.
Figure 3.
Figure 3.. Left panel: pulsed Doppler measurement of LAA emptying velocity (<25 cm/s) at TEE; right panel: measurement of PALS by STE in the same patient.
Figure 4.
Figure 4.. . Left panel: pulsed Doppler measurement of LAA emptying velocity (> 25 cm/s) at TEE; right panel: measurement of PALS by STE in the same patient.
See this image and copyright information in PMC

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