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Multicenter Study
. 2024 Nov 4;22(1):13.
doi: 10.1186/s12947-024-00332-0.

Left atrial function during exercise stress echocardiography as a sign of paroxysmal/persistent atrial fibrillation

Angela Zagatina  1 , Quirino Ciampi  2 , Jesus Vazquez Peteiro  3 , Elena Kalinina  4 , Irina Begidova  4 , Ratnasari Padang  5 , Alla Boshchenko  6 , Elisa Merli  7 , Matteo Lisi  8 , Hugo Rodriguez-Zanella  9 , Sergio Kobal  10 , Gergely Agoston  11 , Albert Varga  11 , Karina Wierzbowska-Drabik  12 , Jarosław D Kasprzak  13 , Rosina Arbucci  14 , Olga Zhuravleva  6 , Jelena Čelutkienė  15 , Jorge Lowenstein  14 , Nithima Chaowalit Ratanasit  16 , Paolo Colonna  17 , Scipione Carerj  18 , Mauro Pepi  19 , Patricia A Pellikka  5 , Eugenio Picano  20 ; Stress Echo 2030 study group
Collaborators, Affiliations
Multicenter Study

Left atrial function during exercise stress echocardiography as a sign of paroxysmal/persistent atrial fibrillation

Angela Zagatina et al. Cardiovasc Ultrasound. .

Abstract

Objective: Atrial cardiomyopathy is closely associated with atrial fibrillation (AF), and some patients exhibit no dysfunction at rest but demonstrate evident changes in left atrial (LA) function and LA volume during exercise. This study aimed to identify distinguishing signs during exercise stress echocardiography (ESE) among patients in sinus rhythm (SR), with and without history of paroxysmal/persistent AF (PAF).

Methods: A prospective cohort of 1055 patients in SR was enrolled across 12 centers. The main study cohort was divided into two groups: the modeling group (n = 513) and the verification group (n = 542). All patients underwent ESE, which included B-lines, LA volume index (LAVi), and LA strain of the reservoir phase (LASr).

Results: Age, resting and stress LAVi and LASr, and B-lines were identified as a combination of detectors for PAF in both groups. In the entire cohort, aside from resting and stress LAVi and LASr, additional parameters differentiating PAF and non-PAF patients were the presence of systemic hypertension, exercise E/e' > 7, worse right ventricle (RV) contraction during exercise (∆ tricuspid annular plane systolic excursion < 5 mm), a lower left ventricular contractile reserve (< 1.6), and a reduced chronotropic reserve (heart rate reserve < 1.64). The composite score, summing all 9 items, yielded a score of > 4 as the best sensitivity (79%) and specificity (65%).

Conclusion: ESE can complement rest echocardiography in the identification of previous PAF in patients with SR through the evaluation of LA functional reservoir and volume reserve, LV chronotropic, diastolic, and systolic reserve, and RV contractile reserve.

Keywords: Atrial fibrillation; B-lines; Exercise stress echo; Left atrium; Reservoir strain.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Example of LAVI and LASr measurement
Fig. 2
Fig. 2
Logistic regression analysis formula predictive value by ROC-analysis
Fig. 3
Fig. 3
Comparison of predictive values of LAVi at rest (in blue) and a composite score (in green) inclusive of age, rest LAVI, and stress LASr
See this image and copyright information in PMC

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