Correlation of electrocardiographic and echocardiographic parameters in assessing left atrial dysfunction

Abstract

Background: Electrocardiographic (ECG) indices, such as the morphology-voltage-P-wave (MVP) score, and echocardiographic parameters like left atrial volume index (LAVi), left atrial reservoir strain (LASr), and left atrial appendage (LAA) emptying velocity (LAAev) are associated with atrial fibrillation (AF) risk. However, the relationships between these markers remain incompletely understood.

Aims: This study aimed to investigate correlations between the ECG MVP score and echocardiographic indices of LA size and function.

Methods: In this prospective study, 60 patients in sinus rhythm, including 8 patients with paroxysmal AF, scheduled for transesophageal echocardiography underwent a 12‑lead ECG and transthoracic echocardiography within 30 min.

Results: Significant correlations were observed between the mitral E/e' ratio and LAVi (r = 0.30, p = 0.029), LASr (r = -0.42, p = 0.002), and LAAev (r = -0.29, p = 0.037). In comparison to patients with mid-high MVP scores, LAAev was significantly lower in those with low MVP scores (49 ± 21 vs. 61 ± 23 cm/s, p = 0.027). No significant differences were observed between the groups in LAVi (40 ± 20 vs. 42 ± 12 ml/m², p = 0.187), LASr (26 ± 11 vs. 25 ± 10 %, p = 0.967), or mitral E/e' ratio (8.2 ± 1.6 vs. 7.3 ± 1.3, p = 0.876). Additionally, patients with paroxysmal AF had significantly lower LASr and higher mitral E/e' ratio compared to those without paroxysmal AF.

Conclusions: While LAVi, LASr, and LAAev were all related to noninvasively assessed left ventiricular (LV) filling pressure, only LAAev was able to differentiate risk categories based on the MVP score. Our findings suggest that a multiparametric approach to evaluating LA and LAA function, and LV filling pressures may offer a more comprehensive assessment of AF risk than using individual parameters.

Keywords: Atrial fibrillation; Left atrial appendage; Left atrial strain; P-wave.