Atrial strain rate echocardiography can predict success or failure of cardioversion for atrial fibrillation: A combined transthoracic tissue Doppler and transoesophageal imaging study

doi:10.1016/j.ijcard.2006.01.051

International Journal of Cardiology

Volume 114, Issue 2, 8 January 2007, Pages 202-209

https://doi.org/10.1016/j.ijcard.2006.01.051 Get rights and content

Abstract

Aims

The purpose of this study was to assess the feasibility of measuring left atrial dysfunction with tissue Doppler imaging derived strain rate and to explore its role in predicting the maintenance of sinus rhythm after cardioversion for atrial fibrillation.

Methods and results

Strain rate (SR) and tissue Doppler imaging (TDI) were performed with offline analysis of the basal left atrial wall (LA). SR detected a systolic (Ssr) and early diastolic (Esr) deformation induced by ventricular motion. LA dimensions and volume were measured. Left atrial appendage emptying (LAA_EV) and filling (LAA_FV) velocities were also obtained by transesophageal echocardiography. 27 healthy age-matched controls and 42 patients with AF before cardioversion were studied. Patients were grouped into (1): those who remained in sinus rhythm (group S, n = 12) and (2) those who either failed cardioversion or reverted to AF within 4 weeks (group F, n = 30). LA dimensions were significantly larger and atrial Esr was significantly lower in group F than group S (all p < 0.01). LAA_EV and LAA_FV were not different between groups S and F. Multivariate regression analysis showed that a lower Esr and larger transverse LA diameter (LADtr) were independent predictors of failure of cardioversion (HR, 95% CI: 0.36, 0.14–0.88 and 2.85, 1.33–6.10, respectively). Esr combined with LADtr improved the sensitivity and specificity for predicting successful cardioversion.

Conclusions

SR can be measured in the basal LA wall in atrial fibrillation and the magnitude of the early diastolic SR could predict the success of cardioversion and the likelihood of maintenance of sinus rhythm.

Section snippets

Methods

We studied 52 patients (age from 36 to 83 years, 28 female) with AF (duration < 1 year) and 27 healthy age-matched normal subjects. The normal subjects had no symptoms of cardiovascular disease, no history of hypertension, diabetes mellitus, valvular heart disease, ischemic heart disease, hyperthyroidism or peripheral vascular disease, and with a normal ECG and 2D echocardiography.

Transthoracic and tranesophageal echocardiography were performed before cardioversion in each patient. Ten patients

Results

Age, heart rate and the duration of AF before cardioversion were not different between group S and group F as shown in Table 1.

Discussion

In the present study, we explored the feasibility of measuring strain rate in AF patients and found that the passive motion velocity and deformation induced by ventricular motion was decreased significantly. These results may reflect decreased compliance of left atrial wall in patients with AF. In addition, a lower Esr predicted a short duration of sinus rhythm after cardioversion. Furthermore, we found that a combination of Esr and LADtr improved the prediction of successful cardioversion. In

Conclusion

Atrial strain rate measurements can be made in patients with AF and may be useful for predicting the success of cardioversion and the maintenance of sinus rhythm. Reduced passive strain rate in LA and enlarged LA dimension are associated with failure of cardioversion or early recurrence of AF. This might reflect unfavorable atrial structure remodeling with reduced LA compliance.

Acknowledgment

We thank Peggo KW Lam M.Phil. for his statistical assistance of this study.

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Citation Excerpt :
Studies have also demonstrated that Doppler tissue imaging can be used as an accurate marker of atrial function.383,384 Two-dimensional speckle-tracking echo has been used as a more sensitive marker to detect early functional remodelling before anatomical alterations occur.385–400 Strain (S) and strain rate (SR) imaging provide data on myocardial deformation by estimating spatial gradients in myocardial velocities.385,388,392,393,401–405
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This study hypothesized that left atrial structural remodeling (LA-TR) correlates with exercise capacity (EC) in a cohort of patients with atrial fibrillation (AF).
Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) imaging provides a method of assessing LA-TR in patients with AF.
A total of 145 patients (32% female, mean age 63.4 ± 11.6 years of age) with AF (66 paroxysmal, 71 persistent, 8 long-standing persistent) presenting for catheter ablation were included in the study. All patients underwent LGE-CMR imaging as well as maximal exercise test using the Bruce protocol prior to catheter ablation of AF. EC was quantified by minutes of exercise and metabolic equivalent (MET) level achieved. LA-TR was quantified from LGE-CMR imaging and classified according to the Utah classification of LA structural remodeling (Utah stage I: <10% LA wall enhancement; Utah II: 10% to <20%; Utah III: 20% to <30%; and Utah IV: >30%). AF recurrence was assessed at 1 year from the date of ablation.
The average duration of exercise was 8 ± 3 min, and the mean MET achieved was 9.7 ± 3.2. METs achieved were inversely correlated with LA-TR (R² = 0.061; p = 0.003). The duration of exercise was also inversely correlated with LA-TR (R² = 0.071; p = 0.001). Both EC and LA-TR were associated with AF recurrence post ablation in univariate analysis, but only LA-TR and age were independently predictive of recurrence in multivariate analysis (p = 0.001). For every additional minute on the treadmill, subjects were 13% more likely to be free of AF 1 year post ablation (p = 0.047).
EC is inversely associated with LA-TR in patients with AF and is predictive of freedom from AF post-ablation.

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^☆: Presented in part at the American College of Cardiology Annual Congress 2003.

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Atrial strain rate echocardiography can predict success or failure of cardioversion for atrial fibrillation: A combined transthoracic tissue Doppler and transoesophageal imaging study☆

Abstract

Aims

Methods and results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusion

Acknowledgment

J Am Coll Cardiol

Am J Cardiol

Int J Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

Int J Cardiol

J Am Soc Echocardiogr

Am Heart J

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications

Arch Intern Med

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N Engl J Med