Left Atrial Deformation Imaging with Ultrasound Based Two‐Dimensional Speckle‐Tracking Predicts the Rate of Recurrence of Paroxysmal and Persistent Atrial Fibrillation After Successful Ablation Procedures
- 28 September 2011
- journal article
- Published by Wiley in Journal of Cardiovascular Electrophysiology
- Vol. 23 (3), 247-255
- https://doi.org/10.1111/j.1540-8167.2011.02177.x
Abstract
Since predictors of recurrence of atrial fibrillation (AF) after ablation procedures are poorly defined, this prospective study was conducted to assess the value of left atrial (LA) deformation imaging with two-dimensional speckle-tracking (2D-ST) to predict AF recurrences after successful ablation procedures. One hundred and three consecutive patients (age 58.1 ± 16.6 years, 72.8% male) with AF (76 paroxysmal, 27 persistent) and 30 matched controls underwent transthoracic echocardiography and 2D-ST-LA-deformation analysis with assessment of LA-radial and LA-longitudinal strain (Sr, Sl), and velocities derived from the apical 4- and 2-chamber views (4CV, 2CV). AF recurrence was assessed during 6 months of follow-up. For determination of AF-related LA changes, AF patients were compared to controls and patients with AF recurrences after ablation procedures (n = 30, 29.1%) were compared with patients who maintained sinus rhythm (n = 73, 70.9%). Atrial deformation capabilities were significantly reduced (P < 0.0005) in patients with AF (4CVSl 17.8 ± 13.5%; 4CVSr 22.3 ± 14.9%; 4CV-velocities 2.53 ± 0.97 seconds) when compared with controls (4CVSl 31.3 ± 12.4%; 4CVSr 30.3 ± 9.1%; 4CV-velocities 3.48 ± 1.01 cm/s). Independent predictors for AF recurrence after ablation procedures were 2CV-LA-global-strain (Sr, P = 0.03; Sl, P = 0.003), 4CV-LA-gobal-strain (Sr, P = 0.03; Sl, P = 0.02), and regional LA-septal wall-Sl (P = 0.008). LA-global-strain parameters were superior to regional LA function analysis for the prediction of AF recurrences, with cutoff values (cov), hazard ratios (HR), positive and negative predictive values (PPV, NPV) were: 4CVSl cov, 10.79% (HR 27.8, P < 0.0005; PPV 78.8%, NPV 93.9%), 4CVSr cov, -16.65% (HR 24.8, P < 0.0005; PPV 69.4%, NPV 96.6%), 2CVSl cov, 12.31% (HR 22.7, P < 0.0005; PPV 75.8%, NPV 95.3%), and 2CVSr cov, -14.9% (HR 12.9, P < 0.0005; PPV 64.3%, NPV 93.2%). Compared with controls, AF itself seems to decrease LA deformation capabilities. The assessment of global LA strain with 2D-ST identifies patients with high risk for AF recurrence after ablation procedures. This imaging technique may help to improve therapeutic guiding for patients with AF.Keywords
This publication has 27 references indexed in Scilit:
- Left Atrial Strain and Strain Rate in Patients With Paroxysmal and Persistent Atrial FibrillationCirculation: Cardiovascular Imaging, 2010
- Detection and Quantification of Left Atrial Structural Remodeling With Delayed-Enhancement Magnetic Resonance Imaging in Patients With Atrial FibrillationCirculation, 2009
- Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle trackingCardiovascular Ultrasound, 2009
- Effect of Preload on Left Ventricular Longitudinal Strain by 2D Speckle TrackingEchocardiography, 2008
- Controversies in ablation of atrial fibrillationEuropean Heart Journal Supplements, 2008
- Long-term follow-up after radiofrequency catheter ablation for atrial fibrillationEP Europace, 2008
- Atrial deformation: the key to maintenance of sinus rhythm in patients with atrial fibrillation?European Heart Journal, 2008
- Abnormalities of left atrial function after cardioversion: an atrial strain rate studyHeart, 2007
- Reverse Remodeling of the Left Cardiac Chambers After Catheter Ablation After 1 Year in a Series of Patients With Isolated Atrial FibrillationCirculation, 2005
- Morphologic Remodeling of Pulmonary Veins and Left Atrium after Catheter Ablation of Atrial Fibrillation:Journal of Cardiovascular Electrophysiology, 2005