Abstract 18093: Unleashing the Role of Speckle Tracking Echocardiography in Detection of Left Atrial Fibrosis

    loading  Checking for direct PDF access through Ovid


Introduction: Atrial fibrillation (AF) is the most common arrhythmia in the clinical setting. Structural atrial remodeling has been observed in clinical and experimental AF models and proved to play a major role in the AF substrate. The relationship between left atrial (LA) structure and function is not fully elucidated.

Patients and methods: Thirty four patients with AF who underwent pulmonary vein isolation (cryo- or radiofrequency ablation) were included between April 2016 and May 2017. They were subjected prior to the Ablation to a 3-dimensional delayed-enhancement MRI and the degree of LA wall fibrosis was detected and quantified using a semi-automated quantification algorithm (Marrek). All patients underwent an echocardiography with tissue Doppler measurements as well as left atrial strain rate obtained by speckle tracking.

Results: Five patients were excluded due to suboptimal echocardiographic images. 29 eligible patients with mean age of 62± 11 years old (42% women) were enrolled for further analysis. 76 % of our cohort had paroxysmal AF prior to the ablation. Mean fibrosis was 14.45 ± 5.63%. Ten patients revealed a Utah-score 1 in MRI whereas 55% of the patients showed a Utah-score 2. Left atrial fibrosis detected with cardiac-MRI showed a strong positive correlation with pA-TDI interval (r=0.84, p<0.0001) and was inversely correlated to left atrial strain rate (r= -0.521, p= 0.005). Moreover, a significant correlation between the left atrial fibrosis obtained in MRI and echocardiographic left atrial volumes was found (r=0.450, p=0.019) irrespective of the paroxysmal or persistent nature of AF.

Conclusion: LA wall fibrosis by delayed-enhancement MRI correlates with a prolonged atrial electromechanical coupling (PA-TDI interval). The disturbed left atrial compliance accompanying AF was revealed through both techniques. Echocardiographic evaluation of LA functional remodeling is feasible and can improve the assessment.

Related Topics

    loading  Loading Related Articles