P262Three-dimensional assesment of left atrial remodelling in atrial fibrillation using 3D echocardiography and angio CT multislice 64

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Introduction: We aimed to study the correlation between the extension of structural and mechanical remodelling of left atrium (LA) (evaluated with Computerized 3D Echocardiography -C3DE and Multislice 64 Computed Tomography -MSCT) and recurrence of atrial fibrillation (AF) after cardioversion in order to identify predictors for recurrence of AF.Methods: Thirty-six patients with AF shorter than 6 months, in whom we performed C3DE and MSCT immediately after cardioversion. In all cases we performed a computerized analysis of LA shape, geometry and volumes, using an adapted 3D echo Qlab software. Contraction amplitude of LA myocardial fibers was determined based on the amplitude of endocardial border movement and displayed as graphical representation and bulls-eye chart. LA contraction amplitude, left ventricular ejection fraction, LA volumes and diameters were determined. LA volumes and diameters were also assesed using MSCT. Follow-up was performed at 1 month and 3 months to analyse the recurrence of AF.Results: 21 patients converted to sinus rhythm maintained the sinus rhythm at 3 months (group 1) and 15 presented AF recurrence (group 2). Both mechanical and structural remodelling were more pronounced in patients who presented AF recurrence. C3DE parameters characterising structural remodelling at 1 month were: LA maximum volumes - 94,2 ml in gr.1 and 142.3 ml in gr 2 (p=0.05), LA maximum diameters - 43 mm in gr.1 compared with 56.5 mm in gr.2 (p=0.03). MSCT derived parameters characterising structural remodelling were similar: LA maximum volumes − 89.5 ml in gr.1 and 146.3 ml in gr 2 (p=0.002), LA maximum diameters - 44 mm in gr.1 and 54.2 mm in gr.2 (p=0.03). Analysis of mechanical remodelling parameters showed a superior contraction amplitude in the rhythm control group −; 2.1 mm, compared with recurrence group − 1.62 mm (p=0.2). Ventricular function was superior in the rhythm control group –LVEF 46.5%, compared with the recurrence group - LVEF 45.3% (p=0.02).Conclusions: We recorded a good correlation between data obtained with 3D echo and MSCT as regard to assesment of structural remodelling in AF. 3D analysis identified several predictors for rhythm ouctome, like parameters charaterising left atrial structural (increase of LA diameters and volumes) or mechanical remodelling process (LA contraction amplitude), while ventricular function was more depressed in patients with AF recurrence. However, extension of structural remodelling showed a higher correlation with AF recurrence than contractile remodelling.

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