P8652d strain of left atrium in the evaluation of myocardial stunning after restoration of sinus rhythm in patients with atrial fibrillation

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Purpose. Transthoracic echocardiographic parameters to evaluate atrial myocardial stunning after restoration of sinus rhythm in patients with atrial fibrillation (AF) are poorly defined.The purpose of this study was to explore LA longitudinal function by Speckle tracking echocardiography after restoration of sinus rhythm in patients with atrial fibrillation.Methods: Consecutive patients with persistent atrial fibrillation submitted to successful cardioversion (CV) were enrolled in the study. All patients underwent transthoracic echocardiography just before and 6 hours after sinus rhythm restoration. Early peak of LA longitudinal strain, corresponding to reservoir function (PALS) and late peak of LA strain, just before LA contraction (PACS) were assumed as parameters of atrial stunning and measured in all subjects using a 12-segment model for the left atrium. Values were obtained by averaging all segments. Patients were followed-up at 4 weeks after electrical cardioversion. In patients with evidence of persistent AF at the 4-week visit, the follow-up was terminated. Atrial strain recovery was obtained as the difference between 4 weeks and 6 hours after CV strain values, and it was expressed as percentage.Results: Among 38 patients fulfilling the selection criteria during the period of enrollment, 15 patients (39%) remained in sinus rhythm at 4 weeks follow-up. 1 month after CV, PALS and PACS were both higher than 6 hours values (PALS: 15 ± 6 s vs 23 ± 5%, p<0.001. PACS: 5 ± 3 s vs 11 ± 3 s, p<0.001). In all patients who remained in sinus rhythm there was an increase in PALS and PACS respect to 6 hours values (35±15% and 47±28%, respectively). PALS increase showed significant correlation with baseline values of LA volume index before CV (R 0.60, p < 0.05), while PACS showed borderline negative correlation with E/E' ratio (R 0.49, p 0.05).Conclusions: These data suggest that 2D atrial strain may be useful to detect functional recovery of atrial myocardium after CV. The amount of recovery was correlated with baseline LA dimensions and with degree of diastolic dysfunction.

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