P943Preoperative left atrial deformation analysis predicts postoperative atrial fibrillation in patients waiting for aortic valve replacement for aortic stenosis


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Abstract

Background: The occurrence of atrial fibrillation (AF) is a common and dangerous complication in patients undergoing aortic valve replacement (AVR); Speckle tracking echocardiography (STE) has recently enabled the quantification of longitudinal myocardial LA deformation dynamics. Our aim was to investigate by STE the eventual pre-existent subclinical mechanical atrial dysfunction in patients who develop AF after AVR.Methods: 76 patients with aortic stenosis in sinus rhythm, undergoing AVR, were prospectively enrolled. Conventional echocardiographic parameters, and peak atrial longitudinal strain (PALS) were measured in all subjects the day before surgery. PALS values were obtained by averaging all segments measured in the 4- and 2-chamber views (global PALS).Results: All patients received a biological valve prosthesis and a standard postoperative care. Postoperative AF occurred in 15 patients (19.8%). Among all clinical and echocardiographic variables analyzed, global PALS demonstrated the highest diagnostic accuracy (AUC of 0.89) and, with a cutoff value less than 16.8%, good sensitivity and specificity of 85% and 91%, respectively, to predict postoperative AF episodes. LA volume indexed and E/E' ratio presented lower diagnostic accuracy (AUC 0.77 and 0.53, respectively).Conclusions: STE analysis of LA myocardial deformation could be considered a promising tool for the evaluation of LA subclinical dysfunction in patients undergoing AVR, giving a potentially better risk stratification for the occurrence of postoperative AF.

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