[PP.14.04] RELATIONSHIP BETWEEN CHANGE IN LEFT ATRIAL STRAIN AFTER CARDIOVERTION WITH RECURRENCE OF ATRIAL FIBRILLATION

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Abstract

Objective:

Strain and strain rate imaging is a promising approach for more comprehensive and reliable echocardiographic assessment of left atrial function. We tried to evaluate whether LA strain and strain rate are associated with AF recurrence after CV in patients with arterial hypertension and coronary artery disease.

Design and method:

Thirty one patients [mean age 64 (60; 72) yrs, 48% men] with paroxysmal and persistent non-valvular AF were studied. All pts underwent conventional and speckle tracking echocardiography before and 10 days after CV. Apical four- and two-chamber views images of 6 myocardial segments in the filling phase were obtained to assess global peak left atrial longitudinal strain (PALS) and strain rate (PALSR) in the reservoir (r) and contractile (c) phase. Follow-up period was 3 months.

Results:

Sinus rhythm maintenance was observed in 13 (42%) patients (group 1) throughout follow-up period whereas 18 (58%) patients (group 2) experienced at least one AF recurrence despite a class III antiarrhythmic drugs. Baseline echocardiographic and speckle tracking measurements were comparable between the 2 groups excluding PALSRc that was higher in group 1 than in group 2 (−1.87 vs −1.49 1/s, p = 0.03, respectively). Changes in PALSr and PALSc 10 days after CV were significantly higher in group 1 to compare with group 2 (1.9 vs 0.5%, p = 0.01, and −1.8 vs −0.7%, p = 0.001, respectively). Linear regression analysis revealed significant association between change in PALSc and AF recurrence (β = −0.67; p = 0.011). ROC curve analysis showed that the optimal change in PALSc cut-off value for predicting AF recurrence was −1.96%, with a sensitivity of 88.9% and a specificity of 61.5% (AUC 0.85; 95% CI 0.71–0.99; p = 0.001).

Conclusions:

Baseline echocardiographic measurements did not show predictive ability regarding recurrent atrial fibrillation. Improvement of global peak left atrial longitudinal strain in contractile phase within 10 days after cardiovertion was independently associated with AF recurrence.

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