Abstract 11301: Left Atrial Function Assessed by Speckle Tracking Echocardiography is a Novel and Useful Marker to Predict the High Risk Patients for the Development of Lone Atrial Fibrillation
Background: The risk stratification of the development of atrial fibrillation (AF) associated with left atrial (LA) remodeling has a public health impact. While LA volume (LAV) is proposed as a predictor of AF, LA function has not yet been fully examined. We assessed the hypothesis that LA function is more useful marker to predict the high risk patients for the development of AF than LAV.
Methods: We studied 198 subjects without cardiac disease; sinus group (n=110, 69±11 yrs. 49 men), paroxysmal AF (n=42, 68±10 yrs. 29 men) and chronic AF (n=46, 70±9 yrs. 35 men). LA total, passive and active emptying function (EF) as a global function, and LA strain rate (SR) at systole, early diastole and atrial contraction as a regional function were obtained in apical 4-chamber view by speckle tracking method. In paroxysmal AF, LA function was measured in sinus rhythm. Average of three measurements was analyzed.
Results: There was no significant difference between sinus group and paroxysmal AF in LV ejection fraction. Global and regional LA function was lower in paroxysmal AF and much lower in chronic AF except SR at early diastole than sinus group. When paroxysmal AF with normal LA dimension (38±2mm, n=15) was compared with sinus group, LA total EF (37±6%) and SR at atrial contraction (−1.0±0.3s-1) were still lower than sinus group. On multivariate logistic analysis, LA total EF and SR at atrial contraction were independent predictors of AF. Using a cutoff of LA total EF = 40% from ROC curve, the sensitivity and specificity for AF development were 93% and 82% and AUC was 0.93, but the values using max. LAV were only 71% and 76% and AUC was 0.77. Comparisons are shown in the table.
Conclusions: LA function assessed at sinus rhythm in patients with paroxysmal AF was reduced compared with sinus group regardless of LA size, suggesting that LA active relaxation and contractility were impaired by LA remodeling. Reduced LA function assessed at sinus rhythm could be a novel and more useful predictor of AF than LA size.
- © 2010 by American Heart Association, Inc.