Vol 79, No 11 (2021)
Original article
Published online: 2021-09-20
Correlations between left atrial strain and left atrial pressures values in patients undergoing atrial fibrillation ablation
Abstract
Background: We aimed to investigate the correlations between left atrial strain (LAS) assessed by speckle tracking echocardiography and directly measured left atrial pressures (LAP) values and to estimate the features of patients with lower LAS values.
Methods: A prospective, observational study was performed on patients with atrial fibrillation (AF) undergoing ablation. Detailed transthoracic echocardiography with the speckle tracking method was used to estimate the LAS reservoir (LASr) and direct measurements of LAP during ablation in all patients.
Results: A total of 172 patients were included (98 with sinus rhythm [SR] and 74 with AF). The patients with lower LASr (first tercile) compared to those with higher (third tercile), were older, more often female, presented with a larger left atrium (LA) (per the LA area and volume index), and had more impaired left ventricular (LV) diastolic function parameters (e’, E/e’). The correlation analysis of the echocardiographic parameters with the LAP revealed the most significant correlations in the SR group, where the E/e’ ratio, LASr, and LAS contraction (LASct) values were all associated with LAP. The cut-off value of LASr estimating high elevated mean LAP (≥15 mm Hg) was 21.88 (Area Under Curve [AUC], 0.81; 95% confidence interval [CI], 0.72–0.90; P <0.0001) for the SR group and 11.25 (AUC, 0.66; 95% CI, 0.53–0.80; P = 0.016) for the AF group.
Conclusions: AF patients with lower LASr are older, more often female, have a larger LA, and have more impaired LV diastolic function. Low LASr and LASct and high E/e’ ratio values are associated with higher LAP in AF patients with SR.
Keywords: atrial fibrillationleft atrial pressureleft atrial strainspeckle tracking echocardiography
References
- Vieira MJ, Teixeira R, Gonçalves L, et al. Left atrial mechanics: echocardiographic assessment and clinical implications. J Am Soc Echocardiogr. 2014; 27(5): 463–478.
- Inciardi RM, Giugliano RP, Claggett B, et al. ENGAGE AF-TIMI 48 Investigators. Left atrial structure and function and the risk of death or heart failure in atrial fibrillation. Eur J Heart Fail. 2019; 21(12): 1571–1579.
- Gupta S, Matulevicius SA, Ayers CR, et al. Left atrial structure and function and clinical outcomes in the general population. Eur Heart J. 2013; 34(4): 278–285.
- Frydas A, Morris DA, Belyavskiy E, et al. Left atrial strain as sensitive marker of left ventricular diastolic dysfunction in heart failure. ESC Heart Fail. 2020; 7(4): 1956–1965.
- Jasic-Szpak E, Marwick TH, Donal E, et al. Prediction of AF in heart failure with preserved ejection fraction: incremental value of left atrial strain. JACC Cardiovasc Imaging. 2021; 14(1): 131–144.
- Sahebjam M, Mazareei A, Lotfi-Tokaldany M, et al. Comparison of left atrial function between hypertensive patients with normal atrial size and normotensive subjects using strain rate imaging technique. Arch Cardiovasc Imag. 2014; 2(1).
- Yasuda R, Murata M, Roberts R, et al. Left atrial strain is a powerful predictor of atrial fibrillation recurrence after catheter ablation: study of a heterogeneous population with sinus rhythm or atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2015; 16(9): 1008–1014.
- Cameli M, Sparla S, Losito M, et al. Correlation of left atrial strain and doppler measurements with invasive measurement of left ventricular end-diastolic pressure in patients stratified for different values of ejection fraction. Echocardiography. 2016; 33(3): 398–405.
- Lindqvist P, Henein M. Left atrial strain rate during atrial contraction predicts raised pulmonary capillary wedge pressure: evidence for left atrio-ventricular interaction. Int J Cardiovasc Imaging. 2021; 37(5): 1529–1538.
- Park J, Joung B, Uhm JS, et al. High left atrial pressures are associated with advanced electroanatomical remodeling of left atrium and independent predictors for clinical recurrence of atrial fibrillation after catheter ablation. Heart Rhythm. 2014; 11(6): 953–960.
- Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1): 1–39.e14.
- Mor-Avi V, Lang RM, Badano LP, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr. 2011; 24(3): 277–313.
- Badano LP, Kolias TJ, Muraru D, et al. Industry representatives, Reviewers: This document was reviewed by members of the 2016–2018 EACVI Scientific Documents Committee. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018; 19(6): 591–600.
- Pathan F, D'Elia N, Nolan MT, et al. Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J Am Soc Echocardiogr. 2017; 30(1): 59–70.e8.
- Uziebło-Życzkowska B, Krzesiński P. Correlations between left ventricular and left atrial function assessed by speckle tracking echocardiography in patients with treated well-controlled arterial hypertension. Cardiol Res Practice. 2021.
- Hindricks G, Potpara T, Dagres N, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021; 42(5): 373–498.
- Vianna-Pinton R, Moreno CA, Baxter CM, et al. Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects. J Am Soc Echocardiogr. 2009; 22(3): 299–305.
- Cameli M, Caputo M, Mondillo S, et al. Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound. 2009; 7: 6.
- Liżewska-Springer A, Dąbrowska-Kugacka A, Lewicka E, et al. Biatrial strain as a new predictive marker of successful pulmonary vein ablation in patients with atrial fibrillation and preserved left ventricular function. Kardiol Pol. 2019; 77(4): 471–474.
- Kuppahally SS, Akoum N, Burgon NS, et al. Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging. 2010; 3(3): 231–239.
- Longobardo L, Todaro MC, Zito C, et al. Role of imaging in assessment of atrial fibrosis in patients with atrial fibrillation: state-of-the-art review. Eur Heart J Cardiovasc Imaging. 2014; 15(1): 1–5.
- Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. EP Europace. 2017; 20(1): e1–e160.
- Goette A, Kalman J, Aguinaga L, et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace. 2016; 18(10): 1455–1490.
- Kuo JY, Chang SH, Sung KT, et al. Left ventricular dysfunction in atrial fibrillation and heart failure risk. ESC Heart Fail. 2020 [Epub ahead of print]; 7(6): 3694–3706.
- Dons M, Jensen JS, Olsen FJ, et al. Global longitudinal strain corrected by RR-interval is a superior echocardiographic predictor of outcome in patients with atrial fibrillation. Int J Cardiol. 2018; 263: 42–47.
- Sun JP, Yang Y, Guo R, et al. Left atrial regional phasic strain, strain rate and velocity by speckle-tracking echocardiography: normal values and effects of aging in a large group of normal subjects. Int J Cardiol. 2013; 168(4): 3473–3479.
- Meel R, Khandheria BK, Peters F, et al. Effects of age on left atrial volume and strain parameters using echocardiography in a normal black population. Echo Res Pract. 2016; 3(4): 115–123.
- Yoshida K, Obokata M, Kurosawa K, et al. Effect of sex differences on the association between stroke risk and left atrial anatomy or mechanics in patients with atrial fibrillation. Circ Cardiovasc Imaging. 2016; 9(10): e004999.
- Mark JB. Atlas of cardiovascular monitoring. Churchill Livingstone, New York 1998: Chapter 4.
- Bergau L, Vollmann D, Luthje L, et al. Measurement of left atrial pressure is a good predictor of freedom from atrial fibrillation. Indian Pacing Electrophysiol J. 2014; 14(4): 181–193.
- Roh SY, Lee DI, Hwang SH, et al. Association of left atrial pressure with late gadolinium enhancement extent in patient who underwent catheter ablation for atrial fibrillation. Sci Rep. 2020; 10(1): 16486.
- Linhart M, Lewalter T, Mittmann-Braun EL, et al. Left atrial pressure as predictor for recurrence of atrial fibrillation after pulmonary vein isolation. J Interv Card Electrophysiol. 2013; 38(2): 107–114.
- Hewing B, Theres L, Spethmann S, et al. Left atrial strain predicts hemodynamic parameters in cardiovascular patients. Echocardiography. 2017; 34(8): 1170–1178.
- Gupta DK, Giugliano RP, Ruff CT, et al. Effective Anticoagulation with Factor Xa Next Generation in AF–Thrombolysis in Myocardial Infarction 48 (ENGAGE AF–IMI 48) Echocardiographic Study Investigators. The prognostic significance of cardiac structure and function in atrial fibrillation: the ENGAGE AF-TIMI 48 echocardiographic substudy. J Am Soc Echocardiogr. 2016; 29(6): 537–544.
- Motoki H, Negishi K, Kusunose K, et al. Global left atrial strain in the prediction of sinus rhythm maintenance after catheter ablation for atrial fibrillation. J Am Soc Echocardiogr. 2014; 27(11): 1184–1192.
