TY  - JOUR
T1  - Left atrial appendage strain and P-wave dispersion: electro-mechanical markers of paroxysmal atrial fibrillation
TT  - Sol atriyal apendiks straini ve P dalga dispersiyonu: paroksismal atriyal fibrilasyonun elektro-mekanik belirteçleri
AU  - Demirtola, Ayşe İrem
AU  - İnan, Duygu
AU  - Mammadli, Anar
AU  - Özkan, Eyüp
AU  - Balaban, İsmail
AU  - Akbulut, İrem Müge
AU  - Akgün, Hüseyin
AU  - Acar, Gamze
AU  - Çolak, Gülnur
AU  - Güler, Ahmet
AU  - Kahvecı, Gökhan
PY  - 2025
DA  - June
Y2  - 2025
DO  - 10.47582/jompac.1652473
JF  - Journal of Medicine and Palliative Care
JO  - J Med Palliat Care / JOMPAC / Jompac
PB  - MediHealth Academy Yayıncılık
WT  - DergiPark
SN  - 2717-7505
SP  - 199
EP  - 206
VL  - 6
IS  - 3
LA  - en
AB  - Aims: Paroxysmal atrial fibrillation (PAF) is a major clinical challenge due to its intermittent nature and the difficulty of early detection. Left atrial appendage (LAA) function plays a crucial role in atrial mechanics, while P-wave dispersion (PWD) reflects electrical inhomogeneity. We hypothesized that both parameters would independently and synergistically predict PAF and aimed to develop an integrative electro-mechanical model to enhance risk stratification.Methods: We retrospectively analyzed 191 patients, including 91 with PAF and 100 in sinus rhythm (SR). LAA function was assessed using speckle-tracking echocardiography, and PWD was measured digitally from 12-lead electrocardiography. Multivariable logistic regression models were constructed: model 1 included clinical parameters, model 2 incorporated PWD, and Model 3 further added LAA strain reservoir (LAA-Sr)Results: PAF patients exhibited significantly lower LAA-Sr (14.7 % [12.2-18.0] vs. 21.6% [19.1-25.3], p
KW  - Atrial fibrillation
KW  - left atrial appendage
KW  - transesophageal echocardiography
KW  - electrocardiography
KW  - prediction 
algorithms
N2  - Giriş ve Amaç:Paroksismal atriyal fibrilasyon (PAF), aralıklı doğası ve erken tespitinin zorluğu nedeniyle önemli bir klinik sorundur. Sol atriyal apendiks (LAA) fonksiyonu, atriyal mekanikte kritik bir rol oynarken, P dalga dispersiyonu (PWD) elektriksel inhomojeniteyi yansıtır. Bu çalışmada, LAA straini ve PWD’nin PAF tespitindeki öngörücü değerini değerlendirmeyi ve mekanik ile elektrofizyolojik parametreleri entegre eden bir prediktif model oluşturmayı amaçladık.Yöntemler:Gerçekleştirilen retrospektif analizde, 91 PAF ve 100 sinüs ritmindeki (SR) hasta olmak üzere toplam 191 hasta değerlendirildi. LAA fonksiyonu speckle-tracking ekokardiyografi ile, PWD ise 12 derivasyonlu EKG’den dijital olarak ölçüldü. Çok değişkenli lojistik regresyon modelleri oluşturuldu: Model 1’de klinik parametreler, Model 2’de ek olarak PWD, Model 3’te ise LAA strain rezervuar (LAA-Sr) eklendi.Bulgular:PAF hastaları, belirgin şekilde daha düşük LAA-Sr (%14,7 [12,2–18,0] vs. %21,6 [19,1–25,3], p  < 0.001) ve daha yüksek PWD (30,3 [27,6–34,5] ms vs. 20,9 [17,3–26,6] ms, p  < 0.001) değerlerine sahipti. Çok değişkenli analizde, LAA-Sr (OR: 1,315, %95 CI: 1,201–1,439, p  < 0.001) ve PWD (OR: 1,128, %95 CI: 1,054–1,215, p = 0.038) bağımsız PAF prediktörleri olarak saptandı. Model 3, en iyi prediktif performansı gösterdi (AUC: 0.983, duyarlılık: %74, özgüllük: %72) ve Model 1 (AUC: 0.890) ile Model 2’ye (AUC: 0.950) kıyasla üstün bulundu.Sonuç:Çalışmamız, LAA straini ve PWD’nin PAF için güçlü ve bağımsız öngörücüler olduğunu ortaya koymaktadır. Mekanik ve elektrofizyolojik belirteçlerin kombinasyonu, AF risk sınıflandırmasını ve erken tespiti güçlendirebilir. Bu bulguların doğrulanması ve PAF risk değerlendirme stratejilerinin optimize edilmesi için gelecekte prospektif, çok merkezli çalışmalar gerekmektedir.
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UR  - https://doi.org/10.47582/jompac.1652473
L1  - https://dergipark.org.tr/en/download/article-file/4666372
ER  -