Research Article
BibTex RIS Cite

Atrial Dispersion Predicts Atrial Fibrillation in Mitral Stenosis: A Five-Year Follow-Up SpeckleTracking Echocardiography Study

Year 2023, Volume: 26 Issue: 1, 27 - 33, 21.03.2023

Abstract

Introduction: Atrial dispersion showing increased electrical heterogeneity may be associated with the occurence of atrial fibrillation (AF). In our study, it was aimed to investigate the effects of atrial dispersion evaluated by speckle tracking echocardiography on the occurence of AF on in patients with mild to moderate rheumatic mitral stenosis.

Patients and Methods: Sixty-two patients with rheumatic mitral stenosis with sinus rhythm, asymptomatic or NYHA 1 symptoms were included in the study. The time to peak atrial strain was measured for each segment by speckle tracking echocardiography in two and four-chamber views. Atrial dispersion was calculated by taking the standard deviation of time to peak strain in 12 left atrial segments. Echocardiographic and clinical parameters of the patients were compared according to the development of AF.

Results: During follow-up (mean follow-up duration, 49.9 ± 12.9 months), 19 patients (30%) developed AF. Compared to patients who did not develop AF at follow-up, patients with AF were older (46.8 ± 10.2 vs. 35.9 ± 12, p= 0.001), while mitral valve area (MVA) (1.38 ± 0.1 vs. ± 1.49 ± 0.18 vs. p= 0.02), PALS (13.7 ± 4 vs. 18.8 ± 5.5, p= 0.001) and PACS (6 ± 2.3 vs. 8.2 ± 3.8, p= 0.002) were found to be lower. Atrial dispersion was found to be increased in patients who developed AF (63.2 ± 13.5 vs. 46.1 ± 22.3, p= 0.003). Age, atrial dispersion and PALS were determined as independent predictors of AF development in Cox regression analysis.

Conclusion: Atrial dispersion, a new parameter measured by STE, predicts the development of AF. Increased atrial dispersion may provide additional benefits in initiating prophylactic antiarrhythmic drug therapy or anticoagulants.

References

  • 1. Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet 2009;374(9697):1271-83.
  • 2. Chugh SS, Blackshear JL, Shen WK, Hammill SC, Gersh BJ. Epidemiology and natural history of atrial fibrillation: Clinical implications. J Am Coll Cardiol 2001;37(2):371-8.
  • 3. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol 2021;77(4):450-500.
  • 4. Josephson ME, Kastor JA, Morganroth J. Electrocardiographic left atrial enlargement. Electrophysiologic, echocardiographic and hemodynamic correlates. Am J Cardiol 1977;39(7):967-71.
  • 5. Kim HJ, Cho GY, Kim YJ, Kim HK, Lee SP, Kim HL, et al. Development of atrial fibrillation in patients with rheumatic mitral valve disease in sinus rhythm. Int J Cardiovasc Imaging 2015;31(4):735-42.
  • 6. Krishnamoorthy KM, Dash PK. Prediction of atrial fibrillation in patients with severe mitral stenosis-role of atrial contribution to ventricular filling. Scand Cardiovasc J 2003;37(6):344-8.
  • 7. Ozaydin M, Turker Y, Varol E, Alaca S, Erdogan D, Yilmaz N, et al. Factors associated with the development of atrial fibrillation in patients with rheumatic mitral stenosis. Int J Cardiovasc Imaging 2010;26(5):547-52.
  • 8. Karabay CY, Zehir R, Güler A, Oduncu V, Kalayci A, Aung SM, et al. Left atrial deformation parameters predict left atrial appendage function and thrombus in patients in sinus rhythm with suspected cardioembolic stroke: A speckle tracking and transesophageal echocardiography study. Echocardiography 2013;30(5):572-81.
  • 9. Okamatsu K, Takeuchi M, Nakai H, Nishikage T, Salgo IS, Husson S, et al. Effects of aging on left atrial function assessed by two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogr 2009;22(1):70-5.
  • 10. Vianna-Pinton R, Moreno CA, Baxter CM, Lee KS, Tsang TSM, Appleton CP. 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.
  • 11. Saraiva RM, Demirkol S, Buakhamsri A, Greenberg N, Popović ZB, Thomas JD, et al. Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr 2010;23(2):172-80.
  • 12. Candan O, Gecmen C, Kahyaoğlu M, Şimsek Z, Çelik M, Uslu A, et al. Clinical utility of left atrial asynchrony and mechanical function in patients with hypertrophic cardiomyopathy. Acta Cardiol Sin 2022;38(2):141-50.
  • 13. Shang Z, Su D, Cong T, Sun Y, Liu Y, Chen N, et al. Assessment of left atrial mechanical function and synchrony in paroxysmal atrial fibrillation with two-dimensional speckle tracking echocardiography. Echocardiography (Mount Kisco, NY). 2017;34(2):176-83.
  • 14. Kawakami H, Ramkumar S, Nolan M, Wright L, Yang H, Negishi K, et al. Left atrial mechanical dispersion assessed by strain echocardiography as an independent predictor of new-onset atrial fibrillation: A case-control study. J Am Soc Echocardiogr 2019;32(10):1268-76.e3.
  • 15. Sarvari SI, Haugaa KH, Stokke TM, Ansari HZ, Leren IS, Hegbom F, et al. Strain echocardiographic assessment of left atrial function predicts recurrence of atrial fibrillation. Eur Heart J Cardiovasc Imaging 2016;17(6):660-7. 16. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021;42(5):373-498.
  • 17. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Eur J Echocardiogr 2009;10(1):1-25.
  • 18. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, 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. Eur Heart J Cardiovasc Imaging 2015;16(3):233-70. 19. Schabelman S, Schiller NB, Silverman NH, Ports TA. Left atrial volume estimation by two-dimensional echocardiography. Cathet Cardiovasc Diagn 1981;7(2):165-78.
  • 20. Pepi M, Tamborini G, Galli C, Barbier P, Doria E, Berti M, et al. A new formula for echo-Doppler estimation of right ventricular systolic pressure. J Am Soc Echocardiogr 1994;7(1):20-6.
  • 21. Jaïs P, Peng JT, Shah DC, Garrigue S, Hocini M, Yamane T, et al. Left ventricular diastolic dysfunction in patients with so-called lone atrial fibrillation. J Cardiovasc Electrophysiol 2000;11(6):623-5.
  • 22. Satoh T, Zipes DP. Unequal atrial stretch in dogs increases dispersion of refractoriness conducive to developing atrial fibrillation. J Cardiovasc Electrophysiol 1996;7(9):833-42.
  • 23. Cameli M, Lisi M, Reccia R, Bennati E, Malandrino A, Solari M, et al. Pre-operative left atrial strain predicts post-operative atrial fibrillation in patients undergoing aortic valve replacement for aortic stenosis. Int J Cardiovasc Imaging 2014;30(2):279-86.
  • 24. Pham TD, Fenoglio JJJ. Right atrial ultrastructural in chronic rheumatic heart disease. Int J Cardiol 1982;1(3-4):289-304.
  • 25. Verdejo HE, Becerra E, Zalaquet R, Del Campo A, Garcia L, Troncoso R, et al. Atrial function assessed by speckle tracking echocardiography is a good predictor of postoperative atrial fibrillation in elderly patients. Echocardiography 2016;33(2):242-8.
  • 26. Pourafkari L, Ghaffari S, Bancroft GR, Tajlil A, Nader ND. Factors associated with atrial fibrillation in rheumatic mitral stenosis. Asian Cardiovasc Thorac Ann 2015;23(1):17-23.
  • 27. Ancona R, Comenale Pinto S, Caso P, Di Salvo G, Severino S, D’Andrea A, et al. Two-dimensional atrial systolic strain imaging predicts atrial fibrillation at 4-year follow-up in asymptomatic rheumatic mitral stenosis. J Am Soc Echocardiogr 2013;26(3):270-7.
  • 28. Kawakami H, Ramkumar S, Nolan M, Wright L, Yang H, Negishi K, et al. Left atrial mechanical dispersion assessed by strain echocardiography as an independent predictor of new-onset atrial fibrillation: A case-control study. J Am Soc Echocardiogr 2019;32(10):1268-76.e3.
  • 29. Degiovanni A, Bortnik M, Dell’Era G, Bolzani V, Occhetta E, Bellomo G, et al. Analysis of electrical and mechanical left atrial properties in patients with persistent atrial fibrillation. Int J Cardiovasc Imaging 2013;29(1):71- 8.
  • 30. Kupczynska K, Michalski BW, Miskowiec D, Kasprzak JD, Szymczyk E, Wejner-Mik P, et al. Incremental value of left atrial mechanical dispersion over CHA2DS2-VASc score in predicting risk of thrombus formation. Echocardiography 2018;35(5):651-60.
  • 31. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2022;43(7):561-632.
There are 29 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Investigations
Authors

Özkan Candan This is me 0000-0001-7700-645X

Publication Date March 21, 2023
Published in Issue Year 2023 Volume: 26 Issue: 1

Cite

Vancouver Candan Ö. Atrial Dispersion Predicts Atrial Fibrillation in Mitral Stenosis: A Five-Year Follow-Up SpeckleTracking Echocardiography Study. Koşuyolu Heart Journal. 2023;26(1):27-33.