Sol atriyal apendiks straini ve P dalga dispersiyonu: paroksismal atriyal fibrilasyonun elektro-mekanik belirteçleri

Yıl 2025, Cilt: 6 Sayı: 3, 199 - 206, 18.06.2025

Ayşe İrem Demirtola , Duygu İnan , Anar Mammadli , Eyüp Özkan , İsmail Balaban , İrem Müge Akbulut , Hüseyin Akgün , Gamze Acar , Gülnur Çolak , Ahmet Güler , Gökhan Kahvecı

https://doi.org/10.47582/jompac.1652473

Öz

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.

Anahtar Kelimeler

Paroksismal atriyal fibrilasyon , Sol atriyal apendiks straini , P dalga dispersiyonu , Speckle-tracking ekokardiyografi , Atriyal fibrilasyon öngörüsü

Proje Numarası

None

Left atrial appendage strain and P-wave dispersion: electro-mechanical markers of paroxysmal atrial fibrillation

Öz

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<0.001) and higher PWD (30.3 [27.6-34.5] ms vs. 20.9 [17.3-26.6] ms, p<0.001). In multivariable analysis, LAA-Sr (OR: 1.315, 95% confidence interval [CI]: 1.201-1.439, p<0.001) and PWD (OR: 1.128, 95% CI: 1.054-1.215, p=0.038) were independent PAF predictors. Model 3, which included both parameters, demonstrated the best predictive performance (AUC: 0.983, sensitivity: 92.8%, specificity: 79.4%) compared to model 1 (AUC: 0.890) and model 2 (AUC: 0.950).
Conclusion: Our study highlights LAA strain and PWD as robust, independent predictors of PAF. The combination of mechanical and electrophysiological markers enhances AF risk stratification and early detection. Future prospective, multicenter studies are warranted to validate these findings and optimize risk assessment strategies for PAF.

Anahtar Kelimeler

Atrial fibrillation , left atrial appendage , transesophageal echocardiography , electrocardiography , prediction algorithms

Etik Beyan

Ethical approval for this study was obtained from the Başakşehir Çam and Sakura City Hospital Clinical Research Ethics Committee (Protocol No: 2022-136), and all procedures were conducted in accordance with the Declaration of Helsinki.

Destekleyen Kurum

None

Proje Numarası

None

Teşekkür

None

Kaynakça

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