Does the left atrial stiffness index predict recurrence of atrial fibrillation in patients undergoing pulmonary vein isolation?
An increased left atrial stiffness index, derived from invasive pressure and echocardiographic strain, independently predicts atrial fibrillation recurrence after pulmonary vein isolation.
INTRODUCTION: An increased left atrial (LA) stiffness reflects the structural remodeling and deterioration of the LA function. This study was designed to estimate LA stiffness by measuring a combination of the strain and LA pressure in patients undergoing pulmonary vein isolation (PVI) of atrial fibrillation (AF) and to evaluate the influence of the LA stiffness on the cardiac function, serum markers, and recurrence of AF after PVI. METHODS: In 155 consecutive patients with AF, the brain natriuretic peptide (BNP) and aminoterminal procollagen type III propeptide (PIIIP) plasma levels were measured before the PVI. The difference between the minimum and maximum LA systolic pressures was directly measured by a transseptal puncture. The ratio of the difference in the LA pressures to the peak systolic LA strain evaluated by speckle-tracking echocardiography was used as an index of the LA stiffness. RESULTS: The calculated LA stiffness index was related to the BNP level (r(s) = 0.444, P < 0.001), E/E' ratio (r(s) = 0.444, P < 0.001), LA volume index (r(s) = 0.370, P < 0.001), and PIIIP level (r(s) = 0.305, P = 0.002). During a mean follow-up period of 33.8 ± 12.2 months, 45 patients (29%) presented with AF recurrences. A Cox proportional hazard regression analysis showed the LA stiffness index was an independent predictor of recurrence of AF (HR 2.88; 95% CI 1.75 to 4.73, P < 0.001). CONCLUSIONS: In patients with AF, the LA stiffness index is related to left ventricular diastolic dysfunction, LA dilatation, and collagen synthesis and may predict AF recurrences after PVI.
Machino‐Ohtsuka et al. (Fri,) studied this question.