Can we refine the natural history of atrial fibrillation by considering baseline echocardiographic parameters?

Introduction Few studies have described 4-cardiac cavities remodelling using 2D transthoracic echocardiography (TTE), including strain cavities parameters in atrial fibrillation (AF) patients. In addition, the potential association of cardiac remodelling with the evolution of cardiac rhythm has been poorly investigated. Hypothesis.We hypothesized that baseline echocardiographic characteristics including strain cavities parameters could further differentiate patients according to their cardiac rhythm at mid-term follow-up, as a marker of AF burden. Methods We prospectively evaluated at baseline 225 patients hospitalized for AF with a complete follow up at 2 years. using 2D transthoracic echocardiography (TTE) parameters and four-chambers strains off-line analysed with Tomtec software. Patients were divided into two groups according to their cardiac rhythm at 2 years follow up: sinus rhythm (M24 SR group, 169 patients) or atrial fibrillation (M24 AF group, 56 patients). Results The main baseline characteristics of the population according to cardiac rhythm at M24 are detailed in Table 1. We observed significant differences between the 2 groups, with regard to age (higher in M24 AF group), history of atrial fibrillation, heart failure and myocardial infarction (more frequent in M24 SR group for all). At admission using 2D TTE, M24 AF group had in comparison with M24 SR group higher left atrial end-systolic indexed volume , higher E/e’ and higher systolic pulmonary arterial pressure. We found no significant differences in left ventricular ejection fraction and right atrial end-systolic volume indexed (Table 1). At admission using 2D strain, M24 AF group had in comparison with M24 SR group lower LA reservoir strain (respectively 8.7 (6.4-13.0) versus 11.4 (7.2-24.2) ml/m2, p=0.005) and lower RA reservoir strain (respectively 12.4 (7.6-18.7) versus 16.6 (10.8-29.1) ml/m2, p=0.004) . No significant differences were observed between the 2 groups with regard to LV and RV strain (Figure 1). Conclusions Baseline 4-cardiac cavities remodeling in AF, including the evaluation of strain parameters, seems to be associated with the natural history of cardiac rhythm at two-years follow-up and could be related to the AF burden.