Exploring Hidden Left Ventricular Dysfunction in COPD Patients without Pulmonary Hypertension

Background: Atrial fibrillation (AF) is associated with left atrial (LA) mechanical dysfunction and an increased risk of thromboembolism, most commonly originating from the left atrial appendage (LAA). Although transesophageal echocardiography (TEE) is the reference standard for detecting LAA thrombus, its semi-invasive nature limits routine use. Left atrial strain assessed by speckle-tracking echocardiography may provide a non-invasive marker of atrial mechanical impairment. Aim: To assess the value of left atrial strain parameters in predicting left atrial appendage thrombosis in patients with non-valvular atrial fibrillation. Methods: This cross-sectional study included 42 patients with non-valvular atrial fibrillation referred for clinically indicated TEE. All patients underwent transthoracic echocardiography with two-dimensional speckle-tracking analysis to measure LA reservoir, conduit, and contractile strains. TEE was performed to assess LAA thrombus, spontaneous echo contrast, and LAA emptying velocities. Statistical analysis included group comparisons and receiver operating characteristic (ROC) curve analysis. Results: LAA thrombus was present in 21/42 (50.0%) patients. LA reservoir strain was significantly lower in patients with thrombus compared with those without thrombus (6.63 ± 2.55% vs 23.72 ± 2.24%, p < 0.001). LA conduit strain and LA contractile strain were also significantly reduced in the thrombus group compared with the non-thrombus group (p < 0.001 for both). Average E/e′ ratio demonstrated excellent diagnostic performance for prediction of LAA thrombus with an optimal cutoff value > 11.6, achieving 100% sensitivity and specificity in this cohort. Conclusion: Left atrial reservoir strain is a strong non-invasive predictor of left atrial appendage thrombosis in non-valvular atrial fibrillation. Incorporating LA strain assessment into routine transthoracic echocardiography may improve thromboembolic risk stratification and guide the need for transesophageal imaging.