Key result
Future AF is linked to ~6-point lower baseline peak atrial longitudinal strain.
Why the study?
The most appropriate modality and duration of heart rhythm monitoring to detect AF remain non-consensual despite a broadening spectrum of techniques.
Are decreased baseline peak atrial longitudinal strain (PALS) and contraction strain rate (pLAct) in sinus rhythm associated with the development of future atrial fibrillation?
Meta-Analysis (n=1,230)
Are decreased baseline peak atrial longitudinal strain (PALS) and contraction strain rate (pLAct) in sinus rhythm associated with the development of future atrial fibrillation?
Mean Difference: -5.55 (95% CI -7.06–-4.03)
Decreased peak atrial longitudinal strain and contraction strain rate measured in sinus rhythm are significant predictors of future atrial fibrillation, highlighting their potential utility in risk stratification and guiding prolonged rhythm monitoring.
Lower PALS may aid AF risk stratification; extends meta-analytic support for strain imaging but requires prospective validation.
Despite the broadening spectrum of heart rhythm-monitoring techniques, the most appropriate modality and duration to detect atrial fibrillation (AF) are not consensual. Two-dimensional speckle tracking for left atrial strain analysis seems feasible to detect atrial cardiomyopathy, which represents a substrate for AF. We aimed to perform a systematic review and meta-analysis on peak atrial longitudinal strain (PALS) and contraction strain rate (pLAct) differences as primary outcomes measured in sinus rhythm (SR) between patients with and without future AF during follow-up (FU). Random-effect model was used. For continuous outcomes, we calculated weighted mean differences (WMD) to compare the two groups We identified eight eligible articles consisting of 1230 patients. Six articles were eligible for quantitative PALS analysis, while three were eligible regarding pLAct. The baseline parameters of the future AF and SR patients were comparable in most of the papers. The PALS value in patients developing future AF was significantly lower compared to patients with no AF (WMD: -5.55% 95% CI -7.06 to -4.03%). Pooled WMD of pLAct between the groups was -0.44 1/s, 95% CI: -0.56 to -0.33 1/s. Baseline PALS and pLAct values of future AF patients were significantly lower than those who remained in SR during FU. PALS and pLAct seem to be sensitive parameters which can be implemented in a predictive model for AF enabling us to find patients who need prolonged heart rhythm-monitoringand it can be also a guidance for oral anticoagulation indication setting.
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Mészáros et al. (2025) conducted a meta-analysis in Atrial Cardiomyopathy / Risk of Atrial Fibrillation (n=1,230). Future atrial fibrillation development vs. Remaining in sinus rhythm during follow-up was evaluated on Baseline peak atrial longitudinal strain (PALS) (WMD -5.55%, 95% CI -7.06 to -4.03). Patients who developed future atrial fibrillation had significantly lower baseline peak atrial longitudinal strain (PALS) compared to those who remained in sinus rhythm (WMD -5.55%, 95% CI -7.06 to -4.03%).
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