Role of 2D speckle-tracking echocardiography in the assessment of left atrial function and its relation to the presence of left atrial appendage thrombus in patients with non-valvular paroxysmal atrial fibrillation

Introduction The study aimed to evaluate the role of speckle-tracking echocardiography (STE) in the assessment of left atrial (LA) function and its relation to the presence of left atrial appendage thrombus (LAAT) compared with the gold standard transesophageal echocardiography (TEE) among patients with nonvalvular paroxysmal atrial fibrillation (AF).Patients and methods Forty five patients with nonvalvular paroxysmal AF were included in the study. All patients underwent transthoracic echocardiography (TTE) immediately prior to or following clinically indicated TEE. LA deformation parameters such as left atrial global longitudinal strain-reservoir (LAGLS-RES), left atrial global longitudinal strain pump (LAGLS-pump), left atrial strain rate systolic (LA SR S), left atrial strain rate emptying (LA SR E), and left atrial strain rate atrial (LA SR A) were measured using 2D-STE. Through TEE, we assessed the presence of LAAT, left atrial appendage ejection fraction (LAA EF), left atrial appendage emptying (LAA E), and left atrial appendage filling (LAA F) velocities. Patients were divided into two groups according to the presence of LAAT.Results LAAT was detected in 14 (31%) patients of our study population. STE-derived LAGLS-RES, LAGLS-pump, and LA SR A values were found to be significantly lower in patients with LAAT. There was positive correlation between LAA E velocity and LAGLS-RES, LAGLS-pump, LA SR S, and LA SR A (r=0.358, P<0.02; r=0.433, P<0.002; r=0.378, P<0.01; and r=0.390, P<0.01, respectively). The area under the receiver operating characteristic curve of LAGLS-RES, LAGLS-Pump, and LA SR A to discriminate patients with LAAT from those without LAAT was 0.74, 0.73, and 0.79, respectively. From all variables examined in the study LASRA was the strongest variable associated with the presence of LAAT.Conclusion 2-D STE can be used for the assessment of LA mechanical function and discriminate patients with LAAT from those without LAAT compared with the gold standard TEE among patients with non-valvular paroxysmal AF.