Key result
Left atrial reservoir strain (LASr) ≤34.1% identified occult atrial fibrillation in asymptomatic populations with 75.4% sensitivity and 87.6% specificity.
Why the study?
Occult AF is a significant risk factor for occult stroke but is difficult to detect.
Does left atrial strain measured by speckle tracking echocardiography improve the identification of occult atrial fibrillation compared to conventional echocardiographic indicators?
Observational (n=354)
Does left atrial strain measured by speckle tracking echocardiography improve the identification of occult atrial fibrillation compared to conventional echocardiographic indicators?
Left atrial reservoir strain (LASr) ≤34.1% measured by speckle tracking echocardiography is a sensitive and specific marker for identifying occult atrial fibrillation in asymptomatic patients.
LASr may aid occult AF detection beyond conventional echo; leaves open prospective validation before screening adoption.
OBJECTIVE: Occult atrial fibrillation (AF) is a significant risk factor for occult stroke but is difficult to detect. Myocardial strain, based on speckle tracking echocardiography (STE), can detect subclinical changes in left atrial (LA) function. This study aimed to investigate the diagnostic value of LA strain in identifying asymptomatic AF patients with normal electrocardiograms and healthy volunteers. METHODS: A total of 354 subjects were retrospectively enrolled. Patients were divided into two groups based on whether they had AF during echocardiography. Patients with sinus rhythm during echocardiography were further divided into healthy control group and occult AF group. Patients with AF during echocardiography were further divided into paroxysmal AF group and persistent AF group. LA mechanical function measured by STE was compared between patients with asymptomatic AF and volunteers. Conventional echocardiographic indicators were measured. The diagnostic value of LA strain for identifying asymptomatic AF was assessed by univariate and multivariate regression analysis and receiver operating characteristic (ROC) curves. RESULTS: Occult AF patients had higher NT-proBNP levels, larger RA area, larger LAVmax and decreased LAEF than control group. However, occult AF patients had lower NT-proBNP levels, RA area and LAVmax and higher LAEF than paroxysmal and persistent AF. The measured LA reservoir strain (LASr), LA conduit strain (LAScd), LA contraction strain (LASct) of occult AF group was significantly lower than that of control group. However, occult AF patients had preserved LAScd and LASct than paroxysmal and persistent AF. RA area, LAEF and LASr were remarkable correlation with occult AF after adjustment for NT-proBNP, LAVmax, and LAScd. The area under curve of ROC for LASr was the greatest among RA area, LAEF and LASr, with a cut-off value of 34.1% (sensitivity: 75.4%, specificity: 87.6%). CONCLUSION: LASr can identify occult AF in the asymptomatic population. Patients with LASr values ≤34.1% have a higher incidence of occult cardiac dysfunction. These findings help identify patients with occult AF and further risk stratification for the AF population.
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Zhao et al. (2023) conducted an observational in Occult atrial fibrillation (n=354). Left atrial reservoir strain (LASr) vs. Healthy controls and patients with paroxysmal or persistent AF was evaluated on Identification of occult atrial fibrillation. Left atrial reservoir strain (LASr) ≤34.1% identified occult atrial fibrillation in asymptomatic populations with 75.4% sensitivity and 87.6% specificity.
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