Key result
Increased left atrial mechanical dispersion and reduced reservoir strain predict new-onset AF in mild rheumatic MS.
Why the study?
Chronic LA pressure overload and rheumatic inflammation cause subclinical atrial remodeling, but whether advanced atrial deformation parameters identify patients with mild rheumatic MS at increased risk of AF remained unclear.
Do left atrial strain and mechanical dispersion predict the onset of atrial fibrillation in patients with mild rheumatic mitral stenosis?
Cohort (n=211)
Do left atrial strain and mechanical dispersion predict the onset of atrial fibrillation in patients with mild rheumatic mitral stenosis?
Hazard Ratio: 1.047 (95% CI 1.02–1.06)
p-value: p=<0.001
Left atrial mechanical dispersion and reservoir strain are independent predictors of new-onset atrial fibrillation in patients with mild rheumatic mitral stenosis, suggesting a role for advanced echocardiography in risk stratification.
May support strain echocardiography for AF risk stratification in mild rheumatic MS; leaves open whether it alters management or outcomes.
A BSTRACT Objectives: Chronic left atrial (LA) pressure overload and rheumatic inflammation cause subclinical atrial remodeling even without severe valvular stenosis. This study intended to determine whether advanced atrial deformation parameters identify patients with increased risk of atrial fibrillation (AF) from mild rheumatic mitral stenosis (MS). Materials and Methods: A prospective cohort study of patients with mild rheumatic MS and sinus rhythm was conducted in Baghdad, Iraq. LA Reservoir Strain (LASr) and LA Mechanical Dispersion (LAMD) were calculated via two-dimensional strain echocardiography at baseline. Patients were followed up for at least 2 years. The primary outcome was the occurrence of AF. Results: Of 211 patients, 39 were found to have new-onset AF. The two strain parameters remained independent predictors of new-onset AF on multivariable Cox proportional hazards regression analysis. New AF occurrence was positively correlated with LAMD (adjusted Hazard ratio [aHR]: 1.047 [95% confidence interval (CI): 1.02–1.06], P < 0.001) and inversely correlated with LASr (aHR: 0.848 [95% CI: 0.79–0.90], P < 0.001). The optimal thresholds for LAMD and LASr for predicting new AF were >58.7 ms and ≤16.6%, respectively, which were defined by the Receiver Operating Characteristic curve. Conclusion: The presence of subclinical electromechanical dysfunction is an independent predictor of AF in mild rheumatic MS. Recognizing this high-risk phenotype supports closer ambulatory rhythm monitoring to allow timely arrhythmia detection and subsequent initiation of anticoagulation to prevent thromboembolic events.
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Abdulameer Jasim Jawad Al-Gburi (2026) conducted a cohort in mild rheumatic mitral stenosis (n=211). Left atrial mechanical dispersion and reservoir strain was evaluated on occurrence of atrial fibrillation (HR 1.047, 95% CI 1.02-1.06, p=<0.001). Left atrial mechanical dispersion (aHR 1.047; 95% CI 1.02-1.06) and reservoir strain (aHR 0.848; 95% CI 0.79-0.90) independently predicted new-onset atrial fibrillation in mild rheumatic MS.
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