Key result
Impaired LAScd linked to ~24% higher AF risk per unit increase in severe COVID-19.
Why the study?
Atrial fibrillation is common in COVID-19 pneumonia, and left atrial strain analysis was evaluated to assess its ability to predict atrial fibrillation in patients with severe hypoxemic COVID-19 pneumonia.
Does automated left atrial strain analysis predict the occurrence of atrial fibrillation in adult patients with severe COVID-19 pneumonia?
Cohort (n=79)
No
Does automated left atrial strain analysis predict the occurrence of atrial fibrillation in adult patients with severe COVID-19 pneumonia?
Odds Ratio: 1.24 (95% CI 1.04–1.48)
p-value: p=0.018
Automated left atrial strain analysis, specifically left atrial strain during the conduit phase (LAScd), is a useful predictor of atrial fibrillation development in patients with severe COVID-19 pneumonia.
May support closer AF monitoring in severe COVID-19; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Atrial fibrillation (AF) is the most documented arrhythmia in COVID-19 pneumonia. Left atrial (LA) strain (LAS) analysis, a marker of LA contractility, have been associated with the development of AF in several clinical situations. We aimed to assess the diagnostic ability of LA strain parameters to predict AF in patients with severe hypoxemic COVID-19 pneumonia. We conducted a prospective single center study in Amiens University Hospital intensive care unit (ICU) (France). Adult patients with severe or critical COVID-19 pneumonia according to the World Health Organization definition and in sinus rhythm were included. Transthoracic echocardiography was performed within 48 h of ICU admission. LA strain analysis was performed by an automated software. The following LA strain parameters were recorded: LA strain during reservoir phase (LASr), LA strain during conduit phase (LAScd) and LA strain during contraction phase (LASct). The primary endpoint was the occurrence of AF during ICU stay. RESULTS: From March 2020 to February of 2021, 79 patients were included. Sixteen patients (20%) developed AF in ICU. Patients of the AF group were significantly older with a higher SAPS II score than those without AF. LAScd and LASr were significantly more impaired in the AF group compared to the other group (- 8.1 [- 6.3; - 10.9] vs. - 17.2 [- 5.0; - 10.2] %; P < 0.001 and 20.2 [12.3;27.3] % vs. 30.5 [23.8;36.2] %; P = 0.002, respectively), while LASct did not significantly differ between groups (p = 0.31). In a multivariate model, LAScd and SOFA cv were significantly associated with the occurrence of AF. A LAScd cutoff value of - 11% had a sensitivity of 76% and a specificity of 75% to identify patients with AF. The 30-day cumulative risk of AF was 42 ± 9% with LAScd > - 11% and 8 ± 4% with LAScd ≤ - 11% (log rank test P value < 0.0001). CONCLUSION: For patients with severe COVID-19 pneumonia, development of AF during ICU stay is common (20%). LAS parameters seem useful in predicting AF within the first 48 h of ICU admission. TRIAL REGISTRATION: NCT04354558.
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Beyls et al. (2021) conducted a cohort in Severe hypoxemic COVID-19 pneumonia (n=79). Left atrial strain during conduit phase (LAScd) vs. Unexposed/reference (lower LAScd) was evaluated on Occurrence of atrial fibrillation during ICU stay (OR 1.24, 95% CI 1.04-1.48, p=0.018). Impaired left atrial strain during the conduit phase (LAScd) was independently associated with the occurrence of atrial fibrillation in severe COVID-19 pneumonia, with an OR of 1.24 for each 1% increase.
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