Key result
Volume-normalized peak-positive LA strain is linked to lower prothrombotic risk independent of CHA2DS2-VASc score.
Why the study?
Left atrial deformation parameters are emerging markers of atrial remodeling in AF and AFL, but their ability to predict thrombotic risk and electrical cardioversion success is unclear.
Do left atrial deformation parameters predict thrombotic risk and successful electrical cardioversion in patients with atrial fibrillation or flutter?
Cohort (n=56)
No
Do left atrial deformation parameters predict thrombotic risk and successful electrical cardioversion in patients with atrial fibrillation or flutter?
Left atrial strain parameters, specifically peak-positive and peak-negative strain normalized by LA volume, can identify patients with AF or AFL at high risk for thrombosis and unsuccessful electrical cardioversion.
LA strain-volume index may refine AF thrombotic risk assessment beyond CHA2DS2-VASc; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: Left atrial deformation (LAD) parameters are new markers of atrial structural remodelling that seem to be affected in atrial fibrillation (AF) and atrial flutter (AFL). This study aimed to determine whether LAD can identify patients with a higher risk of thrombosis and unsuccessful electrical cardioversion (ECV). METHODS: Retrospective study including 56 patients with AF or AFL undergoing ECV, with previous transthoracic (TTE) and transoesophageal echocardiography (TEE) studies. Echocardiographic parameters analysed were as follows: left ventricle function, left atrium (LA) dimensions, LAD parameters (positive and negative strain peaks), left atrial appendage (LAA) filling and emptying velocities and the presence of thrombi. Strain values were analysed according to thrombotic risk and success of ECV. RESULTS: Lower mean values of peak-positive strain (PPS) in patients with prothrombotic velocities (<25 cm/s) and a higher incidence of thrombi in LAA were observed compared with those with normal velocities. Multivariate analysis revealed PPS normalised by LA maximum volume indexed by body surface area (BSA) to be associated with prothrombotic risk (odds ratio 0.000 (95% CI: 0.000-0.243), P 0.017), regardless of CHADs2VASC score. Peak-negative strain normalised by LA volumes indexed by BSA were associated with unsuccessful ECV. CONCLUSIONS: Atrial deformation parameters identify AF and AFL patients with a high risk of thrombosis and unsuccessful ECV. Therefore, these new parameters should be included in anticoagulation management and rhythm vs rate control strategies.
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Costa et al. (2016) conducted a cohort in Atrial fibrillation and atrial flutter (n=56). Peak-positive strain normalized by LA maximum volume indexed by BSA vs. Normal LAA velocities was evaluated on Prothrombotic risk (LAA velocities <25 cm/s or thrombus) (OR 0.000, 95% CI 0.000-0.243, p=0.017). Peak-positive strain normalized by left atrial maximum volume indexed by body surface area was significantly associated with prothrombotic risk (OR 0.000) regardless of CHADs2VASC score.
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