Key result
Impaired LA reservoir strain is linked to ~7-fold higher AF risk in rheumatic mitral stenosis.
Why the study?
Prediction of new-onset atrial fibrillation by assessing left atrial mechanics with speckle-tracking echocardiography in patients with rheumatic mitral stenosis might improve risk stratification and guide therapy.
Does left atrial reservoir strain and strain rate assessment predict new-onset atrial fibrillation in patients with rheumatic mitral stenosis?
Cohort (n=125)
Does left atrial reservoir strain and strain rate assessment predict new-onset atrial fibrillation in patients with rheumatic mitral stenosis?
Hazard Ratio: 7.03 (95% CI 2.08–23.77)
p-value: p=0.002
Impaired left atrial reservoir strain (<21%) and strain rate (<0.8 s-1) are strong independent predictors of new-onset atrial fibrillation in patients with rheumatic mitral stenosis.
May support LA strain for AF risk stratification in rheumatic mitral stenosis; leaves open whether it alters management or improves outcomes.
Background Atrial fibrillation (AF) is a frequent complication of rheumatic mitral stenosis (MS) and is associated with worse outcomes. Prediction of new-onset AF by assessing left atrial (LA) mechanics with speckle-tracking echocardiography might be useful for risk stratification and guiding therapeutic strategies. Therefore, the aim of this study was to assess the association of LA reservoir strain (LASr) and strain rate (LASRr) with AF at follow-up in patients with rheumatic MS. Methods Left atrial reservoir strain and LASRr measured by speckle-tracking echocardiography were assessed in 125 patients (mean age, 50 ± 15 years; 80.8% female) with rheumatic MS and without a history of AF. Patients were followed up for the occurrence of a first episode of AF after the index echocardiogram. Results During a median follow-up of 32 (9.5-70) months, 41 patients (32.8%) developed new-onset AF. Patients who developed AF had significantly more impaired LASr (13.4% ± 5.2% vs 18.9% ± 8.2%; P < .001) and LASRr (0.72 ± 0.26 s −1 vs 0.98 ± 0.36 s −1; P < .001) compared with patients who remained in sinus rhythm. On multivariable Cox regression analysis, LASr < 21% and LASRr < 0.8 s −1 were independently associated with the development of AF at follow-up (hazard ratio = 7.03, 95% CI, 2.08-23.77, P = .002; and hazard ratio = 3.42, 95% CI, 1.59-7.34, P = .002, respectively). Conclusions LASr and LASRr are impaired in patients with rheumatic MS, and the degree of impairment is associated with new-onset AF at follow-up.
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Stassen et al. (2021) conducted a cohort in Rheumatic mitral stenosis (n=125). Impaired left atrial reservoir strain (LASr < 21%) vs. Preserved left atrial reservoir strain (LASr ≥ 21%) was evaluated on New-onset atrial fibrillation (HR 7.03, 95% CI 2.08-23.77, p=0.002). Impaired left atrial reservoir strain (<21%) was independently associated with new-onset atrial fibrillation in patients with rheumatic mitral stenosis (HR 7.03; 95% CI 2.08-23.77; P=0.002).
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