Key result
Advancing AF stages linked to progressive reduction in right atrial reservoir strain from ~41% to ~15%.
Why the study?
Left atrial mechanical dysfunction in AF has been well studied, but how the occurrence and stages of AF affect right atrial function was poorly understood. This study sought to characterize bi-atrial strain across AF stages and compare RA and LA mechanics in identifying paroxysmal AF without LA enlargement.
Does bi-atrial strain analysis via speckle-tracking echocardiography characterize right and left atrial mechanical dysfunction across different stages of atrial fibrillation and identify paroxysmal atrial fibrillation with normal left atrial size?
Observational (n=482)
Does bi-atrial strain analysis via speckle-tracking echocardiography characterize right and left atrial mechanical dysfunction across different stages of atrial fibrillation and identify paroxysmal atrial fibrillation with normal left atrial size?
Atrial fibrillation independently impairs both right and left atrial mechanics progressively across advancing AF stages, and LA strain parameters along with RA mechanical dispersion can identify paroxysmal AF during sinus rhythm even when LA size is normal.
Right atrial reservoir strain declines with advancing atrial fibrillation stages; hypothesis-generating for bi-atrial strain in identifying paroxysmal disease without left atrial enlargement.
Background Left atrial (LA) mechanical dysfunction associated with atrial fibrillation (AF) has been well studied. Whereas, how the occurrence and stages of AF affected right atrium (RA) function was poorly understood. Accordingly, we sought to characterize bi-atrial strain during different stages of AF in detail. Furthermore, we compared the ability of RA and LA mechanics in identifying patients with paroxysmal AF(PAF) without LA enlargement. Methods A total of 422 patients with AF referring for radiofrequency ablation were consecutively enrolled. Patients were categorized according to rhythm and stages of AF: persistent AF(PerAF) (n=194), paroxysmal AF during AF rhythm(PAF-AF)(n=52) and PAF during sinus rhythm(PAF-SR)(n=176) at the time of echocardiography. A control group of 60 individuals was included for comparison, if no cardiac pathology was detected. Using speckle-tracking echocardiography, LA reservoir strain(LASr), RA reservoir strain(RASr)and mechanical dispersion (MD) of LA and RA were measured in all patients. Mechanical dispersion was defined as the standard deviation of the time to peak positive strain corrected by R-R interval. Results Compared to the control group, AF patients exhibited significantly lower RA and LA strain parameters. A progressive decrease in bi-atrial mechanical function was seen as the stage of AF advanced to more persistent forms: RASr and RA MD, 41.4±8.9% and 4.2±2.0%(control), 35.3±9.2% and 6.7±4.1%(PAF-SR), 16.7±8.6% and 10.7±5.9 (PAF-AF) and 15±4.9% and 11.1±4.9% (PerAF); LASr and LA MD, 40.4±7.9% and 4.0±1.6% (control), 26.7±7.6% and 6.4±2.7% (PAF-SR), 12.8±4.6% and 8.8±3.0% (PAF-AF) and 10.7±3.9% and 9.3±3.2% (PerAF),P < 0.01). AF stages were independent determinants of RA and LA mechanics after adjusting for age,gender ,comobidities and conventional echo parameters. LASr, LA MD and RA MD, rather than RASr, were independently associated with PAF-SR with normal LA size (adjusted odds ratio: 0.87,1.50 and 1.33,respectively,all P<0.05). ROC analysis yielded similar discriminative ability for LASr (area under the curve (AUC): 0.79) , LA MD (AUC: 0.71) and RA MD (AUC: 0.70). Conclusions AF affected bi-atrial mechanical function independently, and more so if stage of AF has advanced to more persistent forms. In the presence of sinus rhythm, both LA strain parameters and RA mechanical dispersion could independently identify PAF without LA enlargement. However, RASr seems to be less beneficial in this regard.bi-atrial strainstatistical analysis
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Mao et al. (2026) conducted an observational in Atrial fibrillation (n=482). Atrial fibrillation stages (paroxysmal AF in sinus rhythm, paroxysmal AF in AF rhythm, persistent AF) vs. Healthy controls without cardiac pathology was evaluated on Right atrial reservoir strain (RASr) and left atrial reservoir strain (LASr) (p=<0.01). Advancing atrial fibrillation stages progressively reduced right atrial reservoir strain from 41.4% in controls to 35.3% in PAF-SR, 16.7% in PAF-AF, and 15.0% in persistent AF (P<0.01).
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