Left atrial reservoir strain measured within 48 hours after primary PCI strongly predicted new-onset atrial fibrillation in STEMI patients (AUC 0.901; 95% CI 0.868-0.944; p<0.001).
Cohort (n=198)
Does early measurement of left atrial reservoir strain predict new-onset atrial fibrillation in patients with STEMI after primary PCI?
Left atrial reservoir strain measured within 48 hours of primary PCI for STEMI is a strong, independent predictor of new-onset atrial fibrillation.
Effect estimate: AUC 0.901 (95% CI 0.868-0.944)
p-value: p=<0.001
Abstract Background/Introduction Atrial fibrillation (AF) is a common and clinically significant complication in patients with ST-segment elevation myocardial infarction (STEMI), contributing to increased morbidity and adverse outcomes. Despite advances in revascularization, prediction of AF in the acute phase of STEMI remains a challenge. Early identification of patients at risk for AF may enable timely preventive strategies. Purpose The purpose of this study was to investigate whether early measurement of left atrial strain (especially reservoir strain, LASr) within 48 hours after primary percutaneous coronary intervention (pPCI) can predict new-onset atrial fibrillation in STEMI patients. Methods In this prospective study, 198 patients who underwent primary percutaneous coronary intervention for STEMI between May 2022 and May 2023 were enrolled. Transthoracic echocardiography was performed within 24–48 hours after the procedure to assess left atrial reservoir strain (LASr), left atrial conduit strain (LAScd), left atrial contraction strain (LASct), left atrial volume index (LAVI), global longitudinal strain (GLS), and other conventional parameters. AF was diagnosed using 12-lead electrocardiography or 24-hour Holter monitoring. Results New-onset AF was observed in 11 patients during follow-up. The mean follow-up duration was 548 days. Compared to those without AF, these patients exhibited significantly lower values of LASr, LAScd, and LASct, with the most marked reduction observed in LASr (18 ± 1% vs. 31 ± 10%, p 0.001). In multivariate logistic regression analysis, LASr emerged as the sole independent echocardiographic predictor of AF (p = 0.002). Receiver Operating Characteristic (ROC) curve analysis revealed an area under the curve (AUC) of 0.901 (95% confidence interval CI: 0.868–0.944) for LASr, with 86% sensitivity and 82% specificity at a cutoff value of 19.5% (p 0.001). Conclusion LASr, when measured within the first 48 hours after pPCI, is a strong and independent predictor of new-onset AF in STEMI patients. Incorporating LASr into early risk stratification protocols may improve outcomes through targeted monitoring and timely intervention. However, results should be interpreted cautiously due to the relatively small number of AF events.
Verdiyev et al. (Thu,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=198). Left atrial reservoir strain (LASr) was evaluated on New-onset atrial fibrillation (AUC 0.901, 95% CI 0.868-0.944, p=<0.001). Left atrial reservoir strain measured within 48 hours after primary PCI strongly predicted new-onset atrial fibrillation in STEMI patients (AUC 0.901; 95% CI 0.868-0.944; p<0.001).