Mechanical atrial recovery by speckle-tracking echocardiography in the prediction of recurrence at 2 years after successful cardioversion of persistent atrial fibrillation

Abstract Introduction This study aimed to assess the significance of left atrial (LA) strain in patients with persistent atrial fibrillation (AF), undergoing electrical cardioversion (ECV) and to investigate their predictive value in determining AF recurrence (AFR) at 2-years. Material and methods 60 patients who were admitted for persistent AF with a duration of less than 12 months were prospectively included. Echocardiography was performed in all patients prior to ECV and repeated at seven days during sinus rhythm (SR). Every patient underwent periodic follow-up over the next two years to determine whether the clinical endpoint of AFR had occurred. Results During the follow-up period, 42% of the patients developed AFR. On the initial echocardiography conducted during AF, there was no difference in any echocardiographic parameter between subjects exhibiting AFR and controls. However, reservoir strain (LASr SR) was significantly lower in patients who later developed AFR (7.3 ± 2.91 vs. 13.14 ± 5.35 %, p=0.0001). Contraction strain (LASct SR) was also significantly reduced in patients who later developed AFR (2.66 ± 1.18 vs. 5.93 ± 5.79 %, p=0.017). The multivariate regression analysis with adjustments for NT-proBNP values and the presence of diabetes showed that only LASr SR was an independent predictor of AFR (B = -0.32, p = 0.006). LASr SR values ≤ 12% demonstrated high accuracy (AUC=0.821, 95%CI 0.684 to 0.917), excellent sensitivity (100%), and moderate specificity (61%) in the prediction of AFR. Conclusion LA mechanics assessment may provide key information regarding the recovery of the LA function and the long-term risk of AFR. LASr before and after cardioversion