Single-beat determination of global longitudinal speckle strain in patients with atrial fibrillation
Kazuto Yamaguchi1, Hiroyuki Yoshitomi1, Saki Ito1
1Division of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cyo, Izumo, 693-8501, Japan.
Insights
Assessing global longitudinal strain (GLS) in atrial fibrillation (AF) patients is challenging due to irregular heartbeats. A new index using the RR1/RR2 interval ratio accurately estimates GLS, improving clinical feasibility.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Mechanics
Background:
- Global left ventricular (LV) systolic function is crucial for patient outcomes.
- Assessing global longitudinal speckle strain (GLS) in patients with atrial fibrillation (AF) is unreliable due to beat-to-beat variations.
- Previous research indicates LV contractility correlates with the preceding R-R interval ratio (RR1/RR2).
Purpose of the Study:
- To evaluate the clinical feasibility of a novel index for estimating GLS in AF patients.
- To determine if the GLS at RR1/RR2 = 1 accurately reflects average LV contractility.
Main Methods:
- The RR1/RR2 ratio was evaluated for GLS measurement in 20 AF patients using apical 4-chamber views.
- GLS was recorded over ≥13 cardiac cycles, with linear regression analyzing the relationship between GLS and the RR1/RR2 ratio.
- The GLS at RR1/RR2 = 1 was compared to the measured average GLS.
Main Results:
- A significant correlation was observed between GLS and the RR1/RR2 ratio (r = -0.80).
- The calculated GLS at RR1/RR2 = 1 closely matched the average GLS (-10.17 ± 2.1% vs. -10.06 ± 2.1%).
- GLS from a single beat with equal RR1 and RR2 intervals strongly correlated with the overall average GLS (r = 0.94).
Conclusions:
- The GLS at RR1/RR2 = 1 provides an accurate method for evaluating LV systolic parameters in AF patients.
- This index overcomes the unreliability of averaging multiple irregular heartbeats for GLS assessment.
- The findings support the clinical feasibility of this new index for improved AF patient management.
Background:
Although global left ventricular (LV) systolic function is an important determinant of outcome, the assessment of global longitudinal speckle strain (GLS) in patients with atrial fibrillation (AF) is unreliable because of beat-to-beat variation. Previous studies have confirmed that LV contractility of each irregular beat is predicted from the ratio of preceding R-R (RR1) to pre-preceding R-R (RR2) intervals, and the value when the intervals are equal (RR1/RR2 = 1) estimates the average value of LV contractility. The aim of this study was to assess the clinical feasibility of an index that is obtained on the basis of the RR1/RR2 ratio for the estimation of GLS in patients with AF.
Methods:
We evaluated the RR1/RR2 ratio for the measurement of GLS with apical 4-chamber views in 20 patients with AF. We obtained the GLS for ≥13 cardiac cycles, and the relationship between each GLS at a given cardiac beat and the RR1/RR2 ratio was evaluated by linear regression analysis. The value of GLS at RR1/RR2 = 1 was compared with the measured average value.
Results:
The GLS showed a significant correlation with the RR1/RR2 ratio (r = -0.80). The calculated value of GLS at RR1/RR2 = 1 was quite similar to the average value (-10.17 ± 2.1 % vs. -10.06 ± 2.1 %). The GLS of a single beat with identical RR1 and RR2 intervals showed a significant correlation compared with the measured average value over all cardiac cycles (r = 0.94, y = 0.90x - 0.97).
Conclusions:
The GLS at RR1/RR2 = 1 allows the LV systolic parameter to be accurately evaluated during AF and obviates the less reliable process of averaging multiple irregular beats.
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