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Left atrial longitudinal strain in dilated cardiomyopathy patients: is there a discrimination threshold for atrial
Jacek Kurzawski1, Agnieszka Janion-Sadowska2, Andrzej Gackowski3
1Świętokrzyskie Cardiology Centre, ul. Grunwaldzka 45, 25-736, Kielce, Poland.
Insights
Left atrial strain analysis can distinguish atrial fibrillation (AF) in dilated cardiomyopathy (DCM) patients. Reduced left atrial conduit strain (εCD) below 5.43% and contractile strain (εCT) below -1.97% accurately identify AF in DCM with low ejection fraction.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Electrophysiology
Background:
- Dilated cardiomyopathy (DCM) is associated with an increased risk of atrial fibrillation (AF).
- Accurate differentiation between sinus rhythm (SR) and AF in DCM patients with reduced left ventricular ejection fraction (LVEF) is clinically important.
- Left atrial (LA) strain analysis using speckle tracking echocardiography offers insights into atrial function.
Purpose of the Study:
- To determine the diagnostic threshold of left atrial longitudinal strain for discriminating AF in patients with DCM and LVEF < 25%.
- To assess the feasibility of LA strain analysis in DCM patients with AF.
- To compare LA strain parameters between DCM patients with SR and AF.
Main Methods:
- One hundred DCM patients with LVEF < 25% were enrolled, divided equally into SR and AF groups.
- Exclusion criteria included significant valvular disease, pacemakers, and prosthetic valves.
- Speckle tracking echocardiography was used to measure LA contractile strain (εCT) and conduit strain (εCD). Analysis was time-referenced to P-wave in SR and 200 ms before QRS in AF.
Main Results:
- Left atrial conduit strain (εCD) was significantly lower in AF patients compared to SR patients (4.7% vs. 9.68%, p = 0.0003).
- Receiver operating characteristic (ROC) analysis revealed that εCD < 5.43% (AUC 0.95) and εCT < -1.97% (AUC 0.97) effectively identified patients with AF.
- LA strain analysis was feasible even in DCM patients with AF and reduced LVEF.
Conclusions:
- Left atrial strain analysis, particularly εCD and εCT, is feasible and valuable for differentiating AF from SR in DCM patients with LVEF < 25%.
- Specific thresholds of εCD < 5.43% and εCT < -1.97% demonstrate high diagnostic accuracy for AF detection in this population.
- These findings highlight the potential of LA strain parameters as non-invasive biomarkers for rhythm status assessment in DCM.
Abstract:
To determine the left atrial longitudinal strain discrimination threshold of atrial fibrillation (AF) in patients with dilated cardiomyopathy (DCM). A total of 100 DCM patients and LVEF < 25% were included. Of them, 50 had sinus rhythm (SR), and 50 had AF. Patients with significant valvular disease, cardiac pacemakers and prosthetic valves were excluded. Speckle tracking echocardiography was performed to visualize the inferior and lateral walls of the left atrium as well as the interatrial septum. The Q-Analysis software was used to assess left atrial contractile strain (εCT) during the atrial systole and left atrial conduit strain (εCD) during the atrial filling. In SR patients analysis was P-wave timed. In AF patients the reference point was at 200 ms before the QRS complex on the surface ECG. The εCD was significantly higher in SR patients than in those with AF (9.68% vs. 4.7%; p = 0.0003). ROC analysis demonstrated that εCD less than 5.43% (AUC 0.95; 95% CI 0.905-0.995; p < 0.0001) together with εCT below - 1.97% (AUC = 0.97; 95% CI 0.46-1.00; p < 0.0001) identified patients with AF. In patients with LVEF < 25% and AF left atrial contractile strain analysis is feasible. In these patients both contractile and conduit strain values are significantly lower than in patients with preserved SR, and εCD below 5.43% and εCT less than - 1.97% distinguish SR from AF patients with LVEF < 25%.
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