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Echocardiographic and Electrocardiographic Determinants of Atrial Cardiomyopathy Identify Patients with Atrial

Taiyuan Huang1, Schurr Patrick1, Louisa Katharina Mayer1

  • 1University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany.

Journal of Clinical Medicine
|March 10, 2022
PubMed

Insights

Atrial cardiomyopathy (ACM) increases risk for atrial fibrillation (AF), blood clots, and stroke. Echocardiographic LA global longitudinal strain (LA-GLS) and amplified p-wave duration (APWD) can predict thrombogenesis in AF patients.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • Atrial cardiomyopathy (ACM) is a significant risk factor for atrial fibrillation (AF), left atrial (LA) thrombogenesis, and stroke.
  • Diagnosis of ACM can be achieved through echocardiographic LA strain imaging and measurement of amplified p-wave duration (APWD) in digital 12-lead ECG.
  • Identifying patients with AF who are at risk for LA appendage (LAA) thrombogenesis is crucial for stroke prevention.

Purpose of the Study:

  • To determine the diagnostic thresholds of LA global longitudinal strain (LA-GLS) and APWD for identifying patients with AF at risk for LAA thrombogenesis.
  • To evaluate the efficacy of LA-GLS and APWD in predicting LAA thrombus formation in patients with a history of AF.

Main Methods:

  • One hundred twenty-eight patients with a history of AF were included in the study.
  • Measurements included left atrial appendage maximal flow velocity (LAA-Vel) via transesophageal echocardiography (TEE), LA-GLS via transthoracic echocardiography (TTE), and APWD via digital 12-lead ECG.
  • Receiver operating characteristic (ROC) analysis was performed to establish diagnostic thresholds for LA-GLS and APWD in predicting LAA thrombus.

Main Results:

  • Significant differences in LA-GLS were observed between patients with and without thrombus during both sinus rhythm (SR) and AF.
  • ROC analysis identified optimal thresholds for LAA-thrombus detection: LA-GLS at 17.45% (overall), 19.1% (SR), and 13.9% (AF); APWD at 165 ms.
  • Both LA-GLS and APWD demonstrated strong correlations with LAA-Vel, a validated measure of LA contractile function (r = 0.39, p < 0.001 for both).

Conclusions:

  • LA-GLS and APWD are valuable diagnostic tools for predicting left atrial thrombogenesis in patients with AF.
  • These non-invasive parameters can aid in risk stratification and guide therapeutic strategies for stroke prevention in AF patients.
  • The study establishes specific thresholds for LA-GLS and APWD that effectively discriminate patients with LAA thrombus.

Keywords:
atrial cardiomyopathyatrial fibrillationglobal longitudinal strainleft atrial thrombogenesisp-wave analysisstroke

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