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Updated: Jul 31, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular
Bo Su1, Shi-Kun Sun1, Xin-Jia Dai1
1Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
Insights
A new left atrial appendage (LAA) strain parameter, LAA longitudinal strain amplitude (LAA LSA), effectively predicts thrombosis risk in atrial fibrillation (AF) patients. This novel parameter demonstrates superior accuracy compared to existing methods for assessing LAA function and blood flow stasis.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Atrial fibrillation (AF) significantly impairs left atrial appendage (LAA) function.
- Assessing LAA function is crucial for predicting thrombosis risk in non-valvular AF patients.
- Existing parameters for LAA function and blood flow stasis have limitations.
Purpose of the Study:
- To explore a novel left atrial appendage (LAA) strain parameter reflecting chronic AF impact on LAA function.
- To investigate the relationship between this novel LAA strain parameter and thrombosis risk in non-valvular AF.
- To evaluate the predictive accuracy of the novel parameter against conventional methods.
Main Methods:
- Enrolled 268 patients with non-valvular AF and 58 sinus rhythm subjects.
- Utilized transesophageal echocardiography to measure LAA longitudinal strain amplitude (LAA LSA).
- Defined LAA LSA as the sum of maximum positive and absolute minimum negative peak strains.
- Assessed spontaneous echo contrast (SEC) and thrombus formation.
Main Results:
- Global LAA strain parameters were significantly lower in AF patients compared to sinus rhythm, decreasing from paroxysmal to persistent AF.
- LAA strain parameters were significantly depressed in AF patients with SEC/thrombus.
- LAA global LSA independently predicted SEC/thrombus (OR 0.768) and demonstrated superior predictive accuracy (AUC 0.884) for dense SEC or thrombus compared to conventional parameters.
- LAA LSA exhibited excellent inter- and intra-observer agreement.
Conclusions:
- Novel LAA strain parameters, particularly LAA global LSA, are feasible and reproducible for assessing LAA mechanical function.
- These novel parameters offer superior predictive accuracy for blood flow stasis in the LAA compared to conventional methods.
- LAA LSA is a valuable tool for predicting thrombosis risk in non-valvular AF patients.
Objectives:
We sought to explore a novel left atrial appendage (LAA) strain parameter which could represent the cumulative adverse impact of chronic Atrial fibrillation (AF) on the LAA function, and the relationship between the LAA strain parameter and thrombosis risk in patients with non-valvular AF.
Methods:
We enrolled 268 patients with non-valvular AF and 58 sinus rhythm subjects who underwent transesophageal echocardiography in the study. LAA longitudinal strain amplitude (LAA LSA) was defined as the sum of the value of the maximum positive peak strain (LAA PLS) and the absolute value of the minimum negative peak strain (LAA NLS). Dense spontaneous echo contrast (SEC) was defined as grade 3 or 4 SEC.
Results:
Compared to sinus rhythm group, the global LAA strain parameters were significantly lower in paroxysmal AF (n = 148), and the lowest of them were found in persistent AF (n = 120), which suggested that the global LAA strain parameters could evaluate LAA function in sinus rhythm, paroxysmal AF and persistent AF. Compared with patients in AF without SEC/thrombus (n = 113), the regional and global LAA strain parameters were significantly depressed in AF with SEC/thrombus (n = 155). Multivariate logistic regression analyses showed that LAA global LSA (OR 0.768; 95% CI:0.569, 0.970; p = 0.027) was an independent predicter of the SEC/thrombus. Compared with patients in AF without dense SEC or thrombus (n = 210), the regional and global LAA strain parameters were significantly impaired in the patients with dense SEC/thrombus(n = 58). LAA global LSA (AUC 0.884) had the best predictable accuracy for dense SEC or thrombus, and outperformed LAA PLS, LAA NLS, CHA2DS2-VASc score and conventional LAA functional parameters that have been used in the evaluation blood flow stasis in LAA. LAA LSA showed excellent interobserver and intra-observer agreement beyond LAA PLS and LAA NLS.
Conclusion:
The novel LAA strain parameters, which were feasible and reproducible parameters for evaluation LAA mechanic function, had good predictive accuracy for blood flow stasis in LAA beyond conventional LAA functional parameters.
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