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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
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Left Atrial Structural and Functional Changes in Adults with Congenital Septal Defects and Paroxysmal Atrial
Anton V Minaev1, Marina Yu Mironenko1, Vera I Dontsova1
1A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, 121552 Moscow, Russia.
Journal of Clinical Medicine
|October 16, 2024
Summary
Adults with septal defects and atrial fibrillation (AF) show altered left atrial (LA) function. Key predictors of AF include LA volume index, reservoir strain, and contractile strain, suggesting LA function assessment aids clinical management.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Electrophysiology
Background:
- Congenital septal defects can lead to altered cardiac hemodynamics.
- Atrial fibrillation (AF) is a common arrhythmia, and its development in patients with septal defects requires further investigation.
- Left atrial (LA) structure and function are crucial in the pathophysiology of AF.
Purpose of the Study:
- To differentiate between adult patients with septal defects and paroxysmal AF and those without arrhythmia using LA volume and function parameters.
- To identify specific LA parameters associated with the development of AF in this patient population.
- To evaluate the potential of LA function assessment for predicting AF.
Main Methods:
- Prospective study including 81 adult patients with septal defects and left-to-right shunts.
- Patients were divided into two groups: with paroxysmal AF (n=26) and without AF (n=55).
- Left atrial function was assessed using speckle-tracking echocardiography, analyzing indexed volumes (LAVI, preA-LAVI), ejection fraction (LAEF), expansion index (LAEI), reservoir (LAS-r), conduit (LAS-cd), contractile (LAS-ct) strain, and stiffness index (LASI).
Main Results:
- Significant differences were observed in all LA function parameters between patients with and without AF.
- Univariable analysis identified LAVI, preA-LAVI, LASI, LAEF, LAEI, LAS-r, LAS-c, LAS-ct, age, cardiac index, E/A, and RV pressure as associated with AF.
- Multivariate analysis revealed LAVI (OR 1.236), LAS-r (OR 0.723), and LAS-ct (OR 1.518) as independent predictors of AF. A predictive model showed high accuracy (AUC: 0.97).
Conclusions:
- Speckle-tracking echocardiography reveals significantly different LA function parameters in patients with congenital septal defects who develop AF.
- LA volume index, reservoir strain, and contractile strain are independent predictors of AF development in this cohort.
- LA function assessment using this technique is a valuable tool that can be integrated into routine clinical management for patients with septal defects.
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