Clinical physiology and functional imaging · 2025
Echocardiographic assessment of peak atrial longitudinal strain in paroxysmal atrial fibrillation patients compared to age-matched controls.
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Bastos Larissa, Al-Khalili Faris, Bäck Magnus, Manouras Aristomenis, Engdahl Johan, Shahgaldi Kambiz
Аннотация
AIM: To investigate left atrial (LA) function assessed by peak atrial longitudinal strain (PALS) in an elderly population with silent paroxysmal atrial fibrillation (PAF) compared to age-matched control group.
METHODS: From the STROKESTOP2-study, patients with newly diagnosed silent PAF were enrolled together in a randomly selected age-matched control group. All patients had NT-proBNP levels between 125 and 900 ng/L. Echocardiographic examinations were performed and analyzed offline using dedicated software. In addition to conventional echocardiographic variables, PALS was measured using a two-dimensional speckle tracking (2D-ST) biplane.
RESULTS: The study population (mean age 76 ± 0.3) demonstrated significantly reduced PALS in patients with PAF (N = 69) compared to controls (N = 94) (23.9% ± 6.5% vs 30.7% ± 7.6%, p < 0.001). In the PAF group, 29 (42%) patients had normal LA volume index (LAVI) defined as ≤ $\le $ 34 mL/m2. When subgroups with normal LAVI were compared, PALS was reduced in PAF compared to controls (25.1 ± 8.0 vs 31.1 ± 7.8, p = 0.001). NT-proBNP levels did not differ between the PAF group (median 228 ng/L) and the control group (median: 217 ng/L) (p = 0.16). In multiple linear regression analysis, left ventricular global longitudinal strain, stroke volume index and LAVI were independent predictors of PALS. Receiver operating characteristic curve identified PALS threshold <22% for predicting risk of silent PAF.
CONCLUSION: PALS was significantly reduced in PAF patients even in the absence of significant LA remodeling. PALS <22% predicts risk for silent PAF in general elderly population. In high-risk patients PALS could be used for AF screening enrichment.
METHODS: From the STROKESTOP2-study, patients with newly diagnosed silent PAF were enrolled together in a randomly selected age-matched control group. All patients had NT-proBNP levels between 125 and 900 ng/L. Echocardiographic examinations were performed and analyzed offline using dedicated software. In addition to conventional echocardiographic variables, PALS was measured using a two-dimensional speckle tracking (2D-ST) biplane.
RESULTS: The study population (mean age 76 ± 0.3) demonstrated significantly reduced PALS in patients with PAF (N = 69) compared to controls (N = 94) (23.9% ± 6.5% vs 30.7% ± 7.6%, p < 0.001). In the PAF group, 29 (42%) patients had normal LA volume index (LAVI) defined as ≤ $\le $ 34 mL/m2. When subgroups with normal LAVI were compared, PALS was reduced in PAF compared to controls (25.1 ± 8.0 vs 31.1 ± 7.8, p = 0.001). NT-proBNP levels did not differ between the PAF group (median 228 ng/L) and the control group (median: 217 ng/L) (p = 0.16). In multiple linear regression analysis, left ventricular global longitudinal strain, stroke volume index and LAVI were independent predictors of PALS. Receiver operating characteristic curve identified PALS threshold <22% for predicting risk of silent PAF.
CONCLUSION: PALS was significantly reduced in PAF patients even in the absence of significant LA remodeling. PALS <22% predicts risk for silent PAF in general elderly population. In high-risk patients PALS could be used for AF screening enrichment.