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Left atrial strain and integrated backscatter: predictors of recurrence after paroxysmal, persistent, and long-standing persistent atrial fibrillation catheter ablation
Session:
Comunicações Orais - Sessão 27 - Ecocardiografia
Speaker:
Pedro Brás
Congress:
CPC 2023
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Pedro Garcia Brás; Pedro Silva Cunha; Ana Teresa Timóteo; Guilherme Portugal; Ana Galrinho; Sérgio Laranjo; Madalena Coutinho Cruz; Bruno Valente; Pedro Rio; Ana Sofia Delgado; Margarida Paulo; Manuel Brás; Rui Cruz Ferreira; Mário Oliveira; Luísa Moura Branco
Abstract
<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="font-size:11.0pt">Introduction: Left atrial (LA) strain by two-dimensional (2D) speckle tracking (STE) allows for the characterization of LA myocardial deformation.</span> <span style="font-size:11.0pt">Integrated backscatter (IBS) is a promising tool for noninvasive quantification of myocardial fibrosis. The aim of this study was to compare LA phasic strain, strain rate and IBS between paroxysmal (PAF), persistent (PersAF), and long-standing persistent AF (LsAF) and evaluate its association with AF recurrence post-index catheter ablation (CA).</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="font-size:11.0pt">Methods: Analysis of consecutive patients with symptomatic PAF and PersAF who underwent index CA and had performed an echocardiogram in our center prior to AF CA. LA longitudinal strain in the reservoir phase (LASr), conduit phase (LAScd) and contraction phase (LASct), the respective phases’ strain rate and IBS were assessed by 2D STE at baseline. AF recurrence was documented with 12-lead ECG, 24h Holter monitoring or external loop recorder.</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="font-size:11.0pt">Results: We analyzed 78 patients, 31% with PersAF (46% LsAF), 65% male, mean age 59 ± 14 years, who underwent CA and were followed-up for 12 months. AF recurrence occurred in 22 (28%) patients. Lower values of LA strain and strain rate were found in patients with PersAF, especially in LsAF, both in the reservoir (LASr 9.2±4.9 vs 23.9±9.4, p<0.001) and conduit (LAScd -5.3±2.8 vs -11.3±7.3, p<0.001) phases, comparing to patients with PAF. LA strain was lower in patients with AF recurrence in all phases of the cardiac cycle (LAsct was only evaluated in patients in sinus rhythm during the echocardiogram). IBS values were not significantly different in patients with AF recurrence after CA (111.1±24.2 vs 105.9±33.5, p=0.044).</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="font-size:11.0pt">In a multivariable model, LASr (HR 0.82, 95% CI 0.75-0.90, p<0.001) and LAScd (HR 1.084, 95% CI 1.02-1.15, p=0.010) were independent predictors of AF recurrence after CA. The strain rates in the reservoir and contractile phases were also linked with AF recurrence. A LASr of <18% was associated with a significantly higher rate of AF recurrence both in patients with PAF and with PersAF (Figure 1 – Kaplain-Meier curves) with a sensitivity of 86% and a specificity of 70%. Analyzing the ROC curves for AF recurrence, LASr presented a higher predictive power when compared to LA volume index (AUC 0.894 vs AUC 0.712, p=0.023) (Figure 2). In patients with PAF in sinus rhythm during the echocardiogram, LASct also correlated with AF recurrence. PAF patients who experienced AF recurrence had a higher baseline IBS (109.3±22.1 dB vs 94.7±14 dB, p=0.016); however, IBS was not a significant predictor of AF recurrence after CA (HR 0.99 [95% CI 0.98-1.01], p=0.482).</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="font-size:11.0pt">Conclusion: Patients with PersAF and LsAF showed a significantly impaired LA phasic strain. LA phasic strain parameters were predictors of AF recurrence after CA, independently of LA volume. LASr <18% showed a higher predictive power for AF recurrence compared to LA volume. IBS was not associated with AF recurrence.</span></span></span></p>
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