J Cardiovasc Ultrasound.  2012 Sep;20(3):140-145. 10.4250/jcu.2012.20.3.140.

Left Atrial Mechanical Function and Stiffness in Patients with Paroxysmal Atrial Fibrillation

• Yoon YE
• Kim HJ
• Kim SA
• Kim SH
• Park JH
• Park KH
• Choi S
• Kim MK
• Kim HS
• Cho GY

• KMID: 1808349
• DOI: http://doi.org/10.4250/jcu.2012.20.3.140

Abstract

BACKGROUND
Abnormalities in the left atrial (LA) structure and function may develop in patients with paroxysmal atrial fibrillation (AF). We sought to determine the contribution of LA mechanical function, including LA stiffness, to AF by comparing patients with paroxysmal AF with normal control subjects, and to evaluate whether LA mechanical function and stiffness are related with the structural changes of LA.
METHODS
Sixty-four paroxysmal AF patients (57 +/- 13 years, 59% male) were studied, using a speckle tracking echocardiography, and were compared with 34 age-, gender-, and left ventricular (LV) mass-matched controls (53 +/- 14 years, 61% male). LA volume indices, expansion index for reservoir function, active emptying fraction for contractile function, mitral annular velocities, and global longitudinal LA strain were measured. The ratio of E/e' to LA strain was used as an index of LA stiffness.
RESULTS
Patients with paroxysmal AF had similar LV volume indices, ejection fraction, and diastolic function, when compared with that of the normal controls. However, paroxysmal AF patients showed increased LA volume indices and decreased LA reservoir function, but similar contractile function. LA stiffness was increased in patients with paroxysmal AF than in the control subjects (0.40 +/- 0.25 vs. 0.29 +/- 0.10, p = 0.002), and was related with LA volume indices and reservoir function.
CONCLUSION
Patients with paroxysmal AF have decreased LA reservoir function and increased stiffness, in comparison with that of the control subjects. LA stiffness was significantly related with LA volume indices and reservoir function. LA stiffness can be used for the assessment of LA function in patients with paroxysmal AF.

Keyword

Atrial fibrillation; Left atrial function; Left atrial stiffness

MeSH Terms

Atrial Fibrillation
Atrial Function, Left
Echocardiography
Humans
Sprains and Strains
Track and Field

Figure

• 

  Fig. 1 Correlation of left atrial stiffness and minimal (A), pre-A (B), and maximal (C) left atrial volume indices. The numbers in parenthesis indicate the p-values of corresponding coefficients. LA: left atrial, LAVI: left atrial volume indices, PCC: Pearson's correlation coefficient, SCC: Spearman's rank correlation coefficient.

• 

  Fig. 2 Correlation of left atrial stiffness and left atrial expansion index (A), active emptying fraction (B), kinetic energy (C), and ejection force (D). The numbers in parenthesis indicate the p-values of corresponding coefficients. LA: left atrial, PCC: Pearson's correlation coefficient, SCC: Spearman's rank correlation coefficient.

Reference

1. Vidaillet H, Granada JF, Chyou PH, Maassen K, Ortiz M, Pulido JN, Sharma P, Smith PN, Hayes J. A population-based study of mortality among patients with atrial fibrillation or flutter. Am J Med. 2002. 113:365–370.

2. Stewart S, Hart CL, Hole DJ, McMurray JJ. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med. 2002. 113:359–364.

3. Kuppahally SS, Akoum N, Burgon NS, Badger TJ, Kholmovski EG, Vijayakumar S, Rao SN, Blauer J, Fish EN, Dibella EV, Macleod RS, McGann C, Litwin SE, Marrouche NF. Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging. 2010. 3:231–239.

4. Dittrich HC, Pearce LA, Asinger RW, McBride R, Webel R, Zabalgoitia M, Pennock GD, Safford RE, Rothbart RM, Halperin JL, Hart RG. Left atrial diameter in nonvalvular atrial fibrillation: an echocardiographic study. Stroke Prevention in Atrial Fibrillation Investigators. Am Heart J. 1999. 137:494–499.

5. Parkash R, Green MS, Kerr CR, Connolly SJ, Klein GJ, Sheldon R, Talajic M, Dorian P, Humphries KH. Canadian Registry of Atrial Fibrillation. The association of left atrial size and occurrence of atrial fibrillation: a prospective cohort study from the Canadian Registry of Atrial Fibrillation. Am Heart J. 2004. 148:649–654.

6. Sitges M, Teijeira VA, Scalise A, Vidal B, Tamborero D, Collvinent B, Rivera S, Molina I, Azqueta M, Paré C, Brugada J, Mont L. Is there an anatomical substrate for idiopathic paroxysmal atrial fibrillation? A case-control echocardiographic study. Europace. 2007. 9:294–298.

7. Kurt M, Wang J, Torre-Amione G, Nagueh SF. Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging. 2009. 2:10–15.

8. Machino-Ohtsuka T, Seo Y, Tada H, Ishizu T, Machino T, Yamasaki H, Igarashi M, Xu D, Sekiguchi Y, Aonuma K. Left atrial stiffness relates to left ventricular diastolic dysfunction and recurrence after pulmonary vein isolation for atrial fibrillation. J Cardiovasc Electrophysiol. 2011. 22:999–1006.

9. Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davidson TW, Davis JL, Douglas PS, Gillam LD. ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation. 1997. 95:1686–1744.

10. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ. Chamber Quantification Writing Group. American Society of Echocardiography's Guidelines and Standards Committee. European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005. 18:1440–1463.

11. Quiñones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002. 15:167–184.

12. Triposkiadis F, Harbas C, Sitafidis G, Skoularigis J, Demopoulos V, Kelepeshis G. Echocardiographic assessment of left atrial ejection force and kinetic energy in chronic heart failure. Int J Cardiovasc Imaging. 2008. 24:15–22.

13. D'Andrea A, Caso P, Romano S, Scarafile R, Riegler L, Salerno G, Limongelli G, Di Salvo G, Calabrò P, Del Viscovo L, Romano G, Maiello C, Santangelo L, Severino S, Cuomo S, Cotrufo M, Calabrò R. Different effects of cardiac resynchronization therapy on left atrial function in patients with either idiopathic or ischaemic dilated cardiomyopathy: a two-dimensional speckle strain study. Eur Heart J. 2007. 28:2738–2748.

14. Hwang HJ, Choi EY, Rhee SJ, Joung B, Lee BH, Lee SH, Kim J, Lee MH, Jang Y, Chung N, Kim SS. Left atrial strain as predictor of successful outcomes in catheter ablation for atrial fibrillation: a two-dimensional myocardial imaging study. J Interv Card Electrophysiol. 2009. 26:127–132.

15. Abhayaratna WP, Fatema K, Barnes ME, Seward JB, Gersh BJ, Bailey KR, Casaclang-Verzosa G, Tsang TS. Left atrial reservoir function as a potent marker for first atrial fibrillation or flutter in persons > or = 65 years of age. Am J Cardiol. 2008. 101:1626–1629.

16. Di Salvo G, Caso P, Lo Piccolo R, Fusco A, Martiniello AR, Russo MG, D'Onofrio A, Severino S, Calabró P, Pacileo G, Mininni N, Calabró R. Atrial myocardial deformation properties predict maintenance of sinus rhythm after external cardioversion of recent-onset lone atrial fibrillation: a color Doppler myocardial imaging and transthoracic and transesophageal echocardiographic study. Circulation. 2005. 112:387–395.

17. Henein M, Zhao Y, Henein MY, Lindqvist P. Disturbed left atrial mechanical function in paroxysmal atrial fibrillation: a speckle tracking study. Int J Cardiol. 2012. 155:437–441.