Korean Circ J.  2012 May;42(5):311-318. 10.4070/kcj.2012.42.5.311.

Prediction of Left Atrial Fibrosis With Speckle Tracking Echocardiography in Mitral Valve Disease: A Comparative Study With Histopathology

• Her AY
• Choi EY
• Shim CY
• Song BW
• Lee S
• Ha JW
• Rim SJ
• Hwang KC
• Chang BC
• Chung N

• KMID: 2028759
• DOI: http://doi.org/10.4070/kcj.2012.42.5.311

Abstract

BACKGROUND AND OBJECTIVES
Left atrial (LA) fibrosis is a main determinant of LA remodeling and development of atrial fibrillation. However, non-invasive prediction of LA fibrosis is challenging. We investigated whether preoperative LA strain as measured by speckle tracking echocardiography could predict the degree of LA fibrosis and LA reverse remodeling after mitral valve (MV) surgery.
SUBJECTS AND METHODS
Speckle tracking echocardiography and LA volume measurements were performed in 50 patients one day before MV surgery. LA tissues were obtained during the surgery, and the degrees of their interstitial fibroses were measured. LA volume measurements were repeated within 30 days after surgery (n=50) and 1-year later (n=39).
RESULTS
Left atrial global strain was significantly correlated with the degree of LA fibrosis (r=-0.55, p<0.001), and its correlation was independent of age, underlying rhythm, presence of rheumatic heart disease and type of predominant MV disease (B=-1.37, 95% confidence interval -2.32 - -0.41, p=0.006). The degree of LA fibrosis was significantly correlated with early (r=-0.337, p=0.017) and 1-year (r=-0.477, p=0.002) percent LA volume reduction after MV surgery, but LA global strain was not significant.
CONCLUSION
Left atrial strain as measured by speckle tracking echocardiography might be helpful for predicting the degree of LA fibrosis in patients with MV disease.

Keyword

Echocardiography; Fibrosis; Left atrium

MeSH Terms

Atrial Fibrillation
Echocardiography
Fibrosis
Heart Atria
Humans
Mitral Valve
Rheumatic Heart Disease
Sprains and Strains
Track and Field

Figure

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  Fig. 1 Left atrial (LA) strain as measured by speckle tracking echocardiography and its corresponding histopathology. A case with higher LA global strain (29%) (A) and a lower degree of LA fibrosis (9%) (B). A case with lower LA global strain (6.9%) (C) and a correspondingly high degree of LA fibrosis (40%) (D). The dotted line represents the LA global strain, and the arrow indicates the peak longitudinal strain value. On these histology slides, the purple color represents fibrosis after Masson Trichrome staining (×20).

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  Fig. 2 Correlation between LA global strain and degree of LA fibrosis (A) and its subgroup analysis according to predominant mitral valve disease (B). Correlation of percent LA volume reduction after surgery with degree of LA fibrosis (C) and LA global strain (D). LA: left atrial, MS: mitral stenosis, MR: mitral regurgitation.

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