Korean Circ J.  2008 Jun;38(6):305-312. 10.4070/kcj.2008.38.6.305.

Assessment of Left Atrial Function and Remodeling in Patients With Atrial Fibrillation by Performing Strain Echocardiography: A Prospective Study to Assess the Influence of Renin-Angiotensin System Inhibitors on Atrial Fibrillation

• Cho KI
• Lee SH
• Jang SH
• Lee DW
• Lee HG
• Kim TI

• KMID: 2225777
• DOI: http://doi.org/10.4070/kcj.2008.38.6.305

Abstract

BACKGROUND AND OBJECTIVES: Renin-angiotensin system (RAS) inhibitors are likely to reduce the development of atrial fibrillation (AF) by preventing atrial fibrosis. We attempted to assess the relevance of strain echocardiography for quantitative assessment of the left atrial (LA) status in AF, its modification by RAS inhibitors and changes of biochemical markers during cardiac remodeling in AF.
SUBJECTS AND METHODS
Strain echocardiography is performed 2 times (baseline and 12 month) in 60 patients with AF (RAS inhibitors-used group: 30, non-used group: 30). In an apical 4-chamber view, the regional analysis consisted of placing the region of interest cursor at the basal segments of the septal and lateral wall of LA. Mean peak systolic and early diastolic strain/rate are measured with LA end-systolic antero-posterior, longitudinal and transverse dimensions.
RESULTS
Six patients of RAS inhibitors-used group (group A, 20%) and three patients of non-used group (group B, 10%) were converted to normal sinus rhythm during the study. LA size, E wave velocity, E/E', strain parameters showed no significant differences between groups at the baseline. There were no significant differences in LA size and E wave velocity between groups at the 12 months, however, peak systolic strain/rate were significantly higher in group A (36.71+/-13.63% and 2.98+/-0.59s(-1), p<0.05, respectively) than group B (27.21+/-10.49% and 2.21+/-0.47s(-1)). In addition, peak early diastolic strain/rate were significantly higher in group A (-1.89+/-3.30% and -2.32 +/-0.77s-1 p<0.05, respectively) than group B (-0.83+/-2.79% and -1.77+/-0.25s(-1)). There were no significant differences in C-reactive protein (CRP) and B-type natriuretic peptide (BNP) at the baseline, but BNP were significantly reduced in group A (822.9+/-798.3 pg/mL, p<0.05) than group B (1481.9+/-209.97 pg/mL) at the 12-month follow-up.
CONCLUSION
The increased values of atrial peak systolic and diastolic strain/rate after treatment with RAS inhibitors revealed that passive stretching and shortening of LA wall might improve in some patients with AF even before LA size change possibly because of reduced atrial fibrosis and increased compliance. Our results indicated that strain echocardiography provides clinically useful information of LA function and remodeling and treatment with RAS inhibitors appears to preserve LA reservoir function in AF patients without visible LA structural change.

Keyword

Atrial fibrillation; Echocardiography; Strains

MeSH Terms

Atrial Fibrillation
Atrial Function, Left
Biomarkers
C-Reactive Protein
Compliance
Echocardiography
Fibrosis
Humans
Muscle Stretching Exercises
Natriuretic Peptide, Brain
Prospective Studies
Renin-Angiotensin System
Sprains and Strains
C-Reactive Protein
Natriuretic Peptide, Brain

Figure

• 

  Fig. 1 The longitudinal peak strain/rates that obtained from 2 different areas of the basal segments of the LA free wall and the interatrial septum in the apical 4 chamber view. By tissue Doppler strain (A), and the peak systolic strain was measured (B). LA: left atrial.

• 

  Fig. 2 An example of atrial deformation properties in the RAS inhibitors-used group. Peak systolic strain (A), peak early diastolic strain (B) and strain rate (C) at the baseline (37.5%, -5.8% and -2.16 s-1, respectively) and the increased peak systolic strain (A'), peak early diastolic strain (B') and strain rate (C') at the 12-month follow-up (50.6%, -11.4% and -3.78 s-1, respectively). RAS: renin-angiotensin system.

• 

  Fig. 3 An example of the atrial deformation properties in a patient who was converted to sinus rhythm. The peak systolic strain (A), peak early diastolic strain (B) and strain rate (C) were higher than the mean values of controls (27.65±10.04%, -0.88±0.49% and -1.98±0.49 s-1, respectively).

• 

  Fig. 4 Plots of the change for (A) the peak systolic and diastolic strain and the BNP levels of the RAS inhibitors used group, and (B) the peak systolic and diastolic strain and the BNP levels of the RAS inhibitors not used group. BNP: B-type natriuretic peptide, RAS: renin-angiotensin system.

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