Intensive Cardiac Care Unit, Świętokrzyskie Cardiology Center, Kielce, Poland.
Faculty of Medicine and Health Sciences, The Jan Kochanowski University, Kielce, Poland.
PLoS One. 2020 Jan 29;15(1):e0228239. doi: 10.1371/journal.pone.0228239. eCollection 2020.
The velocity of left atrium appendage (LAA) wall motion during atrial fibrillation (AF) is a potential marker of mechanical remodelling. In this study, we investigated whether the velocity of LAA wall motion during AF predicted the success of electrical cardioversion and long-term sinus rhythm maintenance. Standard echocardiographic data were obtained by transthoracic echocardiography, and LAA wall motion velocities were measured by transoesophageal echocardiography. With logistic regression and receiver operating characteristic curve analyses, we related echocardiographic and clinical data to cardioversion outcomes and sinus rhythm maintenance at 12 months. Of 121 patients prospectively included in the study, electrical cardioversion restored sinus rhythm in 97 (81.2%), and 51 (42%) patients maintained sinus rhythm at 12 months. Patients in whom cardioversion restored sinus rhythm had higher LAA wall motion velocities than did the patients with failed cardioversions (p <0.001). Compared to patients with AF at 12 months, patients who maintained sinus rhythm had lower maximum and end-diastolic left atrial volumes (p ≤ 0.01), lower E/e' ratios (p = 0.005), higher s' values (p = 0.013), and higher LAA motion velocities (p < 0.001). On multivariate logistic regression, only LAA wall motion velocity and E/e' ratios remained significant predictors of sinus rhythm maintenance at 12 months (p ≤ 0.04). LAA wall motion velocity was also a significant predictor of sinus rhythm maintenance when corrected for clinical variables (p = 0.039). Conclusion: LAA wall motion velocity, as a marker of mechanical remodelling, can predict short-term and long-term sinus rhythm maintenance after electrical cardioversion in AF.
左心耳（LAA）壁在心房颤动（AF）期间的运动速度是机械重构的潜在标志物。在这项研究中，我们研究了 AF 期间 LAA 壁运动速度是否可以预测电复律的成功和长期窦性节律维持。通过经胸超声心动图获得标准超声心动图数据，并通过经食管超声心动图测量 LAA 壁运动速度。通过逻辑回归和接收者操作特征曲线分析，我们将超声心动图和临床数据与电复律结果和 12 个月时的窦性节律维持相关联。在这项前瞻性研究中，121 例患者中，97 例（81.2%）电复律恢复窦性节律，51 例（42%）患者在 12 个月时维持窦性节律。电复律恢复窦性节律的患者 LAA 壁运动速度高于电复律失败的患者（p<0.001）。与 12 个月时仍为 AF 的患者相比，维持窦性节律的患者左心房最大和末期容积较低（p≤0.01），E/e'比值较低（p=0.005），s'值较高（p=0.013），LAA 运动速度较高（p<0.001）。多变量逻辑回归分析显示，仅 LAA 壁运动速度和 E/e'比值是 12 个月时维持窦性节律的独立预测因素（p≤0.04）。在校正临床变量后，LAA 壁运动速度也是维持窦性节律的显著预测因素（p=0.039）。结论：作为机械重构的标志物，LAA 壁运动速度可以预测 AF 患者电复律后短期和长期的窦性节律维持。
