Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia.
J Am Soc Echocardiogr. 2022 May;35(5):486-494.e2. doi: 10.1016/j.echo.2021.12.010. Epub 2021 Dec 23.
Atrial fibrillation (AF) is a frequent complication of rheumatic mitral stenosis (MS) and is associated with worse outcomes. Prediction of new-onset AF by assessing left atrial (LA) mechanics with speckle-tracking echocardiography might be useful for risk stratification and guiding therapeutic strategies. Therefore, the aim of this study was to assess the association of LA reservoir strain (LASr) and strain rate (LASRr) with AF at follow-up in patients with rheumatic MS.
Left atrial reservoir strain and LASRr measured by speckle-tracking echocardiography were assessed in 125 patients (mean age, 50 ± 15 years; 80.8% female) with rheumatic MS and without a history of AF. Patients were followed up for the occurrence of a first episode of AF after the index echocardiogram.
During a median follow-up of 32 (9.5-70) months, 41 patients (32.8%) developed new-onset AF. Patients who developed AF had significantly more impaired LASr (13.4% ± 5.2% vs 18.9% ± 8.2%; P < .001) and LASRr (0.72 ± 0.26 s vs 0.98 ± 0.36 sP < .001) compared with patients who remained in sinus rhythm. On multivariable Cox regression analysis, LASr < 21% and LASRr < 0.8 s were independently associated with the development of AF at follow-up (hazard ratio = 7.03, 95% CI, 2.08-23.77, P = .002; and hazard ratio = 3.42, 95% CI, 1.59-7.34, P = .002, respectively).
LASr and LASRr are impaired in patients with rheumatic MS, and the degree of impairment is associated with new-onset AF at follow-up.
心房颤动（AF）是风湿性二尖瓣狭窄（MS）的常见并发症，与预后较差相关。通过斑点追踪超声心动图评估左心房（LA）力学来预测新发 AF 可能有助于风险分层和指导治疗策略。因此，本研究旨在评估风湿性 MS 患者的 LA 储存应变（LASr）和应变率（LASRr）与随访时 AF 的相关性。
通过斑点追踪超声心动图评估 125 例（平均年龄 50±15 岁，80.8%为女性）风湿性 MS 且无 AF 病史患者的 LA 储存应变和 LASRr。患者在指数超声心动图后进行首次 AF 发作的随访。
在中位数为 32（9.5-70）个月的随访期间，41 例（32.8%）患者新发 AF。发生 AF 的患者 LASr 明显降低（13.4%±5.2%比 18.9%±8.2%；P<0.001）和 LASRr 降低（0.72±0.26 s 比 0.98±0.36 s；P<0.001）。多变量 Cox 回归分析显示，LASr<21%和 LASRr<0.8 s 与随访时 AF 的发生独立相关（危险比=7.03，95%CI，2.08-23.77，P=0.002；和危险比=3.42，95%CI，1.59-7.34，P=0.002）。
风湿性 MS 患者的 LASr 和 LASRr 受损，其受损程度与随访时新发 AF 相关。
