Marchandise Sébastien, Garnir Quentin, Scavée Christophe, Varnavas Varnavas, le Polain de Waroux Jean-Benoit, Wauters Aurélien, Beauloye Christophe, Roelants Véronique, Gerber Bernhard L
Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
Front Cardiovasc Med. 2022 May 25;9:856796. doi: 10.3389/fcvm.2022.856796. eCollection 2022.
Non-invasive evaluation of left atrial structural and functional remodeling should be considered in all patients with persistent atrial fibrillation (AF) to optimal management. Speckle tracking echocardiography (STE) has been shown to predict AF recurrence after catheter ablation; however in most studies, patients had paroxysmal AF, and STE was performed while patients were in sinus rhythm.
The aim of this study was to evaluate the ability of STE parameters acquired during persistent AF to assess atrial fibrosis measured by low voltage area, and to predict maintenance of sinus rhythm of catheter ablation.
A total of 94 patients (69 men, 65 ± 9 years) with persistent AF prospectively underwent measurement of Global Peak Atrial Longitudinal Strain (GPALS), indexed LA Volume (LAVI), E/e' ratio, and LA stiffness index (the ratio of E/e' to GPALS) by STE prior to catheter ablation, while in AF. Low-voltage area (LVA) was assessed by electro-anatomical mapping and categorized into absent, moderate (>0 to <15%), and high (≥15%) atrial extent. AF recurrence was evaluated after 3 months of blanking.
Multivariable regression showed that LAVI, GPALS, and LA stiffness independently predicted LVA extent after correcting for age, glomerular filtration rate, and CHADS-VAS score. Of all the parameters, LA stiffness index had the highest diagnostic accuracy (AUC 0.85), allowing using a cut-off value ≥0.7 to predict moderate or high LVA with 88% sensitivity and 47% specificity, respectively. In multivariable Cox analysis, both GPALS and LA stiffness were able to significantly improve the c statistic to predict AF recurrence ( = 40 over 9 months FU) over CHARGE-AF ( < 0.001 for GPALS and = 0.01 for LA stiffness) or CHADS-VAS score ( < 0.001 for GPALS and = 0.02 for LA stiffness). GPALS and LA stiffness also improved the net reclassification index (NRI) over the CHARGE-AF index (NRI 0.67, 95% CI [0.33-1.13] for GPALS and NRI 0.73, 95% CI [0.12-0.91] for LA stiffness, respectively), and over the CHADS-VAS score (NRI 0.43, 95% CI [-0.14 to 0.69] for GPALS and NRI 0.52, 95% CI [0.10-0.84], respectively) for LA stiffness to predict AF recurrence at 9 months.
STE parameters acquired during AF allow prediction of LVA extent and AF recurrence in patients with persistent AF undergoing catheter ablation. Therefore, STE could be a valuable approach to select candidates for catheter ablation.
对于所有持续性心房颤动（AF）患者，为了实现最佳管理，应考虑对左心房结构和功能重塑进行无创评估。斑点追踪超声心动图（STE）已被证明可预测导管消融术后AF复发；然而，在大多数研究中，患者为阵发性AF，且STE是在患者处于窦性心律时进行的。
本研究的目的是评估持续性AF期间获得的STE参数评估通过低电压区域测量的心房纤维化的能力，以及预测导管消融术后窦性心律维持情况的能力。
共有94例持续性AF患者（69例男性，年龄65±9岁）在导管消融术前处于AF状态时，前瞻性地接受了STE测量，包括整体峰值心房纵向应变（GPALS）、左心房容积指数（LAVI）、E/e'比值和左心房僵硬度指数（E/e'与GPALS的比值）。通过电解剖标测评估低电压区域（LVA），并将其分为无、中度（>0至<15%）和高度（≥15%）心房范围。在空白期3个月后评估AF复发情况。
多变量回归显示，在校正年龄、肾小球滤过率和CHADS-VAS评分后，LAVI、GPALS和左心房僵硬度独立预测LVA范围。在所有参数中，左心房僵硬度指数具有最高的诊断准确性（AUC 0.85），使用截断值≥0.7分别以88%的敏感性和47%的特异性预测中度或高度LVA。在多变量Cox分析中，与CHARGE-AF（GPALS的P<0.001，左心房僵硬度的P = 0.01）或CHADS-VAS评分（GPALS的P<0.001，左心房僵硬度的P = 0.02）相比，GPALS和左心房僵硬度均能够显著提高c统计量以预测AF复发（9个月随访期间为40例）。GPALS和左心房僵硬度相对于CHARGE-AF指数（GPALS的净重新分类指数[NRI]为0.6, 95%可信区间[0.33 - 1.13]，左心房僵硬度的NRI为0.73, 95%可信区间[0.12 - 0.91]）以及相对于CHADS-VAS评分（GPALS的NRI为0.43, 95%可信区间[-0.14至0.69]，左心房僵硬度的NRI为0.52, 95%可信区间[0.10 - 0.84]）也提高了预测9个月时AF复发的净重新分类指数。
AF期间获得的STE参数可预测接受导管消融的持续性AF患者的LVA范围和AF复发情况。因此，STE可能是选择导管消融候选者的一种有价值的方法。
