Hopman Luuk H G A, Mulder Mark J, van der Laan Anja M, Bhagirath Pranav, Demirkiran Ahmet, von Bartheld Martin B, Kemme Michiel J B, van Rossum Albert C, Allaart Cornelis P, Götte Marco J W
Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
Int J Cardiol. 2023 May 1;378:23-31. doi: 10.1016/j.ijcard.2023.02.019. Epub 2023 Feb 15.
The present study assesses different left atrial (LA) strain approaches in relation to atrial fibrillation (AF) recurrence after ablation and compares LA feature tracking (FT) strain to novel rapid LA strain approaches in AF patients.
This retrospective single-center study comprised of 110 prospectively recruited AF patients who underwent cardiac magnetic resonance (CMR) imaging in sinus rhythm prior to their first pulmonary vein isolation ablation. LA rapid strain (long axis strain and atrioventricular (AV)-junction strain), LA FT strain, and LA volumes were derived from 2-chamber and 4-chamber cine images. AF recurrence was followed up for 12 months using either 12‑lead ECGs or rhythm Holter monitoring.
Arrhythmia recurrence was observed in 39 patients (36%) after the 90-day blanking period, occurring at a median of 181 (122-286) days. LA long axis strain, AV-junction strain, and FT strain were all more impaired in patients with AF recurrence compared to patients without AF recurrence (long axis strain: P < 0.01; AV-junction strain: P < 0.001; FT strain: P < 0.01, respectively). Area under the curve (AUC) values for LA remodeling parameters in association with AF recurrence were 0.68 for long axis strain, 0.68 for AV-junction strain, 0.66 for FT strain, 0.66 for LA volume index. Phasic FT LA strain demonstrated that contractile strain had the highest AUC (0.70).
Both LA rapid strain and LA FT strain are associated with arrhythmia recurrence after ablation in AF patients. LA rapid strain can be a convenient and reproducible alternative for LA FT strain to assess LA function in clinical practice.
本研究评估了与消融术后房颤（AF）复发相关的不同左心房（LA）应变方法，并比较了AF患者中LA特征追踪（FT）应变与新型快速LA应变方法。
这项回顾性单中心研究纳入了110例前瞻性招募的AF患者，这些患者在首次肺静脉隔离消融术前处于窦性心律时接受了心脏磁共振（CMR）成像。LA快速应变（长轴应变和房室（AV）交界处应变）、LA FT应变和LA容积均从二腔和四腔电影图像中得出。使用12导联心电图或动态心电图监测对AF复发进行了12个月的随访。
在90天空白期后，39例患者（36%）出现心律失常复发，中位复发时间为181（122 - 286）天。与无AF复发的患者相比，AF复发患者的LA长轴应变、AV交界处应变和FT应变均受损更严重（长轴应变：P < 0.01；AV交界处应变：P < 0.001；FT应变：P < 0.01）。与AF复发相关的LA重塑参数的曲线下面积（AUC）值，长轴应变为0.68，AV交界处应变为0.68，FT应变为0.66，LA容积指数为0.66。阶段性FT LA应变显示收缩应变具有最高的AUC（0.70）。
LA快速应变和LA FT应变均与AF患者消融术后的心律失常复发相关。在临床实践中，LA快速应变可作为LA FT应变评估LA功能的一种方便且可重复的替代方法。
