Angelini Eleonora, Sieweke Jan-Thorben, Berliner Dominik, Biber Saskia, Hohmann Stephan, Oldhafer Maximiliane, Schallhorn Sven, Duncker David, Veltmann Christian, Bauersachs Johann, Bavendiek Udo
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Center for Electrophysiology, Klinikum Links der Weser, Bremen, Germany.
Front Cardiovasc Med. 2023 Dec 18;10:1270422. doi: 10.3389/fcvm.2023.1270422. eCollection 2023.
The echocardiographic parameters total atrial conduction time (PA-TDI duration), left atrial (LA) volume index (LAVI), and LA strain reflect adverse atrial remodeling and predict atrial fibrillation (AF).
The aim of this study was to investigate echocardiographic parameters indicating reverse LA remodeling and potential associations with AF recurrence after pulmonary vein isolation (PVI).
This prospective observational study consecutively enrolled patients scheduled for PVI for symptomatic AF. Electrocardiogram (ECG) test and transthoracic echocardiography were performed the day before and after PVI and again 3 months later. AF recurrence was determined by Holter ECG at 3 months, and telephone follow-up at 12 months, after PVI. The parameters of LA remodeling [PA-TDI, LAVI, and LA strain analysis: reservoir strain (LASr), conduit strain (LAScd), contraction strain (LASct)] were determined by transthoracic echocardiography.
A total of 48 patients were included in the study (mean age: 61.4 ± 12.2 years). PA-TDI significantly decreased the day after PVI compared with the baseline (septal PA-TDI 103 ± 13 vs. 82 ± 14.9 ms, ≤ 0.001; lateral PA-TDI 122.4 ± 14.8 vs. 106.9 ± 14.4 ms, ≤ 0.001) and at the 3-month follow-up (septal PA-TDI: 77.8 ± 14.5, ≤ 0.001; lateral PA-TDI 105.2 ± 16.1, ≤ 0.001). LAVI showed a significant reduction at the 3-month follow-up compared with the baseline (47.7 ± 14.4 vs. 40.5 ± 9.7, < 0.05). LASr, LAScd, and LASct did not change after PVI compared with the baseline. AF recurred in 10 patients after PVI (21%). Septal PA-TDI, septal a', and LAVI/a' determined the day after PVI were associated with AF recurrence.
Changes in echocardiographic parameters of LA remodeling and function indicate that functional electromechanical recovery preceded morphological reverse remodeling of the left atrium after PVI. Furthermore, these changes in echocardiographic parameters indicating LA reverse remodeling after PVI may identify patients at high risk of AF recurrence.
超声心动图参数全心房传导时间（PA-TDI 持续时间）、左心房（LA）容积指数（LAVI）和 LA 应变反映了不良心房重构，并可预测心房颤动（AF）。
本研究旨在探讨指示 LA 逆向重构的超声心动图参数以及与肺静脉隔离（PVI）后 AF 复发的潜在关联。
这项前瞻性观察性研究连续纳入计划接受 PVI 治疗的症状性 AF 患者。在 PVI 前一天、PVI 后一天以及 3 个月后再次进行心电图（ECG）检查和经胸超声心动图检查。通过 Holter ECG 在 PVI 后 3 个月以及 12 个月电话随访确定 AF 复发情况。通过经胸超声心动图确定 LA 重构参数[PA-TDI、LAVI 和 LA 应变分析：储存库应变（LASr）、管道应变（LAScd）、收缩应变（LASct）]。
本研究共纳入 48 例患者（平均年龄：61.4±12.2 岁）。与基线相比，PVI 后一天 PA-TDI 显著降低（间隔 PA-TDI：103±13 对比 82±14.9 ms，P≤0.001；侧壁 PA-TDI：122.4±14.8 对比 106.9±14.4 ms，P≤0.001），且在 3 个月随访时仍显著降低（间隔 PA-TDI：77.8±14.5，P≤0.001；侧壁 PA-TDI：105.2±16.1，P≤0.001）。与基线相比，LAVI 在 3 个月随访时显著降低（47.7±14.4 对比 40.5±9.7，P<0.05）。与基线相比，PVI 后 LASr、LAScd 和 LASct 未发生变化。PVI 后 10 例患者发生 AF 复发（21%）。PVI 后一天测定的间隔 PA-TDI、间隔 a'和 LAVI/a'与 AF 复发相关。
LA 重构和功能的超声心动图参数变化表明，PVI 后左心房的功能电机械恢复先于形态学逆向重构。此外，这些指示 PVI 后 LA 逆向重构的超声心动图参数变化可能有助于识别 AF 复发高危患者。
