Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France; Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France.
Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France.
Arch Cardiovasc Dis. 2024 Feb;117(2):134-142. doi: 10.1016/j.acvd.2023.11.015. Epub 2024 Jan 11.
Left atrial (LA) strain is a simple marker of LA function. The aim of the study was to evaluate the determinants of atrial cardiomyopathy in AF.
In this pilot study, we prospectively evaluated clinical, biological, metabolomic and echocardiographic parameters for 85 consecutive patients hospitalized for atrial fibrillation (AF) with restoration of sinus rhythm at 6 months. Eighty-one patients with an analysable LA strain at 6 months were divided into groups according to median reservoir strain:<23.3% (n=40) versus≥23.3% (n=41).
Compared to patients with the highest LA strain, patients with lowest LA strain had multiple differences at admission: clinical (older age; more frequent history of AF; more patterns of persistent AF); biological (higher fasting blood glucose levels, glycated haemoglobin, high-sensitivity C-reactive protein, and urea; lower glomerular filtration rate); metabolomic (higher levels of kynurenine, kynurenine/tryptophan, and urea/creatinine; lower levels of arginine and methionine/methionine sulfoxide); and echocardiographic (higher two-dimensional end-systolic LA volume [LAV] indexes; higher three-dimensional end-systolic and end-diastolic LAV and right atrial volume indexes; lower LA and right atrial emptying fractions and three-dimensional right ventricular ejection fraction) (all P<0.05). Area under the receiver operating characteristic curve to predict LA strain alteration at 6 months was highest for a combined score including clinical, biological, metabolomic and echocardiographic variables at admission (area under the receiver operating characteristic curve 0.871; P<0.0001).
LA reservoir strain could be a memory of initial atrial myocardial stress in AF. It can be predicted using a combination of clinical, biological, metabolomic and echocardiographic admission variables.
左心房（LA）应变是 LA 功能的简单标志物。本研究旨在评估 AF 中心房心肌病的决定因素。
在这项试点研究中，我们前瞻性评估了 85 例因心房颤动（AF）住院并在 6 个月时恢复窦性心律的患者的临床、生物学、代谢组学和超声心动图参数。在 6 个月时有可分析 LA 应变的 81 例患者根据中位储备应变分为两组：<23.3%（n=40）与≥23.3%（n=41）。
与 LA 应变最高的患者相比，LA 应变最低的患者入院时存在多种差异：临床（年龄较大；更频繁的 AF 病史；更多持续性 AF 模式）；生物学（空腹血糖、糖化血红蛋白、高敏 C 反应蛋白和尿素水平较高；肾小球滤过率较低）；代谢组学（犬尿氨酸、犬尿氨酸/色氨酸和尿素/肌酐水平较高；精氨酸和蛋氨酸/蛋氨酸亚砜水平较低）；超声心动图（二维收缩末期 LA 容积[LAV]指数较高；三维收缩末期和舒张末期 LAV 和右心房容积指数较高；LA 和右心房排空分数和三维右心室射血分数较低）（均 P<0.05）。在预测 6 个月时 LA 应变变化的受试者工作特征曲线下面积方面，入院时包括临床、生物学、代谢组学和超声心动图变量的综合评分最高（受试者工作特征曲线下面积 0.871；P<0.0001）。
LA 储备应变可能是 AF 中心房心肌初始应激的记忆。它可以通过结合入院时的临床、生物学、代谢组学和超声心动图变量来预测。
