Minaev Anton V, Mironenko Marina Yu, Dontsova Vera I, Pirushkina Yulia D, Berdibekov Bektur Sh, Voynov Alexander S, Sarkisyan Julia A, Golukhova Elena Z
A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, 121552 Moscow, Russia.
Outpatient Clinic #67 of the Moscow Department of Healthcare, 127083 Moscow, Russia.
J Clin Med. 2024 Oct 9;13(19):6023. doi: 10.3390/jcm13196023.
. To identify the difference between adult patients with septal defects and paroxysmal atrial fibrillation (AF) and patients without a history of arrhythmia using the left atrial (LA) volume and function parameters, to reveal the parameters associated with AF development. . In this prospective study, 81 patients with septal defects and left-to-right shunts were enrolled between 2021 and 2023 and divided into two groups: with paroxysmal AF and without AF. Left atrial function was analyzed based on the indexed left atrial volumes (LAVI and preA-LAVI), ejection fraction (LAEF), expansion index (LAEI), reservoir (LAS-r), conduit (LAS-cd) and contractile (LAS-ct) strain, and stiffness index (LASI) using a Philips CVx3D ultrasound system (Philips, Amsterdam, The Netherlands) and corresponding software. In total, 26 patients with paroxysmal atrial fibrillation (mean age: 59.6 ± 11.7 years, female: 80.8%) and 55 patients with septal defects without any history of arrhythmias (mean age: 44.8 ± 11.6 years, female: 81.8%) were included. All patients were in the NYHA class I or II at baseline. Our findings demonstrated a significant difference between all LA function parameters in the two groups. Upon univariable analysis, the LAVI, preA-LAVI, LASI, LAEF, LAEI, LAS-r, LAS-c, LAS-ct, age, cardiac index, E/A, and RV pressure were found to be associated with AF. The multivariate analysis identified LAVI (OR 1.236, 95% CI 1.022-1.494, = 0.03), LAS-r (OR 0.723, 95% CI 0.556-0.940, = 0.02), and LAS-ct (OR 1.518, 95% CI 1.225-1.880, < 0.001) as independent predictors of AF development. The proposed model demonstrated high sensitivity and specificity with an adjusted classification threshold of 0.38 (AUC: 0.97, 95% CI 0.93-1.00, sensitivity 92% and specificity 92%, < 0.001). . The assessment of LA function using speckle-tracking echocardiography demonstrated significantly different values in the AF group among patients with congenital septal defects. This technique can therefore be implemented in routine clinical management. Atrial fibrillation development in adult patients with congenital septal defects and a left-to-right shunt is associated with the changes in left atrial function under conditions of an increased preload.
利用左心房（LA）容积和功能参数，识别患有房间隔缺损和阵发性心房颤动（AF）的成年患者与无心律失常病史患者之间的差异，以揭示与房颤发生相关的参数。在这项前瞻性研究中，2021年至2023年间纳入了81例患有房间隔缺损和左向右分流的患者，并将其分为两组：阵发性房颤组和无房颤组。使用飞利浦CVx3D超声系统（飞利浦，荷兰阿姆斯特丹）和相应软件，基于左心房容积指数（LAVI和preA-LAVI）、射血分数（LAEF）、扩张指数（LAEI）、储存期（LAS-r）、管道期（LAS-cd）和收缩期（LAS-ct）应变以及硬度指数（LASI）分析左心房功能。总共纳入了26例阵发性心房颤动患者（平均年龄：59.6±11.7岁，女性：80.8%）和55例无任何心律失常病史的房间隔缺损患者（平均年龄：44.8±11.6岁，女性：81.8%）。所有患者基线时均为纽约心脏协会I级或II级。我们的研究结果表明两组所有左心房功能参数之间存在显著差异。单因素分析发现，LAVI、preA-LAVI、LASI、LAEF、LAEI、LAS-r、LAS-c、LAS-ct、年龄、心脏指数、E/A和右心室压力与房颤相关。多因素分析确定LAVI（OR 1.236，95%CI 1.022 - 1.494，P = 0.03）、LAS-r（OR 0.723，95%CI 0.556 - 0.940，P = 0.02）和LAS-ct（OR 1.518，95%CI 1.225 - 1.880，P < 0.001）是房颤发生的独立预测因素。所提出的模型在调整分类阈值为0.38时显示出高敏感性和特异性（AUC：0.97，95%CI 0.93 - 1.00，敏感性92%，特异性92%，P < 0.001）。使用斑点追踪超声心动图评估左心房功能显示，先天性房间隔缺损患者的房颤组中有显著不同的值。因此，该技术可应用于常规临床管理。患有先天性房间隔缺损和左向右分流的成年患者发生心房颤动与前负荷增加情况下左心房功能的变化有关。
