Left atrial strain parameters to predicting elevated left atrial
pressure in patients with atrial fibrillation
Abstract
Objectives: To assess the ability of left atrial(LA) strain
parameters to discriminate patients with elevated left atrial
pressure(LAP) from patients with atrial fibrillation(AF).
Methods and results: A total of 142 patients with non-valvular
AF who underwent first catheter ablation(CA) between November 2022 and
November 2023 were enrolled in the study. Conventional and
speckle-tracking echocardiography(STE)were performed in all patients
within 24 hours before CA,and LAP was invasively measured during the
ablation procedure. According to mean LAP,the study population was
classified into 2 groups of normal LAP(LAP< 15 mmHg, n=101) and
elevated LAP(LAP≥15 mmHg, n=41).Compared with the normal LAP group,
elevated LAP group showed significantly reduced LA reservoir strain
(LASr) [9.14 ( 7.97 -11.80 ) vs 20(13.59-26.96), p <
0.001], and increased LA filling index[9.60 ( 7.15 -12.20 ) vs 3.72
( 2.17 -5.82 ),p<0.001], LA stiffness index[1.13 (
0.82-1.46 ) vs 0.47( 0.30 -0.70 ),p<0.001]. LASr, LA filling
index and LA stiffness index were independent predictors of elevated LAP
after adjusted by the type of AF, EDT, E/e’, mitral E and Peak
acceleration rate of mitral E velocity. The receiver-operating
characteristic curve (ROC) analysis showed LA strain parameters (area
under curve [AUC] 0.794 to 0.819) could provide similar or greater
diagnostic accuracy for elevated LAP, as compared to conventional
echocardiographic parameters. Furthermore, the novel algorithms built by
LASr, LA stiffness index, LA filling index and LA emptying
fraction(LAEF), was used to discriminate elevated LAP in AF with good
accuracy (AUC 0.880, accuracy of 81.69%, sensitivity of 80.49%,
specificity of 82.18%), and much better than 2016 ASE/EACVI algorithms
in AF. Conclusion: In patients with AF,LA strain parameters
could be useful to predict elevated LAP and non-inferior to conventional
echocardiographic parameters. Besides, the novel algorithm built by LA
strain parameters combined with conventional parameters would improve
the diagnostic efficiency.