Left atrial function assessed by speckle tracking echocardiography as a predictor of new-onset non-valvular atrial fibrillation: results from a prospective study in 580 adults.

AIMS The aim of this prospective study was to evaluate left atrial (LA) function for the prediction of increased risk of new-onset non-valvular atrial fibrillation (AF). Risk stratification for new-onset AF based on LA remodelling may have a major public health impact. Although left atrial volume (LAV) or LA dimension have been proposed as predictors of AF, other predictive parameters of LA function have not yet been fully examined. METHODS AND RESULTS LA emptying function (EF), strain rate (SR), and LAV were evaluated in the apical four-chamber view by speckle tracking echocardiography in 580 consecutive adults (age 64 ± 17, 303 men) without a history of atrial arrhythmias. During a follow-up period of 28 months, 32 subjects (age 73 ± 9, 18 men) developed electrocardiographically confirmed AF. Subjects with new-onset AF had lower LA active EF (16 ± 5 vs. 28 ± 8%, P< 0.001) and lower LA SR at atrial contraction (-0.9 ± 0.2 vs. -1.4 ± 0.5 S(-1), P< 0.001), but larger maximum LAV index (59 ± 12 vs. 46 ± 16 mL/m(2), P< 0.001) compared with non-AF subjects at baseline. In multivariate logistic regression analysis, LA active EF was the only independent predictor of new-onset AF. Using an LA active EF cut-off of ≤20%, the sensitivity and specificity for new-onset AF based on receiver operator characteristic curve analysis were 88 and 81%, respectively (area under the curve: 0.92). CONCLUSION Reduced LA active EF (booster pump function) assessed by speckle tracking echocardiography independently predicts the risk of new-onset AF, suggesting a stronger association between LA functional remodelling and AF than between LA size and AF.

[1]  Jane A. Linderbaum,et al.  ACC/AHA/Physician Consortium 2008 Clinical Performance Measures for Adults with Nonvalvular Atrial Fibrillation or Atrial Flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Wr , 2008, Journal of the American College of Cardiology.

[2]  A. Ducharme,et al.  Enalapril Decreases the Incidence of Atrial Fibrillation in Patients With Left Ventricular Dysfunction Insight From the Studies Of Left Ventricular Dysfunction (SOLVD) Trials , 2003, Circulation.

[3]  M. Nieminen,et al.  Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study. , 2005, Journal of the American College of Cardiology.

[4]  R. Walsh,et al.  Left atrial mechanical and biochemical adaptation to pacing induced heart failure. , 1995, Cardiovascular research.

[5]  E. Bernal,et al.  Use of Irbesartan to Maintain Sinus Rhythm in Patients With Long-Lasting Persistent Atrial Fibrillation: A Prospective and Randomized Study , 2002, Circulation.

[6]  S. Yusuf,et al.  Challenges of Establishing New Antithrombotic Therapies in Atrial Fibrillation , 2007, Circulation.

[7]  José Luis Rodrigo,et al.  Three-dimensional-wall motion tracking: a new and faster tool for myocardial strain assessment: comparison with two-dimensional-wall motion tracking. , 2009, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[8]  D. Kass,et al.  Age- and Gender-Related Ventricular-Vascular Stiffening: A Community-Based Study , 2005, Circulation.

[9]  J. Seward,et al.  Minimum vs. maximum left atrial volume for prediction of first atrial fibrillation or flutter in an elderly cohort: a prospective study. , 2008, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[10]  M. Yoshiyama,et al.  Automated assessment of left atrial function from time-left atrial volume curves using a novel speckle tracking imaging method. , 2009, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[11]  Richard B Devereux,et al.  Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardio , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[12]  J. Seward,et al.  Left atrial reservoir function as a potent marker for first atrial fibrillation or flutter in persons > or = 65 years of age. , 2008, The American journal of cardiology.

[13]  Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation. A prospective and randomized study ☆ , 2002 .

[14]  Juan F Granada,et al.  A population-based study of mortality among patients with atrial fibrillation or flutter. , 2002, The American journal of medicine.

[15]  J. Seward,et al.  Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. , 1994, Mayo Clinic proceedings.

[16]  S A Glantz,et al.  Left atrial relaxation and left ventricular systolic function determine left atrial reservoir function. , 1999, Circulation.

[17]  Craig J. Hartley,et al.  A novel feature-tracking echocardiographic method for the quantitation of regional myocardial function: validation in an animal model of ischemia-reperfusion. , 2008, Journal of the American College of Cardiology.

[18]  Yun Zhang,et al.  Enhanced Left Atrial Reservoir, Increased Conduit, and Weakened Booster Pump Function in Hypertensive Patients with Paroxysmal Atrial Fibrillation , 2008, Hypertension Research.

[19]  T. Manolio,et al.  Left atrial volume, geometry, and function in systolic and diastolic heart failure of persons > or =65 years of age (the cardiovascular health study). , 2006, The American journal of cardiology.

[20]  James D. Thomas,et al.  Usefulness of Doppler assessment of pulmonary vein and left atrial appendage flow following pulmonary vein isolation of chronic atrial fibrillation in predicting recovery of left atrial function. , 2005, The American journal of cardiology.

[21]  D. Levy,et al.  Lifetime Risk for Development of Atrial Fibrillation: The Framingham Heart Study , 2004, Circulation.

[22]  B. Gersh,et al.  Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. , 2008, Journal of the American College of Cardiology.

[23]  J B Seward,et al.  Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women. , 2001, Mayo Clinic proceedings.

[24]  Joshua J. E. Blauer,et al.  Left Atrial Strain and Strain Rate in Patients With Paroxysmal and Persistent Atrial Fibrillation: Relationship to Left Atrial Structural Remodeling Detected by Delayed-Enhancement MRI , 2010, Circulation. Cardiovascular imaging.

[25]  K. Tanabe,et al.  Left atrial volume and the risk of paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy. , 2004, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[26]  D. Levy,et al.  Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. , 1998, Circulation.

[27]  References , 1971 .

[28]  M. Arai,et al.  Evaluation of left atrial degeneration for the prediction of atrial fibrillation: usefulness of integrated backscatter transesophageal echocardiography. , 2009, JACC. Cardiovascular imaging.

[29]  K. Hayashi,et al.  Impact of reduced left atrial functions on diagnosis of paroxysmal atrial fibrillation: results from analysis of time-left atrial volume curve determined by two-dimensional speckle tracking. , 2011, Journal of cardiology.