Pre-operative left atrial strain predicts post-operative atrial fibrillation in patients undergoing aortic valve replacement for aortic stenosis

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• 作者：Matteo Cameli (1)
  Matteo Lisi (1)
  Rosanna Reccia (1)
  Elena Bennati (1)
  Angela Malandrino (1)
  Marco Solari (1)
  Elisa Bigio (2)
  Bonizella Biagioli (2)
  Francesca Maria Righini (1)
  Massimo Maccherini (3)
  Mario Chiavarelli (3)
  Michael Henein (4)
  Sergio Mondillo (1)
  
• 关键词：Aortic stenosis ; Atrial fibrillation ; Echocardiography ; Atrial strain ; Speckle tracking
• 刊名：The International Journal of Cardiovascular Imaging (formerly Cardiac Imaging)
• 出版年：2014
• 出版时间：February 2014
• 年：2014
• 卷：30
• 期：2
• 页码：279-286
• 全文大小：638 KB
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• 作者单位：Matteo Cameli (1)
  Matteo Lisi (1)
  Rosanna Reccia (1)
  Elena Bennati (1)
  Angela Malandrino (1)
  Marco Solari (1)
  Elisa Bigio (2)
  Bonizella Biagioli (2)
  Francesca Maria Righini (1)
  Massimo Maccherini (3)
  Mario Chiavarelli (3)
  Michael Henein (4)
  Sergio Mondillo (1)
  
  1. Department of Cardiovascular Diseases, University of Siena, Policlinico “Le Scotte- Viale Bracci 1, 53100, Siena, Italy
  2. Department of Cardiac Surgery, University of Siena, Siena, Italy
  3. Unit of Anaesthesia and Intensive Care Unit, Department of Surgery and Bioengineering, University of Siena, Siena, Italy
  4. Department of Public Health and Clinical Medicine, and Heart Centre, Ume? University, Ume?, Sweden
  
• ISSN：1573-0743

文摘

Post-operative atrial fibrillation (AF) is a common and serious complication in patients undergoing aortic valve replacement (AVR). Speckle tracking echocardiography (STE) has recently enabled the quantification of longitudinal myocardial left atrial (LA) deformation dynamics. Our aim was to investigate LA preoperative mechanical function in patients undergoing AVR for aortic stenosis using STE and determine predictors of post-operative AF. 76 patients with aortic stenosis in sinus rhythm, undergoing AVR, were prospectively enrolled. Conventional echocardiographic parameters, and peak atrial longitudinal strain (PALS) were measured in all subjects the day before surgery. PALS values were obtained by averaging all segments in the 4- and 2-chamber views (global PALS). All patients received biological valve prostheses and a standard postoperative care. Postoperative AF occurred in 15 patients (19.7?%). On univariate analysis among all clinical and echocardiographic variables, global PALS showed the highest diagnostic accuracy (HR 6.55 p?<?0.0001; AUC of 0.89) with a cut-off value <16.9?%, having sensitivity and specificity of 86 and 91?%, respectively, in predicting postoperative AF. LA volume indexed and E/e-ratio had lower diagnostic accuracy (AUC 0.76 and 0.51, respectively). On multivariate analysis global PALS remains a significant predictor of postoperative AF (p?<?0.0001). STE analysis of LA myocardial deformation is considered a promising tool for the evaluation of LA subclinical dysfunction in patients undergoing AVR, giving a potentially better risk stratification for the occurrence of postoperative AF.