Supervisors info:
Κυρίτση Ελένη, Ομότιμη Καθηγήτρια, Τμήμα Νοσηλευτικής, ΠΑΔΑ
Τούσουλης Δημήτριος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Τούτουζας Κωνσταντίνος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: Left atrial strain is a method for assessment of dysfunction and atrial myocardial stunning following electrical cardioversion of atrial fibrillation, as well as the recovery of myocardial function after sinus rhythm is restored.
Purpose: The purpose of this study is to investigate whether left atrial tissue strain (autoLA strain) assessed using the echocardiographic technique of two-dimensional speckle-tracking strain can be used to evaluate the recovery of left atrial function thirty days after successful synchronized electrical cardioversion for paroxysmal or persistent atrial fibrillation.
Materials/Method: For this study, we examined patients admitted to the Cardiology Clinic of General Hospital Asklepieion Voula, Athens due to paroxysmal or persistent atrial fibrillation, who underwent successful synchronized electrical cardioversion, and were followed up at the Echocardiography Laboratory. Data were collected from the patients' electronic records, which included basic demographic and biometric characteristics as well as echocardiographic study records on the day of electrical cardioversion and four weeks later.
Results: Thirty-seven patients were enrolled in this study. Twenty-one of them were males (56.8%) and sixteen females (43.2%). The mean age in years was 62 +/-12.5. BSA (body surface area) was 2.03 m2 +/-1. 26. The comparison of LASr (p<0.01), LAscd (p:0.03), and LASct (p<0.01) values on the day of cardioversion and one month later showed a statistically significant improvement in these parameters. Similarly, the comparison of the commonly used imaging indices such as left atrial diameter (LA) (p:0.043) followed the same trend, confirming the aforementioned results. Additionally, the multivariate analysis revealed that LASr (p:0.003) decreased with increasing age, while an inverse relationship existed between LAScd (p:0.004), LASct (p:0.024), and age respectively. Moreover, BSA appeared to have a detrimental effect on LASct (p:0.037), causing an increase in its value. Finally, the LASr on the day of admission in patients who remained in sinus rhythm was statistically significantly higher in absolute value compared to those who were found to have atrial fibrillation one month later (p:0.004).
Conclusion: In patients with paroxysmal or persistent atrial fibrillation LASr, LAScd, and LASct values were significantly improved thirty days after successful synchronized cardioversion to sinus rhythm, LASr decreased with increasing age, while an inverse relationship existed between LAScd, LASct and age respectively. Consequently, newer imaging methods based on tissue Doppler techniques (TDI) and two-dimensional speckle-tracking strain (left atrial strain - LASr, LAScd, LASct) are useful tools in assessing atrial stunning, timing of recovery of atrial myocardial function, with significant prognostic value for patients’ symptoms and recurrent episodes of paroxysmal atrial fibrillation.
