Left atrial function during exercise stress echocardiography as a sign of paroxysmal/persistent atrial fibrillation

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2024年11月4日

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Angela Zagatina,
Quirino Ciampi,
Jesus Vazquez Peteiro,
Elena Kalinina,
Irina Begidova,
Ratnasari Padang,
Alla Boshchenko,
Elisa Merli,
Matteo Lisi,
Hugo Rodriguez-Zanella,
Sergio Kobal,
Gergely Agoston,
Albert Varga,
Karina Wierzbowska-Drabik,
Jarosław D. Kasprzak,
Rosina Arbucci,
Olga Zhuravleva,
Jelena Čelutkienė,
Jorge Lowenstein,
Nithima Chaowalit Ratanasit,
Paolo Colonna,
Scipione Carerj,
Mauro Pepi,
Patricia A. Pellikka,
Eugenio Picano,
Diego M. Lowenstein Haber,
Sofia Marconi,
Pablo M. Merlo,
Miguel Amor,
Hugo Mosto,
Michael Salamé,
Patricia Carral,
Germán Souto,
Ariel Saad,
Caroline M. Van De Heyning,
Miodrag Ostojic,
Bojan Stanetic,
Tamara Kovačević Preradović,
Clarissa Borguezan-Daros,
Ana Cristina Camarozano,
Iana Simova,
Yi Wang,
Zhang Hongmei,
Ding Geqi,
Zhang Qingfeng,
Yue Heng Wang,
Attila Palinkas,
Robert Sepp,
Eszter D. Palinkas,
Bruno Villari,
Lauro Cortigiani,
Antonello D’Andrea,
Nicola Gaibazzi,
Domenico Tuttolomondo,
Doralisa Morrone,
Fabio Mori,
Maria Grazia D’Alfonso,
Iacopo Olivotto,
Annamaria Del Franco,
Rodolfo Citro,
Rosangela Cocchia,
Eduardo Bossone,
Fausto Rigo,
Francesca Bursi,
Federica Re,
Ilaria Dentamaro,
Marco Fabio Costantino,
Fiorenzo Manganelli,
Jelena Celutkiene,
Jaroslaw D. Kasprzak,
Maciej Haberka,
Natalia Sviazova,
Tamara Ryabova,
Ayten Safarova,
Tatiana Timofeeva,
Aleksandra Nikolic,
Milica Dekleva,
Ana Djordievic-Dikic,
Nikola Boskovic,
Vojislav Giga,
Milorad Tesic,
Srdjan Dedic,
Jesus Peteiro Vazquez,
Patricia A. Pellikka,
Adelaide M. Arruda-Olson,
Garvan C. Kane,
Hector R. Villarraga,
Ylenia Bartolacelli,
Giovanni Benfari,
Andrea Barbieri

摘要

Objective

Atrial cardiomyopathy is closely associated with atrial fibrillation (AF), and some patients exhibit no dysfunction at rest but demonstrate evident changes in left atrial (LA) function and LA volume during exercise. This study aimed to identify distinguishing signs during exercise stress echocardiography (ESE) among patients in sinus rhythm (SR), with and without history of paroxysmal/persistent AF (PAF).

Methods

A prospective cohort of 1055 patients in SR was enrolled across 12 centers. The main study cohort was divided into two groups: the modeling group (n = 513) and the verification group (n = 542). All patients underwent ESE, which included B-lines, LA volume index (LAVi), and LA strain of the reservoir phase (LASr).

Results

Age, resting and stress LAVi and LASr, and B-lines were identified as a combination of detectors for PAF in both groups. In the entire cohort, aside from resting and stress LAVi and LASr, additional parameters differentiating PAF and non-PAF patients were the presence of systemic hypertension, exercise E/e’ > 7, worse right ventricle (RV) contraction during exercise (∆ tricuspid annular plane systolic excursion < 5 mm), a lower left ventricular contractile reserve (< 1.6), and a reduced chronotropic reserve (heart rate reserve < 1.64). The composite score, summing all 9 items, yielded a score of > 4 as the best sensitivity (79%) and specificity (65%).

Conclusion

ESE can complement rest echocardiography in the identification of previous PAF in patients with SR through the evaluation of LA functional reservoir and volume reserve, LV chronotropic, diastolic, and systolic reserve, and RV contractile reserve.

Graphical Abstract

A scoring system predicting the probability of PAF. The score was computed using the cutoff values as in the illustration. The score >4 demonstrated a sensitivity of 79% and a specificity of 65% of PAF.