https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Jena Kardiologie Jena, Deutschland
Background: Left atrial (LA) strain is an echocardiographic method to detect atrial dysfunction as a process of structural and functional remodeling of the atria. In patients (pts) with persistent atrial fibrillation (AF), functional changes and an enlargement of the LA due to structural remodeling has been described. The aim of our study was 1) the echocardiographic assessment of LA function using LA strain, 2) to investigate the correlation between LA strain, left atrial size index (LAVI) using 3D reconstruction of the LA from multi-detector computed tomography (CT) and the invasive measured mean LA pressure (LAP) and 3) to compare the LA strain to patients (pts) without structural heart disease.
Methods: This study includes 92 pts with persistent AF (AF group) who underwent first time LA catheter ablation and 43 pts without structural heart disease or AF who underwent EP study (control group). All subjects underwent measurement of LA strain using imaging using two-dimensional speckle tracking echocardiography (2D-STE) and the pts with AF also underwent cardiac CT. A 3D reconstruction of the LA from the CT was done. The LA volume included LAA and excluded the PV´s. LAVI was calculated by dividing LA volume by body surface area. The LA pressure was measured immediately after transseptal puncture.
Results: AF group: mean age 67 yrs [36 - 81], 69 male (75%), mean LV-EF 53 [25 - 78] %. Control group: mean age 60 yrs [33 - 87], 23 male (53%), mean EF 63 [55 to 83] %.
We found the following LA strain measurement for the AF group: mean LASr 19 [5 - 54] %, mean LAScd -11 [-37 - -0,25] % and mean LASct -8 [-44 - 7] %. LAVI: mean 81 [12 - 163] ml/m2. There is a statistically significant negative correlation between LASr (p = 0.002, r = -0.317) and a statistically positive correlation between LASct (p = 0.007, r = 0.277) compared to the LA volume and between LAScd and the LA volume (p = 0.021, r = 0.241).
The mean LAP was 11 [1 - 27] mmHg. There was no significant correlation between LAP and LAVI (p = 0,917) or LAP and LASr (p = 0,986).
For LASr we found normal values in the control group (mean 39 [17 - 67] %. The LASr was significantly lower in the pts who underwent catheter ablation for persistent AF in comparison to the control group (p < 0.001).
Discussion: LA strain in pts with persistent AF as an expression of functional remodeling is significantly reduced compared to the control group without structural heart disease or AF. LA strain and LAVI correlate in pts with persistent AF, whereas there was no significant correlation between LAP and LAVI or LAP and reservoir strain. Whether early treatment of AF could prevent further fibrotic remodeling with reducing LA volume and improving LA strain needs further research.