Decreased left atrial strain parameters are correlated with prolonged total atrial conduction time in lone atrial fibrillation

  • Chunyan Guo
  • Jiexin LiuEmail author
  • Shumei Zhao
  • Yixing Teng
  • Luhua Shen
Original Paper


To investigate left atrium (LA) strain properties of patients with lone atrial fibrillation (LAF) and to assess relationships between LA strain parameters and total atrial conduction time measured with tissue Doppler imaging (PA-TDI). The study population consisted of 53 patients with LAF. The control group was comprised of 50 normal volunteers. Conventional echocardiography indices were measured. Mitral annular velocities and PA-TDI were assessed with TDI. Two-dimensional speckle-tracking echocardiography (2D-STE) was used to assess LA segmental strain and strain rate. Compared with the control group, PA-TDI was significantly prolonged and LA myocardial Ss, SRs, Sa, and SRa were significantly decreased in the LAF group (all P < 0.001). In the control group, LA myocardial Ss (γ = −0.486, P < 0.01), SRs (γ = −0.436, P < 0.01), and Sa (γ = −0.360, P < 0.05) were correlated negatively with PA-TDI. LA myocardial SRa (γ = 0.377, P < 0.01) was correlated positively with PA-TDI. In the LAF group, LA myocardial Ss (γ = −0.429, P < 0.01), SRs (γ = −0.468, P < 0.01), and Sa (γ = −0.380, P < 0.05) were also correlated negatively, and SRa (γ = 0.390, P < 0.01) was correlated positively, with PA-TDI. Multivariate logistic regression identified PA-TDI as the only predictor of AF onset (OR 1.39; 95 % CI 1.02–1.54; P < 0.01). LA strain parameters were decreased and PA-TDI was prolonged in patients with LAF. Structural remodeling of the LA, assessed by 2D-STE, was correlated with electrical remodeling, determined by PA-TDI. Prolonged PA-TDI was independently associated with AF onset.


Lone atrial fibrillation Strain Total atrial conduction time 



This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest.


  1. 1.
    Artis NJ, Oxborough DL, Williams G, Pepper CB, Tan LB (2008) Two-dimensional strain imaging: a new echocardiographic advance with research and clinical applications. Int J Cardiol 123:240–248CrossRefPubMedGoogle Scholar
  2. 2.
    Helle-Valle T, Crosby J, Edvardsen T, Lyseggen E, Amundsen BH, Smith HJ, Rosen BD, Lima JA, Torp H, Ihlen H, Smiseth OA (2005) New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography. Circulation 112:3149–3156CrossRefPubMedGoogle Scholar
  3. 3.
    Vieira MJ, Teixeira R, Goncalves L, Gersh BJ (2014) Left atrial mechanics: echocardiographic assessment and clinical implications. J Am Soc Echocardiogr 27:463–478CrossRefPubMedGoogle Scholar
  4. 4.
    Tsai WC, Lee CH, Lin CC, Liu YW, Huang YY, Li WT, Chen JY, Lin LJ (2009) Association of left atrial strain and strain rate assessed by speckle tracking echocardiography with paroxysmal atrial fibrillation. Echocardiography 26:1188–1194CrossRefPubMedGoogle Scholar
  5. 5.
    Kuppahally SS, Akoum N, Burgon NS, Badger TJ, Kholmovski EG, Vijayakumar S, Rao SN, Blauer J, Fish EN, Dibella EV, Macleod RS, McGann C, Litwin SE, Marrouche NF (2010) 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. Circ Cardiovasc Imaging 3:231–239CrossRefPubMedGoogle Scholar
  6. 6.
    Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol 57:e101–e198CrossRefPubMedGoogle Scholar
  7. 7.
    Taggar JS, Lip GY (2008) Risk predictors for lone atrial fibrillation. Europace 10:6–8CrossRefPubMedGoogle Scholar
  8. 8.
    Roshanali F, Mandegar MH, Yousefnia MA, Rayatzadeh H, Alaeddini F, Amouzadeh F (2007) Prediction of atrial fibrillation via atrial electromechanical interval after coronary artery bypass grafting. Circulation 116:2012–2017CrossRefPubMedGoogle Scholar
  9. 9.
    Cui QQ, Zhang W, Wang H, Sun X, Wang R, Yang HY, Meng XQ, Zhang Y, Wang H (2008) Assessment of atrial electromechanical coupling and influential factors in nonrheumatic paroxysmal atrial fibrillation. Clin Cardiol 31:74–78CrossRefPubMedGoogle Scholar
  10. 10.
    Merckx KL, De Vos CB, Palmans A, Habets J, Cheriex EC, Crijns HJ, Tieleman RG (2005) Atrial activation time determined by transthoracic Doppler tissue imaging can be used as an estimate of the total duration of atrial electrical activation. J Am Soc Echocardiogr 18:940–944CrossRefPubMedGoogle Scholar
  11. 11.
    De Vos CB, Weijs B, Crijns HJ, Cheriex EC, Palmans A, Habets J, Prins MH, Pisters R, Nieuwlaat R, Tieleman RG (2009) Atrial tissue Doppler imaging for prediction of new-onset atrial fibrillation. Heart 95:835–840CrossRefPubMedGoogle Scholar
  12. 12.
    Antoni ML, Bertini M, Atary JZ, Delgado V, ten Brinke EA, Boersma E, Holman ER, van der Wall EE, Schalij MJ, Bax JJ, van de Veire NR (2010) Predictive value of total atrial conduction time estimated with tissue Doppler imaging for the development of new-onset atrial fibrillation after acute myocardial infarction. Am J Cardiol 106:198–203CrossRefPubMedGoogle Scholar
  13. 13.
    den Uijl DW, Gawrysiak M, Tops LF, Trines SA, Zeppenfeld K, Schalij MJ, Bax JJ, Delgado V (2011) Prognostic value of total atrial conduction time estimated with tissue Doppler imaging to predict the recurrence of atrial fibrillation after radiofrequency catheter ablation. Europace 13:1533–1540CrossRefPubMedGoogle Scholar
  14. 14.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) 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 Cardiology. J Am Soc Echocardiogr 18:1440–1463CrossRefPubMedGoogle Scholar
  15. 15.
    Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA (2002) Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 15:167–184CrossRefPubMedGoogle Scholar
  16. 16.
    Yu CM, Sanderson JE, Marwick TH, Oh JK (2007) Tissue Doppler imaging a new prognosticator for cardiovascular diseases. J Am Coll Cardiol 49:1903–1914CrossRefPubMedGoogle Scholar
  17. 17.
    Sun JP, Yang Y, Guo R, Wang D, Lee AP, Wang XY, Lam YY, Fang F, Yang XS, Yu CM (2013) Left atrial regional phasic strain, strain rate and velocity by speckle-tracking echocardiography: normal values and effects of aging in a large group of normal subjects. Int J Cardiol 168:3473–3479CrossRefPubMedGoogle Scholar
  18. 18.
    Li Y, Li WM, Gong YT, Li BX, Liu W, Han W, Dong D, Sheng L, Xue JY, Zhang L, Chu S, Yang BF (2007) The effects of cilazapril and valsartan on the mRNA and protein expressions of atrial calpains and atrial structural remodeling in atrial fibrillation dogs. Basic Res Cardiol 102:245–256CrossRefPubMedGoogle Scholar
  19. 19.
    Di Salvo G, Caso P, Lo Piccolo R, Fusco A, Martiniello AR, Russo MG, D’Onofrio A, Severino S, Calabro P, Pacileo G, Mininni N, Calabro R (2005) Atrial myocardial deformation properties predict maintenance of sinus rhythm after external cardioversion of recent-onset lone atrial fibrillation: a color Doppler myocardial imaging and transthoracic and transesophageal echocardiographic study. Circulation 112:387–395CrossRefPubMedGoogle Scholar
  20. 20.
    Vianna-Pinton R, Moreno CA, Baxter CM, Lee KS, Tsang TS, Appleton CP (2009) Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects. J Am Soc Echocardiogr 22:299–305CrossRefPubMedGoogle Scholar
  21. 21.
    Schotten U, Ausma J, Stellbrink C, Sabatschus I, Vogel M, Frechen D, Schoendube F, Hanrath P, Allessie MA (2001) Cellular mechanisms of depressed atrial contractility in patients with chronic atrial fibrillation. Circulation 103:691–698CrossRefPubMedGoogle Scholar
  22. 22.
    Boixel C, Fontaine V, Rucker-Martin C, Milliez P, Louedec L, Michel JB, Jacob MP, Hatem SN (2003) Fibrosis of the left atria during progression of heart failure is associated with increased matrix metalloproteinases in the rat. J Am Coll Cardiol 42:336–344CrossRefPubMedGoogle Scholar
  23. 23.
    Weijs B, de Vos CB, Limantoro I, Cheriex EC, Tieleman RG, Crijns HJ (2012) The presence of an atrial electromechanical delay in idiopathic atrial fibrillation as determined by tissue Doppler imaging. Int J Cardiol 156:121–122CrossRefPubMedGoogle Scholar
  24. 24.
    Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ, Tsang TS (2006) Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol 47:2357–2363CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.Cardiovascular Center, Beijing Friendship HospitalCapital Medical UniversityBeijingChina

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