Left atrial electromechanical conduction time predicts atrial fibrillation in patients with mitral stenosis: a 5-year follow-up speckle-tracking echocardiography study

  • Ozkan Candan
  • Cetin Gecmen
  • Arzu Kalayci
  • Cem Dogan
  • Emrah Bayam
  • Mehmet Ozkan
Original Paper

Abstract

Prolonged left atrial electromechanical conduction time is related with atrial electrical remodeling, and is predictive of the development of atrial fibrillation. The aim of our study was to examine whether left atrial electromechanical conduction time (EMT) and left atrial strain as measured by speckle tracking echocardiography (STE) are predictors for the development of atrial fibrillation (AF) in patients with mitral stenosis (MS) at 5-year follow-up. A total of 81 patients (61% females; mean age 38.1 ± 12.1 years) with mild or moderate MS of rheumatic origin according to ACC/AHA guidelines who were in sinus rhythm, and were asymptomatic or have NYHA class 1 symptom were included in the study. AF was searched by 12-lead electrocardiograms or 24-h Holter recordings during follow-up period. Atrial electromechanical conduction time (EMT), peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) were measured by STE. EMTs was defined as the interval between the onset of P-wave to the peak late diastolic longitudinal strain in the basal lateral and septal wall. During the follow-up period of 5 years (mean follow-up duration, 48.2 ± 13.3 months), 30 patients (37%) developed AF on standard 12-lead ECG or at their 24-h Holter recording. At follow-up, patients who developed AF were older than patients without AF (42.4 ± 11.3 vs. 35.6 ± 11.9, p = 0.014). Mitral valve area (MVA) (1.39 ± 0.14 vs. 1.48 ± 0.18, p = 0.03), PALS (13.4 ± 4.6 vs. 19 ± 5.2, p < 0.001) and PACS (6 ± 2.7 vs. 8.4 ± 3.8, p = 0.004), were lower in patients who developed AF than in patients who did not develop. However, EMTs-Septal (208.2 ± 28.4 vs. 180.2 ± 38, p = 0.001), and EMTs-Lateral (247.1 ± 27.6 vs. 213.3 ± 43.5, p < 0.001) were longer in patients with AF than in patients without. In multivariate Cox regression analysis, PALS and left atrial EMTs-Lateral were independent predictors for development of AF at follow-up. In patients with mitral stenosis, left atrial strain and electromechanical conduction time in the lateral wall during the long term follow-up period are predictive for the development of atrial fibrillation. Speckle tracking echocardiography is a basic and easily-implemented method based on left atrial parameters which may be helpful for early detection of atrial fibrillation in patients with mitral stenosis.

Keywords

Mitral stenosis Electromechanical conduction time Atrial fibrillation Speckle tracking echocardiography 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Informed consent

All authors confirmed this study and they agree with submissions this manuscript for your journal.

Research involving human and/or animals participants

Study protocol was approved by the local ethics committee.

References

  1. 1.
    Chandrashekhar Y, Westaby S, Narula J (2009) Mitral stenosis. Lancet 374:1271–1283CrossRefPubMedGoogle Scholar
  2. 2.
    Chugh SS, Blackshear JL, Shen WK et al (2001) Epidemiology and natural history of atrial fibrillation: clinical implications. J Am Coll Cardiol 37:371–378CrossRefPubMedGoogle Scholar
  3. 3.
    Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DF, Freed MD et al (2008) American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52:e1–e142CrossRefPubMedGoogle Scholar
  4. 4.
    Alpert JS, Sabik J, Casgrove DM (1998) Mitral valve disease. In: Topol EJ (ed) Textbook of cardiovascular medicine. Lippincott-Raven, New York, pp 505–506Google Scholar
  5. 5.
    Braunwald E (2001) Valvular heart disease. In: Braunwald E, Zipes DP, Libby P (eds) Heart disease: a textbook of cardiovascular Disease, 6th edn. WB Saunders, Philadelphia, pp 1643–1653Google Scholar
  6. 6.
    Josephson ME, Kastor JA, Morganroth J (1977) Electrocardiographic left atrial enlargement. Electrophysiologic, echocardiographic and hemodynamic correlates. Am J Cardiol 39:967–971CrossRefPubMedGoogle Scholar
  7. 7.
    Kim HJ, Cho GY, Kim YJ, Kim HK, Lee SP, Kim HL, Park JJ, Yoon YE, Zo JH, Sohn DW (2015) Development of atrial fibrillation in patients with rheumatic mitral valve disease in sinus rhythm. Int J Cardiovasc Imaging 31(4):735–742CrossRefPubMedGoogle Scholar
  8. 8.
    Krishnamoorthy KM, Dash PK (2003) Prediction of atrial fibrillation in patients with severe mitral stenosis—role of atrial contribution to ventricular filling. Scand Cardiovasc J 37(6):344–348CrossRefPubMedGoogle Scholar
  9. 9.
    Ozaydin M, Turker Y, Varol E, Alaca S, Erdogan D, Yilmaz N, Dogan A (2010) Factors associated with the development of atrial fibrillation in patients with rheumatic mitral stenosis. Int J Cardiovasc Imaging 26(5):547–552CrossRefPubMedGoogle Scholar
  10. 10.
    Karabay CY, Zehir R, Güler A, Oduncu V, Kalayci A, Aung SM, Karagoz A, Tanboga IH, Candan O, Gecmen C, Erkol A, Esen AM, Kirma C (2013) Left atrial deformation parameters predict left atrial appendage function and thrombus in patients in sinus rhythm with suspected cardioembolic stroke: a speckle tracking and transesophageal echocardiography study. Echocardiography 30(5):572–581CrossRefPubMedGoogle Scholar
  11. 11.
    Vianna-Pinton R, Moreno CA, Baxter CM et al (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
  12. 12.
    Okamatsu K, Takeuchi M, Nakai H et al (2009) Effects of aging on left atrial function assessed by two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogr 22:70–75CrossRefPubMedGoogle Scholar
  13. 13.
    Saraiva RM, Demirkol S, Buakhamsri A et al (2010) Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr 23:172–180CrossRefPubMedGoogle Scholar
  14. 14.
    Henmi R, Ejima K, Shoda M, Yagishita D, Hagiwara N (2016) Interatrial conduction time can predict new-onset atrial fibrillation after radiofrequency ablation of isolated, typical atrial flutter. J Cardiovasc Electrophysiol 27(11):1293–1297CrossRefGoogle Scholar
  15. 15.
    Fujii A, Inoue K, Nagai T, Nishimura K, Uetani T, Suzuki J, Funada JI, Okura T, Higaki J, Ogimoto A (2016) Clinical utility of atrial electromechanical conduction time measured with speckle tracking echocardiography after catheter ablation in patients with atrial fibrillation: a validation study with electroanatomical mapping. Echocardiography 33(9):1317–1325CrossRefPubMedGoogle Scholar
  16. 16.
    Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quinones M (2009) Echocardiographic assessment of valve stenosis: eAE/ASE recommendations for clinical practice. Eur J Echocardiogr 10(1):1–25CrossRefPubMedGoogle Scholar
  17. 17.
    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270CrossRefPubMedGoogle Scholar
  18. 18.
    Schabelman S, Schiller NB, Silverman NH, Ports TA (1981) Left atrial volume estimation by two dimensional echocardiography. Cathet Cardiovasc Diagn 7(2):165–178CrossRefPubMedGoogle Scholar
  19. 19.
    Pepi M, Tamborini G, Galli C, Barbier P, Doria E, Berti M. et al (1994) A new formula or echo-Doppler estimation of right ventricular systolic pressure. J Am Soc Echocardiogr 7(1):20–26CrossRefPubMedGoogle Scholar
  20. 20.
    Satoh T, Zipes DP (1996) Unequal atrial stretch in dogs increases dispersion of refractoriness conductive to developing atrial fibrillation. J Cardiovasc Electrophysiol 60:833–842CrossRefGoogle Scholar
  21. 21.
    Jais P, Peng JT, Shah DC et al (2000) Left ventricular diastolic dysfunction in patients with so-called lone atrial fibrillation. J Cardiovasc Electrophysiol 11:623–625CrossRefPubMedGoogle Scholar
  22. 22.
    Thiedemann KU, Ferrans VJ (1977) Left atrial ultrastructure in mitral valvular disease. Am J Pathol 89:575–604PubMedPubMedCentralGoogle Scholar
  23. 23.
    Pham TD, Fenoglio JJ Jr (1982) Right atrial ultrastructural in chronic rheumatic heart disease. Int J Cardiol 1:289–304CrossRefPubMedGoogle Scholar
  24. 24.
    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 radio frequency cathete rablation. Europace 13(11):1533–1540CrossRefGoogle Scholar
  25. 25.
    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(2):198–203CrossRefPubMedGoogle Scholar
  26. 26.
    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(10):835–840CrossRefPubMedGoogle Scholar
  27. 27.
    Erdem FH, Erdem A, Özlü F, Ozturk S, Ayhan SS, Çağlar SO, Yazici M (2016) Electrophysiological validation of total atrial conduction time measurement by tissue doppler echocardiography according to age and sex in healthy adults. J Arrhythm 32(2):127–132CrossRefPubMedGoogle Scholar
  28. 28.
    Park SM, Kim YH, Choi JI, Pak HN, Kim YH, Shim WJ (2010) Left atrial electromechanical conduction time can predict six-month maintenance of sinus rhythm after electrical cardio version in persistent atrial fibrillation by Doppler tissue echocardiography. J Am Soc Echocardiogr 23(3):309–314CrossRefPubMedGoogle Scholar
  29. 29.
    Guo C, Liu J, Zhao S, Teng Y, Shen L (2016) Decreased left atrial strain parameters are correlated with prolonged total atrial conduction time in lone atrial fibrillation. Int J Cardiovasc Imaging 32(7):1053–1061CrossRefPubMedGoogle Scholar
  30. 30.
    Ozer N, Yavuz B, Can I, Atalar E, Aksöyek S, Ovünç K, Ozmen F, Kes S (2005) Doppler tissue evaluation of intra-atrial and interatrial electromechanical delay and comparison with P-wave dispersion in patients with mitral stenosis. J Am Soc Echocardiogr 18(9):945–948CrossRefPubMedGoogle Scholar
  31. 31.
    Demirkan B, Guray Y, Guray U, Ege MR, Kisacik HL, Sasmaz H, Korkmaz S (2013) The acute effect of percutaneous mitral balloon valvuloplasty on atrial electromechanical delay and P-wave dispersion in patients with mitral stenosis. Herz 38(2):210–215CrossRefPubMedGoogle Scholar
  32. 32.
    Verdejo HE, Becerra E, Zalaquet R, Del Campo A, Garcia L, Troncoso R, Chiong M, Marin A, Castro PF, Lavandero S, Gabrielli L, Corbalán R (2016) Atrial function assessed by speckle tracking echocardiography is a good predictor of postoperative atrial fibrillation in elderly patients. Echocardiography 33(2):242–248CrossRefPubMedGoogle Scholar
  33. 33.
    Cameli M, Lisi M, Reccia R, Bennati E, Malandrino A, Solari M, Bigio E, Biagioli B, Righini FM, Maccherini M, Chiavarelli M, Henein M, Mondillo S (2014) Pre-operative left atrial strain predicts post-operative atrial fibrillation in patients undergoing aortic valve replacement for aortic stenosis. Int J Cardiovasc Imaging 30(2):279–286CrossRefPubMedGoogle Scholar
  34. 34.
    Pourafkari L, Ghaffari S, Bancroft GR, Tajlil A, Nader ND (2015) Factors associated with atrial fibrillation in rheumatic mitral stenosis. Asian Cardiovasc Thorac Ann 23(1):17–23CrossRefPubMedGoogle Scholar
  35. 35.
    Ancona R, ComenalePinto S, Caso P, Di Salvo G, Severino S, D’Andrea A, Calabrò R (2013) Two-dimensional atrial systolicstrain imaging predicts atrial fibrillation at 4-year follow-up in asymptomatic rheumatic mitral stenosis. J Am Soc Echocardiogr 26(3):270–277CrossRefPubMedGoogle Scholar
  36. 36.
    Moreyra AE, Wilson AC, Deac R, Suciu C, Kostis JB, Ortan F, Kovacs T, Mahalingham B (1998) Factors associated with atrial fibrillation in patients with mitral stenosis: a cardiac catheterization study. Am Heart J 135(1):138–145CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Kartal Kosuyolu Heart & Research Hospital, Cardiology ClinicİstanbulTurkey

Personalised recommendations