Left atrial electromechanical conduction time predicts atrial fibrillation in patients with mitral stenosis: a 5-year follow-up speckle-tracking echocardiography study
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.
KeywordsMitral stenosis Electromechanical conduction time Atrial fibrillation Speckle tracking echocardiography
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
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.
- 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.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.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
- 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
- 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
- 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
- 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.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
- 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
- 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.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