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Two-dimensional speckle tracking imaging analyses of the correlations between left atrial appendage function and stroke risk in nonvalvular atrial fibrillation patients

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Abstract

Stroke incidence is the most severe complication associated with atrial fibrillation (AF), and the most common site of thrombus formation in AF patients is the left atrial appendage (LAA). This study was developed to use two-dimensional speckle tracking imaging (2D-STI) to explore associations between LAA strain/strain rate and stroke incidence and to evaluate the value of utilizing LAA strain and strain rate values to support the stratification of nonvalvular AF (NVAF) patients based on stroke risk. A total of 486 AF patients who had undergone transesophageal echocardiography to exclude potential intracardiac thrombosis between March 2021 and November 2022 were consecutively enrolled. Patients meeting the inclusion criteria were separated into two groups according to their history of stroke/transient ischemic attack (TIA). LAA strain and strain rate values in these patients were measured via 2D-STI. Multivariable logistic regression analysis was employed to determine independent risk factors for the construction of a combined predictive model. Of the 333 analyzed patients (134 females, aged 65 (56,72) years), 39 (11.71%, 39/333) had a history of stroke at the time of evaluation. Multivariate logistic regression analysis demonstrated that nonparoxysmal AF, CHA2DS2VASc score, LAA thrombus/spontaneous echo contrast (SEC), LAA strain, and strain rate were all predictors of stroke incidence among NVAF patients. The combined predictive model demonstrated excellent discriminative ability, with an AUC of 0.91 (95%CI 0.87–0.95, P < 0.001), and a sensitivity and specificity of 79.49% and 89.46%, respectively. The Hosmer-Lemeshow test confirmed good calibration, yielding a value of 0.98. Comparative decision curve analysis showed that the model provided superior net benefits compared to the CHA2DS2VASc score. Furthermore, the model exhibited improved predictive performance and reclassification for stroke when compared to the CHA2DS2VASc score (AUC 0.91 vs. 0.88, Z = 2.32, P = 0.02), accompanied by a significant increase in the net reclassification index (+ 5.44%, P < 0.001) and integrated discrimination improvement (8.21%, P < 0.001). These data demonstrate that LAA strain and strain rate, as measured via 2D-STI, can offer value when assessing LAA function in AF patients, potentially providing further predictive value to extant clinical risk scoring strategies.

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Acknowledgements

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Funding

The study was funded by the following grants: Chongqing medical scientific research project(Joint project of Chongqing Health Commission and Science and Technology Bureau)(grant 2022QNXM035); Senior Medical Talents Program of Chongqing for Young and Middle-aged, CQMU Program for Youth Innovation in Future Medicine(grant W0026); Kuanren Talents Program of the Second Affiliated Hospital of Chongqing Medical University (grant KR2019G001); Chongqing Science and Health Joint Medical Research Project-Young and Middle-aged High-level Talent Project (grant 2020GDRC011).

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Authors and Affiliations

  1. Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Road, Yuzhong District, Chongqing, 40010, China

    Xiwangmin Zheng, Haitao Ran, Jianli Ren, Meng Ao, Yefeng Zhu, Maohui Zhang, Ying Han, Shiyu Li, Xia Zhou, Qiujin Yu, Peng Luo & Lei Su

  2. Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Zhiyu Ling

  3. Department of Ultrasound, The Affiliated Qujing hospital of Kunming Medical University, Yunnan, China

    Lingli Hou

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  1. Xiwangmin Zheng
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Contributions

Lei Su contributed to the design of the study, acquisition and interpretation of the data, and the revision of the article. Xiwangmin Zheng contributed to acquisition, analysis and interpretation of data, drafting and revising the manuscript. Haitao Ran, Jianli Ren, Zhiyu Ling, and Meng Ao contributed to the design of the study and acquisition of the data. Lingli Hou, Yefeng Zhu, Maohui Zhang, Ying Han, Shiyu Li, Xia Zhou, Qiujin Yu and Peng Luo contributed to acquisition of the data. The final version of the article was approved for submission by all authors.

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Correspondence to Lei Su.

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The Second Affiliated Hospital of Chongqing Medical University institutional review board approved this study, and patients provided written informed consent(No. 2021 − 247).

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Zheng, X., Ran, H., Ren, J. et al. Two-dimensional speckle tracking imaging analyses of the correlations between left atrial appendage function and stroke risk in nonvalvular atrial fibrillation patients. Int J Cardiovasc Imaging 40, 613–623 (2024). https://doi.org/10.1007/s10554-023-03031-5

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