Abstract
Background
As AF-associated morbidity and mortality are increasing, there is an acute need for improved surveillance and prevention strategies to reduce the impact of AF and related strokes. Specific echocardiographic parameters that can best predict future onset of AF within 3 months are lacking.
Methods
Twenty patients with AF, as identified by presence of ICD-9 diagnosis code, were compared with a control group of twenty age- and sex-matched patients selected from the same clinic population but without a diagnosis of AF. Transthoracic echocardiograms (TTE) obtained within 90 days prior to first documented AF episode (study group) or obtained closest to first clinic visit (control) were selected for review.
Results
Baseline characteristics, including age, BMI, presence of hypertension, hyperlipidemia, diabetes, and heart failure were comparable. Increased left atrial (LA) size (end systolic major axis in 2-chamber view: AF 4.62±0.03 vs control 3.79±0.21, P =0.03), increased mitral inflow (E/A ratio: AF 1.35±0.15 vs control 1.06±0.07, P =0.04), and reduced LA global longitudinal strain (AF -2.69±0.26 vs control - 3.59±0.31, P =0.04) were most closely associated with AF compared with the control group. Multivariate logistic regression was used to develop predictive models for AF onset. A combination of imaging and traditional clinical risk factors was the best AF prediction model with AUC of 0.94, which greatly exceeds the current best predictors published. From these parameters, we developed the SMASH2 scoring system for 90- day AF risk estimation.
Conclusions
Risk factors for AF and early features of atrial cardiomyopathy including male sex, hypertension, LA enlargement, reduced mitral inflow, and reduced LA strain are powerful predictors of AF onset within 90 days, and may be used to prognosticate future AF risk.
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Abbreviations
- 2Ch:
-
2-Chamber view, trans-thoracic echocardiogram
- 4Ch:
-
4-Chamber view, trans-thoracic echocardiogram
- AC:
-
Atrial cardiomyopathy
- AF:
-
Atrial fibrillation
- AStrain:
-
Atrial strain
- E/A ratio:
-
Ratio of peak velocity blood flow from LV relaxation in early diastole (E) to peak velocity flow in late diastole caused by atrial contraction (A)
- EDV:
-
End diastolic volume
- ESV:
-
End systolic volume
- GLS:
-
Global longitudinal strain
- LA:
-
Left atrium
- LAVol :
-
Left atrial volume
- LAEDV:
-
Left atrial end diastolic volume
- LAESV:
-
Left atrial end systolic volume
- LAEF:
-
Left atrial ejection fraction
- LAGLS:
-
Left atrial global longitudinal strain
- LVEF:
-
Left ventricular ejection fraction
- MAPSE:
-
Mitral annular plane systolic excursion
- Maxis:
-
Median longitudinal axis, LA end-diastolic (EDV), or systolic axis (ESV)
- MI:
-
Myocardial ischemia
- TTE:
-
Transthoracic echocardiogram
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Funding
Dr. McCauley is funded by NIH R01-HL151508 and VA Merit I01-BX004918.
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Ethical approval was obtained from the University of Illinois at Chicago Institutional Review Board.
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Dr. McCauley is a member of the Editorial Board of the Journal of Interventional Cardiac Electrophysiology. The other authors do not have any financial or non-financial interests related to the work submitted for publication.
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Darlington, A.M., Rodriguez Ziccardi, M.C., Konda, S. et al. Left atrial echocardiographic parameters predict the onset of atrial fibrillation: the SMASH2 scoring system. J Interv Card Electrophysiol 65, 179–182 (2022). https://doi.org/10.1007/s10840-022-01243-8
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DOI: https://doi.org/10.1007/s10840-022-01243-8