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Journal of Echocardiography

, Volume 15, Issue 4, pp 166–175 | Cite as

Right atrial myocardial deformation by two-dimensional speckle tracking echocardiography predicts recurrence in paroxysmal atrial fibrillation

  • Malini Govindan
  • Anatoli Kiotsekoglou
  • Samir K. Saha
  • A. John Camm
Original Investigation

Abstract

Background

Atrial fibrillation (AF) is a bi-atrial disease yet little attention has been given to right heart function in AF. We propose that the assessment of right atrial (RA) and right ventricular function (RV) using two-dimensional speckle tracking echocardiography (2D-STE) could be valuable in predicting AF recurrence in patients with paroxysmal AF (PAF).

Methods

Thirty patients with PAF were prospectively recruited from a dedicated AF clinic. Right atrial size, volume, and area and RV dimensions were analyzed along with RA and RV strain derived from 2D-STE at baseline and at 3 and 12 months.

Results

Higher RA booster strain independently predicted sinus rhythm (SR) maintenance for up to 1 year (P = 0.001). RV strain was impaired in patients with recurrent AF compared to those in SR (P < 0.05) but did not predict AF recurrence. Two-dimensional STE for RA and RV function was simple to perform with excellent reproducibility (adjusted R 2 0.92–0.99).

Conclusions

Two-dimensional STE is useful and highly reproducible in assessing right heart function in AF patients. RA booster strain function was predictive of sinus rhythm maintenance for up to 1 year.

Keywords

Atrial fibrillation Right atrial strain Right ventricular strain Two-dimensional speckle tracking echocardiography 

Notes

Acknowledgements

Funding was provided by British Heart Foundation (BHF) (Grant Number PG/08/038/24217).

Compliance with ethical standards

This study on patients with PAF was performed at St George’s University of London and St George’s Hospital, NHS Trust, London, UK

Conflict of interest

The British Heart Foundation (BHF) grant reference number was PG/08/038/24217. The title was “Utility of natriuretic peptides in patients with atrial fibrillation undergoing direct-current cardioversion or those requiring rate-control”. The Principal Investigator and grant holder was Professor A John Camm. The BHF grant only covered the peptides in atrial fibrillation. However, we have reported in our manuscript a correlation between peptides and echocardiographic parameters. Dr. Samir Kanti Saha performed the statistical analysis and created the first draft of the manuscript in conjunction with MG and AK. Professor A John Camm was a BHF Professor until June 2012. The grant started on the 01/07/2008. Dr. Malini Govindan was funded by this BHF grant as a Research Fellow in order to complete her PhD thesis. Malini Govindan, Anatoli Kiotsekoglou, Samir Kanti Saha, and John Camm declare that they have no conflicts of interest.

Informed consent

The study was approved by the Local Ethics Committee at St George’s University of London, London, UK and informed consent was obtained from eligible patients.

Human and animal rights statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Haissaguerre M, Shah DC, Jais P, et al. Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation. 2000;102(20):2463–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Haissaguerre M, Jais P, Shah DC, et al. Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation. 2000;101(12):1409–17.CrossRefPubMedGoogle Scholar
  3. 3.
    Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo MA, Maseri A. Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation. 1997;96(4):1180–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Ime-Sempe C, Folliguet T, Rucker-Martin C, et al. Myocardial cell death in fibrillating and dilated human right atria. J Am Coll Cardiol. 1999;34(5):1577–86.CrossRefGoogle Scholar
  5. 5.
    Dinanian S, Boixel C, Juin C, et al. Downregulation of the calcium current in human right atrial myocytes from patients in sinus rhythm but with a high risk of atrial fibrillation. Eur Heart J. 2008;29(9):1190–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Lai LP, Su MJ, Lin JL, et al. Down-regulation of L-type calcium channel and sarcoplasmic reticular Ca(2+)-ATPase mRNA in human atrial fibrillation without significant change in the mRNA of ryanodine receptor, calsequestrin and phospholamban: an insight into the mechanism of atrial electrical remodeling. J Am Coll Cardiol. 1999;33(5):1231–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Van Wagoner DR, Pond AL, Lamorgese M, Rossie SS, McCarthy PM, Nerbonne JM. Atrial L-type Ca2+ currents and human atrial fibrillation. Circ Res. 1999;85(5):428–36.CrossRefPubMedGoogle Scholar
  8. 8.
    Lang RM, Bierig M, Devereux RB, et al. 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. J Am Soc Echocardiogr. 2005;18(12):1440–63.CrossRefPubMedGoogle Scholar
  9. 9.
    Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685–713.CrossRefPubMedGoogle Scholar
  10. 10.
    Stefani L, De LA, Maffulli N, et al. Speckle tracking for left ventricle performance in young athletes with bicuspid aortic valve and mild aortic regurgitation. Eur J Echocardiogr. 2009;10(4):527–31.CrossRefPubMedGoogle Scholar
  11. 11.
    Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging. 2009;2(5):356–64.CrossRefPubMedGoogle Scholar
  12. 12.
    Di SG, Caso P, Lo PR, et al. 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. 2005;112(3):387–95.CrossRefGoogle Scholar
  13. 13.
    Schneider C, Malisius R, Krause K, et al. Strain rate imaging for functional quantification of the left atrium: atrial deformation predicts the maintenance of sinus rhythm after catheter ablation of atrial fibrillation. Eur Heart J. 2008;29(11):1397–409.CrossRefPubMedGoogle Scholar
  14. 14.
    Cameli M, Caputo M, Mondillo S, et al. Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound. 2009;7:6.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Henein M, Zhao Y, Henein MY, Lindqvist P. Disturbed left atrial mechanical function in paroxysmal atrial fibrillation: a speckle tracking study. Int J Cardiol. 2012;155(3):437–41.CrossRefPubMedGoogle Scholar
  16. 16.
    Hirose T, Kawasaki M, Tanaka R, et al. Left atrial function assessed by speckle tracking echocardiography as a predictor of new-onset non-valvular atrial fibrillation: results from a prospective study in 580 adults. Eur Heart J Cardiovasc Imaging. 2012;13(3):243–50.CrossRefPubMedGoogle Scholar
  17. 17.
    Tsai WC, Lee CH, Lin CC, et al. Association of left atrial strain and strain rate assessed by speckle tracking echocardiography with paroxysmal atrial fibrillation. Echocardiography. 2009;26(10):1188–94.CrossRefPubMedGoogle Scholar
  18. 18.
    Kuppahally SS, Akoum N, Burgon NS, et al. 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. 2010;3(3):231–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Saha SK, Anderson PL, Caracciolo G, et al. Global left atrial strain correlates with CHADS2 risk score in patients with atrial fibrillation. J Am Soc Echocardiogr. 2011;24(5):506–12.CrossRefPubMedGoogle Scholar
  20. 20.
    Peluso D, Badano LP, Muraru D, et al. Right atrial size and function assessed with three-dimensional and speckle-tracking echocardiography in 200 healthy volunteers. Eur Heart J Cardiovasc Imaging. 2015;16:712–8.CrossRefGoogle Scholar
  21. 21.
    Govindan M, Kiotsekoglou A, Saha SK, et al. Validation of echocardiographic left atrial parameters in atrial fibrillation using the index beat of preceding cardiac cycles of equal duration. J Am Soc Echocardiogr. 2011;24(10):1141–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Raymond RJ, Hinderliter AL, Willis PW, et al. Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. J Am Coll Cardiol. 2002;39(7):1214–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Ausma J, Wijffels M, Thone F, Wouters L, Allessie M, Borgers M. Structural changes of atrial myocardium due to sustained atrial fibrillation in the goat. Circulation. 1997;96(9):3157–63.CrossRefPubMedGoogle Scholar
  24. 24.
    Boutjdir M, Le Heuzey JY, Lavergne T, et al. Inhomogeneity of cellular refractoriness in human atrium: factor of arrhythmia? Pacing Clin Electrophysiol. 1986;9(6 Pt 2):1095–100.CrossRefPubMedGoogle Scholar
  25. 25.
    Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation. 1995;92(7):1954–68.CrossRefPubMedGoogle Scholar
  26. 26.
    Akutsu Y, Kaneko K, Kodama Y, et al. Association between left and right atrial remodeling with atrial fibrillation recurrence after pulmonary vein catheter ablation in patients with paroxysmal atrial fibrillation: a pilot study. Circ Cardiovasc Imaging. 2011;4(5):524–31.CrossRefPubMedGoogle Scholar
  27. 27.
    Kalifa J, Jalife J, Zaitsev AV, et al. Intra-atrial pressure increases rate and organization of waves emanating from the superior pulmonary veins during atrial fibrillation. Circulation. 2003;108(6):668–71.CrossRefPubMedGoogle Scholar
  28. 28.
    Stiles MK, John B, Wong CX, et al. Paroxysmal lone atrial fibrillation is associated with an abnormal atrial substrate: characterizing the “second factor”. J Am Coll Cardiol. 2009;53(14):1182–91.CrossRefPubMedGoogle Scholar
  29. 29.
    Bertaglia E, Stabile G, Senatore G, et al. A clinical and health-economic evaluation of pulmonary vein encircling ablation compared with antiarrhythmic drug treatment in patients with persistent atrial fibrillation (Catheter Ablation for the Cure of Atrial Fibrillation-2 study). Europace. 2007;9(3):182–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Della BP, Riva S, Fassini G, et al. Long-term follow-up after radiofrequency catheter ablation of atrial fibrillation: role of the acute procedure outcome and of the clinical presentation. Europace. 2005;7(2):95–103.CrossRefGoogle Scholar
  31. 31.
    van Brakel TJ, van der Krieken T, Westra SW, van der Laak JA, Smeets JL, van Swieten HA. Fibrosis and electrophysiological characteristics of the atrial appendage in patients with atrial fibrillation and structural heart disease. J Interv Card Electrophysiol. 2013;38(2):85–93.CrossRefPubMedGoogle Scholar
  32. 32.
    Kumagai K, Uno K, Khrestian C, Waldo AL. Single site radiofrequency catheter ablation of atrial fibrillation: studies guided by simultaneous multisite mapping in the canine sterile pericarditis model. J Am Coll Cardiol. 2000;36(3):917–23.CrossRefPubMedGoogle Scholar
  33. 33.
    Nattel S, Burstein B, Dobrev D. Atrial remodeling and atrial fibrillation: mechanisms and implications. Circ Arrhythm Electrophysiol. 2008;1(1):62–73.CrossRefPubMedGoogle Scholar
  34. 34.
    Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. 2008;117(13):1717–31.CrossRefPubMedGoogle Scholar
  35. 35.
    Meyer P, Filippatos GS, Ahmed MI, et al. Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure. Circulation. 2010;121(2):252–8.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Forfia PR, Fisher MR, Mathai SC, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med. 2006;174(9):1034–41.CrossRefPubMedGoogle Scholar
  37. 37.
    Valsangiacomo Buechel ER, Mertens LL. Imaging the right heart: the use of integrated multimodality imaging. Eur Heart J. 2012;33(8):949–60.CrossRefPubMedGoogle Scholar
  38. 38.
    Su HM, Lin TH, Hsu PC, et al. Global left ventricular longitudinal systolic strain as a major predictor of cardiovascular events in patients with atrial fibrillation. Heart. 2013;99(21):1588–96.CrossRefPubMedGoogle Scholar
  39. 39.
    Sheehan F, Redington A. The right ventricle: anatomy, physiology and clinical imaging. Heart. 2008;94(11):1510–5.CrossRefPubMedGoogle Scholar
  40. 40.
    Pathan FM, D’Elia N, Mark T, et al. Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J Am Soc Echocardiogr. 2016;. doi: 10.1016/j.echo.2016.09.007.PubMedGoogle Scholar
  41. 41.
    Saha SK, Söderberg S, Lindqvist P. Association of right atrial mechanics with hemodynamics and physical capacity in patients with idiopathic pulmonary arterial hypertension: insight from a single-center cohort in northern Sweden. Echocardiography. 2016;33(1):46–56. doi: 10.1111/echo.12993 (Epub 2015 Jun 11).CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Echocardiography 2017

Authors and Affiliations

  1. 1.Department of Cardiovascular SciencesSt George’s University of LondonLondonUK
  2. 2.Department of Clinical Physiology, University Hospital of ÖrebroÖrebroSweden
  3. 3.Research and DevelopmentSundsvall Hospital at the Karolinska InstituteSundsvallSweden

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