Left atrial function during exercise stress echocardiography as a sign of paroxysmal/persistent atrial fibrillation

Atrial cardiomyopathy is closely associated with atrial fibrillation (AF), and some patients exhibit no dysfunction at rest but demonstrate evident changes in left atrial (LA) function and LA volume during exercise. This study aimed to identify distinguishing signs during exercise stress echocardiography (ESE) among patients in sinus rhythm (SR), with and without history of paroxysmal/persistent AF (PAF). A prospective cohort of 1055 patients in SR was enrolled across 12 centers. The main study cohort was divided into two groups: the modeling group (n = 513) and the verification group (n = 542). All patients underwent ESE, which included B-lines, LA volume index (LAVi), and LA strain of the reservoir phase (LASr). Age, resting and stress LAVi and LASr, and B-lines were identified as a combination of detectors for PAF in both groups. In the entire cohort, aside from resting and stress LAVi and LASr, additional parameters differentiating PAF and non-PAF patients were the presence of systemic hypertension, exercise E/e' > 7, worse right ventricle (RV) contraction during exercise (∆ tricuspid annular plane systolic excursion < 5 mm), a lower left ventricular contractile reserve (< 1.6), and a reduced chronotropic reserve (heart rate reserve < 1.64). The composite score, summing all 9 items, yielded a score of > 4 as the best sensitivity (79%) and specificity (65%). ESE can complement rest echocardiography in the identification of previous PAF in patients with SR through the evaluation of LA functional reservoir and volume reserve, LV chronotropic, diastolic, and systolic reserve, and RV contractile reserve. A scoring system predicting the probability of PAF. The score was computed using the cutoff values as in the illustration. The score >4 demonstrated a sensitivity of 79% and a specificity of 65% of PAF.

Authors
Zagatina Angela , Ciampi Quirino , Peteiro J.V. , Kalinina Elena , Begidova Irina , Padang Ratnasari , Boshchenko Alla , Merli Elisa , Lisi Matteo , Rodriguez-Zanella Hugo , Kobal Sergio , Agoston Gergely , Varga Albert , Wierzbowska-Drabik Karina , Kasprzak J.D. , Arbucci Rosina , Zhuravleva Olga , Čelutkienė Jelena , Lowenstein Jorge , Ratanasit N.C. , Colonna Paolo , Carerj Scipione , Pepi Mauro , Pellikka P.A. , Picano Eugenio , Haber D.M. , Marconi Sofia , Merlo P.M. , Amor Miguel , Mosto Hugo , Salamé Michael , Carral Patricia , Souto Germán , Saad Ariel , Van De Heyning C.M. , Ostojic Miodrag , Stanetic Bojan , Preradović T.K. , Borguezan-Daros Clarissa , Camarozano A.C. , Simova Iana , Wang Yi , Hongmei Zhang , Geqi Ding , Qingfeng Zhang , Wang Y.H. , Palinkas Attila , Sepp Robert , Palinkas E.D. , Villari Bruno , Cortigiani Lauro , D’Andrea Antonello , Gaibazzi Nicola , Tuttolomondo Domenico , Morrone Doralisa , Mori Fabio , D’Alfonso M.G. , Olivotto Iacopo , Del Franco Annamaria , Citro Rodolfo , Cocchia Rosangela , Bossone Eduardo , Rigo Fausto , Bursi Francesca , Re Federica , Dentamaro Ilaria , Costantino M.F. , Manganelli Fiorenzo , Celutkiene Jelena , Kasprzak J.D. , Haberka Maciej , Sviazova Natalia , Ryabova Tamara , Safarova Ayten , Timofeeva Tatiana , Nikolic Aleksandra , Dekleva Milica , Djordievic-Dikic Ana , Boskovic Nikola , Giga Vojislav , Tesic Milorad , Dedic Srdjan , Vazquez J.P. , Pellikka P.A. , Arruda-Olson A.M. , Kane G.C. , Villarraga H.R. , Bartolacelli Ylenia , Benfari Giovanni , Barbieri Andrea
Journal
Cardiovascular Ultrasound
Publisher
BioMed Central
Number of issue
1
Language
English
Pages
13
Status
Published
Volume
22
Year
2024
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