title: Speckle echocardiographic left atrial strain and stiffness index as predictors of maintenance of sinus rhythm after cardioversion for atrial fibrillation: a prospective study.
abstract: BACKGROUND
  Echocardiographic left atrial (LA) strain parameters have been associated with atrial fibrillation (AF) in prior studies. Our goal was to determine if strain measures [peak systolic longitudinal strain (LAS) and stiffness index (LASt)] changed after cardioversion (CV); and their relation to AF recurrence.
  
  
  RESULTS
  46 participants with persistent AF and 41 age-matched participants with no AF were recruited. LAS and LASt were measured before and immediately after CV using 2D speckle tracking imaging (2DSI). Maintenance of sinus rhythm was assessed over a 6-month follow up. Mean LAS was lower, and mean LASt higher, in participants with AF before CV as compared to control group (11.9±1.0 vs 35.7±1.7, p<0.01 and 1.31±0.17 vs 0.23±0.01, p<0.01, respectively). There was an increase in the mean LAS immediately after CV (11.9±1.0 vs 15.9±1.3, p<0.01), whereas mean LASt did not change significantly after CV (p=0.62). Although neither LAS nor LASt were independently associated with AF recurrence during the follow-up period, change in LAS after cardioversion (post-CV LAS-pre-CV LAS) was significantly higher among individuals who remained in sinus rhythm when compared to individuals with recurrent AF (3.6±1.1 vs 0.4±0.8, p=0.02).
  
  
  CONCLUSIONS
  LAS and LASt differed between participants with and without AF, irrespective of the rhythm at the time of echocardiographic assessment. Baseline LAS and LASt were not associated with AF recurrence. However, change in LAS after CV may be a useful predictor of recurrent arrhythmia.
authors.affiliation: Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
authors.forename: Amir Y
authors.initials: AY
authors.lastname: Shaikh
authors.forename: Abhishek
authors.initials: A
authors.lastname: Maan
authors.forename: Umar A
authors.initials: UA
authors.lastname: Khan
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Aurigemma
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Hill
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kane
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Tighe
authors.forename: Eric
authors.initials: E
authors.lastname: Mick
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D015150:Echocardiography, Doppler; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome