title: Two-dimensional atrial systolic strain imaging predicts atrial fibrillation at 4-year follow-up in asymptomatic rheumatic mitral stenosis.
abstract: BACKGROUND
  The aim of this study was to assess systolic left atrial (LA) reservoir function in patients with mitral stenosis (MS) using two-dimensional (2D) strain (ε) and strain rate imaging and its prognostic value in predicting atrial fibrillation (AF) at 4-year follow-up.
  
  
  METHODS
  One hundred one asymptomatic patients with pure rheumatic MS and 70 healthy controls were evaluated using standard Doppler echocardiography (mitral valve area, mean gradient, systolic pulmonary pressure, LA width, LA volumes, and LA ejection fraction) and 2D speckle-tracking.
  
  
  RESULTS
  LA width, volumes, and systolic pulmonary pressure were significantly increased (P < .0001), and LA 2D ε and strain rate were significantly impaired in patients with MS (P < .0001). At 4-year follow-up, 20 patients (20%) showed AF on standard electrocardiography or 24-hour Holter electrocardiography. Patients with MS who had AF were older than those who did not, without significant differences in LA dimensions, volumes, ejection fraction, and compliance index. Instead, atrial myocardial systolic 2D ε was significantly impaired in patients with events. On multivariate analysis (age, LA volume, planimetric mitral area, average annular Ea, and LA strain) the best predictor of AF was average LA peak systolic ε (coefficient, 0.43; SE, 0.098; P < .01), with an area under the receiver operating characteristic curve of 0.761 (SE, 0.085; 95% confidence interval, 0.587-0.888, P = .002) for a cutoff value of 17.4%.
  
  
  CONCLUSIONS
  The results of 2D ε imaging are abnormal in patients with asymptomatic MS and predict AF at 4-year follow-up.
authors.affiliation: Noninvasive Cardiology Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy. ancona.r@libero.it
authors.forename: Roberta
authors.initials: R
authors.lastname: Ancona
authors.forename: Salvatore
authors.initials: S
authors.lastname: Comenale Pinto
authors.forename: Pio
authors.initials: P
authors.lastname: Caso
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Salvo
authors.forename: Sergio
authors.initials: S
authors.lastname: Severino
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016279:Atrial Function, Left; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012214:Rheumatic Heart Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D013599:Systole