title: Evaluation of left atrial deformation to predict left atrial stasis in patients with non-valvular atrial fibrillation - a pilot-study.
abstract: BACKGROUND
  Speckle tracking-derived strain and strain rate are recently available parameters to assess left atrial (LA) deformation. We hypothesized that such new parameters could be of interest to evaluate the risk of LA stasis among patients with atrial fibrillation (AF).
  
  
  METHODS
  Single-centre study enrolling all patients with non-valvular AF lasting longer than 48 hours for whom no therapeutic anticoagulation was given in the preceding 3 weeks and who were assessed through transesophageal and transthoracic echocardiogram during a 6 month time interval. LA deformation was assessed by transthoracic echocardiogram through speckle tracking analysis, whereas LA stasis parameters were sought on transesophageal echocardiogram.
  
  
  RESULTS
  Among the 82 assessed patients, LA appendage thrombi or sludge were found in 16 (19.5%). A moderate positive correlation was found between peak positive strain rate and maximum emptying velocity (r = 0.589; P <0.001) and peak positive strain rate and maximum filling velocity of the LA appendage (r = 0.651; P <0.001). Peak negative strain rate was also found to be associated with both maximum emptying velocity (r = -0.513; P <0.001) and maximum filling velocity of the LAA (r = -0.552; P <0.001). AF duration, peak negative strain rate and time-to-peak positive strain were independent predictors of LAA thrombi or sludge on multivariate analysis logistic regression. The area under the curve for the estimated probabilities using the obtained logistic regression model was 0.89 (95%CI 0.81-0.96; P <0.001).
  
  
  CONCLUSIONS
  Our findings suggest that LA mechanical dysfunction assessed through speckle tracking may be of interest to predict LA stasis in the setting of AF.
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Praceta Prof, Mota Pinto, Coimbra 3000-075, Portugal. rui_providencia@yahoo.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.forename: Ana
authors.initials: A
authors.lastname: Faustino
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Ferreira
authors.forename: Lino
authors.initials: L
authors.lastname: Gonçalves
authors.forename: Joana
authors.initials: J
authors.lastname: Trigo
authors.forename: Ana
authors.initials: A
authors.lastname: Botelho
authors.forename: Sérgio
authors.initials: S
authors.lastname: Barra
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity