title: Thromboembolic risk in atrial fibrillation: association between left atrium mechanics and risk scores. A study based on 3D wall-motion tracking technology.
abstract: OBJECTIVE
  Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a significantly high risk of stroke and systemic embolism. The aim of our study was to assess the association between left atrium (LA) mechanics measured by 3D wall-motion tracking (3DWMT) technology and the most common thromboembolic risk scores (CHADS2, CHA2DS2-VASc).
  
  
  METHODS
  A total of 101 consecutive patients with permanent AF referred were included. Conventional bidimensional (2D) LA parameters, and LA mechanics by means of 3DWMT were studied. Association between LA 2D and 3DWMT parameters and both risk scores was evaluated as well as its correlation with every component of the score individually.
  
  
  RESULTS
  Mean age was 78 ± 10 years. Mean CHADS2 was 2.7 ± 1.3 and mean CHA2DS2-VASc was 4.4 ± 1.7. Values of 2D and 3DWTM LA parameters were: 2D area 26.4 ± 9.7 cm(2) , 2D volume index 49.4 ± 10.1 mL/m(2) , 3DWMT left atrial emptying fraction (LAEF) 15.9 ± 8.4%, longitudinal strain 9.1 ± 4.5% and area strain 14.9 ± 8.8%. Linear regression analysis showed statistically significant correlation between LA longitudinal strain and LAEF with CHADS2 and CHA2DS2-VASc scores. For each 10% variation in longitudinal strain, CHADS2 and CHA2DS2-VASc scores change in 0.7 and 0.8 points, respectively.
  
  
  CONCLUSIONS
  Left atrial longitudinal strain and emptying fraction assessed by 3D WMT technology have correlation with both CHADS2 and CHA2DS2-VASc scores. Each 10% of variation in longitudinal strain represents a 0.7 and 0.8 points change in those risk scores. LA mechanics evaluation might provide additional value to risk scores and could be considered to be a predictor of stroke in patients with AF.
authors.affiliation: Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Fabián
authors.initials: F
authors.lastname: Islas
authors.forename: Carmen
authors.initials: C
authors.lastname: Olmos
authors.forename: Catarina
authors.initials: C
authors.lastname: Vieira
authors.forename: José A
authors.initials: JA
authors.lastname: De Agustín
authors.forename: Pedro
authors.initials: P
authors.lastname: Marcos-Alberca
authors.forename: Adriana
authors.initials: A
authors.lastname: Saltijeral
authors.forename: Carlos
authors.initials: C
authors.lastname: Almería
authors.forename: José L
authors.initials: JL
authors.lastname: Rodrigo
authors.forename: Miguel A
authors.initials: MA
authors.lastname: García Fernández
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Pérez de Isla
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015984:Causality; D015897:Comorbidity; D019560:Echocardiography, Three-Dimensional / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D015994:Incidence; D008297:Male; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D013923:Thromboembolism / Q000000981:diagnostic imaging* / Q000453:epidemiology*
keywords: 3D-echocardiography; left atrium; strain