title: Left atrial remodelling assessed by 2D and 3D echocardiography identifies paroxysmal atrial fibrillation.
abstract: OBJECTIVE
  Paroxysmal atrial fibrillation (PAF) is common, often silent, and can be difficult to detect. Echocardiographic parameters assessing left atrial (LA) remodelling correlated with atrial fibrosis in permanent AF, but less is known about earlier stages such as PAF. We aimed to evaluate whether 2D and 3D echocardiographic (2DE and 3DE) assessment of LA anatomy and function is able to identify patients with PAF.
  
  
  RESULTS
  This case-control study included 102 patients without overt heart disease, 44 patients with PAF. Anatomical remodelling was assessed using indexed maximal, minimal, and pre-atrial contraction volumes. Reservoir, conduit, and pump functions were assessed by volume and strain methods. All parameters were assessed by 2DE and 3DE and were compared between the two groups. Receiver-operating characteristic curves were constructed for each parameter for PAF prediction. PAF patients had bigger LA volumes than non-PAF group. Using 3DE, all atrial functions were impaired in the PAF group, regardless of the parameters used (all P < 0.05), whereas using 2DE, conduit function did not reach significant difference. Areas under the curve (AUCs) for 3D parameters were higher than those for equivalent 2DE parameters. PAF was best predicted by LA minimal indexed volume assessed by 2DE or 3DE (AUC 0.82 and 0.86, respectively) and 3D-LA ejection fraction and area strain (AUC = 0.82 and 0.81, respectively).
  
  
  CONCLUSIONS
  Anatomical and functional LA remodelling assessed by 2DE and 3DE is independently and strongly associated with PAF, suggesting that these parameters can help identify PAF.
authors.affiliation: INSERM UMR-1060, CarMeN Laboratory, Université Claude Bernard Lyon1, Lyon F-69373, France mathieu.schaaf@chu-lyon.fr.|Service d'Explorations Fonctionnelles Cardiovasculaires, Groupement Hospitalier Est, Hospices Civils de Lyon, 28 Avenue Doyen Lépine, Bron 69677, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Schaaf
authors.affiliation: Hospices Civils de Lyon, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé Université Lyon 1, Villeurbanne F-69100, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Andre
authors.affiliation: Service d'Explorations Fonctionnelles Cardiovasculaires, Groupement Hospitalier Est, Hospices Civils de Lyon, 28 Avenue Doyen Lépine, Bron 69677, France.
authors.forename: Mikhaïl
authors.initials: M
authors.lastname: Altman
authors.affiliation: Hospices Civils de Lyon, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé Université Lyon 1, Villeurbanne F-69100, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Maucort-Boulch
authors.affiliation: Centre d'investigation clinique de Lyon, Hospices Civils de Lyon, CIC1407 28 Avenue Doyen Lépine, Bron 69677, France.
authors.forename: Joël
authors.initials: J
authors.lastname: Placide
authors.affiliation: Rythmology Division, Groupement Hospitalier Est, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue Doyen Lépine, Bron 69677, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Chevalier
authors.affiliation: INSERM UMR-1060, CarMeN Laboratory, Université Claude Bernard Lyon1, Lyon F-69373, France.|Service d'Explorations Fonctionnelles Cardiovasculaires, Groupement Hospitalier Est, Hospices Civils de Lyon, 28 Avenue Doyen Lépine, Bron 69677, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Bergerot
authors.affiliation: INSERM UMR-1060, CarMeN Laboratory, Université Claude Bernard Lyon1, Lyon F-69373, France.|Service d'Explorations Fonctionnelles Cardiovasculaires, Groupement Hospitalier Est, Hospices Civils de Lyon, 28 Avenue Doyen Lépine, Bron 69677, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Thibault
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016275:Atrial Function / Q000502:physiology; D064752:Atrial Remodeling / Q000502:physiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D019560:Echocardiography, Three-Dimensional; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011379:Prognosis; D012372:ROC Curve; D012016:Reference Values; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*
keywords: 3D-echocardiography; atrial remodelling; paroxysmal atrial fibrillation; strain