title: Non-invasively estimated left atrial stiffness is associated with short-term recurrence of atrial fibrillation after electrical cardioversion.
abstract: As atrial stiffness (Kla) is an important determinant of cardiac pump function, better mechanical characterization of left atrial (LA) cavity would be clinically relevant. Pulmonary venous ablation is an option for atrial fibrillation (AF) treatment that offers a powerful context for improving our understanding of LA mechanical function. We hypothesized that a relation could be detected between invasive estimation of Klaand new non-invasive deformation parameters and traditional LA and left ventricular (LV) function descriptors, so that Klacan be estimated non-invasively. We also hypothesized that a non-invasive surrogate of Klawould be useful in predicting AF recurrence after cardioversion.
  
  
  
  In 20 patients undergoing AF ablation, LA pressure-volume curves were derived from invasive pressure and echocardiographic images; Klawas calculated during ascending limb of V-loop as ΔLA pressure/ΔLA volume. 2D-speckle-tracking echocardiographic LA and LV longitudinal strains and volumes, ejection fraction (EF) and ventricular stiffness (Klv), as obtained from mitral deceleration time, were tested as non-invasive Klapredictors. In 128 sinus rhythm patients 1 month after electrical cardioversion for persistent AF, non-invasively estimated Kla(computed-Kla) was tested as predictor of recurrence at 6 months.
  
  
  
  Tertiles of mean LA pressure correlated with increasing Kla(trend, p=0.06) and decreasing LA peak strain, LVEF, and LV longitudinal strain (p=0.029, p=0.019, and p=0.024). There were no differences in LA and LV volumes and Klvacross groups. Multiple regression analysis identified LV longitudinal strain as the only independent predictor of Kla(p=0.014). Patients in highest quartile of computed-Kla(estimated as [log]=0.735+0.051×LV strain) tended to have highest AF recurrence rate (25%) as compared with remaining 3 quartiles (9%, 9%, 3%, p=0.09).
  
  
  
  Klacan be assessed invasively in patients undergoing AF ablation and it can be estimated non-invasively using LV strain. AF recurrence after cardioversion tends to be highest in highest quartile of computed-Kla.
authors: Clinical Cardiology, Università del Piemonte Orientale, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy. Electronic address: paolo.marino@maggioreosp.novara.it.
authors: Paolo Nicola
authors: PN
authors: Marino
authors: Clinical Cardiology, Università del Piemonte Orientale, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy.
authors: Anna
authors: A
authors: Degiovanni
authors: Clinical Cardiology, Università del Piemonte Orientale, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy.
authors: Lara
authors: L
authors: Baduena
authors: Clinical Cardiology, Università del Piemonte Orientale, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy.
authors: Eraldo
authors: E
authors: Occhetta
authors: Clinical Cardiology, Università del Piemonte Orientale, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy.
authors: Gabriele
authors: G
authors: Dell'Era
authors: Wales Heart Research Institute, Cardiff University, Cardiff, UK.
authors: Tamas
authors: T
authors: Erdei
authors: Wales Heart Research Institute, Cardiff University, Cardiff, UK.
authors: Alan G
authors: AG
authors: Fraser
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy; D016279:Atrial Function, Left / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D006328:Cardiac Catheterization / Q000295:instrumentation; D004452:Echocardiography; D004554:Electric Countershock; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008365:Manometry / Q000295:instrumentation; D008875:Middle Aged; D012008:Recurrence; D059289:Vascular Stiffness / Q000502:physiology*
keywords: Atrial fibrillation recurrence; Atrial stiffness; Electrical cardioversion