title: Descending aortic mechanics and atrial fibrillation: a two-dimensional speckle tracking transesophageal echocardiography study.
abstract: Vascular mechanics assessed with two-dimensional speckle tracking echocardiography (2D-STE) could be used as a new imaging surrogate of vascular stiffening. The CHA2DS2-VASc score is considered accurate as an estimate of stroke risk in non-valvular AF, although many potential stroke risk factors have not been included in this scoring method. The purpose of this research is to study the feasibility of evaluating vascular mechanics at the descending aorta in non-valvular AF patients using transesophageal 2D-STE and to analyze the association between descending aortic mechanics and stroke. We prospectively recruited a group of 44 patients referred for a transesophageal echocardiogram (TEE) in the context of cardioversion for non-valvular AF. A short-axis view of the descending aorta, one to two centimeters after the aortic arch was selected for the vascular mechanics assessment with the 2D-STE methodology. The vascular mechanics parameters analyzed were circumferential aortic strain (CAS) and early circumferential aortic strain rate (CASR). A clinical assessment was performed with focus on the past stroke history and the CHA2DS2-VASc score. The mean age of our cohort was 65 ± 13 years and 75% were men; AF was known for 2.8 ± 2.5 years and it was considered paroxystic in 41% of cases. Waveforms adequate for measuring 2D-STE were present in 85% of the 264 descending aortic wall segments. The mean CAS was 3.5 ± 1.2% and the mean CASR was 0.7 ± 0.3 s-1. The inter- and intra-observer variability for aortic mechanics was considered adequate. The median CHA2DS2VASc score was 2 (2-3). As the score increased we noted that both the CAS (r = -0.38, P = 0.01) and the CASR (r = -0.42, P < 0.01) decreased. Over 16% of the AF patients had a past history of stroke. These patients had lower values of both descending aortic strain [2.2 (1.8-2.6) vs. 3.9 (3.3-4.9)%, P < 0.01] and strain rate [0.4 (0.3-0.4) vs. 0.7 (0.6-1.1) s-1, P < 0.01]. CAS remained independently associated with a past history of stroke after adjustment for the CHA2DS2VASc score. Our data showed that non-valvular AF patients with a past history of stroke had lower values of aortic mechanics assessed with transesophageal 2D-STE.
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo, Coimbra, Portugal. rogeriopteixeira@gmail.com.|Faculdade de Medicina Universidade de Coimbra, Coimbra, Portugal. rogeriopteixeira@gmail.com.
authors.forename: Rogério
authors.initials: R
authors.lastname: Teixeira
authors.affiliation: Lister Hospital, Stevenage, UK.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Monteiro
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo, Coimbra, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Dinis
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo, Coimbra, Portugal.
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Santos
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo, Coimbra, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Botelho
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo, Coimbra, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Quintal
authors.affiliation: Serviço de Cardiologia, Hospital da Luz, Lisboa, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Cardim
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra - Hospital Geral, Quinta dos Vales, São Martinho do Bispo, Coimbra, Portugal.|Faculdade de Medicina Universidade de Coimbra, Coimbra, Portugal.
authors.forename: Lino
authors.initials: L
authors.lastname: Gonçalves
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging* / Q000503:physiopathology; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016279:Atrial Function, Left; D001696:Biomechanical Phenomena; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000503:physiopathology; D059289:Vascular Stiffness
keywords: Atrial fibrillation; CHA2DS2VASc score; Left atrial appendage; Speckle-tracking; Strain, strain rate; Stroke; Transesophageal echocardiogram