engleski

Left atrial global longitudinal strain predicts atrial fibrillation recurrence in hypertensive patients with atrial fibrillation and preserved ejection fraction treated with first catheter ablation

Purpose: Atrial fibrillation (AF) is the most common chronic arrhythmia associated with unfavorable cardiovascular outcome. Hypertension is one of the most important risk factors for AF. AF frequently recurs after radiofrequency catheter ablation (CA). This study investigated novel echocardiographic strain parameters as predictors of outcome in hypertensive AF patients treated with first CA. Methods: 116 patients (pts, mean age 62 years, 67% males, mean CHA2DS2-VASc = 1.96) with paroxysmal (63 pts) and persistent (53 pts) AF and preserved ejection fraction (EF >50%) underwent first CA and echocardiography ≤ 30 days prior to CA. Left atrial (LA-GS) and left ventricular (LV-GS) global longitudinal strains were measured with 2D speckle tracking, and patients were followed for AF recurrence. Results: During follow-up of 14.4±5.3 months, 59 pts (51%) had AF recurrence. LA-GS (dichotomized to > or < 24.4 %) predicted freedom from AF recurrence (Figure 1). Patients with AF recurrence had lower LA-GS (16.2% vs 25.1% ; p<0.001), lower magnitude of LV-GS (-13.9% vs -16.0% ; p=0.001) and greater minimal LA volume index (LAVI, 27 vs 18 mL/m2 ; p<0.001). LA-GS < 24.4% had 90% sensitivity and 56% specificity for predicting AF recurrence. By multivariable Cox regression analysis (adjusted for age, gender, type and duration of AF, CHA2DS2-VASc score, minimal LAVI, LA and LV global longitudinal strain), LA-GS entered either as a binary (<24.4%) (HR=6.55, 95% CI=2.80-15.34 ; p<0.001) or a continuous variable (HR=0.88, 95% CI=0.84-0.92 ; p<0.001) and persistent AF (HR=2.49, 95% CI=1.27-4.87 ; p=0.008) were independent predictors of AF recurrence. Conclusion: LA-GS using speckle tracking echocardiography is a strong and independent predictor of AF recurrence after first CA therapy in hypertensive patients with AF and preserved EF.

left atrial strain ; atrial fibrillation ; hypertension ; catheter ablation

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