Evaluating subclinical left ventricular and left atrial dysfunction in idiopathic atrial fibrillation: A speckle-tracking based strain-analysis

https://doi.org/10.1016/j.ijcard.2023.04.024Get rights and content
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Highlights

  • Idiopathic atrial fibrillation occurred in the absence of established AF risk factors.

  • Global longitudinal strain was normal in patients with idiopathic atrial fibrillation.

  • Speckle-tracking imaging did not detect any overt LV dysfunction compared to healthy controls.

Abstract

Objective

A subset of patients with atrial fibrillation (AF) presents without established AF risk factors and normal left ventricular (LV) systolic function, called idiopathic AF (IAF). Traditionally, echocardiography derived LV dimensions and ejection fraction (EF) are used to exclude LV dysfunction in IAF, but their sensitivity is limited. Our objective is to evaluate the presence of subtle alterations in LV function despite normal LVEF in patients with IAF compared to healthy controls, using speckle-tracking echocardiography (STE) based global longitudinal strain (GLS).

Methods

Standard transthoracic echocardiography was performed in 80 patients with IAF and 129 healthy controls. Patients with overt cardiac disease as well as known established AF risk factors were excluded. STE analysis was performed to assess GLS of the LV, and left atrial strain (LAS).

Results

LVEF was normal and comparable between patients with IAF and healthy controls (63 ± 4% for both groups; p = 0.801). Mean GLS was within normal limits for both groups but statistically significantly more negative in patients with IAF (−20.6 ± 2.5% vs. -19.7 ± 2.5%; p = 0.016), however not when indexed for ventricular cycle length (p = 0.784). No differences in LA volume or non-indexed LAS were seen in patients with IAF compared to healthy controls.

Conclusions

In this selected group of IAF patients, STE did not detect any overt LV or LA dysfunction compared to healthy controls. Thus, IAF occurred in these patients not only in the absence of established AF risk factors but also without evidence of ventricular or atrial dysfunction.

Keywords

Idiopathic atrial fibrillation
Echocardiography
Left ventricular function
Global longitudinal strain
Speckle-tracking

Cited by (0)

1

First authors contributed equally.

2

This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation

3

Last authors contributed equally