Atrial Strain and Strain Rate: A Novel Method for the Evaluation of Atrial Stunning

Ozkan, Hakan; Binici, Suleyman; Tenekecioglu, Erhan; Ari, Hasan; Bozat, Tahsin

doi:10.5935/abc.20160131

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Original Articles • Arq. Bras. Cardiol. 107 (4) • Oct 2016 • https://doi.org/10.5935/abc.20160131 copy

Atrial Strain and Strain Rate: A Novel Method for the Evaluation of Atrial Stunning

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Atrial fibrillation (AF) is the most common arrhythmia seen in adults. Atrial stunning is defined as the temporary mechanical dysfunction of the atrial appendage developing after AF has returned to sinus rhythm (SR).

Objectives:

We aimed to evaluate atrial contractile functions by strain and strain rate in patients with AF, following pharmacological and electrical cardioversion and to compare it with conventional methods.

Methods:

This study included 41 patients with persistent AF and 35 age-matched control cases with SR. All the AF patients included in the study had transthoracic and transesophageal echocardiography performed before and after. Septum (SEPsSR), left atrium (LAsSR) and right atrium peak systolic strain rate (RAsSR) were defined as the maximum negative value during atrial contraction and septum (SEPε), left atrium (LAε) and right atrium peak systolic strain (RAε) was defined as the percentage of change. Parameters of two groups were compared.

Results:

In the AF group, 1st hour and 24th hour LAε, RAε, SEPε, LAsSR, RAsSR, SEPsSR found to be significantly lower than in the control group (LAε: 2.61%±0.13, 3.06%±0.19 vs 6.45%±0.27, p<0.0001; RAε: 4.03%±0.38, 4.50%±0.47 vs 10.12%±0.64, p<0.0001; SEPε: 3.0%±0.22, 3.19%±0.15 vs 6.23%±0.49, p<0.0001; LAsSR: 0.61±0.04s-¹, 0.75±0.04s- ¹ vs 1.35±0.04s-¹, p<0.0001; RAsSR: 1.13±0.06s-¹, 1.23±0.07s-¹ vs 2.10±0.08s- ¹, p<0.0001; SEPsSR: 0.76±0.04s- ¹, 0.78±0.04s- ¹ vs 1.42±0.06 s- ¹, p<0.0001).

Conclusion:

Atrial strain and strain rate parameters are superior to conventional echocardiographic parameters for the evaluation of atrial stunning in AF cases where SR has been achieved.

Keywords:
Atrial Fibrillation; Arrhythmia, Cardiac; Myocardial Stunning; Echocardiography, Transesophageal; Electric Cardioversion

	AF group (n=41)	Controlgroup (n=35)	p value
Age (year)	59.38±1.40	55.83±1.65	NS
Male	15 (36.59%)	14 (%40)	NS
Female	26 (64.41%)	21 (%60)	NS
AF duration (day)	207.76±47.72	-
Baseline heart rate (bpm)	94.29±2.21	72.57±1.81	0.001
Body surface area (m²)	1.84±0.27	1.79±0.13	NS
Systolic blood pressure (mm Hg)	125.67±2.88	128.00 ±3.05	NS
Diastolic blood pressure (mm Hg)	79.44±1.54	79.57±1.88	NS
Diabetes mellitus	7 (15.6%)	11 (21.4%)	NS
Hypertension	25 (55.6%)	15 (42.9%)	NS
Dyslipidemia	6 (13.3%)	2 (5.7%)	NS
CAD	5 (11.1%)	7 (20%)	NS
Smoking	17 (37.8%)	11 (21.4%)	NS
Acetylsalicylic acid	36 (8%0)	12 (34.3%)	<0.0001
Beta-blockers	13 (28.9%)	9 (25.7%)	NS
Calcium channel blockers	10 (22.2%)	10 (28.6%)	NS
Nitrate	4 (8.9%)	3 (8.6%)	NS
Digoxin	15 (33.3%)	1 (2.9%)	0.001
ACEI	14 (31.1%)	8 (22.9%)	NS
ARB	5 (11.1%)	4 (11.4%)	NS
Lipid lowering drugs	6 (13.3%)	2 (5.7%)	NS
Diuretics	11 (24.4%)	4 (11.4%)	NS
Warfarin	3 (6.7%)	-	NS

	AF group (n=41)	Control group (n=35)	p value
Left atrium (cm)	4.47±0.06	4.37±0.06	NS
LVEDD (cm)	4.80±0.10	4.81±0.97	NS
LVESD (cm)	3.27±0.11	3.08±0.10	NS
Septum (cm)	1.15±0.03	1.14±0.03	NS
Posterior wall (cm)	1.13±0.03	1.06±0.03	NS
Ejection fraction (%)	61.08±1.63	64.14±1.59	NS
Fractional shortening (%)	32.09±1.16	34.85±1.08	NS
End-systolic volume (mL)	45.44±4.34	40.22±3.41	NS
End-diastolic volume (mL)	105.52±6.27	101.31±5.00	NS
Pulmonary artery pressure (mmHg)	27.51±0.93	27.17±1.06	NS
Mitral regurgitation
None	5 (11.1%)	9 (25.7%)	NS
Mild	37 (82.2%	9 (25.7%)	NS
Moderate	3 (6.7%)	3 (8.6%)	NS
Aortic regurgitation
None	12 (26.7%)	13 (37.1%)	NS
Mild	30 (66.7%)	21 (60%)	NS
Moderate	3 (6.7%)	1 (2.9%)	NS
Tricuspid regurgitation
None	32 (71.1%)	23 (65.7%)	NS
Mild	12 (26.7%)	12 (34.3%)	NS
Moderate		1 (2.2%)	NS
LAA peak emptying velocity (cm/s)	37.05±1.73	-
LAA mean emptying velocity (cm/s)	29.82±1.45	-
LAA peak filling velocity (cm/s)	36.68±1.77	-
LAA mean filling velocity (cm/s)	29.60±1.41	-

	AF group	Control group	p value
Mitral E velocity (m/s)
1^st hour	0.82±0.04	0.83±0.02	NS
24^th hour	0.80±0.04	0.83±0.02	NS
1^st month	0.81±0.04	0.83±0.02	NS
Mitral A velocity (m/s)
1^st hour	0.61±0.04	0.79±0.02	0.016
24^th hour	0.64±0.03	0.79±0.02	0.029
1^st month	0.79±0.04	0.79±0.02	NS
Mitral E/A ratio
1^st hour	1.34±0.10	1.16±0.04	0.004
24^th hour	1.30±0.08	1.16±0.04	0.018
1^st month	1.10±0.04	1.16±0.04	NS
Mitral A time-velocity integral
1^st hour	5.84±0.38	6.20±0.17	NS
24^th hour	6.12±0.41	6.20±0.17	NS
1^st month	6.56±0.51	6.20±0.17	NS
Left atrial ejection force (kdyne)
1^st hour	8.23±0.96	11.82±0.61	0.015
24^th hour	9.36±0.99	11.82±0.61	0.043
1^st month	11.67±1.01	11.82±0.61	NS

	AF	Control	p value
TV E velocity (m/s)
1^st hour	0,52±0,01	0,58±0,02	NS
24^th hour	0,54±0,01	0,58±0,02	NS
1^st month	0,55±0,02	0,58±0,02	NS
TV A velocity (m/s)
1^st hour	0,36±0,01	0,44±0,01	0,04
24^th hour	0,40±0,01	0,44±0,01	NS
1^st month	0,45±0,01	0,44±0,01	NS
TV E/A ratio
1^st hour	1,36±0,04	1,26±0,06	NS
24^th hour	1,35±0,03	1,26±0,06	NS
1^st month	1,22±0,03	1,26±0,06	NS
TV A time-velocity integral
1^st hour	3,86±0,19	4,72±0,24	NS
24^th hour	4,21±0,21	4,72±0,24	NS
1^st month	4,66±0,23	4,72±0,24	NS
Right atrial ejection force (kdyne)
1^st hour	3,03±0,21	5,88±0,43	0,010
24^th hour	3,28±0,21	5,88±0,43	0,023
1^st month	5,45±0,36	5,88±0,43	NS

	Group A (n=24)	Group B (n=17)	Group C (n=35)		p value
	Group A (n=24)	Group B (n=17)	Group C (n=35)	A-B	A-C	B-C
LAε (%)
1^st hour	2.72±0.13	2.45±0.25	6.45±0.27	NS	<0.0001	<0.0001
24^th hour	3.09±0.24	3.02±0.34	6.45±0.27	NS	<0.0001	<0.0001
1^st month	6.38±0.45	4.46±0.34	6.45±0.27	0.01	NS	0.03
SEPε (%)
1^st hour	3.21±0.36	2.75±0.22	6.23±0.49	NS	<0.0001	<0.0001
24^th hour	3.17±0.18	3.22±0.26	6.23±0.49	NS	<0.0001	<0.0001
1^st month	6.17±0.67	5.79±0.60	6.23±0.49	NS	NS	NS
RAε (%)		w
1^st hour	3.80±0.33	3.31±0.33	10.12±0.64	NS	<0.0001	<0.0001
24^th hour	5.10±0.70	4.51±0.32	10.12±0.64	NS	<0.0001	<0.0001
1^st month	11.66±1.22	6.88 ± 0.32	10.12±0.64	0.02	NS	0.02
LAsSR(s¯¹)
1^st hour	0.67±0.06	0.53±0.06	1.35±0.04	NS	<0.0001	<0.0001
24^th hour	0.86±0.07	0.59±0.06	1.35±0.04	0.013	<0.0001	<0.0001
1^st month	1.53±0.13	1.05±0.03	1.35±0.04	0.02	NS	0.03
SEPsSR (s¯¹)
1^st hour	0.83±0.05	0.67±0.07	1.42±0.04	NS	<0.0001	<0.0001
24^th hour	0.83±0.05	0.70±0.07	1.42±0.04	NS	<0.0001	<0.0001
1^st month	1.35±0.09	1.28±0.11	1.42±0.04	NS	NS	NS
RAsSR (s¯¹)
1^st hour	1.16±0.07	1.08±0.13	2.10±0.08	NS	<0.0001	<0.0001
24^th hour	1.32±0.09	1.08±0.14	2.10±0.08	NS	<0.0001	<0.0001
1^st month	2.22±0.08	1.78±0.23	2.10±0.08	0.04	NS	0.04

	Group A (n=24)	Group B (n=17)	Group C (n=35)		p value
	Group A (n=24)	Group B (n=17)	Group C (n=35)	A-B	A-C	B-C
Left atrial ejection force (kdyne)
1^st hour	10.05±1.40	5.50±0.83	12.40±0.66	0.019	NS	<0.0001
24^th hour	10.98±1.39	6.59±0.92	12.40±0.66	0.032	NS	<0.0001
1^st month	12.32±1.16	10.63±1.42	12.40±0.66	NS	NS	NS
Mitral A velocity (m/s)
1^st hour	0.73±0.05	0.45±0.07	0.79±0.04	<0.0001	NS	<0.0001
24^th hour	0.69±0.04	0.51±0.07	0.79±0.04	0.04	NS	<0.0001
1^st month	0.76±0.06	0.68±0.05	0.79±0.04	NS	NS	NS
Mitral A time-velocity integral
1^st hour	6.73±0.56	4.58±0.25	7.20±0.17	0.004	NS	<0.0001
24^th hour	6.94±0.59	4.80±0.27	7.20±0.17	0.01	NS	<0.0001
1^st month	7.18±1.08	7.17±0.97	7.20±0.17	NS	NS	NS
Mitral E/A ratio
1^st hour	1.24±0.08	2.05±0.15	1.16±0.08	<0.0001	NS	<0.0001
24^th hour	1.18±0.06	1.73±0.12	1.16±0.08	0.004	NS	0.001
1^st month	1.12±0.05	1.32±0.13	1.16±0.08	NS	NS	NS
Right atrial ejection force (kdyne)
1^st hour	3.11±0.24	2.91±0.40	4.88±0.11	NS	0.016	0.0001
24^th hour	3.33±0.20	3.21±0.45	4.88±0.11	NS	NS	0.001
1^st month	4.68±0.39	4.40±0.70	4.88±0.11	NS	NS	NS
TV A velocity (m/s)
1^st hour	0.42±0.01	0.33±0.01	0.44±0.01	0.005	NS	0.0001
24^th hour	0.42±0.01	0.35±0.01	0.44±0.01	0.023	NS	0.005
1^st month	0.45±0.01	0.41±0.02	0.44±0.01	NS	NS	NS
TV A time-velocity integral
1^st hour	4.40±0.22	3.76±0.19	4.72±0.24	NS	NS	NS
24^th hour	4.49±0.23	3.91±0.20	4.72±0.24	NS	NS	NS
1^st month	4.67±0.23	4.18±0.23	4.72±0.24	NS	NS	NS
TV E/A ratio
1^st hour	1.27±0.03	1.44±0.07	1.26±0.06	NS	NS	NS
24^th hour	1.26±0.03	1.31±0.07	1.26±0.06	NS	NS	NS
1^st month	1.17±0.04	1.19±0.09	1.26±0.06	NS	NS	NS

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