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Left atrial mechanical dispersion assessed by strain echocardiography as an independent predictor of new-onset atrial fibrillation: a case-control study


Kawakami, H and Ramkumar, S and Nolan, M and Wright, L and Yang, H and Negishi, K and Marwick, TH, Left atrial mechanical dispersion assessed by strain echocardiography as an independent predictor of new-onset atrial fibrillation: a case-control study, Journal of the American Society of Echocardiography, 32, (10) pp. 1268-1276. ISSN 0894-7317 (2019) [Refereed Article]

Copyright Statement

Copyright 2019 American Society of Echocardiography

DOI: doi:10.1016/j.echo.2019.06.002


Background: Left atrial (LA) enlargement is associated with atrial fibrillation (AF), but new-onset AF often occurs in the absence of LA enlargement. AF may be related to myocardial fibrosis, and even though left ventricular fibrosis is associated with mechanical dispersion, this phenomenon is not well studied in AF. We hypothesized that detection of LA dysfunction and mechanical dispersion using strain echocardiography is useful for predicting new-onset AF.

Methods: Baseline echocardiography was performed at entry in 576 community-based participants at risk of heart failure or AF. In this case-control study, we compared 35 individuals with new-onset AF (age 70 4 years; 57% men) over 2 years of follow-up with 35 age- and sex-matched individuals who did not develop AF from the same cohort. Using speckle-tracking echocardiography, we measured the LA strain in each of 12 segments in the two- and four-chamber views. LA mechanical dispersion was defined as the SD of time to peak positive strain corrected by the R-R interval (SD-TPS, %).

Results: There was no significant difference in LA volume index (32.5 9.2 mL/m2 vs 29.5 8.3 mL/m2; P = .16); patients with new-onset AF had significantly worse LA pump strain (16.6% 4.3% vs 20.6% 4.3%; P < .01) and reservoir strain (31.4% 7.7% vs 38.0% 7.3%; P < .01) than those without AF. SD-TPS was significantly higher in patients with AF than in those without it (6.3% 2.3% vs 3.9% 1.6%; P < .01). SD-TPS was independently associated with new-onset AF after adjustment for patient characteristics, LA volume, and strain (hazard ratio = 1.26; 95% CI, 1.10-1.45; P < .01). In the nested Cox models, the model based on the LA volume and strain for predicting new onset AF was significantly improved by adding SD-TPS (P < .01).

Conclusions: LA dispersion obtained from strain echocardiography seems to provide incremental information about LA volume and function in the prediction of new-onset AF and warrants testing in a larger study.

Item Details

Item Type:Refereed Article
Keywords:atrial fibrillation, dispersion, echocardiography, left atrium, strain
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Yang, H (Ms Hilda Yang)
UTAS Author:Negishi, K (Dr Kazuaki Negishi)
ID Code:137417
Year Published:2019
Web of Science® Times Cited:26
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-02-12
Last Modified:2022-08-30

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