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Impact of disease stage on the performance of strain markers in the prediction of atrial fibrillation


Ramkumar, S and Pathan, F and Kawakami, H and Ochi, A and Yang, H and Potter, EL and Marwick, TH, Impact of disease stage on the performance of strain markers in the prediction of atrial fibrillation, International Journal of Cardiology pp. 1-9. ISSN 0167-5273 (2020) [Refereed Article]

Copyright Statement

2020 Published by Elsevier B.V.

DOI: doi:10.1016/j.ijcard.2020.09.057


Background: Assessing atrial fibrillation (AF) risk may be useful in primary prevention (PP; people with risk factors) and secondary prevention (SP; eg. embolic stroke of unknown source). We sought whether disease stage influenced the prediction of AF by echocardiography.

Methods: We compared a PP cohort (351 community-based participants ≥65 years with ≥1 risk factor for AF) and a SP cohort (453 patients after transient ischemic attack or stroke). LV global longitudinal strain (GLS) and left atrial reservoir strain (LARS) were measured from DICOM images. AF was diagnosed by 12 lead ECG, Holter or by single lead monitor over median follow-up of 22 months (PP) and 35 months (SP). The clinical and echocardiographic characteristics of those with AF were compared to those in sinus rhythm. Nested Cox-regression models assessed for independent and incremental predictive value of LARS and GLS in both cohorts.

Results: AF developed in 42 PP (12%) and 60 SP (13%), and was associated with age, higher CHARGE-AF score, increased LA volume and LV mass (p < 0.05). Patients developing AF had reduced GLS (17 3.5% vs. 20 3%, p < 0.001) and LARS (28 11% vs. 35 8%, p < 0.001). However, the predictive value of both GLS (area under the ROC curve 0.83 vs 0.56, p < 0.001) and LARS (0.83 vs 0.57, p < 0.001) was greater in SP than PP. LARS was independently associated with AF in both cohorts (p < 0.05), but GLS was only independently associated in the SP cohort.

Conclusion: AF risk assessment with LARS is suitable for different risk cohorts, but GLS is more useful in SP.

Item Details

Item Type:Refereed Article
Keywords:atrial fibrillation, left atrium, screening, 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:Pathan, F (Dr Faraz Pathan)
UTAS Author:Ochi, A (Miss Ayame Ochi)
UTAS Author:Yang, H (Ms Hilda Yang)
UTAS Author:Marwick, TH (Professor Tom Marwick)
ID Code:141274
Year Published:2020
Web of Science® Times Cited:2
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-10-09
Last Modified:2022-08-30

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