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Title: The value of serial echocardiography in risk assessment of patients with paroxysmal atrial fibrillation
Author: Leung, M.
van Rosendael, P. J.
van der Bijl, P.
Regeer, M. V.
van Wijngaarden, S. E.
Leung, D. Y.
Delgado, V.
Marsan, N. A.
Ng, A. C. T.
Bax, J. J.
Issue Date: 2024
Journal: International Journal of Cardiovascular Imaging
Abstract:  Progression from paroxysmal to persistent atrial fibrillation (AF) is associated with increased morbidity and mortality. We examined the association of left atrial (LA) remodeling by serial echocardiography, and AF progression over an extended follow-up period. Two-hundred ninety patients (mean age 61 � 11�years, 73% male) who underwent transthoracic echocardiography performed at first presentation for non-valvular paroxysmal AF (PAF) and repeat echocardiogram 1-year later, were followed for progression to persistent AF. LA and left ventricular (LV) dimensions, volumes, LA reservoir, conduit and booster pump strains, LV global longitudinal systolic strain (GLS) assessed�by 2D speckle tracking, and PA-TDI (time delay between electrical and mechanical LA activation? reflecting the extent of LA fibrosis) were compared on serial echocardiography. Sixty-nine (24%) patients developed persistent AF over a mean follow-up period of 6.3�years. At baseline, patients with subsequent persistent AF had larger LA dimensions (46�mm vs. 42�mm, p < 0.001), indexed LA volumes (41�ml/m2 vs. 34�ml/m2, p < 0.001), lower LA reservoir and conduit strain (17.6% vs. 27.6%, p < 0.001; 10.5% vs. 16.3%, p < 0.001; respectively) and longer PA-TDI (155�ms vs. 132�ms, p < 0.001) compared to the PAF group. Patients with subsequent persistent AF showed over time significant enlargement in LA volumes (from 37.7�ml/m2 to 42.4�ml/m2, p < 0.001), lengthening of PA-TDI (from 142.2�ms to 162.2�ms, p = 0.002), and decline in LA reservoir function (from 21.9% to 18.1%, p = 0.024) after adjusting for age, gender, diabetes and LV GLS. There were no changes in LA diameter, LA conduit or booster pump function. Conversely, the PAF group showed no decline in LA function. Patients who developed persistent AF had larger LA�size and impaired LA function and atrial conduction times at baseline, compared to patients who remained PAF. Over the 1-year time course of serial echocardiographic evaluation, there was progression of LA remodeling in patients who subsequently developed persistent AF, but not in patients who remained in�PAF. � The Author(s), under exclusive licence to Springer Nature B.V. 2023.
ISSN: 15695794 (ISSN)
Digital object identifier: 10.1007/s10554-023-03014-6
Appears in Collections:Liverpool Hospital

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