Predictive And Long-term Prognostic Value Of Two-Dimensional Speckle Tracking Strain Rate Imaging On Cardioconversion Outcome In Patients With Atrial Fibrillation

Objective: Through measurement of strain and strain rate of left atrium and left ventricle of patients with atrial fibrillation(AF),evaluating the predictive value of speckle tracking technology on the outcome of conversion in patients with AF,and prognostic significance of keeping sinus rhythm after successful cardioversion.Methods: 91 patients with AF who intended to do cardioversion were included in this study,echocardiographic examination were performed in 1-3 days before cardioversion treatment,as well as 3 days and 6 months after the treatment.Echocardiographic measures include the left atrial diameter(left atrial diameter LAD),left atrial volume(maximum Left atrial maximum volume LAVmax),minimum left atrial volume(Left atrial minimum volume LAVmin),the left atrial ejection fraction(Left atrial ejection fraction LAEF%),early diastolic peak velocity of mitral valve(Mitral valve mouth early diastolic peak flow velocity E),early diastolic peak velocity of mitral annulus(Peak early diastolic velocity of mitral valve ring E ’),and their ratio(E/E ’),left ventricular end diastolic volume(Left ventricular end-diastolic volume LV-EDVml),left ventricular systolic At the end of(Left ventricular end systolic volume capacity LV-ESVml),left ventricular ejection fraction(Left ventricular ejection fraction LVEF%),left ventricular systolic left atrial strain rate(left atrial strain average rate in the left ventricular systolic mSRs),left ventricular diastolic left atrial early average strain rate(left atrial strain rate in the early left ventricular diastole m SRe),left atrial systolic strain rate(Left atrial systolic average strain rate mSRa),left ventricular global longitudinal strain(global longitudinal strain GLS)and strain rate(GLSR),radial peak systolic strain(global Radial strain GRS)and strain rate(GRSR)and other indicators,statistical analysis.Patients were divided into two groups according to the outcome of conversion therapy: the successful group and the failure group.The patients who had successful cardioversion were followed up at least 6 months via phone or survey form.According to whether recurrence of atrial fibrillation,the followed-up patients were divided into two groups: maintaining sinus rhythm group and atrial fibrillation recurrence group,As control,the same age of 50 healthy volunteers were included and echocardiographic measures were analyzed as AF patients.SPSS 17 software was used for statistical analysis,all data were expressed by SX?,compared with the same group of data between the paired t test,independent samples t test was used for comparison between groups of data,the data among the groups compared with single factor variance analysis,the predictive value of the application of multivariate Logistic regression analysis.P<0.05 showed statistical difference.Results: Compared with the normal control group,E/E ’,LAD,LAVmax,LAVmin,LV-EDV,LV-ESV were significantly increased(P<0.05),LVEF decreased(P<0.05)and LAEF disappeared in AF group;After successful cardioversion treatment,the LAEF recovers,but other indexes were not obviously changed(P>0.05).At 6 months after successful cardioversion,the LAD,E/E ’,LAVmax:,LAVmin,LV-EDV,LV-ESV and some other indexes decreased(P<0.05),but LAEF and LVEF were significantly increased(P<0.05).The left ventricular GLS,GRS,GLSR,GRSR in patients with AF were decreased(P<0.05)compared with the control group,however there was no significant difference in left ventricular GLS,GRS,GLSR,GRSR(P>0.05)3 days after cardioversion treatment.There was also no significant difference in left ventricular GLS,GRS,GLSR,and GRSR before andafter successful cardioversion and whether cardioversion succeed or not(P>0.05)at 3days after cardioversion treatment.However the above index of LV(strain and strain rate)were significantly increased at 6 months after successful cardioversion(sinus rhythm group)(P<0.05).As for LA strain measurement,mSRs and mSRe decreased significantly(P<0.05)in all patients with AF before and after cardioversion treatment compared with the control group,while m SRa disappeared before cardioversion treatment.When compared the successful group with failure group,we found that there was no significant difference of mSRs(P>0.05)before and after cardioversion,but significantly higher m SRe in the successful group(P<0.05),the difference kept existing after successful cardioversion.After 6 months of follow-up,we found the mSRs,m SRe and mSRa were significantly increased in the group which maintaining sinus rhythm,compared with pre-and post-cardioversion(3 days)(P<0.05),but still lower than control group.In the recurrence group,mSRa disappeared,and mSRs was not statistically significant(P>0.05)when compared with pre-and post-cardioversion(3 days),mSRe was significantly lower than that of 3 days after cardioversion(P<0.05).When compared the group maintaining sinus rhythm with recurrence group,we found that there was no significant difference in mSRs(P>0.05),but mSRe was higher(P<0.05)in the group maintaining sinus rhythm before cardioversion.After successful cardioversion,mSRa appear in both group,and the pattern of higher mSRe in the group with maintaining sinus rhythm and similar mSRs between both groups remains.At 6 month follow-up,we found no significant difference in mSRs(P>0.05),but mSRe and mSRa significantly increased in the group with maintaining sinus rhythm(P<0.05).Logistic regression analysis was used to evaluate the strain indicators of OR,95% CI,P values of left atrial and left ventricular,the results showed that mSRe is the strongest predictor of successful cardioversion and long-term maintenance of sinus rhythm.Conclusion: Left ventricular systolic and diastolic function,as well as left atrial function impaired in variable degree in patients with AF.Analysis on left atrial strain and strain rate indicated patients with higher mSRe is more likely to be converted to sinus rhythm and more likely maintaining sinus rhythm at 6 months.Successful cardioversion and maintenance improve left ventricular and left atrial structure and function.Left atrial strain index(mSRe)is an independent predictor for predicting the success of atrial fibrillation conversion and maintenance in patients with atrial fibrillation.