Evaluating Right Ventricular Function To Predict The Onset Of Paroxysmal Atrial Fibrillation By Speckle Tracking Imaging And Contrast-enhanced Echocardiography

Objective:To investigate right ventricular function by speckle tracking imaging and contrast-enhanced echocardiography in predicting the onset of paroxysmal atrial fibrillation(PAF).Methods:36 patients with PAF confirmed in the cardiovascular medicine department of our hospital from January 2019 to January 2020 were prospectively collected.2D echocardiography and contrast-enhanced echocardiography were performed at the onset of atrial fibrillation and sinus rhythm.Left and right atrial diameters were measured.Right ventricular fractional area change(FAC)and right ventricular visualization were assessed with and without contrast enhancement.QLab10 software was used to calculate tricuspid annular plane systolic excursion(TAPSE),and generate right and left ventricular time-strain curves.FAC with contrast-enhanced echocardiography and TAPSE,LVGLS,RVGLS were taken as the baseline value when atrial fibrillation had not occurred.After 6 months,the patients were divided into two groups according to whether atrial fibrillation occurs or not.Evaluated the above parameters again,and the differences of the above parameters in each group were compared.Receiver operating characteristic(ROC)curve was used to analyze the value of each parameter in predicting atrial fibrillation occurs.Results:After 6 months,there were 21 cases in the onset group and 13 cases in the no onset group.1.LVGLS and RVGLS decreased in AF paroxysm when compared to those in sinus rhythm(P<0.05).2.The difference of FAC with and without contrast-enhanced echocardiography was statistically significant in those with image improvement value ≥6.3.After 6 months,there was significant difference in value of RVGLS between the onset group and baseline value of the same group(P<0.05).There were no statistical significance in FAC with contrast-enhanced echocardiography and TAPSE,LVGLS.4.The baseline value of RVGLS in the onset group was lower than that in the no onset group(P<0.05).There was no significant difference in the value of TAPSE,LVGLS and FAC with contrast-enhanced echocardiography between the two groups.5.ROC curve showed when RVGLS<17.88,the area under the curve is 0.857,the sensitivity and specificity of predict AF onset were 71.4% and 84.6% respectively.TAPSE,LVGLS and FAC had no predictive value(area under the curve:0.465、0.498、0.520,P=0.736、0.986、0.845).Conclusions:1.The contractility of the right and left ventricular myocardium decreased at the onset of atrial fibrillation.2.Contrast-enhanced echocardiography can significantly improve the clarity of RV images and the accuracy of FAC measurement.3.RVGLS can sensitively detect changes in right ventricular systolic function in PAF patients.4.RVGLS has certain predictive value for PAF onset.However TAPSE,LVGLS with STI and FAC with contrast-enhanced echocardiography have no predictive value for PAF onset.