Assessment Of Left Atrial Function In Patients With Atrial Fibrillation By Three-dimensional Speckle Tracking Imaging

ObjectiveThree-dimensional speckle tracking imaging (3D-STI) is a novel technique for theassessment of myocardial deformation. However, whether this technique is applicablefor the evaluation of left atrial (LA) function remains unclear. To address this issue,we evaluated LA deformation and synchrony by3D-STI in patients with atrialfibrillation (AF).MethodsThirty-seven patients with paroxysmal atrial fibrillation (AF1group), forty-threepatients with persistent atrial fibrillation (AF2group) and forty controls were studied.Apical full-volume images were acquired in all subjects and then were analyzed byoff-line3D-STI analysis software. The software divided LA into16segmentsautomatically. The myocardial motions were tracking by3D-STI.To quantify LA deformation, peak ventricular systolic longitudinal strain, radial strain, circumferential strain, and area strain of16segments of LA (PLS, PRS, PCS,PAS), LA global peak ventricular systolic longitudinal strain, radial strain,circumferential strain, and area strain (GLSs, GRSs, GCSs, GASs), LA global peakpre-atrial contraction longitudinal strain, radial strain, circumferential strain, and areastrain (GLSa, GRSa, GCSa, GASa) were measured. To quantify LA synchrony, thetime of peak longitudinal strain, radial strain, circumferential strain, and area strain of16segments of LA (TLS, TRS, TCS, TAS), the time of global peak longitudinalstrain, radial strain, circumferential strain, and area strain (GTLS, GTRS, GTCS,GTAS), the standard deviation of time to peak longitudinal strain, radial strain,circumferential strain, and area strain (TLS-SD, TRS-SD, TCS-SD, TAS-SD) weremeasured. And the cor-relationship between left atrial ejection fraction and3D-STIparameters was studied.Results1. Along with the severity of AF, the trend of peak strain of16segments of LAgradually reduced. Comparing with controls, PLS、PRS、PCS、PAS values of AFgroup was further reduced (P <0.05),2. Compared with controls, GLSs, GRSs, GCSs and GASs values of AF group weresignificantly decreased (P<0.05), GLSa and GASa values of AF1group weresignificantly reduced (P<0.05), while no significantly differences were found inGRSa and GCSa values between controls and AF1group (P>0.05).3. Along with the severity of AF, the time of peak strain of16segments of LA andthe time of global peak strain showed a gradually increasing trend. Comparingwith controls, TLS, TRS, TCS, and TAS values of AF group were significantlyincreased (P <0.05), while GTLS, GTRS, GTCS, and GTAS values of AF groupwere significant increased (P <0.05).Compared with controls, the deformationparameters of AF group were significantly higher (P<0.05).4.3D-STI deformation parameters were correlated positively with each other. Thedeformation parameters were correlated positively with LAEF, and thesynchronization parameters were modestly correlated with LAEF.5. ROC curve analysis LA global peak ventricular systolic strain and the standard deviation of time to peak strain detecting of myocardial function in patients withAF. And longitudinal strain had the best ability to identify atrial fibrillation thanother strains.Conclusion3D-STI enables to measure the myocardial function change early in patients andreflects the severity. Therefore3D-STI can also be used for the evaluation of AF leftatrial function in patients and clinical reference for the timing of surgery.