AUTHOR=Marchandise Sébastien , Garnir Quentin , Scavée Christophe , Varnavas Varnavas , le Polain de Waroux Jean-Benoit , Wauters Aurélien , Beauloye Christophe , Roelants Véronique , Gerber Bernhard L. 

TITLE=Prediction of Left Atrial Fibrosis and Success of Catheter Ablation by Speckle Tracking Echocardiography in Patients Imaged in Persistent Atrial Fibrillation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.856796

DOI=10.3389/fcvm.2022.856796

ISSN=2297-055X

ABSTRACT=Background. Non-invasive evaluation of left atrial structural and functional remodeling should be considered in all persistent atrial fibrillation (AF) patients to optimal management. Speckle-Tracking echocardiography (STE) has been shown to predict AF recurrence after catheter ablation, however in most studies, patients had paroxysmal AF and STE was performed while patients were in sinus rhythm.
Aim. To evaluate the ability of Speckle-Tracking echocardiography (STE) parameters acquired during persistent AF to assess atrial fibrosis measured by low voltage area, and to predict maintenance of sinus rhythm of catheter ablation.

Methods: 94 patients (69 males, 65±9 years) with persistent AF prospectively underwent measurement of Global Peak Atrial Strain (GPALS), indexed LA Volume (LAVi), E/e’ ratio, and LA stiffness index (the ratio of E/e′ to GPALS) by STE prior to catheter ablation, while in AF. Low Voltage Area (LVA) was assessed by Electro-Anatomical Mapping and categorized into absent, moderate (>0% to <15%), and high (≥15%) of atrial extent. AF recurrence was evaluated after 3 months blanking.

Results:  Multivariate regression showed that LAVi, GPALS, and LA stiffness independently predicted LVA extent after correcting for age, glomerular filtration rate, and CHAD2S2Vasc score. Of all parameters LA stiffness index had the highest diagnostic accuracy (AUC 0.85), allowing by using a cut-off value ≥ 0.7 to predict moderate or high LVA with 88% sensitivity and 47% specificity respectively. In multivariate Cox analysis, both GPALS and LAStiffness were able to significantly improve the c statistic to predict AF recurrence (n=40 over 9 months FU) over CHARGE-AF (p<0.001 for GPALS and p=0.01 for LA stiffness) or CHADS2VASC2 score (p<0.001 for GPALS and p=0.02 for LA stiffness). GPALS and LA stiffness also improved the net reclassification index NRI over the CHARGE-AF index), and over the CHADS2VASC2 score  to predict AF recurrence at 9 months.

Conclusion: STE parameters acquired during AF allow prediction of LVA extent and AF recurrence in patients with persistent AF undergoing catheter ablation. Therefore, STE could be a valuable approach to select candidates for catheter ablation.