Incremental diagnostic role of left atrial strain analysis in thrombotic risk assessment of nonvalvular atrial fibrillation patients planned for electrical cardioversion

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Abstract
During the COVID-19 pandemic, transesophageal echocardiography (TEE) for left atrial appendage thrombosis (LAAT)
detection should be limited to situations of absolute necessity. We sought to identify the main conventional and functional
echocardiographic parameters associated with LAAT on TEE in non-valvular atrial fibrillation (NVAF) patients planned
for electrical cardioversion (ECV). This retrospective study included 125 consecutive NVAF patients (71.5±7.8 yrs, 75
males), who underwent TEE at our Institution between April 2016 and January 2020, to exclude LAAT before scheduled
ECV. All patients underwent a transthoracic echocardiography (TTE) implemented with speckle tracking echocardiography
(STE) analysis of left atrial (LA) strain and strain rate (SR) parameters. 28% of patients were diagnosed with LAAT, while
72% without LAAT. Compared to controls, patients with LAAT had significantly higher CHA2DS2-
Vasc Score and average
E/e’ ratio, and significantly lower left ventricular ejection fraction (LVEF). Moreover, LA-peak positive global atrial strain
(GSA+) and LA-SR parameters were significantly reduced in patients with LAAT. Multivariate logistic regression revealed
that, differently from CHA2DS2-
Vasc Score, LVEF (OR 0.88, 95%CI 0.81–0.97, p = 0.01), average E/e’ ratio (OR 2.36,
95%CI 1.41–3.98, p = 0.001), and LA-GSA+ (OR 0.57, 95%CI 0.36-0-90, p = 0.01) were independently associated with
LAAT. LA-GSA+ (optimal cut-off ≤ 9.1%, AUC 0.95) showed the highest diagnostic performance. Finally, a strong linear
correlation of LA peak-to-peak SR with both LA appendage filling (r = 0.86) and emptying (r = 0.83) velocities was demonstrated.
TTE implemented with STE analysis of LA mechanics improves thrombotic risk assessment of NVAF patients.

本数据集关联该研究论文的原始实验数据

摘要：
在新型冠状病毒肺炎（COVID-19）大流行期间，用于检测左心耳血栓（left atrial appendage thrombosis, LAAT）的经食管超声心动图（transesophageal echocardiography, TEE）应仅在绝对必要的情况下开展。本研究旨在明确拟接受心脏电复律（electrical cardioversion, ECV）的非瓣膜性心房颤动（non-valvular atrial fibrillation, NVAF）患者中，与TEE检出LAAT相关的主要常规及功能超声心动图参数。本回顾性研究纳入2016年4月至2020年1月间于本机构接受TEE检查以排除LAAT、拟行ECV的125例连续入组NVAF患者（年龄71.5±7.8岁，男性75例）。所有患者均接受经胸超声心动图（transthoracic echocardiography, TTE）联合斑点追踪超声心动图（speckle tracking echocardiography, STE）分析，以获取左心房（left atrial, LA）应变及应变率（strain rate, SR）参数。结果显示，28%的患者确诊LAAT，72%未检出LAAT。与无LAAT的对照组相比，LAAT患者的CHA₂DS₂-VASc评分、平均E/e’比值显著更高，左心室射血分数（left ventricular ejection fraction, LVEF）显著更低。此外，左心房正向峰值全局心房应变（LA-peak positive global atrial strain, GSA+）及LA应变率参数在LAAT患者中显著降低。多变量logistic回归分析显示，与CHA₂DS₂-VASc评分不同，LVEF（优势比OR=0.88，95%置信区间CI：0.81~0.97，P=0.01）、平均E/e’比值（OR=2.36，95%CI：1.41~3.98，P=0.001）及LA-GSA+（OR=0.57，95%CI：0.36~0.90，P=0.01）与LAAT独立相关。LA-GSA+（最佳截断值≤9.1%，受试者工作特征曲线下面积AUC=0.95）展现出最高的诊断效能。最后，本研究证实LA峰-峰应变率与左心耳充盈（r=0.86）、排空（r=0.83）速度均存在强线性相关。联合STE分析左心房力学功能的TTE可改善NVAF患者的血栓风险评估。