Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking

Li Wang; Jiali Fan; Zixuan Wang; Yuping Liao; Bingyuan Zhou; Changsheng Ma

doi:10.21037/qims-21-942

Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking

Quant Imaging Med Surg. 2022 May;12(5):2721-2731. doi: 10.21037/qims-21-942.

Authors

Li Wang¹, Jiali Fan¹, Zixuan Wang², Yuping Liao¹, Bingyuan Zhou¹, Changsheng Ma¹

Affiliations

¹ Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
² Department of Clinical Medicine, Soochow University, Suzhou, China.

Abstract

Background: The use of transesophageal echocardiography (TEE) is a clinically feasible method for quantitative analysis of left atrial appendage (LAA) function. LAA dysfunction is closely associated with atrial fibrillation (AF)-related stroke. However, there are few studies on the changes in LAA function in patients with different types of AF. This study aimed to observe changes in LAA systolic motion and function in patients with different types of AF by using speckle-tracking echocardiography (STE).

Methods: A retrospective study of 216 patients with non-valvular AF was conducted. The LAA was divided into three parts: the basal segment (B), middle segment (M), and top segment (A). Speck -racking technology was used to measure and record the forward strain values of the basal segment (B), middle segment (M), and top segment (A) of the LAA, and the peak positive strain dispersion of the LAA was calculated. The left atrial appendage mechanical dispersion (LAAMD) was defined as the standard deviation (SD) of the peak positive strain at each segment of the R-R interval.

Results: Partial speckle-tracking parameters of the LAA showed statistical significance between the two groups. The peak strain on the top segment of the LAA was reduced in the persistent atrial fibrillation (per-AF) group compared to the paroxysmal atrial fibrillation (par-AF) group [11.87 (6.47-20.12) vs. 16.02 (9.76-24.50); 12.66 (6.66-21.22) vs. 20.16 (14.16-30.56); both P<0.01]. In the group with lower LAAMD, the proportion of patients with persistent AF (per-AF) was higher (66.3% vs. 33.7%; P<0.001), the left atrial dilatation was more significant (45.80±5.656 vs. 42.85±4.867; P<0.001), the LAA filling velocity and LAA empty velocity were lower (42.35±20.354 vs. 51.0±20.599; 38.71±24.39 vs. 51.62±21.282; both P<0.001), the LAA ejection fraction was significantly lower (52.16±25.538 vs. 70.85±20.741; P=0.000), and the peak positive strains of the M and A of the LAA were lower than those in the higher LAAMD group.

Conclusions: The deformability of the LAA is decreased diffusely in per-AF, especially in the A of the LAA. Compliance with LAA was worse in patients with per-AF than in those with par-AF.

Keywords: Non-valvular atrial fibrillation (NVAF); left atrial appendage (LAA); speckle-tracking echocardiography (STE); transesophageal echocardiography (TEE).