Study on the relationship between atrial high-rate episode and left atrial strain in patients with cardiac implantable electronic device

Ping Wang; Boshui Huang; Chang Fang; Peiwei Wang; Chaodi Tan; Yuping Zheng; Guifu Wu; Shaoxin Zheng; Shuxian Zhou

doi:10.21037/qims-23-1237

Study on the relationship between atrial high-rate episode and left atrial strain in patients with cardiac implantable electronic device

Quant Imaging Med Surg. 2024 Feb 1;14(2):1844-1859. doi: 10.21037/qims-23-1237. Epub 2024 Jan 15.

Authors

Ping Wang^#^{1

2

3

4}, Boshui Huang^#^{1

2}, Chang Fang^{1

2}, Peiwei Wang^{1

2}, Chaodi Tan^{1

2}, Yuping Zheng^{1

2}, Guifu Wu^#⁴, Shaoxin Zheng^#^{1

2}, Shuxian Zhou^#^{1

2}

Affiliations

¹ Division of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
² Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China.
³ Guangzhou Cadre Health Management Center, Guangzhou, China.
⁴ Division of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.

^# Contributed equally.

Abstract

Background: Although atrial high-rate episode (AHRE) and atrial fibrillation (AF) cannot entirely be identical, recent studies suggest AHRE is linked to AF development and shares some characteristics with AF regarding thromboembolism. At present, there is still lack of predictive indicators for AHRE and diagnostic methods and clinical indicators for AHRE in patients without cardiac implantable electronic device (CIED). The aim of this study was thus to explore the relationship between AHRE and left atrial (LA) strain parameters with the goal of identifying high-risk populations of AHRE by LA strain characteristics.

Methods: From February 2022 to May 2023, a total of 105 CIED patients were enrolled and divided into two groups based on whether AHRE had occurred: AHRE (-) group (n=65) and AHRE (+) group (n=40). Real-time three-dimensional echocardiography (RT-3DE) technique was used to obtain the LA time-volume curve. The collected dynamic images were analyzed on the Echopac 204 workstation to obtain the parameters of LA. The four-dimensional automatic LA quantitative analysis (4D Auto LAQ) technology was used to analyze the LA strain parameters: LA reservoir longitudinal strain (LASr), LA conduit longitudinal strain (LAScd), LA contraction longitudinal strain (LASct), LA reservoir circumferential strain (LASr-c), LA conduit circumferential strain (LAScd-c), LA contraction circumferential strain (LASct-c). Correlation analysis was carried out using Binary logistic regression analysis. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the diagnostic performance of LASct in AHRE.

Results: Body surface area (BSA) [odds ratio (OR) =8.34, 95% confidence interval (CI): 1.32-72.30, P=0.037], LASct (OR =1.20, 95% CI: 1.05-1.39, P=0.013) and LA end-systolic volume (LAESV) (OR =1.02, 95% CI: 1.00-1.04, P=0.023) were the influencing factors of AHRE. Only LASct (OR =1.18, 95% CI: 1.01-1.38, P=0.041) was found to be an independent influencing factor of AHRE. This result remained significant after adjusting for age, sex, hypertension, diabetes, and stroke history. The ROC curve showed that the cut-off for predicting AHRE was LASct =-4.125% with sensitivity of 37.5% and specificity of 87.7%.

Conclusions: This cross-sectional study found that decreased LASct (absolute value) is an independent risk factor for the AHRE and has diagnostic efficacy in certain degree for the occurrence of AHRE.

Keywords: Atrial high-rate episode (AHRE); cardiovascular implantable electronic device; echocardiography; left atrial strain (LA strain).