Automated left atrial strain analysis for predicting new-onset atrial fibrillation in patients with ST-elevation myocardial infarction: A prospective echocardiography study

• Published in: Archives of cardiovascular diseases 2024-01, Vol.117 (1), p.S57
• Main Authors: Beyls, C., Hermida, A., Martin, N., Debrigode, R., Peschanski, J., Vialatte, A., Fournier, A., Jarry, G., Landemaine, T., Malaquin, D., Kubala, M., Mahjoub, Y., Leborgne, L.
• Format: Article
• Language: English
• Subjects: Cardiology and cardiovascular system; Human health and pathology; Life Sciences
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2023.10.103

IntroductionNew-onset of atrial fibrillation (NOAF) is a well-known rhythmic complication of patients with ST-elevation myocardial infarction (STEMI), probably due to left atrial (LA) remodeling. LA strain can predict NOAF in several cardiovascular diseases.ObjectiveThis study sought to identify whether LA strain can predict NOAF in patients with STEMI and sinus rhythm.MethodWe conducted a prospective single-center study in Amiens University Hospital Cardiovascular Intensive Care Unit (CICU) (France). Adult patients with a STEMI and transthoracic echocardiography performed within 48 hours of CICU admission were included. LA strain analysis was performed by automated software. The following LA strain parameters were recorded: LA strain during the reservoir phase (LASr), LA strain during the conduit phase (LAScd), LA strain during the contraction phase (LASct), and the LA stiffness index (LASI). The primary endpoint was the occurrence of NOAF during the CICU stay.ResultsFrom March 2020 to December 2022, 176 patients were included. Twenty-one patients (12%) developed NOAF. In the NOAF group, patients were older (67 [59–80] years vs. 59 [51–67] years; P = 0.006) and with a higher TIMI score (4 [2–7] vs. 3 [1–4], P = 0.005). All LAS parameters were significantly more impaired in the NOAF group compared to the other group, notably for LASr (13 [10.5 vs. 28.4]% vs. 36.6 [29.0–44.9]%; P = 0.001). A LASr cut-off value of 27% had a sensitivity of 81% and a specificity of 80% to identify patients with NOAF (Fig. 1). In a multivariate model, LASr was significantly associated with the occurrence of NOAF (Odds ratio of 1.18, [95% confidence interval: 1.09 to 1.26]. The 30-day cumulative risk of NOAF was 42 ± 7% with LASr < 27% and 4 ± 2% with LASr ≥ 27% (log-rank test P-value < 0.0001).ConclusionNOAF is a frequent complication of STEMI. LASr seems helpful for identifying patients with a high risk of NOAF during the CICU stay.