Left atrial strain analysis and new-onset atrial fibrillation in patients with ST-segment elevation myocardial infarction: A prospective echocardiography study - 19/04/24
, Alexis Hermida c , Martin Nicolas d, Romain Debrigode d, Alexis Vialatte d, Julia Peschanski a, Camille Bunelle a, Alexandre Fournier d, Geneviève Jarry d, Thomas Landemaine d, Dorothée Malaquin d, Maciej Kubala c, Yazine Mahjoub a, Laurent Leborgne dGraphical abstract |
Highlights |
• | New-onset atrial fibrillation (NOAF) is a well-known rhythmic complication of STEMI. |
• | Left atrial strain during the reservoir phase (LASr) can predict NOAF. |
• | An LASr cut-off 27% had 81% sensitivity and 80% specificity for NOAF. |
• | The risk of NOAF during hospital stay was 30% if LASr<27% and 4% if LASr≥27%. |
• | LASr may help identify patients at high risk of NOAF during the hospital stay. |
Abstract |
Background |
New-onset atrial fibrillation (NOAF) is a well-known complication of ST-segment elevation myocardial infarction (STEMI), probably due to left atrial (LA) remodelling. LA strain (LAS) can predict NOAF in several cardiovascular diseases.
Objective |
To assess whether LAS predicts NOAF in sinus rhythm patients with STEMI during hospitalization.
Methods |
Adults with a STEMI and transthoracic echocardiography performed within 48hours of admission were included. LAS analysis, performed by automated software, recorded LAS during the reservoir phase (LASr), the conduit phase (LAScd) and the contraction phase (LASct).
Results |
From May 2021 to November 2022, 175 patients were included, 21 (12%) of whom developed NOAF. NOAF patients were older (median [Q1–Q3]: 67 [59–80] vs 59 [51–67]years; P=0.006) and had a higher Thrombolysis In Myocardial Infarction scores (4 [2–7] vs 3 [1–4]; P=0.005). All LAS parameters were significantly impaired in NOAF patients, especially LASr (13.0% [10.5–28.4] vs 36.6% [29.0–44.9]; P=0.001). An LASr cut-off of 27% had a sensitivity of 81% and a specificity of 80% to identify patients with NOAF. In a multivariable model, LASr was significantly associated with NOAF (odds ratio 1.18, 95% confidence interval 1.09–1.26; P=0.003). The cumulative risk of NOAF during hospital stay was 30% (18–43 with LASr<27% and 4% [1.5–8.5] with LASr≥27% [P<0.0001]).
Conclusion |
NOAF is a frequent complication of STEMI. LASr seems helpful for identifying patients at high risk of NOAF during hospitalization.
Le texte complet de cet article est disponible en PDF.Keywords : ST-segment elevation myocardial infarction (STEMI), New-onset atrial fibrillation (NOAF), Left atrial strain, Reservoir, Myocardial infarction
Plan
Vol 117 - N° 4
P. 266-274 - avril 2024 Retour au numéro
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