Patterns of structural and functional remodeling of the left ventricle in patients with various forms of atrial fibrillation

Objective. The purpose of this study was to compare the structural and functional changes of the left ventricle (LV) in patients with various forms of atrial fibrillation (AF).

Materials and methods. 70 patients with paroxysmal AF (group 1; median age 73 [64.75; 76.5] years, 49 (70%) women) and 54 patients with persistent or permanent forms of AF (group 2; median age 78.5 [68;83] years, 33 (61%) women) was included in the study/ All patients were underwent transthoracic echocardiography (EchoCG) using the speckle tracking technique.

Results. In patients with permanent/persistent AF, compared with patients with paroxysmal AF, the several parametres were significantly lower: the stroke volume (SV) (49.2 [39.8; 57.8] ml versus 54.2 [46.2; 60.3] ml, respectively, p = 0.039), LV ejection fraction (EF) (61.4% [51.2; 67.1] versus 65.9% [61.4; 70.2], respectively, p < 0.001), absolute values of the global longitudinal LV strain (–15.1% [–18.5; –9.3] vs. –19.6% [–22.2; –16.2] respectively, p < 0.001), global LV circular strain (–16.4% [–22.9; –11.0] vs. –20.9% [–25.8; –17.6], respectively, p < 0.001), end-systolic LV elasticity (3.6 [2.7; 4.57] mmHg/ml vs. 4.3 [3.3; 5.3] mmHg/ml, respectively, p = 0.011). At the same time, the end-diastolic size (EDS), the end-diastolic volume (EDV) and its index, and the end-systolic volume (ESV) did not differ statistically significantly between the groups.

Conclusion. In patients with persistent/permanent forms of AF, there is a more pronounced violation of LV systolic function compared with patients with paroxysmal AF, which manifests itself in lower values of SV, LV EF, absolute values of the global longitudinal strain and global circular strain of the LV.

1. Arakelyan M. G., Bokeriya L. A., Vasileva E. YU., Golicyn S. P., Goluhova E. Z., Gorev M. V., Davtyan K. V., Drapkina O. M., Kropacheva E. S., Kuchinskaya E. A., Lajovich L. Yu., Mironov N. Yu., Mishina I. E., Panchenko E. P., Revishvili A. Sh., Rzaev F. G., Tatarskii B. A., Ucumueva M. D., Shahmatova O. O., Shlevkov N. B., Shpektor A. V., Andreev D. A., Artyukhina E. A., Barbarash O. L., Galyavich A. S., Duplyakov D. V., Zenin S. A., Lebedev D. S., Mihailov E. N., Novikova N. A., Popov S. V., Filatov A. G., Shlyakhto E. V., Shubik Yu. V. 2020. Clinical guidelines for Atrial fibrillation and atrial flutter. Rossiiskii kardiologicheskii zhurnal. 2021; 26 (7): 4594. (In Russ.) https://doi.org/10.15829/1560-4071-2021-4594. (In Russ.)

2. Hindricks G., Potpara T., Dagres N., Arbelo E., Bax J. J., Blomström-Lundqvist C., Boriani G., Castella M., Dan G. A., Dilaveris P. E., Fauchier L., Filippatos G., Kalman J. M., La Meir M., Lane D. A., Lebeau J. P., Lettino M., Lip G. Y. H., Pinto F. J., Thomas G. N. ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for CardioThoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. 2021; 42 (5): 373-498. http://doi.org/10.1093/eurheartj/ehaa612.

3. Hopman L., Mulder M. J., van der Laan A. M., Demirkiran A., Bhagirath P., van Rossum A. C. Impaired left atrial reservoir and conduit strain in patients with atrial fibrillation and extensive left atrial fibrosis. J Cardiovasc Magn Reson. 2021; 23 (1): 131. DOI: 10.1186/s12968-021-00820-6.

4. Allessie M., Ausma J., Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res. 2002; 54 (2): 230-246. DOI: 10.1016/S0008-6363(02)00258-4:

5. Bokeriya L. A., Shengeliya L. D. Changes in the heart in atrial fibrillation. Part I. Atrial fibrillation cardiopathy: new dilemmas and old problems. Annaly aritmologii. 2016; 13 (3): 138-147. (In Russ.)

6. Lyon A., van Mourik M., Cruts L., Heijman J., Bekkers S., Schotten U. Both beat-to-beat changes in RR-interval and left ventricular filling time determine ventricular function during atrial fibrillation. Europace. 2021; 23 (23 Suppl 1): i21-i28. DOI: 10.1093/europace/euaa387.

7. Olsen F. J., Darkner S., Chen X., Pehrson S., Johannessen A., Hansen J. Left atrial structure and function among different subtypes of atrial fibrillation: an echocardiographic substudy of the AMIO-CAT trial. Eur Heart J Cardiovasc Imaging. 2020; 21 (12): 1386-1394. DOI: 10.1093/ehjci/jeaa222.

8. Fozilov H. G., Shek A. B., Bekmetova F. M., Alieva R. B., Muhamedova M. G., Mullabaeva G. U., Donierov Sh. N., Ilhomova L. T., Bekmetova S. I., Hotamova M. N. Features of deformation properties of the left ventricle in patients with coronary artery disease. Klinicheskaya i eksperimental'naya hirurgiya. Zhurnal imeni akademika B. V. Petrovskogo. 2021; 9 (3): 118-124. (In Russ.)

9. Ponomarenko I. V., Sukmanova I. A., Sanaeva A. K., Trubina E. V., Narenkova S. O. Opportunities of speckle-tracking echocardiography in the diagnosis of subclinical left ventricular dysfunction. Kardiologiya: novosti, mneniya, obuchenie. 2023; 11 (2): 22-29. DOI: https://doi.org/10.33029/2309-1908-2023-11-2-22-29. (In Russ.)

10. Karlsen S., Dahlslett T., Grenne B., Sjøli B., Smiseth O., Edvardsen T., Brunvand H. Global longitudinal strain is a more reproducible measure of left ventricular function than ejection fraction regardless of echocardiographic training. Cardiovasc Ultrasound. 2019; 17 (1): 18. DOI: 10.1186/s12947-019-0168-9.

11. Kim H. D., Cho D. H., Kim M. N., Hwang S. H., Shim J., Choi J. I., Kim Y. H, Park S. M. Left Atrial Dysfunction, Fibrosis and the Risk of Thromboembolism in Patients With Paroxysmal and Persistent Atrial Fibrillation. Int J Heart Fail. 2022; 4 (1): 42-53. DOI: 10.36628/ijhf.2021.0043.

12. Kuo J. Y. Editorial to "Longer diagnosis-to-ablation time is associated with recurrence of atrial fibrillation after catheter ablation: Systematic review and meta-analysis". J Arrhythm. 2020; 36 (2): 295-296. DOI: 10.1002/joa3.12305.

13. Lang R. M., Badano L. P., Mor-Avi V. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. of the American Society of Echocardiography. 2015; 28 (1): 1-39.e14.

14. Galderisi M., Cosyns B., Edvardsen T. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2017; 18 (12): 1301-1310. DOI: 10.1093/ehjci/jex244.

15. Nagueh S. F., Smiseth O. A., Appleton C. P. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29 (4): 277-314. DOI: 10.1016/j.echo.2016.01.011.

16. Donal E., Lip G. Y., Galderisi M. EACVI/EHRA Expert Consensus Document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2016; 17 (4): 355-383. DOI: 10.1093/ehjci/jev354.

17. Badano L. P., Kolias T. J., Muraru D. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ ASE/Industry Task Force to standardize deformation imaging. Published correction appears in Eur Heart J Cardiovasc Imaging. 2018; 19 (7): 830- 833]. Eur Heart J Cardiovasc Imaging. 2018; 19 (6): 591-600. DOI: 10.1093/ehjci/jey042.

18. Mor-Avi V., Lang R. M., Badano L. P. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications: endorsed by the Japanese Society of Echocardiography. Journal of the American Society of Echocardiography. 2011; 24 (3): 277-313.

19. Voigt J. U., Cvijic M. 2- and 3-dimensional myocardial strain in cardiac health and disease. JACC Cardiovasc. Imaging. 2019; 12 (9): 1849-1863.

20. Von Jeinsen B., Vasan R. S., McManus D. D., Mitchell G. F., Cheng S., Xanthakis V. Joint influences of obesity, diabetes, and hypertension on indices of ventricular remodeling: findings from the community-based Framingham heart study. PLoS One. 2020; 15 (12): e0243199.

21. Van Mourik M. J. W., Linz D., Verwijs H. J. A., Bekkers S. C. A. M., Weerts J., Schotten U., Rocca H. B., Lumens J., Crijns H. J. G. M., Weijs B., Knackstedt C. Evaluating subclinical left ventricular and left atrial dysfunction in idiopathic atrial fibrillation: A speckle-tracking based strain-analysis. Int J Cardiol. 2023; 383: 159-165. DOI: 10.1016/j.ijcard.2023.04.024.

22. Dons M., Jensen J. S., Olsen F. J., de Knegt M. C., Fritz-Hansen T., Vazir A., et al. Global longitudinal strain corrected by RR-interval is a superior echocardiographic predictor of outcome in patients with atrial fibrillation. Int. J. Cardiol. 2018; 263: 42-47.

23. Ren J. F., Chen S., Callans D. J., Liu Q., Supple G., Frankel D. S., Santangeli P., Jiang R., Lin D., Hyman M., Yu L., Riley M., Sun Y., Zhang Z., Yu C., Schaller R. D., Dixit S., Wang B., Jiang C., Marchlinski F. E. ICE-Derived Left Atrial and Left Ventricular Endocardial and Myocardial Speckle Tracking Strain Patterns in Atrial Fibrillation at the Timeof Radiofrequency Ablation. J Atr Fibrillation. 2021; 13 (5): 2509. DOI: 10.4022/jafib.2509.

24. Lu S., Liu H., Sun J., Zhang J., Li L., Tang Q., Liu Y., Deng Y. Evaluation of left atrial and ventricular remodeling in atrial fibrillation subtype by using speckle tracking echocardiography. Front. Cardiovasc. Med. 2023; 10: 1208577. DOI: 10.3389/fcvm.2023.1208577.

25. Gopinathannair R., Etheridge Susan P., Marchlinski Francis E., Spinale Francis G., Lakkireddy .D, Olshansky B. Arrhythmia-induced cardiomyopathies. J Am Coll Cardiol. 2015; 66 (15): 1714-1728. DOI: 10.1016/j.jacc.2015.08.038.

26. Sengupta Partho P., Narula J. À la mode atrioventricular mechanical coupling. JACC Cardiovasc Imaging. 2014; 7 (1): 109-111. DOI: 10.1016/j.jcmg.2013.12.001.

27. Shantsila E., Shantsila A., Blann A. D., Lip G. Y. H. Left ventricular fibrosis in atrial fibrillation. Am J Cardiol. 2013; 111 (7): 996-1001. DOI: 10.1016/j.amjcard.2012.12.005