Echocardiographic and Electrocardiographic Determinants of Atrial Cardiomyopathy Identify Patients with Atrial Fibrillation at Risk for Left Atrial Thrombogenesis
Objective: Atrial cardiomyopathy (ACM) is associated with development of AF, left atrial (LA) thrombogenesis, and stroke. Diagnosis of ACM is feasible using both echocardiographic LA strain imaging and measurement of the amplified p-wave duration (APWD) in digital 12-lead-ECG. We sought to determine...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/5/1332 |
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| author | Taiyuan Huang Schurr Patrick Louisa Katharina Mayer Björn Müller-Edenborn Martin Eichenlaub Martin Allgeier Jürgen Allgeier Heiko Lehrmann Christoph Ahlgrim Marius Bohnen Simon Schoechlin Dietmar Trenk Nikolaus Jander Franz Josef Neumann Thomas Arentz Amir Jadidi |
| author_facet | Taiyuan Huang Schurr Patrick Louisa Katharina Mayer Björn Müller-Edenborn Martin Eichenlaub Martin Allgeier Jürgen Allgeier Heiko Lehrmann Christoph Ahlgrim Marius Bohnen Simon Schoechlin Dietmar Trenk Nikolaus Jander Franz Josef Neumann Thomas Arentz Amir Jadidi |
| author_sort | Taiyuan Huang |
| collection | DOAJ |
| description | Objective: Atrial cardiomyopathy (ACM) is associated with development of AF, left atrial (LA) thrombogenesis, and stroke. Diagnosis of ACM is feasible using both echocardiographic LA strain imaging and measurement of the amplified p-wave duration (APWD) in digital 12-lead-ECG. We sought to determine the thresholds of LA global longitudinal strain (LA-GLS) and APWD that identify patients with AF at risk for LA appendage (LAA) thrombogenesis. Methods: One hundred and twenty-eight patients with a history of AF were included. Left atrial appendage maximal flow velocity (LAA-Vel, in TEE), LA-GLS (TTE), and APWD (digital 12-lead-ECG) were measured in all patients. ROC analysis was performed for each method to determine the thresholds for LA-GLS and the APWD, enabling diagnosis of patients with LAA-thrombus. Results: Significant differences in LA-GLS were found during both rhythms (SR and AF) between the thrombus group and control group: LA-GLS in SR: 14.3 ± 7.4% vs. 24.6 ± 9.0%, <i>p</i> < 0.001 and in AF: 11.4 ± 4.2% vs. 16.1 ± 5.0%, <i>p</i> = 0.045. ROC analysis revealed a threshold of 17.45% for the entire cohort (AUC 0.82, sensitivity: 84.6%, specificity: 63.6%, Negative Predictive Value (NPV): 94.3%) with additional rhythm-specific thresholds: 19.1% in SR and 13.9% in AF, and a threshold of 165 ms for APWD (AUC 0.90, sensitivity: 88.5%, specificity: 75.5%, NPV: 96.2%) as optimal discriminators of LAA-thrombus. Moreover, both LA-GLS and APWD correlated well with the established contractile LA-parameter LAA-Vel in TEE (r = 0.39, <i>p</i> < 0.001 and r = −0.39, <i>p</i> < 0.001, respectively). Conclusion: LA-GLS and APWD are valuable diagnostic predictors of left atrial thrombogenesis in patients with AF. |
| first_indexed | 2024-03-09T20:34:51Z |
| format | Article |
| id | doaj.art-45e092224d2e4a91aa784f5473f4b329 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T20:34:51Z |
| publishDate | 2022-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-45e092224d2e4a91aa784f5473f4b3292023-11-23T23:14:18ZengMDPI AGJournal of Clinical Medicine2077-03832022-02-01115133210.3390/jcm11051332Echocardiographic and Electrocardiographic Determinants of Atrial Cardiomyopathy Identify Patients with Atrial Fibrillation at Risk for Left Atrial ThrombogenesisTaiyuan Huang0Schurr Patrick1Louisa Katharina Mayer2Björn Müller-Edenborn3Martin Eichenlaub4Martin Allgeier5Jürgen Allgeier6Heiko Lehrmann7Christoph Ahlgrim8Marius Bohnen9Simon Schoechlin10Dietmar Trenk11Nikolaus Jander12Franz Josef Neumann13Thomas Arentz14Amir Jadidi15University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Imaging, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinical Pharmacology, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Imaging, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, GermanyUniversity of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, GermanyObjective: Atrial cardiomyopathy (ACM) is associated with development of AF, left atrial (LA) thrombogenesis, and stroke. Diagnosis of ACM is feasible using both echocardiographic LA strain imaging and measurement of the amplified p-wave duration (APWD) in digital 12-lead-ECG. We sought to determine the thresholds of LA global longitudinal strain (LA-GLS) and APWD that identify patients with AF at risk for LA appendage (LAA) thrombogenesis. Methods: One hundred and twenty-eight patients with a history of AF were included. Left atrial appendage maximal flow velocity (LAA-Vel, in TEE), LA-GLS (TTE), and APWD (digital 12-lead-ECG) were measured in all patients. ROC analysis was performed for each method to determine the thresholds for LA-GLS and the APWD, enabling diagnosis of patients with LAA-thrombus. Results: Significant differences in LA-GLS were found during both rhythms (SR and AF) between the thrombus group and control group: LA-GLS in SR: 14.3 ± 7.4% vs. 24.6 ± 9.0%, <i>p</i> < 0.001 and in AF: 11.4 ± 4.2% vs. 16.1 ± 5.0%, <i>p</i> = 0.045. ROC analysis revealed a threshold of 17.45% for the entire cohort (AUC 0.82, sensitivity: 84.6%, specificity: 63.6%, Negative Predictive Value (NPV): 94.3%) with additional rhythm-specific thresholds: 19.1% in SR and 13.9% in AF, and a threshold of 165 ms for APWD (AUC 0.90, sensitivity: 88.5%, specificity: 75.5%, NPV: 96.2%) as optimal discriminators of LAA-thrombus. Moreover, both LA-GLS and APWD correlated well with the established contractile LA-parameter LAA-Vel in TEE (r = 0.39, <i>p</i> < 0.001 and r = −0.39, <i>p</i> < 0.001, respectively). Conclusion: LA-GLS and APWD are valuable diagnostic predictors of left atrial thrombogenesis in patients with AF.https://www.mdpi.com/2077-0383/11/5/1332atrial fibrillationatrial cardiomyopathyglobal longitudinal strainp-wave analysisleft atrial thrombogenesisstroke |
| spellingShingle | Taiyuan Huang Schurr Patrick Louisa Katharina Mayer Björn Müller-Edenborn Martin Eichenlaub Martin Allgeier Jürgen Allgeier Heiko Lehrmann Christoph Ahlgrim Marius Bohnen Simon Schoechlin Dietmar Trenk Nikolaus Jander Franz Josef Neumann Thomas Arentz Amir Jadidi Echocardiographic and Electrocardiographic Determinants of Atrial Cardiomyopathy Identify Patients with Atrial Fibrillation at Risk for Left Atrial Thrombogenesis Journal of Clinical Medicine atrial fibrillation atrial cardiomyopathy global longitudinal strain p-wave analysis left atrial thrombogenesis stroke |
| title | Echocardiographic and Electrocardiographic Determinants of Atrial Cardiomyopathy Identify Patients with Atrial Fibrillation at Risk for Left Atrial Thrombogenesis |
| title_full | Echocardiographic and Electrocardiographic Determinants of Atrial Cardiomyopathy Identify Patients with Atrial Fibrillation at Risk for Left Atrial Thrombogenesis |
| title_fullStr | Echocardiographic and Electrocardiographic Determinants of Atrial Cardiomyopathy Identify Patients with Atrial Fibrillation at Risk for Left Atrial Thrombogenesis |
| title_full_unstemmed | Echocardiographic and Electrocardiographic Determinants of Atrial Cardiomyopathy Identify Patients with Atrial Fibrillation at Risk for Left Atrial Thrombogenesis |
| title_short | Echocardiographic and Electrocardiographic Determinants of Atrial Cardiomyopathy Identify Patients with Atrial Fibrillation at Risk for Left Atrial Thrombogenesis |
| title_sort | echocardiographic and electrocardiographic determinants of atrial cardiomyopathy identify patients with atrial fibrillation at risk for left atrial thrombogenesis |
| topic | atrial fibrillation atrial cardiomyopathy global longitudinal strain p-wave analysis left atrial thrombogenesis stroke |
| url | https://www.mdpi.com/2077-0383/11/5/1332 |
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