Incremental value of diastolic wall strain in predicting heart failure events in patients with atrial fibrillation

• Published in: Heart and vessels Vol. 39; no. 9; pp. 785 - 794
• Main Authors: Taniguchi, Naoki, Miyasaka, Yoko, Suwa, Yoshinobu, Nakai, Eri, Harada, Shoko, Otagaki, Hiromi, Shiojima, Ichiro
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-09-2024; Springer Nature B.V
• Subjects: Ablation; Age; Biomedical Engineering and Bioengineering; Cardiac arrhythmia; Cardiac Surgery; Cardiology; Cardiomyopathy; Cardiovascular disease; Cardiovascular diseases; Catheters; Chi-square test; Confidence intervals; Congestive heart failure; Coronary artery disease; Defibrillators; Diastole; Echocardiography; Ejection fraction; Fibrillation; Heart diseases; Heart failure; Likelihood ratio; Medical instruments; Medicine; Medicine & Public Health; Original Article; Radiofrequency ablation; Strain; Systole; Thickness; Vascular Surgery; Ventricle; Heart failure; Diastolic wall strain; Predictive value; Echocardiography; Atrial fibrillation
• ISSN: 0910-8327; 1615-2573; 1615-2573
• DOI: 10.1007/s00380-024-02401-w

Diastolic wall strain (DWS), an echocardiographic index based on linear elasticity theory, has been identified as a predictor of heart failure (HF) in patients with sinus rhythm. However, its effectiveness in atrial fibrillation (AF) patients remains uncertain. This study aims to assess DWS as a predictor of HF in AF patients with preserved ejection fraction. We analysed a prospective database of AF patients undergoing transthoracic echocardiography. AF patients with reduced left ventricular ejection fraction (< 50%), posterior wall motion abnormality, hypertrophic cardiomyopathy, valvular heart disease, pericardial disease, congenital heart disease, or history of pacemaker/implantable cardioverter-defibrillator implantation or cardiac surgery were excluded. The study followed patients until HF development, death, or last visit. Follow-up for patients who underwent catheter ablation was censored on the date of their procedure. HF was ascertained based on the Framingham criteria. DWS was calculated using a validated formula: DWS = (PWs -PWd)/PWs, where PWs is the posterior wall thickness at end-systole and PWd is the posterior wall thickness at end-diastole. Among 411 study patients (mean age 69.6 years, 66% men), 20 (5%) was underwent catheter ablation and 57 (14%) developed HF during a mean follow-up of 82 months. Cox-proportional hazards demonstrated that low DWS (≤ 0.33) significantly predicted HF events (hazard ratio [HR] 3.28, 95% confidence interval [CI]) 1.81–5.94,
P
 < 0.0001), independent of age (per 10 years; HR 1.99, 95% CI 1.35–2.93,
P
 < 0.001), indexed left ventricular mass (per 10 g/m
2
; HR 1.16, 95% CI 1.05–1.27,
P
 < 0.01), and indexed left atrial volume (per 10 mL/m
2
; HR 1.14, 95% CI 1.04–1.24,
P
 < 0.01). Additionally, global log-likelihood ratio chi-square statistics indicated that DWS incrementally predicts HF development beyond age, indexed left ventricular mass, and left atrial volume (
P
 < 0.001).