To assess the value of pressure-strain loop (PSL) in evaluating left ventricular myocardial work (MW) in patients with paroxysmal atrial fibrillation (PAF).

A total of 45 patients with PAF diagnosed at the Department of Cardiology, Beijing Chaoyang Hospital Affiliated to Capital Medical University from October 2019 to November 2020 were included. According to whether the patients had a history of hypertension, they were divided into either a PAF with hypertension (HP) group (25 cases) or a PAF without HP group (20 cases). Another 20 healthy volunteers were selected as controls. Dynamic images of left ventricular apical three-chamber, four-chamber, and two-chamber views were collected and imported into EchoPAC 203 workstation for analysis. Two-dimensional speckle tracking echocardiography (2D-STE) was used to obtain the global longitudinal strain (GLS) and mechanical dispersion (MD) of the left ventricle. The PSL was obtained based on GLS combined with left ventricular pressure. The global myocardial work parameters were measured, which included GWI (global work index), GCW (global constructive work), GWW (global wasted work), and GWE (global work efficiency). The differences of these parameters among the three groups were evaluated, and the correlation of left ventricular ejection fraction (LVEF) and MD with myocardial global work parameters was analyzed.

Compared with the control group, left ventricular end diastolic menstruation and left ventricular end systolic diameter increased in the PAF without HP group (P<0.05). Compared with the control group, MD increased, and GLS, GWI, and GWE decreased in the PAF without HP group. Compared with the PAF without HP group, MD further increased and GWE further decreased in the PAF with HP group. Meanwhile, GWI, GCW, and GWW in the PAF with HP group increased significantly compared with those of the PAF without HP group (P<0.05). Among PAF patients, LVEF was positively correlated with GWI, GWE, and GCW (r=0.452, P=0.002; r=0.369, P=0.014; r=0.382, P=0.010); MD was negatively correlated with GWE (r=-0.629, P<0.001) and positively correlated with GWW (r=0.317, P= 0.034).

PSL can quantitatively evaluate the work of left ventricular myocardium in PAF patients. It can more comprehensively reflect the changes in left ventricular myocardial systolic function in PAF patients than GLS, providing a basis for clinical diagnosis and disease management.