Biatrial structure and function reverse remodelling in patients with persistent atrial fibrillation after cardioversion: evidence from three dimensional echocardiography and two dimensional speckle tracking imaging

doi:10.3877/cma.j.issn.1672-6448.2023.08.008

Abstract

Abstract:

Objective

To explore the bilateral atrial structure and function reverse remodelling by using real-time three dimensional echocardiography (RT3DE) and two dimensional speckle tracking imaging (2DSTI) to evaluate the biatrial diameter, volume, and function changes in persistent atrial fibrillation (PeAF) patients with sinus rhythm after cardioversion.

Methods

This is a prospective study in which 21 patients with PeAF who had been successfully cardioverted at the Cardiology Department of the Second Affiliated Hospital of Chongqing Medical University from August 2020 to December 2021 with no recurrence after 3 months of follow-up were included(case group), as well as 18 healthy volunteers (healthy control group) who underwent physical examination at the Second Affiliated Hospital of Chongqing Medical University. The subjects had their atrial diameter, volume, and function evaluated by conventional ultrasound, RT3DE, and 2DSTI. Patients with PeAF were assessed at 2 days (M0), 1 month (M1), and 3 months (M3) after cardioversion. The right atrial and left atrial parameters assessed included: left atrial anteroposterior diameter (LAAPD), left atrial left-right diameter (LALRD), left atrial superior-inferior diameter (LASID), right atrial transverse diameter (RATD), left ventricular ejection fraction (LVEF), the ratio of early diastolic mitral inflow velocity to early diastolic myocardial relaxation velocity (E/e'), left atrial /right atrial maximal volume (LAVmax/RAVmax), left atrial/right atrial pre-P wave volume (LAVpre/RAVpre), left atrial/right atrial minimal volume (LAVmin/RAVmin), left atrial/right atrial maximal volume index (LAVImax/RAVImax), left atrial/right atrial pre-P wave volume index (LAVIpre/RAVIpre), left atrial/right atrial minimal volume index (LAVImin/RAVImin), left atrial/right atrial total ejection fraction (LATEF/RATEF), left atrial/right atrial passive ejection fraction (LAPEF/RAPEF), left atrial/right atrial active ejection fraction (LAAEF/RAAEF), left atrial/right atrial expansion index (LAEI/RAEI), left atrial/right atrial strain during reservoir phase (LASr/RASr), left atrial/right atrial strain during conduit phase (LAScd/RAScd), and left atrial/right atrial strain during contraction phase (LASct/RASct). The differences in the above parameters between the healthy control group and the case group at M0, M1, and M3 were compared and analyzed.

Results

LAAPD, LALRD, LASID, RATD, LAVmax/RAVmax, LAVpre/RAVpre, LAVmin/RAVmin, LAVImax/RAVImax, LAVIpre/RAVIpre, and LAVImin/RAVImin decreased gradually after cardioversion (P<0.05), LASr/RASr, LAScd/RAScd, LASct/RASct, RATEF,RAPEF, LAAEF/RAAEF, and LAEI/RAEI increased after cardioversion (P<0.05), but there were no significant changes in LATEF and LAPEF (P>0.05). The RAVImax (P=0.532) and LAScd (P=0.180) at M3 and RAScd (P=0.188) at M1 in the case group had no significant changes compared with those of the healthy control group, but the other parameters were statistically significant from those of the healthy control group (P<0.05).

Conclusion

RT3DE and 2D-STI are useful in the evaluation of biatrial reverse remodelling in successfully cardioverted patients with PeAF. The right artium may have greater and faster ability to conduct reverse structure and function remodelling in PeAF patients after cardioversion than the left artium.

Key words: Atrial fibrillation, Cardioversion, Sinus rhythm, Three dimensional echocardiography, Two dimensional speckle tracking imaging, Atrial remodelling

Danni Liu, Meng Ao, Haitao Ran, Shiyu Li, Fang Qin. Biatrial structure and function reverse remodelling in patients with persistent atrial fibrillation after cardioversion: evidence from three dimensional echocardiography and two dimensional speckle tracking imaging[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 827-835.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2023.08.008

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Figures/Tables 7

References 20

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临床资料	正常对照组（n=18）	病例组（n=21）	统计值	P值
男性 [例（%）]	12（66.7）	15（71.4）	χ²=0.103	0.748
年龄（岁，）	69±10	67±6	t=0.818	0.418
身高（cm，）	163±9	167±8	t=1.384	0.175
体重（kg，）	63±10	70±12	t=1.943	0.060
体表面积（m²，）	1.68±0.17	1.79±0.19	t=1.942	0.060

临床资料	正常对照组（n=18）	病例组（n=21）	统计值	P值
男性 [例（%）]	12（66.7）	15（71.4）	χ²=0.103	0.748
年龄（岁，）	69±10	67±6	t=0.818	0.418
身高（cm，）	163±9	167±8	t=1.384	0.175
体重（kg，）	63±10	70±12	t=1.943	0.060
体表面积（m²，）	1.68±0.17	1.79±0.19	t=1.942	0.060

临床资料	对照组（n=18）	病例组（n=21）			统计值	P值
临床资料	对照组（n=18）	M0	M1	M3	统计值	P值
心率（次/分，）	72±13	63±8^a	60±9^a	59±9^a	F=2.212	0.123
抗心律失常药 [例（%）]	-	15（71.4）	15（71.4）	13（61.9）	χ²=0.586	0.746
抗凝药 [例（%）]	-	18（85.7）	19（90.5）	19（90.50）	χ²=0.286	0.867
沙库巴曲缬沙坦 [例（%）]	-	13（61.90）	12（57.10）	12（57.1）	χ²=0.131	0.937

临床资料	对照组（n=18）	病例组（n=21）			统计值	P值
临床资料	对照组（n=18）	M0	M1	M3	统计值	P值
心率（次/分，）	72±13	63±8^a	60±9^a	59±9^a	F=2.212	0.123
抗心律失常药 [例（%）]	-	15（71.4）	15（71.4）	13（61.9）	χ²=0.586	0.746
抗凝药 [例（%）]	-	18（85.7）	19（90.5）	19（90.50）	χ²=0.286	0.867
沙库巴曲缬沙坦 [例（%）]	-	13（61.90）	12（57.10）	12（57.1）	χ²=0.131	0.937

参数	对照组（n=18）	病例组（n=21）			统计值	P值
参数	对照组（n=18）	M0	M1	M3	统计值	P值
LAAPD（mm）	32.56±2.91	41.19±2.64^a	39.67±2.50^ab	38.71±3.21^ab	F=21.202	<0.001
LALRD（mm）	35.67±2.77	42.67±3.67^a	40.00（39.00，43.00）^a	40.95±3.85^ab	χ²=8.576	0.014
LASID（mm）	52.00±4.21	60.00（59.00，62.00）^a	59.38±5.11^a	58.10±4.49^ab	χ²=16.029	<0.001
LVEF（%）	68.78±4.72	65.05±7.04	66.43±6.82	66.48±6.03	F=0.591	0.559
E/e'	10.16±2.08	9.45（8.15，10.40）	8.55（7.45，11.45）	9.19±3.32	χ²=4.875	0.087
LAVmax（ml）	40.44±7.52	68.19±12.75^a	62.71±12.81^ab	57.95±15.44^ab	F=17.266	<0.001
LAVImax（ml/m²）	24.36±5.05	38.78±9.27^a	35.73±9.40^ab	32.97±9.92^ab	F=19.103	<0.001
LAVmin（ml）	16.61±4.35	41.67±12.84^a	37.67±12.25^ab	34.05±13.73^ab	F=7.102	0.005
LAVImin（ml/m²）	9.96±2.69	23.95±8.77^a	21.63±8.42^ab	19.55±8.82^ab	F=6.541	0.008
LAVpre（ml）	28.00±6.96	50.38±11.10^a	48.52±11.50^a	44.33±13.70^ab	F=6.075	0.005
LAVIpre（ml/m²）	16.79±4.16	28.78±8.11^a	27.69±8.21^a	25.35±9.02^ab	F=5.798	0.006
LAEI（%）	152.20±47.84	59.60（54.20，91.70）^a	74.08±28.03^a	80.02±30.85^ab	χ²=6.381	0.041
LATEF（%）	59.09±7.10	39.83±11.28^a	41.10±9.58^a	42.82±10.24^a	F=1.259	0.295
LAPEF（%）	31.31±7.83	26.34±8.35^a	22.70（18.30，27.90）^a	24.27±6.76^a	χ²=3.349	0.187
LAAEF（%）	40.59±6.89	18.64±10.31^a	23.73±9.03^ab	24.80±9.23^ab	F=6.035	0.011
LASr（%）	36.03±3.98	21.60±6.27^a	23.81±6.66^ab	27.00±6.71^ab	F=22.043	<0.001
LAScd（%）	-18.19±3.51	-14.91±3.58^a	-15.70±3.73^a	-16.60±3.73	F=3.400	0.043
LASct（%）	-17.85±3.42	-4.80（-9.10，-3.20）^a	-8.11±4.31^a	-10.40±4.29^ab	χ²=14.482	0.001

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