Oral Abstract
Julia Treiber, MD
senior physician
Kerckhoff Klinik, Germany
Julia Treiber, MD
senior physician
Kerckhoff Klinik, Germany
Sören Backhaus, MD
Consultant Cardiologist
Department of Cardiology, Heart Centre, Kerckhoff-Clinic Bad Nauheim, Germany
Jan Sebastian Wolter, MD
senior physician
Kerckhoff Klinik Bad Nauheim, Germany
Thomas Neumann, MD
senior physician
kerckhoff clinik Bad Nauheim, Germany
Malte Kuniss, MD
senior physician
kerckhoff clinic Bad Nauheim, Germany
Jörg Yogarajah, MD
physician
kerckhoff clinic Bad Nauheim, Germany
Till Keller, MD
physician
Kerckhoff-Klinik, Germany
Samuel Sossalla, MD
chief medical officer
Kerckhoff Klinik, Germany
Andreas Rolf, MD
Senior Cardiologist
Kerckhoff Klinikum Bad Nauheim, Germany
Strain imaging proves superior to ejection fraction (EF) in detecting subtle impairment in myocardial contractility. There is also emerging evidence, that strain reflects changes in myocardial microstructure caused by adverse remodelling of the left ventricular (LV) myocardium. Atrial fibrillation (AF) has significant influence on both left atrial (LA) and LV function and remodelling. AF can induce or aggravate heart failure (HF). The underlying mechanism remains to be elucidated. Changes in LV strain might reflect differences in myocardial microstructure between AF and sinus rhythm (SR) patients over a wide range of LV-EFs.
Purpose: To determine the LV-EF independent difference of global longitudinal (GLS) and circumferential strain (GCS) between patients with AF and SR in a large cohort of all comer patients.
Methods:
Patients with indication for cardiovascular magnetic resonance (CMR) were enrolled in a high volume single-center all-comer registry. Patients were divided in an AF and no AF group. The presence of paroxysmal AF was adjudicated by two physicians blinded to the imaging results. All CMR examinations were performed on a 3 Tesla scanner. GLS and GCS were assessed by feature tracking on standard steady state free precision cine imaging by cvi42. Differences in strain parameters were corrected for EF, endsystolic volume index (ESVi) and relative late gadolinium enhancement mass (LGEmass) by ANCOVA.
Results:
Out of a cohort of 2879 patients, 590 had history of paroxysmal AF. The AF group had lower EF (52 ± 15 % vs 48 ± 16 %, p = 0.001), higher ESVi (46 ± 31 ml/m2 vs 50 ± 31 ml/m2, p = 0.007) and LGEmass (4 ± 6 % vs 5 ± 8 %, p = 0.001). After adjustment for baseline differences in EF, ESVi and LGEmass AF patients continuously showed significantly reduced GLS (- 16.0 ± 0.07 % vs. -14.4 ± 0.15 %; p < 0.001) and GCS (-16.9 ± 0.07 % vs. -16.1 ± 0.14 %, p < 0.001).
Conclusion: Even if controlled for baseline differences in EF, AF patients have significantly lower GCS and GLS. Differences in myocardial microstructure induced by AF may explain these differences. These results are hypothesis generating and should be confirmed by longitudinal observation studies.
