LAUSR

Objective: Left ventricular diastolic dysfunction (DD) is one of the main mechanisms of structural and functional changes of the left atrium (LA). It can be caused by impaired ventricular-arterial coupling (VAC). The relationships between VAC, LA remodeling and atrial fibrillation (AF), however, remain unclear. We tried to evaluate VAC parameters with LA remodeling and their predictive value for AF recurrence during a 3-month follow-up period in patients with recurrent AF and mild to moderate left ventricular DD. Design and method: Sixty patients [45% male, median age 65 (61; 72) years] with recurrent non-valvular AF and mild to moderate DD were enrolled in the study and treated with amiodarone 200 mg + metoprolol 50 mg daily (n = 30) or sotalol 160 mg daily (n = 30). All the patients underwent conventional and speckle tracking echocardiography. Global peak LA longitudinal strain (PALS) and strain rate (PALSR) in the reservoir (r) and contractile (c) phases were assessed using 6 segments in the 4-chamber and 2-chamber views. To assess VAC EaI, EesI, Ea/Ees, systemic vascular resistance index and total arterial compliance (TAC) were calculated. Follow-up period was 3 months. Results: EaI was significantly associated with LA size (r = −0.38, p = 0.003), LA end diastolic volume (r = −0.33, p = 0.009) and PALSc (r = −0.31, p = 0.02). EesI correlated with E/A (r = −0.3, p = 0.02). Ea/Ees was related to E/E’ (r = 0.4, p = 0.002). Thirty-five (58%) patients (group 1) had complete antiarrhythmic response, whereas 25 (42%) patients (group 2) experienced at least one AF recurrence. Despite having comparable E/E’, E’ and LA volume index, the patients of group 1 had significantly higher PALSr (15.7 vs 12.6, p = 0.004), PALSc (−16.2 vs -13.9, p = 0.008), PALSRr (2.44 vs 1.76, p < 0,001), PALSRc (−2.4 vs −1.66, p < 0.001), E (0.87 vs 0.69, p < 0.001), IVRT (90 vs 89, p = 0.04) and TAC (1.26 vs 1.08, p = 0.04), whereas Ees corrected by afterload was higher in group 2 (619 vs 803, p = 0,004). Stepwise multiple regression analysis revealed that PALSRc was linked to AF recurrence (&bgr; = 0.38, p = 0.04). Conclusions: VAC parameters were significantly related to LA remodeling and DD but had no prognostic value in recurrence of AF. Only PALSRc was independently associated with complete antiarrhythmic effect.