Correlation between left atrial function and the left atrial low voltage zones in patients with atrial fibrillation and stroke

doi:10.3877/cma.j.issn.2095-6568.2022.04.008

Abstract

Abstract:

Objective

To explore the correlation between left atrial function and the left atrial low-voltage zones (LVZs) in patients with nonvalvular atrial fibrillation and stroke.

Methods

Patients with atrial fibrillation and stroke who admitted to the department of cardiology, The First Affiliated Hospital with Nanjing Medical University were enrolled from April 1st to September 30th, 2022. A pre-procedural echocardiography was performed to assess the left atrial function, such as the max of left atrial volume (LAVmax), the minimum of left atrial volume (LAVmin), the index of left atrial volume (LAVI), and detailed voltage mapping by an electro-anatomical mapping system was applied to evaluate the LA LVZs. Patients were divided into two groups according to the presence of the LVZs: LVZs group (LVZs ratio>5%) and no LVZs group (LVZs ratio≤5%). The correlation between the LVZs and left atrial function was then analyzed.

Results

There were 26 patients enrolled totally, aged (60.77±10.31) years, 8 female (30.77%,8/26), 7 in LVZs group, 19 in no LVZs group. Compared to no LVZs group, the patients in LVZs group presented more women [71.4% (5/7) vs. 15.8% (3/19), P =0.014) and higher CHA₂DS₂-VASc scores (6 vs. 3, P =0.039). Echocardiography showed larger LAV max [(118.43±37.67) ml vs. (88.11±30.00) ml, P =0.043)], larger LAV min [(97.00±37.59) ml vs. [(54.89±29.42) ml, P =0.006], higher LAVI (65 vs. 44, P=0.004), lower LAEF (18.93%±8.30% vs. 40.39%±15.66%, P=0.002) and worse Reservoir function [21.98(12.22, 37.04)% vs. 64.52(38.57, 111.43)%, P=0.002]. Multivariable logistic regression analyses revealed female (OR=54.814, 95%CI 1.104-2721.590, P=0.044), lower LAEF(OR=0.822, 95%CI 0.696-0.970, P=0.020) to be independent predictors of the presence of LVZs.

Conclusion

Echocardiography-based assessment of left atrial function can predict the level of the left atrial LVZs in patients with atrial fibrillation and stroke, thereby guiding subsequent ablation strategies.

Key words: Atrial fibrillation, Left atrial function, Low-voltage zone, Echocardiography

Tingting Wu, Nan Wu, Kexin Wang, Weizhu Ju, Minglong Chen, Zidun Wang. Correlation between left atrial function and the left atrial low voltage zones in patients with atrial fibrillation and stroke[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(04): 231-237.

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Figures/Tables 6

临床资料	有低电压区组	无低电压区组	P值
人数（例）	7	19
年龄（岁， $x ¯ ± s$ ）	62.43±6.32	60.16±11.52	0.532
女［例（%）］	5 （71.4）	3 （15.8）	0.014^a
持续性心房颤动［例（%）］	6 （85.7）	10 （52.6）	0.190
合并症［例（%）］
高血压	5 （71.4）	10 （52.6）	0.658
糖尿病	3 （42.9）	3 （15.8）	0.293
冠心病	5 （71.4）	9 （47.4）	0.391
心功能不全	3 （42.9）	3 （15.8）	0.293
CHA₂DS₂-VASc［分， M（IQR）］	6 （4， 6）	3 （3，5）	0.039^a
HAS-BLED［分， M（IQR）］	1 （1， 1）	1 （1，1）	0.703
血红蛋白（g/L， $x ¯ ± s$ ）	129.57±9.54	138.47±13.24	0.118
NT-pro BNP［ng/L， M（IQR）］	751.2 （532，1649）	515.0 （252，819）	0.126
ALT［U， M（IQR）］	14.5 （12.3，38.9）	25.8 （17.7，30.7）	0.272
血肌酐（Umol/L， $x ¯ ± s$ ）	72.79±15.11	69.40±8.97	0.486

临床资料	有低电压区组	无低电压区组	P值
人数（例）	7	19
年龄（岁， $x ¯ ± s$ ）	62.43±6.32	60.16±11.52	0.532
女［例（%）］	5 （71.4）	3 （15.8）	0.014^a
持续性心房颤动［例（%）］	6 （85.7）	10 （52.6）	0.190
合并症［例（%）］
高血压	5 （71.4）	10 （52.6）	0.658
糖尿病	3 （42.9）	3 （15.8）	0.293
冠心病	5 （71.4）	9 （47.4）	0.391
心功能不全	3 （42.9）	3 （15.8）	0.293
CHA₂DS₂-VASc［分， M（IQR）］	6 （4， 6）	3 （3，5）	0.039^a
HAS-BLED［分， M（IQR）］	1 （1， 1）	1 （1，1）	0.703
血红蛋白（g/L， $x ¯ ± s$ ）	129.57±9.54	138.47±13.24	0.118
NT-pro BNP［ng/L， M（IQR）］	751.2 （532，1649）	515.0 （252，819）	0.126
ALT［U， M（IQR）］	14.5 （12.3，38.9）	25.8 （17.7，30.7）	0.272
血肌酐（Umol/L， $x ¯ ± s$ ）	72.79±15.11	69.40±8.97	0.486

超声心动图资料	有低电压区组	无低电压区组	P
左心室射血分数［%， M（IQR）］	62.1 （61.2~63.0）	64.4 （62.4， 66.4）	0.093
左心室舒张末内径（mm， $x ¯ ± s$ ）	46.86±2.91	47.84±3.32	0.496
左心房前后径（mm， $x ¯ ± s$ ）	46.14±5.61	42.95±5.43	0.199
左心房储存期纵向应变值（ $x ¯ ± s$ ）	14.91±8.70	21.14±11.10	0.195
左心房通道期纵向应变值（ $x ¯ ± s$ ）	-13.33±5.97	-15.42±7.06	0.494
左心房收缩期的纵向应变值（ $x ¯ ± s$ ）	-1.60±3.67	-5.70±6.59	0.135
左心房最大容积（ml， $x ¯ ± s$ ）	118.43±37.67	88.11±30.00	0.043^a
左心房最小容积（ml， $x ¯ ± s$ ）	97.00±37.59	54.89±29.42	0.006^a
左心房射血分数（%， $x ¯ ± s$ ）	18.93±8.30	40.39±15.66	0.002^a
左心房容积指数［ml/m²， M（IQR）］	65 （59， 71）	44 （34.2，58）	0.004^a
左心房膨胀指数［%， M（IQR）］	21.98 （12.22， 37.04）	64.52 （38.57，111.43）	0.002^a

超声心动图资料	有低电压区组	无低电压区组	P
左心室射血分数［%， M（IQR）］	62.1 （61.2~63.0）	64.4 （62.4， 66.4）	0.093
左心室舒张末内径（mm， $x ¯ ± s$ ）	46.86±2.91	47.84±3.32	0.496
左心房前后径（mm， $x ¯ ± s$ ）	46.14±5.61	42.95±5.43	0.199
左心房储存期纵向应变值（ $x ¯ ± s$ ）	14.91±8.70	21.14±11.10	0.195
左心房通道期纵向应变值（ $x ¯ ± s$ ）	-13.33±5.97	-15.42±7.06	0.494
左心房收缩期的纵向应变值（ $x ¯ ± s$ ）	-1.60±3.67	-5.70±6.59	0.135
左心房最大容积（ml， $x ¯ ± s$ ）	118.43±37.67	88.11±30.00	0.043^a
左心房最小容积（ml， $x ¯ ± s$ ）	97.00±37.59	54.89±29.42	0.006^a
左心房射血分数（%， $x ¯ ± s$ ）	18.93±8.30	40.39±15.66	0.002^a
左心房容积指数［ml/m²， M（IQR）］	65 （59， 71）	44 （34.2，58）	0.004^a
左心房膨胀指数［%， M（IQR）］	21.98 （12.22， 37.04）	64.52 （38.57，111.43）	0.002^a

	单因素回归分析			多因素回归分析
因素	OR	95% CI	P	OR	95% CI	P
女性	13.333	1.713~103.751	0.013^a	54.814	1.104~2721.590	0.044^a
年龄	1.024	0.935~1.120	0.613
持续性心房颤动	5.400	0.541~53.892	0.151
高血压	2.250	0.346~14.611	0.396
糖尿病	4.000	0.575~27.819	0.161
冠心病	2.778	0.428~18.038	0.284
心功能不全	4.000	0.575~27.819	0.161
CHA₂DS₂-VASc	1.908	1.004~3.626	0.049^a
HAS-BLED	0.625	0.057~6.801	0.700
血红蛋白（g/L）	0.933	0.854~1.019	0.121
NT-pro BNP（ng/L）	1.001	0.999~1.003	0.162
ALT（U/L）	0.975	0.913~1.040	0.438
血肌酐（umol/L）	1.031	0.949~1.119	0.471
左心室射血分数（%）	0.934	0.775~1.127	0.477
左心房前后径（mm）	1.114	0.944~1.314	0.202
左心房储存期纵向应变值	0.937	0.848~1.035	0.197
左心房通道期纵向应变值	1.050	0.917~1.203	0.479
左心房收缩期的纵向应变值	1.161	0.949~1.420	0.146
左心房射血分数（%）	0.859	0.756~0.975	0.019^a	0.822	0.696~0.970	0.020^a
左心房容积指数（ml/m²）	1.159	1.013~1.326	0.032^a

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