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Prediction of left atrial fibrosis with speckle tracking echocardiography in mitral valve disease: a comparative study with histopathology.

Her AY, Choi EY, Shim CY, Song BW, Lee S, Ha JW, Rim SJ, Hwang KC, Chang BC, Chung N - Korean Circ J (2012)

Bottom Line: Speckle tracking echocardiography and LA volume measurements were performed in 50 patients one day before MV surgery.LA tissues were obtained during the surgery, and the degrees of their interstitial fibroses were measured.LA volume measurements were repeated within 30 days after surgery (n=50) and 1-year later (n=39).

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Kangwon National University Hospital, Chuncheon, Korea.

ABSTRACT

Background and objectives: Left atrial (LA) fibrosis is a main determinant of LA remodeling and development of atrial fibrillation. However, non-invasive prediction of LA fibrosis is challenging. We investigated whether preoperative LA strain as measured by speckle tracking echocardiography could predict the degree of LA fibrosis and LA reverse remodeling after mitral valve (MV) surgery.

Subjects and methods: Speckle tracking echocardiography and LA volume measurements were performed in 50 patients one day before MV surgery. LA tissues were obtained during the surgery, and the degrees of their interstitial fibroses were measured. LA volume measurements were repeated within 30 days after surgery (n=50) and 1-year later (n=39).

Results: Left atrial global strain was significantly correlated with the degree of LA fibrosis (r=-0.55, p<0.001), and its correlation was independent of age, underlying rhythm, presence of rheumatic heart disease and type of predominant MV disease (B=-1.37, 95% confidence interval -2.32 - -0.41, p=0.006). The degree of LA fibrosis was significantly correlated with early (r=-0.337, p=0.017) and 1-year (r=-0.477, p=0.002) percent LA volume reduction after MV surgery, but LA global strain was not significant.

Conclusion: Left atrial strain as measured by speckle tracking echocardiography might be helpful for predicting the degree of LA fibrosis in patients with MV disease.

No MeSH data available.


Related in: MedlinePlus

Left atrial (LA) strain as measured by speckle tracking echocardiography and its corresponding histopathology. A case with higher LA global strain (29%) (A) and a lower degree of LA fibrosis (9%) (B). A case with lower LA global strain (6.9%) (C) and a correspondingly high degree of LA fibrosis (40%) (D). The dotted line represents the LA global strain, and the arrow indicates the peak longitudinal strain value. On these histology slides, the purple color represents fibrosis after Masson Trichrome staining (×20).
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Figure 1: Left atrial (LA) strain as measured by speckle tracking echocardiography and its corresponding histopathology. A case with higher LA global strain (29%) (A) and a lower degree of LA fibrosis (9%) (B). A case with lower LA global strain (6.9%) (C) and a correspondingly high degree of LA fibrosis (40%) (D). The dotted line represents the LA global strain, and the arrow indicates the peak longitudinal strain value. On these histology slides, the purple color represents fibrosis after Masson Trichrome staining (×20).

Mentions: For the LV speckle tracking analysis, apical four- and two-chamber view images were obtained using conventional gray scale echocardiography (Vivid 7; GE Medical Systems). For the LA speckle tracking analysis, LA-focused images in apical four-chamber and two-chamber views were obtained. Two consecutive heart cycles were recorded and averaged, and five consecutive heart cycles were averaged for AF patients. A minimum frame rate of 40 frames per second was required for the reliable operation of this program. Recordings were processed using acoustic-tracking software (EchoPAC v8.0; GE Medical Systems), allowing offline, semi-automated analysis of speckle-based strain.11) For 2D speckle tracking strain analysis, a line was manually drawn along the LA endocardial border of the apical four- and two-chamber views after contraction, when the LA was at its minimum volume, using the point-and-click approach. The software then automatically generated additional lines near the atrial epicardium and mid-myocardial line, with the narrowest region of interest (ROI). The ROI then included the entire LA myocardial wall, and a click feature increased or decreased the widths between endocardial and epicardial line for thicker or thinner walls, respectively. The software generated strain curves for each atrial segment. A total of 12 segments were analyzed for each patient for whom the imaging results were of adequate quality. To trace the ROI in the discontinuity of the LA wall corresponding to the pulmonary veins and LA appendage, the directions of the LA endocardial and epicardial surfaces at the junction with these structures were extrapolated. The peak atrial longitudinal global strain was generated using the peaks of entire LA segments and the mean values obtained in the four- and two-chamber views (Fig. 1).


Prediction of left atrial fibrosis with speckle tracking echocardiography in mitral valve disease: a comparative study with histopathology.

Her AY, Choi EY, Shim CY, Song BW, Lee S, Ha JW, Rim SJ, Hwang KC, Chang BC, Chung N - Korean Circ J (2012)

Left atrial (LA) strain as measured by speckle tracking echocardiography and its corresponding histopathology. A case with higher LA global strain (29%) (A) and a lower degree of LA fibrosis (9%) (B). A case with lower LA global strain (6.9%) (C) and a correspondingly high degree of LA fibrosis (40%) (D). The dotted line represents the LA global strain, and the arrow indicates the peak longitudinal strain value. On these histology slides, the purple color represents fibrosis after Masson Trichrome staining (×20).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369962&req=5

Figure 1: Left atrial (LA) strain as measured by speckle tracking echocardiography and its corresponding histopathology. A case with higher LA global strain (29%) (A) and a lower degree of LA fibrosis (9%) (B). A case with lower LA global strain (6.9%) (C) and a correspondingly high degree of LA fibrosis (40%) (D). The dotted line represents the LA global strain, and the arrow indicates the peak longitudinal strain value. On these histology slides, the purple color represents fibrosis after Masson Trichrome staining (×20).
Mentions: For the LV speckle tracking analysis, apical four- and two-chamber view images were obtained using conventional gray scale echocardiography (Vivid 7; GE Medical Systems). For the LA speckle tracking analysis, LA-focused images in apical four-chamber and two-chamber views were obtained. Two consecutive heart cycles were recorded and averaged, and five consecutive heart cycles were averaged for AF patients. A minimum frame rate of 40 frames per second was required for the reliable operation of this program. Recordings were processed using acoustic-tracking software (EchoPAC v8.0; GE Medical Systems), allowing offline, semi-automated analysis of speckle-based strain.11) For 2D speckle tracking strain analysis, a line was manually drawn along the LA endocardial border of the apical four- and two-chamber views after contraction, when the LA was at its minimum volume, using the point-and-click approach. The software then automatically generated additional lines near the atrial epicardium and mid-myocardial line, with the narrowest region of interest (ROI). The ROI then included the entire LA myocardial wall, and a click feature increased or decreased the widths between endocardial and epicardial line for thicker or thinner walls, respectively. The software generated strain curves for each atrial segment. A total of 12 segments were analyzed for each patient for whom the imaging results were of adequate quality. To trace the ROI in the discontinuity of the LA wall corresponding to the pulmonary veins and LA appendage, the directions of the LA endocardial and epicardial surfaces at the junction with these structures were extrapolated. The peak atrial longitudinal global strain was generated using the peaks of entire LA segments and the mean values obtained in the four- and two-chamber views (Fig. 1).

Bottom Line: Speckle tracking echocardiography and LA volume measurements were performed in 50 patients one day before MV surgery.LA tissues were obtained during the surgery, and the degrees of their interstitial fibroses were measured.LA volume measurements were repeated within 30 days after surgery (n=50) and 1-year later (n=39).

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Kangwon National University Hospital, Chuncheon, Korea.

ABSTRACT

Background and objectives: Left atrial (LA) fibrosis is a main determinant of LA remodeling and development of atrial fibrillation. However, non-invasive prediction of LA fibrosis is challenging. We investigated whether preoperative LA strain as measured by speckle tracking echocardiography could predict the degree of LA fibrosis and LA reverse remodeling after mitral valve (MV) surgery.

Subjects and methods: Speckle tracking echocardiography and LA volume measurements were performed in 50 patients one day before MV surgery. LA tissues were obtained during the surgery, and the degrees of their interstitial fibroses were measured. LA volume measurements were repeated within 30 days after surgery (n=50) and 1-year later (n=39).

Results: Left atrial global strain was significantly correlated with the degree of LA fibrosis (r=-0.55, p<0.001), and its correlation was independent of age, underlying rhythm, presence of rheumatic heart disease and type of predominant MV disease (B=-1.37, 95% confidence interval -2.32 - -0.41, p=0.006). The degree of LA fibrosis was significantly correlated with early (r=-0.337, p=0.017) and 1-year (r=-0.477, p=0.002) percent LA volume reduction after MV surgery, but LA global strain was not significant.

Conclusion: Left atrial strain as measured by speckle tracking echocardiography might be helpful for predicting the degree of LA fibrosis in patients with MV disease.

No MeSH data available.


Related in: MedlinePlus