Skip to main content
Top
Published in: Advances in Therapy 4/2024

05-03-2024 | Atrial Fibrillation | Original Research

Left Atrial Strain Insights in Atrial Fibrillation and the Interplay with Metabolic Syndrome

Authors: Hyun-Jin Kim, Hyun-Sun Kim

Published in: Advances in Therapy | Issue 4/2024

Login to get access

Abstract

Introduction

Understanding the interplay between metabolic syndrome and left atrial (LA) function is crucial, especially in patients newly diagnosed with atrial fibrillation (AF). We evaluated the association between subclinical atrial function and metabolic syndrome in patients diagnosed with new-onset AF.

Methods

A retrospective analysis was conducted on 220 patients, aged between 20 and 100 years, who were newly diagnosed with AF. These patients were divided into two groups based on the presence or absence of metabolic syndrome. LA reservoir strain, a measure of LA function, was assessed using transthoracic echocardiography. Statistical methods, including receiver operating characteristic (ROC) curve and logistic regression analyses, were employed to evaluate the association between LA strain and metabolic syndrome.

Results

Among the 220 patients, 108 had metabolic syndrome and displayed more adverse clinical characteristics. The LA reservoir strain was significantly lower in this group (9.7% ± 5.2% vs. 12.0% ± 5.8%, p = 0.003). ROC curve analysis identified 9.3% as the optimal cutoff value for predicting metabolic syndrome, with a sensitivity of 50.9% and specificity of 70.5%. Further, multivariate analysis confirmed that an LA reservoir strain below 9.3% was independently linked to metabolic syndrome (odds ratio 4.261, 95% confidence interval 1.134–16.009, p = 0.032).

Conclusions

The findings reveal a significant association between lower LA reservoir strain values and the presence of metabolic syndrome in patients newly diagnosed with AF. An LA strain value below 9.3% serves as a critical diagnostic and prognostic indicator, highlighting its clinical importance in managing patients with AF.
Appendix
Available only for authorised users
Literature
1.
go back to reference Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42:373–498.CrossRefPubMed Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42:373–498.CrossRefPubMed
2.
go back to reference Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139:e56–528.CrossRefPubMed Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139:e56–528.CrossRefPubMed
3.
go back to reference Walters TE, Wick K, Tan G, et al. Symptom severity and quality of life in patients with atrial fibrillation: psychological function outweighs clinical predictors. Int J Cardiol. 2019;279:84–9.CrossRefPubMed Walters TE, Wick K, Tan G, et al. Symptom severity and quality of life in patients with atrial fibrillation: psychological function outweighs clinical predictors. Int J Cardiol. 2019;279:84–9.CrossRefPubMed
4.
go back to reference Huh JH, Kang DR, Kim JY, Koh KK. Metabolic syndrome fact sheet 2021: executive report. Cardiometab Syndr J. 2021;1:125–34.CrossRef Huh JH, Kang DR, Kim JY, Koh KK. Metabolic syndrome fact sheet 2021: executive report. Cardiometab Syndr J. 2021;1:125–34.CrossRef
5.
go back to reference Oliver W, Matthews G, Ayers CR, et al. Factors associated with left atrial remodeling in the general population. Circ Cardiovasc Imaging. 2017;10:e005047. Oliver W, Matthews G, Ayers CR, et al. Factors associated with left atrial remodeling in the general population. Circ Cardiovasc Imaging. 2017;10:e005047.
6.
go back to reference Malaescu GG, Mirea O, Capota R, et al. Left atrial strain determinants during the cardiac phases. JACC Cardiovasc Imaging. 2022;15:381–91.CrossRefPubMed Malaescu GG, Mirea O, Capota R, et al. Left atrial strain determinants during the cardiac phases. JACC Cardiovasc Imaging. 2022;15:381–91.CrossRefPubMed
7.
go back to reference Sun BJ, Park JH, Lee M, et al. Normal reference values for left atrial strain and its determinants from a large Korean multicenter registry. J Cardiovasc Imaging. 2020;28:186–98.CrossRefPubMedPubMedCentral Sun BJ, Park JH, Lee M, et al. Normal reference values for left atrial strain and its determinants from a large Korean multicenter registry. J Cardiovasc Imaging. 2020;28:186–98.CrossRefPubMedPubMedCentral
8.
go back to reference Kim YG, Choi KJ, Han S, et al. Metabolic syndrome and the risk of new-onset atrial fibrillation in middle-aged East Asian men. Circ J. 2018;82:1763–9.CrossRefPubMed Kim YG, Choi KJ, Han S, et al. Metabolic syndrome and the risk of new-onset atrial fibrillation in middle-aged East Asian men. Circ J. 2018;82:1763–9.CrossRefPubMed
9.
go back to reference Kwon CH, Kim H, Kim SH, et al. The impact of metabolic syndrome on the incidence of atrial fibrillation: a nationwide longitudinal cohort study in South Korea. J Clin Med. 2019;8:1095. Kwon CH, Kim H, Kim SH, et al. The impact of metabolic syndrome on the incidence of atrial fibrillation: a nationwide longitudinal cohort study in South Korea. J Clin Med. 2019;8:1095.
10.
go back to reference Yilmaz H, Ozcan KS, Sayar N, et al. Metabolic syndrome is associated with atrial electrical and mechanical dysfunction. Med Princ Pract. 2015;24:147–52.CrossRefPubMedPubMedCentral Yilmaz H, Ozcan KS, Sayar N, et al. Metabolic syndrome is associated with atrial electrical and mechanical dysfunction. Med Princ Pract. 2015;24:147–52.CrossRefPubMedPubMedCentral
11.
go back to reference Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation. 2005;112:2735–52.CrossRefPubMed Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation. 2005;112:2735–52.CrossRefPubMed
12.
go back to reference Hong AR, Lim S. Clinical characteristics of metabolic syndrome in Korea, and its comparison with other Asian countries. J Diabetes Investig. 2015;6:508–15.CrossRefPubMedPubMedCentral Hong AR, Lim S. Clinical characteristics of metabolic syndrome in Korea, and its comparison with other Asian countries. J Diabetes Investig. 2015;6:508–15.CrossRefPubMedPubMedCentral
13.
go back to reference Cameli M, Mandoli GE, Loiacono F, et al. Left atrial strain: a useful index in atrial fibrillation. Int J Cardiol. 2016;220:208–13.CrossRefPubMed Cameli M, Mandoli GE, Loiacono F, et al. Left atrial strain: a useful index in atrial fibrillation. Int J Cardiol. 2016;220:208–13.CrossRefPubMed
14.
go back to reference Badano LP, Kolias TJ, Muraru D, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018;19:591–600.CrossRefPubMed Badano LP, Kolias TJ, Muraru D, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018;19:591–600.CrossRefPubMed
15.
go back to reference Pathan F, D’Elia N, Nolan MT, Marwick TH, Negishi K. Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J Am Soc Echocardiogr. 2017;30(59–70): e8. Pathan F, D’Elia N, Nolan MT, Marwick TH, Negishi K. Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J Am Soc Echocardiogr. 2017;30(59–70): e8.
17.
go back to reference Ionin VA, Zaslavskaya EL, Barashkova EI, et al. Molecular mechanisms of left atrial fibrosis development in patients with atrial fibrillation and metabolic syndrome: what biomarkers should be used in clinical practice? Russian J Cardiol. 2021;26:4579. Ionin VA, Zaslavskaya EL, Barashkova EI, et al. Molecular mechanisms of left atrial fibrosis development in patients with atrial fibrillation and metabolic syndrome: what biomarkers should be used in clinical practice? Russian J Cardiol. 2021;26:4579.
18.
go back to reference Biccire FG, Bucci T, Menichelli D, et al. Mediterranean diet: a tool to break the relationship of atrial fibrillation with the metabolic syndrome and non-alcoholic fatty liver disease. Nutrients. 2022;14:1260. Biccire FG, Bucci T, Menichelli D, et al. Mediterranean diet: a tool to break the relationship of atrial fibrillation with the metabolic syndrome and non-alcoholic fatty liver disease. Nutrients. 2022;14:1260.
19.
go back to reference Zheng Y, Xie Z, Li J, et al. Meta-analysis of metabolic syndrome and its individual components with risk of atrial fibrillation in different populations. BMC Cardiovasc Disord. 2021;21:90.CrossRefPubMedPubMedCentral Zheng Y, Xie Z, Li J, et al. Meta-analysis of metabolic syndrome and its individual components with risk of atrial fibrillation in different populations. BMC Cardiovasc Disord. 2021;21:90.CrossRefPubMedPubMedCentral
20.
go back to reference Sabatino J, De Rosa S, Leo I, et al. Early reduction of left atrial function predicts adverse clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Open Heart. 2021;8:e001685. Sabatino J, De Rosa S, Leo I, et al. Early reduction of left atrial function predicts adverse clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Open Heart. 2021;8:e001685.
21.
go back to reference Tanasa A, Burlacu A, Popa C, et al. A systematic review on the correlations between left atrial strain and cardiovascular outcomes in chronic kidney disease patients. Diagnostics (Basel). 2021;11:671. Tanasa A, Burlacu A, Popa C, et al. A systematic review on the correlations between left atrial strain and cardiovascular outcomes in chronic kidney disease patients. Diagnostics (Basel). 2021;11:671.
22.
go back to reference Nguyen J, Weber J, Hsu B, et al. Comparing left atrial indices by CMR in association with left ventricular diastolic dysfunction and adverse clinical outcomes. Sci Rep. 2021;11:21331.CrossRefPubMedPubMedCentral Nguyen J, Weber J, Hsu B, et al. Comparing left atrial indices by CMR in association with left ventricular diastolic dysfunction and adverse clinical outcomes. Sci Rep. 2021;11:21331.CrossRefPubMedPubMedCentral
23.
go back to reference Delgado V, Di Biase L, Leung M, et al. Structure and function of the left atrium and left atrial appendage: AF and stroke implications. J Am Coll Cardiol. 2017;70:3157–72.CrossRefPubMed Delgado V, Di Biase L, Leung M, et al. Structure and function of the left atrium and left atrial appendage: AF and stroke implications. J Am Coll Cardiol. 2017;70:3157–72.CrossRefPubMed
24.
go back to reference Triposkiadis F, Xanthopoulos A, Butler J. Cardiovascular aging and heart failure: JACC review topic of the week. J Am Coll Cardiol. 2019;74:804–13.CrossRefPubMed Triposkiadis F, Xanthopoulos A, Butler J. Cardiovascular aging and heart failure: JACC review topic of the week. J Am Coll Cardiol. 2019;74:804–13.CrossRefPubMed
25.
go back to reference Lin KJ, Cho SI, Tiwari N, et al. Impact of metabolic syndrome on the risk of atrial fibrillation recurrence after catheter ablation: systematic review and meta-analysis. J Interv Card Electrophysiol. 2014;39:211–23.CrossRefPubMed Lin KJ, Cho SI, Tiwari N, et al. Impact of metabolic syndrome on the risk of atrial fibrillation recurrence after catheter ablation: systematic review and meta-analysis. J Interv Card Electrophysiol. 2014;39:211–23.CrossRefPubMed
26.
go back to reference Balarini CM, Braga VA. Editorial: new translational insights on metabolic syndrome: obesity, hypertension. Diabetes and Beyond Front Physiol. 2016;7:229.PubMed Balarini CM, Braga VA. Editorial: new translational insights on metabolic syndrome: obesity, hypertension. Diabetes and Beyond Front Physiol. 2016;7:229.PubMed
27.
go back to reference Park HS, Sung JH, Ryu CS, et al. The synergistic effect of plasminogen activator inhibitor-1 (PAI-1) polymorphisms and metabolic syndrome on coronary artery disease in the Korean population. J Pers Med. 2020;10:229. Park HS, Sung JH, Ryu CS, et al. The synergistic effect of plasminogen activator inhibitor-1 (PAI-1) polymorphisms and metabolic syndrome on coronary artery disease in the Korean population. J Pers Med. 2020;10:229.
28.
go back to reference Miller JT, O’Rourke RA, Crawford MH. Left atrial enlargement: an early sign of hypertensive heart disease. Am Heart J. 1988;116:1048–51.CrossRefPubMed Miller JT, O’Rourke RA, Crawford MH. Left atrial enlargement: an early sign of hypertensive heart disease. Am Heart J. 1988;116:1048–51.CrossRefPubMed
29.
go back to reference Vidula MK, Chirinos JA. Left atrial coupling index and its prognostic value in heart failure with reduced ejection fraction. Circ Cardiovasc Imaging. 2021;14: e012221.CrossRefPubMedPubMedCentral Vidula MK, Chirinos JA. Left atrial coupling index and its prognostic value in heart failure with reduced ejection fraction. Circ Cardiovasc Imaging. 2021;14: e012221.CrossRefPubMedPubMedCentral
30.
go back to reference Chen YL, Chen YC, Chang YT, et al. GJA1 expression and left atrial remodeling in the incidence of atrial fibrillation in patients with obstructive sleep apnea syndrome. Biomedicines. 2021;9:1463. Chen YL, Chen YC, Chang YT, et al. GJA1 expression and left atrial remodeling in the incidence of atrial fibrillation in patients with obstructive sleep apnea syndrome. Biomedicines. 2021;9:1463.
31.
go back to reference Bao L, Cheng L, Gao X, et al. Left atrial morpho-functional remodeling in atrial fibrillation assessed by three dimensional speckle tracking echocardiography and its value in atrial fibrillation screening. Cardiovasc Ultrasound. 2022;20:13.CrossRefPubMedPubMedCentral Bao L, Cheng L, Gao X, et al. Left atrial morpho-functional remodeling in atrial fibrillation assessed by three dimensional speckle tracking echocardiography and its value in atrial fibrillation screening. Cardiovasc Ultrasound. 2022;20:13.CrossRefPubMedPubMedCentral
Metadata
Title
Left Atrial Strain Insights in Atrial Fibrillation and the Interplay with Metabolic Syndrome
Authors
Hyun-Jin Kim
Hyun-Sun Kim
Publication date
05-03-2024
Publisher
Springer Healthcare
Published in
Advances in Therapy / Issue 4/2024
Print ISSN: 0741-238X
Electronic ISSN: 1865-8652
DOI
https://doi.org/10.1007/s12325-024-02815-y

Other articles of this Issue 4/2024

Advances in Therapy 4/2024 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.