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01-12-2021 | Transthoracic Echocardiography | Research

Automated left atrial strain analysis for predicting atrial fibrillation in severe COVID-19 pneumonia: a prospective study

Authors: Christophe Beyls, Alexis Hermida, Yohann Bohbot, Nicolas Martin, Christophe Viart, Solenne Boisgard, Camille Daumin, Pierre Huette, Hervé Dupont, Osama Abou-Arab, Yazine Mahjoub

Published in: Annals of Intensive Care | Issue 1/2021

Abstract

Background

Atrial fibrillation (AF) is the most documented arrhythmia in COVID-19 pneumonia. Left atrial (LA) strain (LAS) analysis, a marker of LA contractility, have been associated with the development of AF in several clinical situations. We aimed to assess the diagnostic ability of LA strain parameters to predict AF in patients with severe hypoxemic COVID-19 pneumonia. We conducted a prospective single center study in Amiens University Hospital intensive care unit (ICU) (France). Adult patients with severe or critical COVID-19 pneumonia according to the World Health Organization definition and in sinus rhythm were included. Transthoracic echocardiography was performed within 48 h of ICU admission. LA strain analysis was performed by an automated software. The following LA strain parameters were recorded: LA strain during reservoir phase (LASr), LA strain during conduit phase (LAScd) and LA strain during contraction phase (LASct). The primary endpoint was the occurrence of AF during ICU stay.

Results

From March 2020 to February of 2021, 79 patients were included. Sixteen patients (20%) developed AF in ICU. Patients of the AF group were significantly older with a higher SAPS II score than those without AF. LAScd and LASr were significantly more impaired in the AF group compared to the other group (− 8.1 [− 6.3; − 10.9] vs. − 17.2 [− 5.0; − 10.2] %; P < 0.001 and 20.2 [12.3;27.3] % vs. 30.5 [23.8;36.2] %; P = 0.002, respectively), while LASct did not significantly differ between groups (p = 0.31). In a multivariate model, LAScd and SOFA cv were significantly associated with the occurrence of AF. A LAScd cutoff value of − 11% had a sensitivity of 76% and a specificity of 75% to identify patients with AF. The 30-day cumulative risk of AF was 42 ± 9% with LAScd > − 11% and 8 ± 4% with LAScd ≤ − 11% (log rank test P value < 0.0001).

Conclusion

For patients with severe COVID-19 pneumonia, development of AF during ICU stay is common (20%). LAS parameters seem useful in predicting AF within the first 48 h of ICU admission.

Trial registration: NCT04354558.

Guo T, Fan Y, Chen M, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5:811. https://doi.org/10.1001/jamacardio.2020.1017.CrossRefPubMed

Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323:1061. https://doi.org/10.1001/jama.2020.1585.CrossRefPubMedPubMedCentral

COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2021;47:60–73. https://doi.org/10.1007/s00134-020-06294-x.CrossRef

Wetterslev M, Haase N, Hassager C, et al. New-onset atrial fibrillation in adult critically ill patients: a scoping review. Intensive Care Med. 2019;45:928–38. https://doi.org/10.1007/s00134-019-05633-x.CrossRefPubMed

Inciardi RM, Adamo M, Lupi L, et al. Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy. Eur Heart J. 2020;41:1821–9. https://doi.org/10.1093/eurheartj/ehaa388.CrossRefPubMed

Gawałko M, Kapłon-Cieślicka A, Hohl M, et al. COVID-19 associated atrial fibrillation: Incidence, putative mechanisms and potential clinical implications. Int J Cardiol Heart Vasc. 2020;30: 100631. https://doi.org/10.1016/j.ijcha.2020.100631.CrossRefPubMedPubMedCentral

Pardo Sanz A, Salido Tahoces L, Ortega Pérez R, et al. New-onset atrial fibrillation during COVID-19 infection predicts poor prognosis. Cardiol J. 2021;28:34–40. https://doi.org/10.5603/CJ.a2020.0145.CrossRefPubMed

Hu Y-F, Cheng W-H, Hung Y, et al. Management of atrial fibrillation in COVID-19 pandemic. Circ J. 2020;84:1679–85. https://doi.org/10.1253/circj.CJ-20-0566.CrossRefPubMed

Russo V, Rago A, Carbone A, et al. Atrial fibrillation in COVID-19: from epidemiological association to pharmacological implications. J Cardiovasc Pharmacol. 2020. https://doi.org/10.1097/FJC.0000000000000854.CrossRefPubMed

10.

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. https://doi.org/10.1093/ehjci/jey042.CrossRefPubMed

11.

Cameli M, Mandoli GE, Loiacono F, et al. Left atrial strain: a useful index in atrial fibrillation. Int J Cardiol. 2016;220:208–13. https://doi.org/10.1016/j.ijcard.2016.06.197.CrossRefPubMed

12.

Rasmussen SMA, Olsen FJ, Jørgensen PG, et al. Utility of left atrial strain for predicting atrial fibrillation following ischemic stroke. Int J Cardiovasc Imaging. 2019;35:1605–13. https://doi.org/10.1007/s10554-019-01601-0.CrossRefPubMed

13.

Park JJ, Park J-H, Hwang I-C, et al. Left atrial strain as a predictor of new-onset atrial fibrillation in patients with heart failure. JACC Cardiovasc Imaging. 2020;13:2071–81. https://doi.org/10.1016/j.jcmg.2020.04.031.CrossRefPubMed

14.

Toulouse E, Masseguin C, Lafont B, et al. French legal approach to clinical research. Anaesth Crit Care Pain Med. 2018;37:607–14. https://doi.org/10.1016/j.accpm.2018.10.013.CrossRefPubMed

15.

Le Gall JR. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–63. https://doi.org/10.1001/jama.270.24.2957.CrossRefPubMed

16.

Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10.CrossRefPubMed

17.

Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323:1239. https://doi.org/10.1001/jama.2020.2648.CrossRefPubMed

18.

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). Eur Heart J. 2021;42:373–498. https://doi.org/10.1093/eurheartj/ehaa612.CrossRefPubMed

19.

Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003.CrossRefPubMed

20.

Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36:2921–64. https://doi.org/10.1093/eurheartj/ehv318.CrossRefPubMed

21.

Popescu BA, Andrade MJ, Badano LP, et al. European Association of echocardiography recommendations for training, competence, and quality improvement in echocardiography. Eur J Echocardiogr. 2009;10:893–905. https://doi.org/10.1093/ejechocard/jep151.CrossRefPubMed

22.

Lemeshow S, Hosmer DW. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. 1982;115:92–106. https://doi.org/10.1093/oxfordjournals.aje.a113284.CrossRefPubMed

23.

Romero C, te Velde L, Ponsen H, Cleophas TJ. C-statistics versus logistic regression for assessing the performance of qualitative diagnostic tests. Clin Chem Lab Med. 2012. https://doi.org/10.1515/cclm.2011.726.CrossRef

24.

Colon CM, Barrios JG, Chiles JW, et al. Atrial arrhythmias in COVID-19 patients. JACC Clin Electrophysiol. 2020;6:1189–90. https://doi.org/10.1016/j.jacep.2020.05.015.CrossRefPubMedPubMedCentral

25.

Bhatla A, Mayer MM, Adusumalli S, et al. COVID-19 and cardiac arrhythmias. Heart Rhythm. 2020;17:1439–44. https://doi.org/10.1016/j.hrthm.2020.06.016.CrossRefPubMedPubMedCentral

26.

Peltzer B, Manocha KK, Ying X, et al. Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19. J Cardiovasc Electrophysiol. 2020;31:3077–85. https://doi.org/10.1111/jce.14770.CrossRefPubMed

27.

Kanjanahattakij N, Rattanawong P, Krishnamoorthy P, et al. New-onset atrial fibrillation is associated with increased mortality in critically ill patients: a systematic review and meta-analysis. Acta Cardiol. 2019;74:162–9. https://doi.org/10.1080/00015385.2018.1477035.CrossRefPubMed

28.

Saraiva RM, Pacheco NP, Pereira TOJS, et al. Left atrial structure and function predictors of new-onset atrial fibrillation in patients with chagas disease. J Am Soc Echocardiogr. 2020;33:1363-1374.e1. https://doi.org/10.1016/j.echo.2020.06.003.CrossRefPubMed

29.

Saraiva RM, Demirkol S, Buakhamsri A, et al. Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr. 2010;23:172–80. https://doi.org/10.1016/j.echo.2009.11.003.CrossRefPubMed

30.

Pessoa-Amorim G, Mancio J, Vouga L, et al. Impaired left atrial strain as a predictor of new-onset atrial fibrillation after aortic valve replacement independently of left atrial size. Rev Esp Cardiol. 2018;71:466–76. https://doi.org/10.1016/j.rec.2017.10.005.CrossRefPubMed

31.

Goerlich E, Minhas A, Gilotra N, et al. Left atrial function in patients with COVID-19 and its association with incident atrial fibrillation/flutter. J Am Soc Echocardiogr. 2021. https://doi.org/10.1016/j.echo.2021.05.015.CrossRefPubMedPubMedCentral

32.

Rosenberg MA, Manning WJ. Diastolic dysfunction and risk of atrial fibrillation: a mechanistic appraisal. Circulation. 2012;126:2353–62. https://doi.org/10.1161/CIRCULATIONAHA.112.113233.CrossRefPubMed

33.

Labbé V, Ederhy S, Lapidus N, et al. Transesophageal echocardiography for cardiovascular risk estimation in patients with sepsis and new-onset atrial fibrillation: a multicenter prospective pilot study. Ann Intensive Care. 2021;11:146. https://doi.org/10.1186/s13613-021-00934-1.CrossRefPubMedPubMedCentral

34.

Fan J-L, Su B, Zhao X, et al. Correlation of left atrial strain with left ventricular end-diastolic pressure in patients with normal left ventricular ejection fraction. Int J Cardiovasc Imaging. 2020;36:1659–66. https://doi.org/10.1007/s10554-020-01869-7.CrossRefPubMedPubMedCentral

35.

von Roeder M, Rommel K-P, Kowallick JT, et al. Influence of left atrial function on exercise capacity and left ventricular function in patients with heart failure and preserved ejection fraction. Circ Cardiovasc Imaging. 2017. https://doi.org/10.1161/CIRCIMAGING.116.005467.CrossRef

36.

Freaney PM, Shah SJ, Khan SS. COVID-19 and heart failure with preserved ejection fraction. JAMA. 2020;324:1499. https://doi.org/10.1001/jama.2020.17445.CrossRefPubMed

37.

Helms J, Combes A, Aissaoui N. Cardiac injury in COVID-19. Intensive Care Med. 2021. https://doi.org/10.1007/s00134-021-06555-3.CrossRefPubMedPubMedCentral

38.

Song L, Zhao S, Wang L, et al. Cardiovascular changes in patients with COVID-19 from Wuhan, China. Front Cardiovasc Med. 2020;7:150. https://doi.org/10.3389/fcvm.2020.00150.CrossRefPubMedPubMedCentral

39.

Caravita S, Baratto C, Di Marco F, et al. Haemodynamic characteristics of COVID-19 patients with acute respiratory distress syndrome requiring mechanical ventilation. An invasive assessment using right heart catheterization. Eur J Heart Fail. 2020;22:2228–37. https://doi.org/10.1002/ejhf.2058.CrossRefPubMed

40.

Voigt J-U, Mălăescu G-G, Haugaa K, Badano L. How to do LA strain. Eur Heart J Cardiovasc Imaging. 2020;21:715–7. https://doi.org/10.1093/ehjci/jeaa091.CrossRefPubMed

41.

Monnet X, Jabot J, Maizel J, et al. Norepinephrine increases cardiac preload and reduces preload dependency assessed by passive leg raising in septic shock patients. Crit Care Med. 2011;39:689–94. https://doi.org/10.1097/CCM.0b013e318206d2a3.CrossRefPubMed

42.

Voigt J-U, Cvijic M. 2- and 3-Dimensional myocardial strain in cardiac health and disease. JACC Cardiovasc Imaging. 2019;12:1849–63. https://doi.org/10.1016/j.jcmg.2019.01.044.CrossRefPubMed

Title: Automated left atrial strain analysis for predicting atrial fibrillation in severe COVID-19 pneumonia: a prospective study
Authors: Christophe Beyls
Alexis Hermida
Yohann Bohbot
Nicolas Martin
Christophe Viart
Solenne Boisgard
Camille Daumin
Pierre Huette
Hervé Dupont
Osama Abou-Arab
Yazine Mahjoub
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Transthoracic Echocardiography
Pneumonia
Atrial Fibrillation
COVID-19
Published in: Annals of Intensive Care / Issue 1/2021
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-021-00955-w

At a glance: The STEP trials

Springer Medicine

Automated left atrial strain analysis for predicting atrial fibrillation in severe COVID-19 pneumonia: a prospective study

Abstract

Background

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Results

Conclusion

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