Armin Osmanagic1, Sören Möller2, Azra Osmanagic3, Hussam M Sheta1, Kristina H Vinther1, Kenneth Egstrup1. 1. Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark. 2. Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark. 3. Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
Abstract
BACKGROUND: Attempts to achieve rhythm control using direct-current cardioversion (DCC) are common in those with persistent atrial fibrillation (AF). Although often successful, AF recurs within 1 month in as many as 57% of patients. The aim of this study was to assess whether a baseline left atrial sphericity index (LASI) acquired by 2-dimensional transthoracic echocardiography (TTE) could be used as a predictor of AF recurrence after successful DCC. HYPOTHESIS: A baselline LASI assessed by 2D TTE can predict AF recurrence after successful DCC in patients with persistent AF. METHODS: A total of 124 consecutive patients with persistent AF lasting <120 days underwent successful DCC. Other than β-blockers, no other antiarrhythmic treatment was administered. Prior to DCC, all patients underwent thorough TTE, and LASI was calculated as the fraction of the left atrial width/length of the largest possible left atrial volume in a 4-chamber view. The primary outcome was a TTE-estimated baseline LASI as a predictor of AF recurrence after successful DCC for persistent AF. RESULTS: Anatomically, a more spherical shape of the left atrium (LASI >0.9) proved to be a strong and independent predictor of AF recurrence, with an odds ratio between 4.1 (95% confidence interval: 1.6-11.9, P = 0.005) and 7.6 (95% confidence interval: 3.3-19.7; P = 7.2 × 10(-6) ). The receiver operating characteristic curve indicated good power for distinguishing between recurring and nonrecurring AF, and we chose a cutoff of 0.9 because high specificity was a priority for clinical reasons. CONCLUSIONS: In conclusion, baseline LASI >0.9 was associated with significantly greater AF recurrence throughout the 12-month follow-up period.
BACKGROUND: Attempts to achieve rhythm control using direct-current cardioversion (DCC) are common in those with persistent atrial fibrillation (AF). Although often successful, AF recurs within 1 month in as many as 57% of patients. The aim of this study was to assess whether a baseline left atrial sphericity index (LASI) acquired by 2-dimensional transthoracic echocardiography (TTE) could be used as a predictor of AF recurrence after successful DCC. HYPOTHESIS: A baselline LASI assessed by 2D TTE can predict AF recurrence after successful DCC in patients with persistent AF. METHODS: A total of 124 consecutive patients with persistent AF lasting <120 days underwent successful DCC. Other than β-blockers, no other antiarrhythmic treatment was administered. Prior to DCC, all patients underwent thorough TTE, and LASI was calculated as the fraction of the left atrial width/length of the largest possible left atrial volume in a 4-chamber view. The primary outcome was a TTE-estimated baseline LASI as a predictor of AF recurrence after successful DCC for persistent AF. RESULTS: Anatomically, a more spherical shape of the left atrium (LASI >0.9) proved to be a strong and independent predictor of AF recurrence, with an odds ratio between 4.1 (95% confidence interval: 1.6-11.9, P = 0.005) and 7.6 (95% confidence interval: 3.3-19.7; P = 7.2 × 10(-6) ). The receiver operating characteristic curve indicated good power for distinguishing between recurring and nonrecurring AF, and we chose a cutoff of 0.9 because high specificity was a priority for clinical reasons. CONCLUSIONS: In conclusion, baseline LASI >0.9 was associated with significantly greater AF recurrence throughout the 12-month follow-up period.
Authors: Jouni K Kuusisto; Pauli A K Pöyhönen; Jani Pirinen; Lauri J Lehmonen; Heli P Räty; Nicolas Martinez-Majander; Jukka Putaala; Juha Sinisalo; Vesa Järvinen Journal: BMC Med Imaging Date: 2021-11-09 Impact factor: 1.930