Noninvasive assessment of left atrial fibrosis. Correlation between echocardiography, biomarkers, and electroanatomical mapping

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 35; no. 9; pp. 1326 - 1334
• Main Authors: Pilichowska‐Paszkiet, Ewa, Baran, Jakub, Sygitowicz, Grażyna, Sikorska, Agnieszka, Stec, Sebastian, Kułakowski, Piotr, Zaborska, Beata
• Format: Journal Article
• Language: English
• Published: United States 01.09.2018
• Subjects: atrial fibrillation; Atrial Fibrillation - blood; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - pathology; Biomarkers - blood; Echocardiography - methods; Female; Fibrosis; Heart Atria - diagnostic imaging; Heart Atria - pathology; Humans; left atrium; Male; Matrix Metalloproteinase 9 - blood; Middle Aged; Peptide Fragments - blood; Procollagen - blood; Prospective Studies; strain; Transforming Growth Factor beta1 - blood; strain; left atrium; atrial fibrillation
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/echo.14043

Aim Left atrial (LA) fibrosis promotes atrial fibrillation (AF), may predict poor radiofrequency catheter ablation (RFCA) outcome, and may be assessed invasively using electroanatomical mapping (EAM). Speckle tracking echocardiography (STE) enables quantitative assessment of LA function. The aim was to assess the relationship between LA fibrosis derived from EAM and LA echocardiographic parameters as well as biomarkers of fibrosis in patients with AF. Methods Sixty‐six patients (64% males, mean age 56 ± 10) with nonvalvular AF treated with first RFCA were prospectively studied. Seventy‐three percent of patients were in sinus rhythm at the time of examination. LA geometry, systolic, and diastolic function were assessed. In STE global, peak atrial longitudinal (PALS) and contractile (PACS) strain were calculated. LA stiffness index (LAs) — the ratio of E/e′ to PALS — was assessed. The EAM of LA was build using Carto System before RFCA. Low amplitude potentials area (LAPA) was quantitatively analyzed and expressed as a percentage of LA surface using the cut‐off <0.5 mV to detect potential sites of fibrosis. The serum concentrations of MMP‐9, PIIINP, and TGFβ1were estimated before RFCA. Results Pearson correlation analysis showed a significant correlation between LA diastolic function parameters: PALS (−0.54, P < .001), LAs (0.65, P < .001), and LAPA in patients who were in sinus rhythm. Also LA volume significantly correlated with LAPA (0.44, P < .002). None of biomarkers correlated with LAPA. Conclusion Left atrial diastolic parameters derived from STE correlate well with the extent of LA fibrosis. Thus, STE may be useful in the noninvasive assessment of LA fibrosis and selection of candidates for RFCA.