Echocardiographic predictors of atrial fibrillation after mitral valve replacement

Objectives

Detection of the echocardiographic predictors of post-operative atrial fibrillation in patients with rheumatic mitral valve disease undergoing mitral valve replacement.

Methods

The study included 50 patients with rheumatic mitral valve disease undergoing mitral valve replacement. Preoperative assessment included standard two-dimensional echocardiography to assess LA diameter, volume, and emptying fraction, LV volume and ejection fraction. TDI derived velocity, strain of the left atrium and speckle tracking to assess left ventricular function then postoperative follow up for 1 month for occurrence of atrial fibrillation.

Results

The incidence of postoperative AF was 44%; these patients were significantly older (P = 0.001) and show higher prevalence of DM (P = 0.001) and HTN (P = 0.001). Also, LA diameters (antero-posterior, transverse and longitudinal) and LA volumes (maximal and minimal) were increased (P < 0.001), but no difference in LA emptying fraction (P > 0.05). Systolic LA strain and left ventricular global longitudinal strain were significantly reduced in those patients (P value <0.001). Echocardiographic predictors of AF were LA systolic strain (P value <0.001) and LV global longitudinal strain (P value = 0.003). Cutoff value for systolic LA strain ≤23 had sensitivity 90.91% and specificity 93.33% in predicting POAF. While, left ventricular global longitudinal strain ≤?14.9% had sensitivity 63.6% and specificity 100.0% in predicting AF.

Conclusion

LA systolic strain and LV global longitudinal strain were significant predictors of POAF. Echocardiographic parameters can identify patients at greater risk of developing POAF who can benefit from preventive measure and guide the selection of prosthesis.