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Speckle echocardiographic left atrial strain and stiffness index as predictors of maintenance of sinus rhythm after cardioversion for atrial fibrillation: a prospective study

Amir Y Shaikh1, Abhishek Maan1, Umar A Khan1, Gerard P Aurigemma2, Jeffrey C Hill3, Jennifer L Kane2, Dennis A Tighe2, Eric Mick4 and David D McManus25*

Author Affiliations

1 Department of Internal Medicine, University of Massachusetts Medical School, Worcester, USA

2 Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, USA

3 Sanford-Brown College of Boston, Boston, USA

4 Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, USA

5 Department of Medicine, Cardiology Division, Electrophysiology Section, University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA

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Cardiovascular Ultrasound 2012, 10:48  doi:10.1186/1476-7120-10-48

Published: 3 December 2012



Echocardiographic left atrial (LA) strain parameters have been associated with atrial fibrillation (AF) in prior studies. Our goal was to determine if strain measures [peak systolic longitudinal strain (LAS) and stiffness index (LASt)] changed after cardioversion (CV); and their relation to AF recurrence.

Methods and results

46 participants with persistent AF and 41 age-matched participants with no AF were recruited. LAS and LASt were measured before and immediately after CV using 2D speckle tracking imaging (2DSI). Maintenance of sinus rhythm was assessed over a 6-month follow up. Mean LAS was lower, and mean LASt higher, in participants with AF before CV as compared to control group (11.9 ± 1.0 vs 35.7 ± 1.7, p<0.01 and 1.31 ± 0.17 vs 0.23 ± 0.01, p<0.01, respectively). There was an increase in the mean LAS immediately after CV (11.9 ± 1.0 vs 15.9 ± 1.3, p<0.01), whereas mean LASt did not change significantly after CV (p=0.62). Although neither LAS nor LASt were independently associated with AF recurrence during the follow-up period, change in LAS after cardioversion (post-CV LAS – pre-CV LAS) was significantly higher among individuals who remained in sinus rhythm when compared to individuals with recurrent AF (3.6 ± 1.1 vs 0.4 ± 0.8, p=0.02).


LAS and LASt differed between participants with and without AF, irrespective of the rhythm at the time of echocardiographic assessment. Baseline LAS and LASt were not associated with AF recurrence. However, change in LAS after CV may be a useful predictor of recurrent arrhythmia.

Arrhythmia; Echocardiography; Strain; Stiffness