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Left Atrial Structure and Function Predictors of New-Onset Atrial Fibrillation in Patients with Chagas Disease

2020; Elsevier BV; Volume: 33; Issue: 11 Linguagem: Inglês

10.1016/j.echo.2020.06.003

1097-6795

Roberto Magalhães Saraiva, Nicole P. Pacheco, Thayanne O.J.S. Pereira, Andréa Rodrigues da Costa, Marcelo Teixeira de Holanda, Luiz Henrique Conde Sangenis, Fernanda S. N. S. Mendes, Andréa Silvestre de Sousa, Alejandro Marcel Hasslocher‐Moreno, Sérgio Salles Xavier, Mauro Felippe Felix Mediano, Henrique Horta Veloso,

Trypanosoma species research and implications

Highlights•The authors evaluated predictors of new-onset AF in Chagas disease.•AF occurred in 11% of patients during a mean follow-up period of 5.6 years.•Almost half of patients were asymptomatic at the time of diagnosis.•LA function was an independent predictor of new-onset AF.•Total LA emptying fraction was the best predictor of AF among LA function parameters.AbstractBackgroundAtrial fibrillation (AF) carries ominous consequences in patients with Chagas disease. The aim of this study was to determine whether left atrial (LA) volume and function assessed using three-dimensional echocardiographic (3DE) imaging and two-dimensional speckle-tracking echocardiographic deformation analysis of strain (ε) could predict new-onset AF in patients with Chagas disease.MethodsA total of 392 adult patients with chronic Chagas disease (59% women; mean age, 53 ± 11 years) who underwent echocardiography were consecutively enrolled in this prospective longitudinal study. Echocardiographic evaluation included two-dimensional (2D) Doppler echocardiography, with evaluation of left ventricular systolic and diastolic function, LA size, and LA and left ventricular function on 3DE and ε analyses. Multivariate Cox proportional-hazards regression analysis models adjusting for age, sex, hypertension, presence of a pacemaker, and 2D Doppler echocardiographic parameters were used to test if the variables of interest had independent prognostic value for AF prediction.ResultsPatients with Chagas disease were followed for 5.6 ± 2.7 years. Among these, 139 (35.5%) had the indeterminate form, 224 (57.1%) had the cardiac form, five (1.3%) had the digestive form, and 24 (6.1%) had the cardiodigestive form. The study end point of AF occurred in 45 patients. Total LA emptying fraction (hazard ratio, 0.93; 95% CI, 0.89–0.98; P = .002), passive LA emptying fraction (HR, 0.95; 95% CI, 0.91–0.99; P = .02), and peak negative global LA ε (HR, 1.22; 95% CI, 1.05–1.41; P = .01) were predictors of new-onset AF independent of clinical and 2D Doppler echocardiographic parameters.ConclusionsLA function assessed on 3DE and ε analyses predicts new-onset AF in patients with Chagas disease independent of clinical and 2D Doppler echocardiographic indexes.Graphical abstractLA function evaluated on 3DE imaging or speckle-tracking echocardiography, but not LA volume, is an independent predictor of new-onset AF in patients with Chagas disease. The reservoir component of LA function measured on 3DE imaging (total LA emptying fraction < 51.8%) can identify a population at high risk for AF as depicted by the cumulative survival curves.