Int J Cardiovasc Imaging. 2025 Jul 5. doi: 10.1007/s10554-025-03458-y. Online ahead of print.
ABSTRACT
New-onset atrial fibrillation (AF) affects up to 21% of ST-segment elevation myocardial infarction (STEMI) patients. The value of LA reservoir strain to predict new-onset AF in a STEMI population has not been thoroughly investigated. We aimed to explore the incremental value of LA reservoir strain for predicting new-onset AF post-STEMI. Data were analyzed retrospectively from an ongoing STEMI registry. LA reservoir strain < 23% on transthoracic echocardiography was used as threshold for impaired LA function. The endpoint was new-onset AF. In total, 1238 patients (age 60 ± 12 years, 75% male) were included. After a median follow-up of 23 months, 92 (7.4%) patients developed new-onset AF. A similar prevalence of LA volume index ≥ 34 ml/m2 was seen between post-STEMI patients who developed new-onset AF and those who did not. In contrast, impaired LA reservoir strain was 1.5 times more common in individuals who developed AF (72% versus 48%; p < 0.001). Cumulative, event-free survival rates at five years in patients with preserved versus impaired LA reservoir strain were 93% versus 84%, respectively (log-rank χ2 = 19.81; p < 0.001). On multivariate Cox regression analysis LA reservoir strain remained significantly associated with new-onset AF (HR 0.97 (95% CI: 0.94-0.99); p = 0.025). Addition of LA reservoir strain provided incremental prognostic value over baseline clinical and echocardiographic risk markers (χ2 56.93 vs. 59.98; p = 0.013). Impaired LA reservoir strain was 1.5 times more common in patients who experienced new-onset AF post-STEMI, and was of incremental value for predicting the development of AF after adjusting for clinical and echocardiographic risk factors.
PMID:40615694 | DOI:10.1007/s10554-025-03458-y