Reduced left atrial strain in magnetic resonance imaging is associated with abnormal P-waves in patients after acute myocardial infarction. (8th February 2021) - Wester, M
Abstract: Funding Acknowledgements: Type of funding sources: Public hospital(s). Main funding source(s): ReForM-B-Program Background: Abnormal P-wave terminal force in lead V1 (PTFV1) is associated with atrial remodeling. The relationship between PTFV1 and atrial function after acute myocardial injury is insufficiently understood and may be elucidated by detailed feature tracking (FT) strain analysis of cardiac magnetic resonance images (CMR). Purpose: We investigated the relationship between PTFV1 and left atrial (LA) strain (measured by CMR) in a patient cohort presenting with acute myocardial infarction (MI). Methods: 56 patients with acute MI underwent CMR within 3-5 days after MI. PTFV1 was measured as the product of negative P-wave amplitude and duration in lead V1 (Fig. A). A PTFV1 >4000 ms*µV was defined as abnormal. CMR cine data were retrospectively analyzed using a dedicated FT software. LA strain (ε) and strain rate (SR) for atrial reservoir ([εs]; [SRs]), conduit ([εe]; [SRe]) and booster function ([εa]; [SRa]) were measured in two long-axis views (Fig. A). Results: Patients with abnormal PTFV1 had significantly reduced LA conduit function εe and SRe (Fig. B + D). There was a significant negative correlation between the extent of PTFV1 and both εe and SRe (Fig. C + E). In univariate and multivariate regression models, both PTFV1 and age predicted atrial conduit function. In contrast, multiple clinical co-factors had no significant influence on εe (Table). Interestingly, linear regression models revealed only mild dependency of PTFV1 on conventional parameters of cardiac function such as left ventricular ejection fraction (p = 0.059; R²(adj.)=0.047), and no dependency on structural parameters such as LA area (p = 0.639; R²(adj.)=0.016), or LA fractional area change (p = 0.825; R²(adj.)=0.020). Conclusion: Abnormal PTFV1 was associated with reduced LA function independent from numerous clinical co-factors in patients presenting with acute myocardial infarction.