scholarly journals The loss of left atrial contractile function predicts worse outcome in HFrEF: a speckle tracking study

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
GE Mandoli ◽  
MC Pastore ◽  
G Benfari ◽  
M Setti ◽  
L Maritan ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Contractile Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Volume Index ◽  
Systolic Pulmonary Artery Pressure ◽  
Atrial Contraction

Abstract Funding Acknowledgements Type of funding sources: None. Background in chronic heart failure (HF), high cardiac pressure induces a progressive remodeling of small pulmonary arteries up to pulmonary hypertension development. At the end of left atrial (LA) conduit function, pulmonary and left heart end-systolic pressures equalize. This might affect LA systole. Purpose we investigated whether peak atrial contraction strain (PACS), measured by speckle tracking echocardiography (STE), was independently associated with outcome in HF with reduced ejection fraction(HFrEF). Methods 168 outpatients with HFrEF and sinus-rhythm referred to our echo-labs were prospectively enrolled. After clinical and echocardiographic evaluation, off-line STE analysis was performed. The endpoints were cardiovascular (CV) death and HF hospitalization respectively. Spline knotted survival model identified the optimal cut-off value for PACS. Results The 152 included patients were stratified based on PACS < 8%(n = 76) or PACS≥8%(n = 76). Mean age was 61 ± 12, mean EF was 30 ± 9%. Characteristics of the two groups are presented in Table 1. Over a mean follow-up of 3.41 ± 1.9 years, 117 events (51 CV death, 66 HF hospitalizations) were collected. By univariate and multivariate Cox analysis, global PACS emerged as a strong and independent predictor of CV death and HF hospitalization, even after adjusting for age, sex, LV strain, E/e’, LA volume index (HR 0.6 per 5 unit decrease in PACS). Kaplan Meier curves showed a sustained divergence in event-free survival rates for the two groups (Fig.1). Conclusions The reduction of PACS significantly and independently affects CV outcome in HFrEF. Although limited to patients with sinus rhythm, it could offer additive prognostic information for HFrEF patients. Table 1 Variable PACS < 8 PACS ≥ 8 P value Age 61.5± 11.4 61.8 ± 12.7 0.4 NYHA class >2 26% (n = 39) 11% (n = 17) <0.0001 NT pro BNP 2293.7 ± 1636 1335 ± 242 0.04 E/E’ ratio 16.1 ± 9.09 12.1 ± 7.09 0.0015 LV GLS -7.28 ± 3.4 -10.17 ± 3.2 <0.001 sPAP 40.5 ± 13.7 30.3 ± 9.3 <0.0001 LAVI 64.4 ± 20.4 45.5 ± 15.8 <0.0001 PALS 9.8 ± 4.9 20.2 ± 7 <0.0001 E, peak early diastolic “E” wave; E’, medium velocity of early mitral annulus descent; GLS, global longitudinal strain; LAVI, left atrial volume index; LV, left ventricular; PACS, peak atrial contraction strain; PALS, peak atrial longitudinal strain; sPAP, systolic pulmonary artery pressure. Abstract Figure. Fig.1

Early change in left atrial and left ventricular strain predicts sinus rhythm maintenance after cardioversion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kupczynska ◽  
D Miskowiec ◽  
B Michalski ◽  
L Szyda ◽  
K Wierzbowska-Drabik ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Recurrence Risk ◽  
Left Ventricular ◽  
Mechanical Function ◽  
Af Recurrence

Abstract Background Atrial fibrillation (AF) impairs mechanical function of the heart, especially atria and restoration of sinus rhythm (SR) leads to improvement of mechanics. The predicting role of changes in strain parameters for AF recurrence is not established yet. Purpose To analyse changes in left atrial (LA) and left ventricular (LV) mechanical function after conversion to SR and their prognostic values for AF recurrence during 24 months follow-up. Methods Prospective study involved 59 patients after successful electrical cardioversion (EC) because of nonvalvular AF (mean age 65±4 years, 47% female). Speckle tracking analysis (STE) was applied to calculate longitudinal strain of LV and LA before EC and within 24 hours after restoration of SR and additionally total left heart strain (TS) defined as a sum of absolute peak LV and LA strain. We calculated change in strain between AF and SR analyses expressed as delta (Δ). During follow-up we noticed AF recurrence in 42 (71%) patients, most of them (93%) during 1st year after EC. Median time of AF recurrence was 3 months. Results We noticed significant immediate post-EC improvement in peak LA longitudinal strain (PALS) and LV global longitudinal strain (LVGLS) (table). Unlike CHA2DS2-VASc score, strain parameters were predictors of AF recurrence. Every 1% increment in ΔLVGLS was related with 13% increase in AF recurrence risk (p=0.02) and every 1% increment in ΔPALS and ΔTS were related with 9% decrease in AF recurrence risk (p=0.007 and p=0.0014, respectively). Multivariate analysis revealed ΔTS as a strongest predictor with 9% decrease in AF risk per every 1% increment. The criterion of ΔTS ≤7.5% allows to predict AF recurrence with 81% sensitivity and 63% specificity. Conclusions Speckle tracking measurements are able to detect early mechanical changes in LA even within 24 hours of SR and these absolute changes in LVGLS as well as PALS can predict AF recurrence, with optimal stratification by novel parameter - TS. Funding Acknowledgement Type of funding source: None

scholarly journals Speckle tracking-derived left atrial stiffness predicts adverse events after successful electrical cardioversion

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Kupczynska ◽  
D Miskowiec ◽  
B Michalski ◽  
J D Kasprzak
Keyword(s):  
Sinus Rhythm ◽  
Median Time ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Electrical Cardioversion ◽  
Reservoir Function ◽  
Af Recurrence

Abstract Background Atrial fibrillation (AF) impairs cardiac mechanics and leads to adverse remodelling. Increased left atrial (LA) stiffness reflecting LA reservoir function and left ventricular (LV) filling pressure is one of the symptoms of LA remodelling. Purpose To analyse LA stiffness within 24 hours after successful electrical cardioversion and its prognostic value during 2-years follow-up. Methods Prospective study involved 71 patients with nonvalvular AF (mean age 64±13 years, 61% male). All patients underwent echo during 24 hours after conversion to sinus rhythm. We analysed standard echocardiographic and Doppler parameters. Using speckle-tracking method we assessed peak LA longitudinal strain in 4- and 2-chamber view. LA stiffness was calculated as the quotient of peak LA longitudinal strain (LA reservoir function) and mean E/E' ratio. The clinical endpoints were predefined as AF recurrence and cardiovascular hospitalization. Results Median time of current AF episode was 2 (IQR 0.4–5) months. Standard echo measurements revealed median of LV ejection fraction 55% (IQR 45–58) and median of LA volume indexed to body surface area 42 ml/m2 (IQR 34–51). During follow-up we noticed AF recurrence in 48 (68%) patients and cardiovascular hospitalization in 43 (61%) patients. Median time-to-event was 2.4 (IQR 1 to 6.9) and 7 (IQR 2.1–11) months, respectively. Receiver operating characteristic curve analysis revealed that LA stiffness >0.53 (AUC=0.821; p<0.0001) and >0.95 (AUC=0.788; p<0.0001) were the optimal cut-off values for predicting AF recurrence and cardiovascular hospitalization. Figure presents Kaplan-Meier survival analysis for AF recurrence (A) and for hospitalization (B). Moreover LA stiffness remain statistically significant in multivariate Cox regression analysis even after adjustment for betablockers, antiarrhythmic drugs, coronary artery disease, heart failure and mitral regurgitation. Relative risk was 1.51 (95% CI 1.09–2.09), p=0.01 for AF recurrence and 1.49 (95% CI 1.05–2.13) for cardiovascular hospitalization. Conclusions Speckle tracking-derived LA stiffness assessed early after the restoration of sinus rhythm independently predicts AF recurrence and cardiovascular hospitalization. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm

2021 ◽  
Author(s):  
Jae‐Hyeong Park ◽  
In‐Chang Hwang ◽  
Jin Joo Park ◽  
Jun‐Bean Park ◽  
Goo‐Yeong Cho
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Univariate Analysis ◽  
Global Longitudinal Strain ◽  
Significant Risk ◽  
Left Ventricular ◽  
Volume Index ◽  
Increased Risk

Background Stroke is a major comorbidity in patients with heart failure (HF), especially in those with decreased left atrial (LA) function, and thus, identifying patients highly at risk of stroke can prevent its occurrence. We evaluated the predictive value of global longitudinal strain of LA (LAGLS) in patients with acute HF and sinus rhythm. Methods and Results In this retrospective study, 2461 patients (53.3% men, 69.7±14.4 years old) with sinus rhythm and LAGLS among 4312 consecutive patients with acute HF from 3 tertiary hospitals were included. HF phenotypes were defined as HF with reduced ejection fraction (EF) (left ventricular EF ≤40%), HF with midrange EF (40% <left ventricular EF <50%), and HF with preserved ejection fraction (left ventricular EF ≥50%). Primary outcome was new‐onset stroke. The mean left ventricular EF was 39.4%±15.6%. Moreover, 1388 (57.5%), 342 (14.2%), and 682 (28.3%) were classified with HF with reduced EF, HF with midrange EF, and HF with preserved EF, retrospectively. LAGLS was 17.2%±10.4%. During the follow‐up duration (mean: 30.3±25.4 months), 100 patients experienced stroke. Patients with stroke had higher LA diameter ( P =0.031) and lower LAGLS ( P =0.010) than those without stroke. In the univariate analysis, age, diabetes mellitus, LA diameter, LA volume index, and LAGLS were significant risk factors for stroke. In the multivariate analysis, each 1% decrease in LAGLS was associated with a 3.8% increased risk for stroke (hazard ratio [HR], 1.038; 95% CI, 1.013–1.065; P =0.003). When applying a LAGLS cutoff point of 14.5%, patients with LAGLS <14.5% had approximately twice the risk for stroke after adjusting other significant variables (HR, 1.940; 95% CI, 1.269–2.965; P =0.002). Conclusions In patients with acute HF and sinus rhythm, decreased LAGLS (<14.5%) was associated with an increased risk for stroke, with an annual incidence of 2.38%.

scholarly journals Correlations between left ventricular and left atrial function assessed by speckle tracking echocardiography in patients with treated well-controlled arterial hypertension

2020 ◽  
Author(s):  
Beata Uziebło-Życzkowska ◽  
Paweł Krzesiński
Keyword(s):  
Arterial Hypertension ◽  
Diastolic Function ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Statistical Significance ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Diastolic Function

Abstract BackgroundEven in patients with well-controlled arterial hypertension (AH) and without significant comorbidities left ventricular (LV) and left atrial (LA) strain abnormalities may sometimes be found in speckle-tracking echocardiography. Therefore, the aim of this study was to investigate the correlation between LA strain and LV diastolic and systolic function in a group of patients with treated, well-controlled AH.Methods LA contractile, conduit, and reservoir function, together with echocardiographic signs of LV diastolic function and LV global longitudinal strain (LV GLS), were assessed in 101 patients with treated, well-controlled AH who met the standard criteria of normal LV ejection fraction (LVEF) and normal LV diastolic function.ResultA relevant percentage of study participants presented lower than reference LV and LA strain values. Moreover, there were statistically significant differences in LA longitudinal strain (LAS) values (LAS during reservoir phase—LASr (p<0.001) and LAS during conduit phase—LAScd (p = 0.008)) between patients with high and lower LV GLS, confirmed by significant correlations between LASr, LAScd, and GLS. In the correlations analysis between LAS values and LV diastolic function parameters, statistical significance was obtained for the following: LASct (contraction) vs. e’avg, LASct vs. E/A, LASct vs. A, LAScd vs. e’avg, LAScd vs. E/A, and LAScd vs. A. Conclusions LV and LA strain abnormalities occurred within a significant percentage of patients with treated, well-controlledAH. Impaired LA strain is associated with lower LV strain and reduced LV diastolic function parameters, reflecting both the passive and active properties of the LA.

P3431Machine learning applied to energy waveform ECG for prediction of subclinical myocardial dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Potter ◽  
Y Liu ◽  
S Teo ◽  
M Inouye ◽  
T H Marwick
Keyword(s):  
Machine Learning ◽  
At Risk ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Supervised Machine Learning ◽  
Volume Index ◽  
Elderly Subjects ◽  
Echocardiographic Evaluation

Abstract Background Energy waveform (ew) ECG used continuous wavelet transforms (CWT) to create time-frequency energy characterisations. Although ewECG changes reflect myocardial disease, the optimal measures for prediction of subclinical left ventricular dysfunction (sLVD) are unclear. Aim Using machine learning, we investigated whether ewECG could predict sLVD in community subjects at risk of heart failure (HF). Methods Asymptomatic community subjects aged ≥65 yrs. with ≥1 non-ischaemic risk factor for HF underwent clinical evaluation, MyoVista (HeartSciences, Southlake, TX) ewECG and echocardiographic evaluation. sLVD was defined as systolic (global longitudinal strain, GLS≤16%) or diastolic (E/e' ≥15, E/e'>10 with left atrial enlargement, or impaired relaxation with other changes). A gradient boosting algorithm (supervised machine learning) with regularisation was implemented to predict sLVD using 362 ewECG features. The performance was assessed by precision, recall, F measure, precision-recall (PR) curve and receiver operating characteristic (ROC) curve. Feature importance was inspected by information gain node splitting. Results Of 97 subjects (age 71 (68–73) yrs., 53% female) 56 (58%) had sLVD. For prediction of sLVD, ewECG showed areas under PR and ROC curves of 0.86 and 0.8 respectively. The feature of greatest importance, with twice the importance of the second was a CWT frequency related to depolarisation. Baseline characteristics Hypertension (%) 83 (86) Diabetes Mellitus (%) 34 (36) Atrial Fibrillation (%) 8 (8) BMI (IQR) 31 (27–34) LVMi (SD) 73 (23) Ejection fraction (SD) 60 (6) GLS (SD) 18 (3) E/e' (IQR) 8 (7–10) LAVi (IQR) 33 (28–40) IQR, Interquartile range; BMI, body mass index; LVMi, left ventricular mass index; GLS, global longitudinal strain; LAVi, left atrial volume index. Prediction model performance Conclusion ewECG shows good predictive performance for sLVD in elderly subjects at risk of HF. HF prevention strategies incorporating ewECG to select individuals for echocardiographic evaluation should be considered. Acknowledgement/Funding Baker Heart and Diabetes Institute

scholarly journals P1294Evaluation of right atrium mechanics and relation with loading conditions by speckle tracking echocardiographyP1295Late detection of left ventricular dysfunction using 2D and 3D speckle-tracking in patients with history of non-severe acute myocarditisP1296The impact of abnormal circadian BP profile on left atrial function by 2D speckle tracking echocardiography and its effect on functional capacity in hypertensive patientsP1297Right heart echocardiographic parameters alterations in asymptomatic breast cancer patients during chemotherapyP1299The Impact of myocardial deformation imaging for assessment of long-life prognosis in young patients with Kawasaki diseasesP1300Early detection of lv systolic dysfunction in asymptomatic patients with rheumatoid arthritis using global longitudinal strain assessmentP1301Cardiovascular risk assessment in haemodialysis patients with preserved left ventricular ejection fraction and left ventricular hypertrophyP1302Echocardiographic determinants of the functional capacity in systemic sclerosis: role of the right heartP1303 Speckle tracking echocardiography assessment of left atrial strain in hypertensive patientsP1304Comparison of global longitudinal strain in rheumatic mitral regurgitation and degenerative mitral regurgitation : does etiology affect?P1305Specific correlations between aortic stiffness and three-dimensional speckle-tracking echocardiography-derived segmental left ventricular strainsP1306Three-dimensional right ventricular strain analysis for the dependency of preload changes

2016 ◽  
Vol 17 (suppl 2) ◽  
pp. ii277-ii280
Author(s):  
S. Unlu ◽  
T. Caspar ◽  
T. Ahmed ◽  
M. Abdar Esfahani ◽  
R. Marinov ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Functional Capacity ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

scholarly journals Relationship between left atrial strain and left atrial bipolar voltage in patients undergoing catheter ablation for atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Takahashi ◽  
T Kitai ◽  
T Watanabe ◽  
T Fujita
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Low Voltage ◽  
Pulmonary Veins ◽  
Global Longitudinal Strain ◽  
Inferior Wall ◽  
Bipolar Voltage ◽  
Global Mean

Abstract Background Low-voltage zone (LVZ) in the left atrium (LA) seems to represent fibrosis. LA longitudinal strain assessed by speckle tracking method is known to correlate with the extent of fibrosis in patients with mitral valve disease. Purpose We sought to identify the relationship between LA longitudinal strain and LA bipolar voltage in patients with atrial fibrillation (AF). We tested the hypothesis that LA strain can predict LA bipolar voltage. Methods A total of 96 consecutive patients undergoing initial AF ablation were analyzed. All patients underwent transthoracic echocardiography including 2D speckle tracking measurement on the day before ablation during sinus rhythm (SR group, N=54) or during AF (AF group, N=42). LA longitudinal strain was measured at basal, mid, and roof level of septal, lateral, anterior, and inferior wall in apical 4- and 2-chamber view. Global longitudinal strain (GLS) was defined as an average value of the 12 segments. LA voltage map was created using EnSite system, and global mean voltage was defined as a mean of bipolar voltage of the whole LA excluding pulmonary veins and left atrial appendage. LVZ was defined as less than 1.0 mV. Results There was a significantly positive correlation between GLS and global mean voltage (r=0.708, p&lt;0.001). Multivariate regression analysis showed that GLS and age were independent predictors of global mean voltage. There was a significant negative correlation between global mean voltage and LVZ areas. Conclusions There was a strong correlation between LA longitudinal strain and LA mean voltage. GLS can independently predict LA mean voltage, subsequently LVZ areas in patients with AF. Funding Acknowledgement Type of funding source: None

scholarly journals Direct comparison of multilayer left ventricular global longitudinal strain using CMR feature tracking and speckle tracking echocardiography

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saikrishna Ananthapadmanabhan ◽  
Giau Vo ◽  
Tuan Nguyen ◽  
Hany Dimitri ◽  
James Otton
Keyword(s):  
Feature Tracking ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Imaging Modality ◽  
Global Longitudinal Strain ◽  
Intraclass Correlation ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Multilayer Strain

Abstract Background Cardiac magnetic resonance feature tracking (CMR-FT) and speckle tracking echocardiography (STE) are well-established strain imaging modalities. Multilayer strain measurement permits independent assessment of endocardial and epicardial strain. This novel and layer specific approach to evaluating myocardial deformation parameters may provide greater insight into cardiac contractility when compared to whole-layer strain analysis. The aim of this study is to validate CMR-FT as a tool for multilayer strain analysis by providing a direct comparison between multilayer global longitudinal strain (GLS) values between CMR-FT and STE. Methods We studied 100 patients who had an acute myocardial infarction (AMI), who underwent CMR imaging and echocardiogram at baseline and follow-up (48 ± 13 days). Dedicated tissue tracking software was used to analyse single- and multi-layer GLS values for CMR-FT and STE. Results Correlation coefficients for CMR-FT and STE were 0.685, 0.687, and 0.660 for endocardial, epicardial, and whole-layer GLS respectively (all p < 0.001). Bland Altman analysis showed good inter-modality agreement with minimal bias. The absolute limits of agreement in our study were 6.4, 5.9, and 5.5 for endocardial, whole-layer, and epicardial GLS respectively. Absolute biases were 1.79, 0.80, and 0.98 respectively. Intraclass correlation coefficient (ICC) values showed moderate agreement with values of 0.626, 0.632, and 0.671 respectively (all p < 0.001). Conclusion There is good inter-modality agreement between CMR-FT and STE for whole-layer, endocardial, and epicardial GLS, and although values should not be used interchangeably our study demonstrates that CMR-FT is a viable imaging modality for multilayer strain

Impact of rhythm in non-valvular atrial fibrillation on four cardiac chamber deformation imaging

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Philabout ◽  
L Soulat-Dufour ◽  
I Benhamou-Tarallo ◽  
S Lang ◽  
S Ederhy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Cardiac Rhythm ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Chamber ◽  
Deformation Imaging ◽  
And Function

Abstract Background Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome. Purpose To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6). Methods In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7) Results In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p&lt;0.001), lower global RA reservoir strain (+8.6 (−5.4 to 11.6) versus +24.3 (+12.3 to +44.9)%; p&lt;0.001), lower global LV longitudinal strain (respectively −12.8 (−15.2 to −10.4) versus −19.1 (−21.8 to −18.3)%; p&lt;0.001) and lower global RV longitudinal strain (respectively −14.2 (−17.3 to −10.7) versus −23.8 (−31.1 to −16.2)%; p=0.001). When compared with the AF-SR group at M0 the AF-AF group had no significant differences with regard to global LA and RA reservoir strain, global LV and RV longitudinal strain (Table). Between M0 and M6 there was a significant improvement in global longitudinal strain of the four chambers in the AF-SR group whereas no improvements were noted in the AF-AF and SR-SR group (Figure). Conclusion Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm. Evolution of strain between M0 and M6 Funding Acknowledgement Type of funding source: None

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