Left Atrial Mechanical Function And Stiffness In Patients With Premature Ventricular Contraction: A Speckle Tracking Study

Aim. Ventricular extrasystole (PVC) is characterized by premature ventricular depolarization and is associated with increased risk of arrhythmias and structural heart disease. This study aimed to investigate the association between the PVC burden and left atrial (LA) function in individuals without known cardiac disease.
Material and methods. A cross-sectional study was conducted on 102 patients with PVCs who were admitted to a cardiology clinic. Transthoracic echocardiography was used to assess left ventricle (LV) parameters, including LV mass, LV ejection fraction (LVEF), LV global longitudinal strain (LVGLS), and LA function was evaluated using strain imaging. The PVC burden was categorized into three groups: <10 %, 10–20 %, and >20 %.
Results. Changes in LV dimensions and LV mass index were associated with the groups with the PVC burden with 10–20 %, and >20 %. but differences in LVEF and LVGSL were not significant. Mean E / e’ increased as the PVC burden increased (p<0.001). The mean global LA peak strain decreased as the PVC burden increased (p<0.001), while other mean LA measurements increased as the PVC burden increased (p<0.001) A higher PVC burden was associated with impaired LA function, as indicated by decreased global LA peak strain (PVC burden <10 %=38.1±3.2 vs. PVC burden 10–20 %=32.4±3.2 vs. PVC burden >20 %=27.7±2.6, in all groups p<0.001) and with increased LA stiffness (PVC burden <10 %=18.6±3.2 vs. PVC burden 10–20 %=27.5±5.5 vs. PVC burden >20 %=39.0±7.9, in all groups p<0.001). A strong negative correlation was found between global LA peak strain and LA stiffness (r=–0.779, p<0.001).
Conclusion. In individuals without known cardiac disease, a higher PVC burden was associated with impaired LA function, indicated by increased E / e’, decreased LA strain, and increased LA stiffness. These findings suggest that PVC burden may contribute to LA dysfunction, potentially increasing the risk of cardiovascular events.

1.

2. Lee A, Walters TE, Gerstenfeld EP, Haqqani HM. Frequent Ventricular Ectopy: Implications and Outcomes. Heart, Lung and Circulation. 2019;28(1):178–90. DOI: 10.1016/j.hlc.2018.09.009

3. Simpson RJ, Cascio WE, Schreiner PJ, Crow RS, Rautaharju PM, Heiss G. Prevalence of premature ventricular contractions in a population of African American and white men and women: The Atherosclerosis Risk in Communities (ARIC) study. American Heart Journal. 2002;143(3):535–40. DOI: 10.1067/mhj.2002.120298

4. Ephrem G, Levine M, Friedmann P, Schweitzer P. The Prognostic Significance of Frequency and Morphology of Premature Ventricular Complexes during Ambulatory Holter Monitoring: Prognostic Significance of Multiform PVCs. Annals of Noninvasive Electrocardiology. 2013;18(2):118–25. DOI: 10.1111/anec.12010

5. Winkens RAG, Höppener PF, Kragten JA, Verburg MP, Crebolder HFJM. Are premature ventricular contractions always harmless? European Journal of General Practice. 2014;20(2):134–8. DOI: 10.3109/13814788.2013.859243

6. Delgado V, Ypenburg C, Van Bommel RJ, Tops LF, Mollema SA, Marsan NA et al. Assessment of Left Ventricular Dyssynchrony by Speckle Tracking Strain Imaging. Journal of the American College of Cardiology. 2008;51(20):1944–52. DOI: 10.1016/j. jacc.2008.02.040

7. Niwano S, Wakisaka Y, Niwano H, Fukaya H, Kurokawa S, Kiryu M et al. Prognostic significance of frequent premature ventricular contractions originating from the ventricular outflow tract in patients with normal left ventricular function. Heart. 2009;95(15):1230–7. DOI: 10.1136/hrt.2008.159558

8. Kanei Y, Friedman M, Ogawa N, Hanon S, Lam P, Schweitzer P. Frequent Premature Ventricular Complexes Originating from the Right Ventricular Outflow Tract Are Associated with Left Ventricular Dysfunction: RVOT PVCs and LV Dysfunction. Annals of Noninvasive Electrocardiology. 2008;13(1):81–5. DOI: 10.1111/j.1542-474X.2007.00204.x

9. Barutçu A, Gazi E, Temiz A, Bekler A, Altun B, Kırılmaz B et al. Assessment of left-atrial strain parameters in patients with frequent ventricular ectopic beats without structural heart disease. The International Journal of Cardiovascular Imaging. 2014;30(6):1027–36. DOI: 10.1007/s10554-014-0423-y

10. Dandel M, Lehmkuhl H, Knosalla C, Suramelashvili N, Hetzer R. Strain and Strain Rate Imaging by Echocardiography - Basic Concepts and Clinical Applicability. Current Cardiology Reviews. 2009;5(2):133–48. DOI: 10.2174/157340309788166642

11. Park Y, Kim S, Shin J, Oh AR, Shin EJ, Lee JH et al. Frequent Premature Ventricular Complex Is Associated with Left Atrial Enlargement in Patients with Normal Left Ventricular Ejection Fraction. Pacing and Clinical Electrophysiology. 2014;37(11):1455–61. DOI: 10.1111/pace.12447

12. Ribeiro WN, Yamada AT, Grupi CJ, Silva GTD, Mansur AJ. Premature atrial and ventricular complexes in outpatients referred from a primary care facility. PLOS ONE. 2018;13(9):e0204246. DOI: 10.1371/journal.pone.0204246

13. Voigt J-U, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/ Industry Task Force to standardize deformation imaging. European Heart Journal - Cardiovascular Imaging. 2015;16(1):1–11. DOI: 10.1093/ehjci/jeu184

14. Lang R, Bierig M, Devereux R, Flachskampf F, Foster E, Pellikka P et al. Recommendations for chamber quantification. European Journal of Echocardiography. 2006;7(2):79–108. DOI: 10.1016/j.euje.2005.12.014

15. Sugimoto T, Dulgheru R, Bernard A, Ilardi F, Contu L, Addetia K et al. Echocardiographic reference ranges for normal left ventricular 2D strain: results from the EACVI NORRE study. European Heart Journal - Cardiovascular Imaging. 2017;18(8):833–40. DOI: 10.1093/ehjci/jex140

16. Katritsis DG, Siontis GCM, Camm AJ. Prognostic Significance of Ambulatory ECG Monitoring for Ventricular Arrhythmias. Progress in Cardiovascular Diseases. 2013;56(2):133–42. DOI: 10.1016/j.pcad.2013.07.005

17. Sheldon SH, Gard JJ, Asirvatham SJ. Premature Ventricular Contractions and Non-sustained Ventricular Tachycardia: Association with Sudden Cardiac Death, Risk Stratification, and Management Strategies. Indian Pacing and Electrophysiology Journal. 2010;10(8):357– 71. PMID: 20811538

18. Cha Y-M, Lee GK, Klarich KW, Grogan M. Premature Ventricular Contraction-Induced Cardiomyopathy: A Treatable Condition. Circulation: Arrhythmia and Electrophysiology. 2012;5(1):229–36. DOI: 10.1161/CIRCEP.111.963348

19. Barutcu A, Bekler A, Temiz A, Kirilmaz B, Gazi E, Altun B et al. Assessment of the effects of frequent ventricular extrasystoles on the left ventricle using speckle tracking echocardiography in apparently normal hearts. The Anatolian Journal of Cardiology. 2016;16(1):48–54. DOI: 10.5152/akd.2015.6166

20. Bogun F, Crawford T, Reich S, Koelling TM, Armstrong W, Good E et al. Radiofrequency ablation of frequent, idiopathic premature ventricular complexes: Comparison with a control group without intervention. Heart Rhythm. 2007;4(7):863–7. DOI: 10.1016/j.hrthm.2007.03.003

21. Tabata T, Grimm RA, Bauer FJ, Fukamachi K, Takagaki M, Ochiai Y et al. Giant Flow Reversal in Pulmonary Venous Flow as a Possible Mechanism for Asynchronous Pacing-induced Heart Failure. Journal of the American Society of Echocardiography. 2005;18(7):722–8. DOI: 10.1016/j.echo.2004.12.013

22. Huizar JF, Kaszala K, Potfay J, Minisi AJ, Lesnefsky EJ, Abbate A et al. Left Ventricular Systolic Dysfunction Induced by Ventricular Ectopy: A Novel Model for Premature Ventricular Contraction-Induced Cardiomyopathy. Circulation: Arrhythmia and Electrophysiology. 2011;4(4):543–9. DOI: 10.1161/CIRCEP.111.962381

23. Akoum NW, Daccarett M, Wasmund SL, Hamdan MH. An Animal Model for Ectopy-Induced Cardiomyopathy. Pacing and Clinical Electrophysiology. 2011;34(3):291–5. DOI: 10.1111/j.1540-8159.2010.02947.x

24. Leitman M, Lysyansky P, Sidenko S, Shir V, Peleg E, Binenbaum M et al. Two-dimensional strain–a novel software for real-time quantitative echocardiographic assessment of myocardial function. Journal of the American Society of Echocardiography. 2004;17(10):1021–9. DOI: 10.1016/j.echo.2004.06.019

25. Akkaya M, Roukoz H, Adabag S, Benditt DG, Anand I, Li JM et al. Improvement of left ventricular diastolic function and left atrial reverse remodeling after catheter ablation of premature ventricular complexes. Journal of Interventional Cardiac Electrophysiology. 2013;38(3):179–85. DOI: 10.1007/s10840-013-9836-0

26. Cozma D, Streian CG, Petrescu L, Mornos C. Subclinical left atrium remodelling in patients with frequent premature ventricular contractions. Kardiologia Polska. 2014;72(11):1141–7. DOI: 10.5603/KP.a2014.0133

27. Yoon YE, Kim H-J, Kim S-A, Kim SH, Park J-H, Park K-H et al. Left Atrial Mechanical Function and Stiffness in Patients with Paroxysmal Atrial Fibrillation. Journal of Cardiovascular Ultrasound. 2012;20(3):140–5. DOI: 10.4250/jcu.2012.20.3.140

28. Kurt M, Wang J, Torre-Amione G, Nagueh SF. Left Atrial Function in Diastolic Heart Failure. Circulation: Cardiovascular Imaging. 2009;2(1):10–5. DOI: 10.1161/CIRCIMAGING.108.813071