The application value of two-dimensional speckle tracking imaging technology in evaluating the functions of the left atrium and left atrial appendage in patients with non-valvular atrial fibrillation: A comparative cross-sectional study

Atrial fibrillation (AF) is associated with increased risk of stroke due to left atrial appendage (LAA) thrombus formation. Two-dimensional speckle tracking imaging (2D-STI) may provide valuable insights into left atrial and LAA functional changes associated with thrombus formation. This study aimed to evaluate the functions of the left atrium (LA) and LAA in patients with non-valvular AF by using 2D-STI and explore echocardiographic parameters associated with the presence of LAA thrombus. In this comparative cross-sectional study, consecutive patients with non-valvular AF who were scheduled for radiofrequency ablation were screened. Finally, 68 eligible AF patients and 30 age-matched healthy controls were included. All AF patients underwent preoperative transthoracic echocardiography, transesophageal echocardiography, and two-dimensional speckle tracking imaging, and were classified according to the presence or absence of LAA thrombus detected by transesophageal echocardiography into the thrombus group (n = 32) and the non-thrombus group (n = 36). The healthy controls were included as a reference group for comparison of echocardiographic parameters. The left atrial appendage emptying velocity (LAAEV), left atrial global longitudinal strain (LAGLS), and LAA global longitudinal strain (LAAGLS) were measured and compared between groups. Compared with the control group, AF patients showed significantly reduced LAAEV, LAGLS, and left atrial appendage global longitudinal strain (all P < .05). In AF patients, the thrombus group had significantly lower LAAEV, LAGLS, and left atrial appendage global longitudinal strain compared to the non-thrombus group (all P < .05). Multivariable logistic regression analysis showed that LAAEV and left atrial strain during reservoir phase were significantly associated with the presence of LAA thrombus. 2D-STI can quantitatively evaluate the functional changes of the LA and LAA. LAAEV and left atrial strain during reservoir phase may serve as useful echocardiographic markers for assisting clinical evaluation of LAA thrombus.