{
  "abstract": "Introduction Atrial fibrillation (AF) represents a significant healthcare issue globally. Whilst direct oral anticoagulation has helped, somewhat, to address the associated stroke risk, symptoms secondary to AF, AF related cardiomyopathy and embolic stroke in the context of silent AF, remain unaddressed burdens. It is recognised that early intervention in AF offers the most benefit, both with respect to rhythm control, and to the benefit of risk factor modification. This is particularly important for at risk patients such as those who have had an embolic stroke of undetermined source, or those with hypertrophic cardiomyopathy. As such, identifying useful predictors of AF remains an essential component of the future management of AF.Purpose The assessment of left atrial strain, including left atrial reservoir strain (LARS - figure 1), has become more accessible with vendors creating automated approaches, facilitating quick and easy assessment of the different left atrial strain parameters. LARS is affected by both electrical and anatomical changes in the left atrium, and thus it’s not surprising that it has been shown to be associated with the development of AF. The aim of this work was to systematically review published literature assessing left atrial reservoir strain as a predictor of future AF.Abstract 6-005 Figure 1Figure 1 shows the approach to calculation of the left atrial reservoir strain in the apical 4 chamber view. The left atrium was manually contoured and split into segments, with the software creating strain curves for each segment. The QRS complex was used to determine the start point of the strain curves. The individual strain curves were averaged (dashed white line), and the 3 phases of atrial contraction (reservoir, conduit, contractile) were identified and used to measure the relevant strain values.Methods The electronic databases PubMed, Embase, Google Scholar, Scopus and Web of Science were systematically searched using the key words ‘atrial strain’ and ‘atrial fibrillation’ from inception to April 2024. An initial titular analysis, followed by abstract and full text screening was performed. Data was extracted using a pre-specified collection form. A random-effects model with generic inverse variance weights was utilised to pool the most adjusted effect measure from each study.Results After excluding duplicate studies, 1564 studies were screened, with 252 full-texts being assessed for eligibility. A total of 25 studies were identified that associated percentage change in LARS and subsequent AF, and were pooled for meta-analysis.In the pooled studies a total of 10913 patients were included with 1488 cases of incident stroke. The meta-analysis of the studies suggested that a 1% increase in left atrial strain associated with a pooled odds ratio of 0.92 (95% CI 1.06–1.22) for incident AF (figure 2). This implies that impaired left atrial reservoir function is associated with a higher incidence of AF. Sensitivity analysis by removing one study at each time did not significantly alter the results.Abstract 6-005 Figure 2Forest plot showing the association between 1% increase in left atrial reservoir strain and incident AF across the pooled studiesConclusion This comprehensive meta-analysis including 10913 patients from 25 studies, emphasises the association between changes in LARS and future AF. With LARS steadily becoming a ubiquitous echo parameter in standard transthoracic echocardiography datasets, further work on how temporal changes in LARS influences AF onset, may allow for the creation of AF screening programmes. This would be of particular benefit to patients at risk of future AF, and may allow for the targeting of aggressive risk modification programmes.",
  "authors": [
    {
      "affiliations": [
        "Cardiovascular Clinical Research, University of East Anglia"
      ],
      "name": "R Chattopadhyay"
    },
    {
      "affiliations": [
        "Department of Cardiology, Addenbrookes Hospital, Cambridge"
      ],
      "name": "A Elawady"
    },
    {
      "affiliations": [
        "Department of Cardiology, Addenbrookes Hospital, Cambridge"
      ],
      "name": "M Thakur"
    },
    {
      "affiliations": [
        "Cardiovascular Clinical Research, University of East Anglia"
      ],
      "name": "G Matthews"
    },
    {
      "affiliations": [
        "Department of Cardiology, Addenbrookes Hospital, Cambridge"
      ],
      "name": "P Pugh"
    },
    {
      "affiliations": [
        "Cardiovascular Clinical Research, University of East Anglia"
      ],
      "name": "V Vassiliou"
    }
  ],
  "title": "6-005 A meta-analysis on left atrial reservoir strain as a predictor of AF",
  "uid": "5d64bfe7-7e0f-5183-9c55-83752f8ff406"
}