Objective:  Atrial cardiomyopathy (ACM) is associated with development of AF, LA thrombogenesis and stroke. Diagnosis of ACM is feasible using LA Strain Imaging. We sought to determine the LA global longitudinal strain (LA-GLS) thresholds (both during sinus rhythm (SR) and AF) that identify patients at risk for LA thrombogenesis.

Methods: One hundred and twenty-eight patients with history of AF were included. Based on 12-lead-ECG and TEE results, participants were divided into SR and AF groups and further into four cohorts: SR without LA-thrombus (n=73), SR with LA-thrombus (n=9), AF without LA-thrombus (n=29), AF with LA-thrombus (n=17). LA-GLS was measured using transthoracic echocardiography in each cohort and compared within each group. LA-GLS during AF was determined as the mean of six consecutive measurements in 2- and 4-chamber views. ROC analysis was performed for each rhythm to determine the LA-GLS threshold enabeling diagnosis of patients at risk for LA-thrombus.

Results: Significant differences in LA-GLS were found during both rhythms (SR and AF) between patients without versus with LA-thrombus: LA-GLS in SR: (24.6%+/-9.0%) vs (14.3%+/-7.4%), p=0.017 and in AF (15.8%+/-4.9%) vs (11.39%+/-4.2%), p=0.015. ROC analysis revealed a threshold of 19.1% and 14.8% as best LA-GLS discriminators of LA-thrombus during SR and AF, respectively (AUC (SR) 0.79, sensitivity: 77.8%, specificity: 67.1% and AUC (AF) 0.74, sensitivity: 76.5%, specificity: 53.6%; see figure A and B).

Conclusion: Echocardiographic LA-GLS is significantly related to the presence of LA thrombus and enables identifying patients at risk for thrombus both in SR and AF.