{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:07:39Z","timestamp":1787069259584,"version":"build-2736575974"},"reference-count":22,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T00:00:00Z","timestamp":1728432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Moscow Center for Innovative Technologies in Healthcare","award":["2002-25\/23"],"award-info":[{"award-number":["2002-25\/23"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Aims. To identify the difference between adult patients with septal defects and paroxysmal atrial fibrillation (AF) and patients without a history of arrhythmia using the left atrial (LA) volume and function parameters, to reveal the parameters associated with AF development. Methods and results. In this prospective study, 81 patients with septal defects and left-to-right shunts were enrolled between 2021 and 2023 and divided into two groups: with paroxysmal AF and without AF. Left atrial function was analyzed based on the indexed left atrial volumes (LAVI and preA-LAVI), ejection fraction (LAEF), expansion index (LAEI), reservoir (LAS-r), conduit (LAS-cd) and contractile (LAS-ct) strain, and stiffness index (LASI) using a Philips CVx3D ultrasound system (Philips, Amsterdam, The Netherlands) and corresponding software. In total, 26 patients with paroxysmal atrial fibrillation (mean age: 59.6 \u00b1 11.7 years, female: 80.8%) and 55 patients with septal defects without any history of arrhythmias (mean age: 44.8 \u00b1 11.6 years, female: 81.8%) were included. All patients were in the NYHA class I or II at baseline. Our findings demonstrated a significant difference between all LA function parameters in the two groups. Upon univariable analysis, the LAVI, preA-LAVI, LASI, LAEF, LAEI, LAS-r, LAS-c, LAS-ct, age, cardiac index, E\/A, and RV pressure were found to be associated with AF. The multivariate analysis identified LAVI (OR 1.236, 95% CI 1.022\u20131.494, p = 0.03), LAS-r (OR 0.723, 95% CI 0.556\u20130.940, p = 0.02), and LAS-ct (OR 1.518, 95% CI 1.225\u20131.880, p &lt; 0.001) as independent predictors of AF development. The proposed model demonstrated high sensitivity and specificity with an adjusted classification threshold of 0.38 (AUC: 0.97, 95% CI 0.93\u20131.00, sensitivity 92% and specificity 92%, p &lt; 0.001). Conclusions. The assessment of LA function using speckle-tracking echocardiography demonstrated significantly different values in the AF group among patients with congenital septal defects. This technique can therefore be implemented in routine clinical management. The key message. Atrial fibrillation development in adult patients with congenital septal defects and a left-to-right shunt is associated with the changes in left atrial function under conditions of an increased preload.<\/jats:p>","DOI":"10.3390\/jcm13196023","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T12:22:48Z","timestamp":1728476568000},"page":"6023","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Left Atrial Structural and Functional Changes in Adults with Congenital Septal Defects and Paroxysmal Atrial Fibrillation"],"prefix":"10.3390","volume":"13","author":[{"given":"Anton V.","family":"Minaev","sequence":"first","affiliation":[{"name":"A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, 121552 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina Yu.","family":"Mironenko","sequence":"additional","affiliation":[{"name":"A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, 121552 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera I.","family":"Dontsova","sequence":"additional","affiliation":[{"name":"A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, 121552 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulia D.","family":"Pirushkina","sequence":"additional","affiliation":[{"name":"A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, 121552 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bektur Sh.","family":"Berdibekov","sequence":"additional","affiliation":[{"name":"A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, 121552 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander S.","family":"Voynov","sequence":"additional","affiliation":[{"name":"Outpatient Clinic #67 of the Moscow Department of Healthcare, 127083 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia A.","family":"Sarkisyan","sequence":"additional","affiliation":[{"name":"Outpatient Clinic #195 of the Moscow Department of Healthcare, 127083 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena Z.","family":"Golukhova","sequence":"additional","affiliation":[{"name":"A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, 121552 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e43","DOI":"10.3346\/jkms.2021.36.e43","article-title":"Impact of Atrial Fibrillation on Survival in Adults with Congenital Heart Disease: A Retrospective Population-based Study","volume":"36","author":"Jang","year":"2021","journal-title":"J. Korean Med. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"550","DOI":"10.21037\/cdt-20-634","article-title":"Therapy of supraventricular and ventricular arrhythmias in adults with congenital heart disease-narrative review","volume":"11","author":"Wasmer","year":"2021","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1038\/s41440-020-00551-8","article-title":"Left atrial stiffness index as a marker of early target organ damage in hypertension","volume":"44","author":"Zhao","year":"2021","journal-title":"Hypertens. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"oeac023","DOI":"10.1093\/ehjopen\/oeac023","article-title":"Prognostic value of left atrial strain in patients with congenital aortic stenosis","volume":"2","author":"Mutluer","year":"2022","journal-title":"Eur. Heart J. Open."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Jia, F., Chen, A., Zhang, D., Fang, L., and Chen, W. (2022). Prognostic Value of Left Atrial Strain in Heart Failure: A Systematic Review and Meta-Analysis. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.935103"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.jcmg.2020.07.040","article-title":"Prediction of AF in Heart Failure With Preserved Ejection Fraction: Incremental Value of Left Atrial Strain","volume":"14","author":"Marwick","year":"2021","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1536\/ihj.19-173","article-title":"Influence of Percutaneous Occlusion of Atrial Septal Defect on Left Atrial Function Evaluated Using 2D Speckle Tracking Echocardiography","volume":"61","author":"Suzuki","year":"2020","journal-title":"Int. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"123","DOI":"10.4250\/jcvi.2020.0142","article-title":"Long-Term Left Atrial Function after Device Closure and Surgical Closure in Adult Patients with Atrial Septal Defect","volume":"29","author":"Seo","year":"2021","journal-title":"J. Cardiovasc. Imaging"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1111\/echo.15421","article-title":"Cardiac remodeling after atrial septal defects device closure","volume":"39","author":"Saedi","year":"2022","journal-title":"Echocardiography"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1016\/j.ultrasmedbio.2018.02.015","article-title":"Bi-Atrial Function before and after Percutaneous Closure of Atrial Septum in Patients with and without Paroxysmal Atrial Fibrillation: A 2-D and 3-D Speckle Tracking Echocardiographic Study","volume":"44","author":"Vitarelli","year":"2018","journal-title":"Ultrasound Med. Biol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e001298","DOI":"10.1136\/openhrt-2020-001298","article-title":"Atrial fibrillation in patients with an atrial septal defect in a single centre cohort during a long clinical follow-up: Its association with closure and outcome of therapy","volume":"7","author":"Evertz","year":"2020","journal-title":"Open Heart"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.1007\/s10554-021-02163-w","article-title":"Importance of left atrial mechanical function as a predictor of atrial fibrillation risk following cardiac surgery","volume":"37","author":"Darweesh","year":"2021","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1136\/hrt.2006.099366","article-title":"Left atrial Frank-Starling law assessed by real-time, three-dimensional echocardiographic left atrial volume changes","volume":"93","author":"Anwar","year":"2007","journal-title":"Heart"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"825","DOI":"10.21037\/qims-22-307","article-title":"Right atrial volumes and strains in healthy adults: Is the Frank-Starling mechanism working?-detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study","volume":"13","author":"Nemes","year":"2023","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.echo.2016.09.007","article-title":"Normal Ranges of Left Atrial Strain by Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis","volume":"30","author":"Pathan","year":"2017","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.jcmg.2019.12.008","article-title":"LA Mechanics in Decompensated Heart Failure","volume":"13","author":"Deferm","year":"2020","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.echo.2018.08.012","article-title":"Left Atrial Function Predicts Cardiovascular Events in Patients With Chronic Heart Failure With Reduced Ejection Fraction","volume":"32","author":"Malagoli","year":"2018","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1016\/S0735-1097(19)32137-0","article-title":"Peak left atrial strain in reservoir phase predicts cardiac events in patients with heart failure with preserved ejection fraction","volume":"73","author":"Bolog","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ikejder, Y., Sebbani, M., Hendy, I., Khramz, M., Khatouri, A., and Bendriss, L. (2020). Impact of Arterial Hypertension on Left Atrial Size and Function. Biomed. Res. Int., 2020.","DOI":"10.1155\/2020\/2587530"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1111\/jch.13066","article-title":"The relationship between nighttime hypertension and left atrial function","volume":"19","author":"Tadic","year":"2017","journal-title":"J. Clin. Hypertens."},{"key":"ref_22","first-page":"59","article-title":"Anatomical and functional remodeling of the left atrium in patients with paroxysmal and persistent atrial fibrillation after cryoballoon isolation of pulmonary vein orifices","volume":"18","author":"Avanesyan","year":"2024","journal-title":"Creat. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/19\/6023\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:10:05Z","timestamp":1760112605000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/19\/6023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,9]]},"references-count":22,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["jcm13196023"],"URL":"https:\/\/doi.org\/10.3390\/jcm13196023","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,9]]}}}