Assessment of left-atrial strain parameters in patients with frequent ventricular ectopic beats without structural heart disease

  • Ahmet Barutçu
  • Emine Gazi
  • Ahmet Temiz
  • Adem Bekler
  • Burak Altun
  • Bahadır Kırılmaz
  • Uğur Küçük
Original Paper


Ventricular ectopic beats (VEBs) are often encountered in daily clinical practice. Clinical significance of VEBs seen in patients without structural cardiovascular diseases is controversial. We aimed to investigate the effects of VEBs on left atrium (LA) function using speckle tracking echocardiography with LA strain parameters. Patients with frequent VEBs (more than 30 times in 1 h, according to the Lown classification) were identified. Identified patients were evaluated by speckle tracking methods. There were 40 patients with frequent VEBs and 40 controls in our study. The general characteristics were similar of the study population. The LA global longitudinal strain parameters were significantly different. Global Peak atrial longitudinal strain (PALS) (38.39 ± 7.93 vs. 44.15 ± 6.71, p = 0.001) and peak atrial contraction strain (PACS) (16.37 ± 4.58 vs. 20.49 ± 3.65, p = 0.000) were revealed significantly lower in the VEBs group. Time to peak longitudinal strain (TPLS) was found significantly longer in the VEBs group [485.5 (352–641) vs. 435 (339–516.5) p = 0.000]. Number of VEBS was correlated with TPLS (r = 0.499, p = 0.000). PALS and PACS were negatively correlated with number of VEBs (r = −0.348, p = 0.002 and r = −0.444, p = 0.000, respectively). We described that in this study, The LA functions are affected by VEBs adversely. This deterioration is increasing as the number of VEBs.


Left atrium Speckle tracking Ventricular ectopic beat 


Conflict of interest



  1. 1.
    Ataklte F, Erqou S, Laukkanen J, Kaptoge S (2013) Meta-analysis of ventricular premature complexes and their relation to cardiac mortality in general populations. J Interv Card Electrophysiol 38(3):179–185CrossRefGoogle Scholar
  2. 2.
    Ng GA (2006) Treating patients with ventricular with ventricular ectopic beats. Heart 92:1707–1712PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Cameli M (2012) Novel echocardiographic techniques to assess left atrial size, anatomy and function. Cardiovasc Ultrasound 10:4PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Tsai WC, Lee CH, Lin CC, Liu YW, Huang YY, Li WT, Chen JY, Lin LJ (2009) Association of left atrial strain and strain rate assessed by speckle tracking echocardiography with paroxysmal atrial fibrillation. Echocardiography 26(10):1188–1194PubMedCrossRefGoogle Scholar
  5. 5.
    Sitges M, Teijeira VA, Scalise A, Vidal B, Tamborero D, Collvinent B, Rivera S, Molina I, Azqueta M, Paré C, Brugada J, Mont L (2007) Is there an anatomical substrate for idiopathic paroxysmal atrial fibrillation? A case–control echocardiographic study. Europace 9(5):294–298PubMedCrossRefGoogle Scholar
  6. 6.
    Vianna-Pinton R, Moreno CA, Baxter CM, Lee KS, Tsang TS, Appleton CP (2009) Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects. J Am Soc Echocardiogr 22(3):299–305PubMedCrossRefGoogle Scholar
  7. 7.
    Nakao F, Wasaki Y, Kimura M, Iwami T, Iida H, Wakeyama T, Miura T, Ogawa H, Matsuzaki M (2001) Evaluation of left atrial function by the functional volume change curve derived from Doppler flow spectra. Jpn Circ J 65:953–957PubMedCrossRefGoogle Scholar
  8. 8.
    Marino P, Faggian G, Bertolini P, Mazzucco A, Little W (2004) Early mitral deceleration and left atrial stiffness. Am J Physiol Heart Circ Physiol 287:1172–1178CrossRefGoogle Scholar
  9. 9.
    Pérez-Paredes M, Gonzálvez M, Ruiz Ros JA, Giménez DM, Carnero A, Carrillo A, Cubero T, Martínez-Corbalán FR, García Almagro F (2004) Assessment of left atrial wall velocities by pulsed wave tissue Doppler ımaging. A new approach to the study of atrial function. Rev Esp Cardiol 57:1059–1066CrossRefGoogle Scholar
  10. 10.
    Di Salvo G, Caso P, Piccolo RL, Fusco A, Martiniello AR, Russo MG, D’Onofrio A, Severino S, Calabró P, Pacileo G, Mininni N, Calabró R (2005) Atrial myocardial deformation properties predict maintenance of sinus rhythm after external cardioversion of recent-onset lone atrial fibrillation: a color Doppler myocardial imaging and transthoracic and transesophageal echocardiographic study. Circulation 112:387–395PubMedCrossRefGoogle Scholar
  11. 11.
    Wang Z, Tan H, Zhong M, Jiang G, Zhang Y, Zhang W (2008) Strain rate imaging for noninvasive functional quantification of the left atrium in hypertensive patients with paroxysmal atrial fibrillation. Cardiology 109(1):15–24PubMedCrossRefGoogle Scholar
  12. 12.
    Cameli M, Lisi M, Focardi M, Reccia R, Natali BM, Sparla S, Mondillo S (2012) Left atrial deformation analysis by speckle tracking echocardiography for prediction of cardiovascular outcomes. Am J Cardiol 110:264–269PubMedCrossRefGoogle Scholar
  13. 13.
    Niwano S, Wakisaka Y, Niwano H, Fukaya H, Kurokawa S, Kiryu M, Hatakeyama Y, Izumi T (2009) Prognostic significance of frequent premature ventricular contractions originating from the ventricular outflow tract in patients with normal left ventricular function. Heart 95:1230–1237PubMedCrossRefGoogle Scholar
  14. 14.
    Vijgen J, Hill P, Biblo LA, Carlson MD (1997) Tachycardia-induced cardiomyopathy secondary to right ventricular outflow tract ventricular tachycardia: improvement of left ventricular systolic function after radiofrequency catheter ablation of the arrhythmia. J Cardiovasc Electrophysiol 8:445–450PubMedCrossRefGoogle Scholar
  15. 15.
    Chugh SS, Shen WK, Luria DM, Smith HC (2000) First evidence of premature ventricular complex-induced cardiomyopathy: a potentially reversible cause of heart failure. J Cardiovasc Electrophysiol 11:328–329PubMedCrossRefGoogle Scholar
  16. 16.
    Grimm W, Menz V, Hoffmann J, Maisch B (2001) Reversal of tachycardia induced cardiomyopathy following ablation of repetitive monomorphic right ventricular outflow tract tachycardia. Pacing Clin Electrophysiol 24:166–171PubMedCrossRefGoogle Scholar
  17. 17.
    Shiraishi H, Ishibashi K, Urao N, Tsukamoto M, Hyogo M, Keira N, Hirasaki S (2002) A case of cardiomyopathy induced by premature ventricular complexes. Circ J 66:1065–1067PubMedCrossRefGoogle Scholar
  18. 18.
    Kennedy HL, Whitlock JA, Sprague MK, Kennedy LJ, Buckingham TA, Goldberg RJ (1985) Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N Engl J Med 312:193–197PubMedCrossRefGoogle Scholar
  19. 19.
    Gaita F, Giustetto C, Di Donnna P, Richiardi E, Libero L, Brusin MC, Molinari G, Trevi G (2001) Long-tern follow-up of right ventricular monomorphic extrasystoles. J Am Coll Cardiol 38:364–370PubMedCrossRefGoogle Scholar
  20. 20.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Chamber quantification writing group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography: Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463Google Scholar
  21. 21.
    Sirbu C, Herbots L, D’hooge J, Claus P, Marciniak A, Langeland T, Bijnens B, Rademakers FE, Sutherland GR (2006) Feasibility of strain and strain rate imaging for the assessment of regional left atrial deformation: a study in normal subjects. Eur J Echocardiogr 7:199–208PubMedCrossRefGoogle Scholar
  22. 22.
    Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M, Marino E, Galderisi M (2009) Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound 7:6PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Cameli M, Lisi M, Righini FM, Massoni A, Natali BM, Focardi M, Tacchini D, Tacchini D, Geyer A, Curci V, Di Tommaso C, Lisi G, Maccherini M, Chiavarelli M, Massetti M, Tanganelli P, Mondillo S (2013) Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol 111:595PubMedCrossRefGoogle Scholar
  24. 24.
    Azemi T, Rabdiya VM, Ayirala SR, McCullough LD, Silverman DI (2012) Left atrial strain is reduced in patients with atrial fibrillation, stroke or TIA, and low risk CHADS(2) scores. J Am Soc Echocardiogr 25:1327–1332PubMedCrossRefGoogle Scholar
  25. 25.
    Grant C, Brunnel IL, Greene DG (1964) The reservoir function of the LA during ventricular systole: an echocardiographic study of atrial stroke volume and work. Am J Med 37:36–43Google Scholar
  26. 26.
    Mondillo S, Cameli M, Caputo ML, Lisi M, Palmerini E, Padeletti M, Ballo P (2011) Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr 24:898–908PubMedCrossRefGoogle Scholar
  27. 27.
    Cameli M, Lisi M, Giacomin E, Caputo M, Navarri R, Malandrino A, Ballo P, Agricola E, Mondillo S (2011) Chronic mitral regurgitation: left atrial deformation analysis by two-dimensional speckle tracking echocardiography. Echocardiography 28:327–334PubMedCrossRefGoogle Scholar
  28. 28.
    Antoni ML, Ten Brinke EA, Marsan NA, Atary JZ, Holman ER, van der Wall EE, Schalij MJ, Bax JJ, Delgado V (2011) Comprehensive assessment of changes in left atrial volumes and function after ST-segment elevation acute myocardial infarction: role of two-dimensional speckle tracking strain imaging. J Am Soc Echocardiogr 5:1126–1133CrossRefGoogle Scholar
  29. 29.
    Hirose T, Kawasaki M, Tanaka R, Ono K, Watanabe T, Iwama M, Noda T, Watanabe S, Takemura G, Minatoguchi S (2012) Left atrial function assessed by speckle tracking echocardiography as a predictor of new onset non-valvular atrial fibrillation: results from a prospective study in 580 adults. Eur J Echocardiogr 13:243–250Google Scholar
  30. 30.
    Cameli M, Lisi M, Righini FM, Focardi M, Alfieri O, Mondillo S (2012) Left atrial speckle tracking analysis in patients with mitral insufficiency and history of paroxysmal atrial fibrillation. Int J Cardiovasc Imaging 28:1663–1670PubMedCrossRefGoogle Scholar
  31. 31.
    Selvaraj RJ (2013) Premature ventricular complexes and left atrial appendage dysfunction—another head on a many-headed Hydra? Indian Pacing Electrophysiol J 13(4):134–135PubMedCentralPubMedGoogle Scholar
  32. 32.
    Eichhorn EJ, Willard JE, Alvarez L, Kim AS, Glamann DB, Risser RC, Grayburn PA (1992) Are contraction and relaxation coupled in patients with and without congestive heart failure? Circulation 85:2132–2139PubMedCrossRefGoogle Scholar
  33. 33.
    Takemoto M, Yoshimura H, Ohba Y, Matsumoto Y, Yamamoto U, Mohri M, Yamamoto H, Origuchi H (2005) Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease. J Am Coll Cardiol 45:1259–1265PubMedCrossRefGoogle Scholar
  34. 34.
    Yarlagadda RK, Iwai S, Stein KM, Markowitz SM, Shah BK, Cheung JW, Tan V, Lerman BB, Mittal S (2005) Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricularoutflow tract. Circulation 112:1092–1097PubMedCrossRefGoogle Scholar
  35. 35.
    Goyal R, Harvey M, Daoud EG, Brinkman K, Knight BP, Bahu M, Weiss R, Bogun F, Man KC, Strickberger SA, Morady F (1996) Effect of coupling interval and pacing cyclelength on morphology of paced ventricular complexes. Implications for pace mapping. Circulation 94:2843–2849PubMedCrossRefGoogle Scholar
  36. 36.
    Kennedy HI, Pescarmona JE, Bouchard RJ, Goldberg RJ, Caralis DG (1982) Objective evidence of occult myocardial dysfunction in patients with frequent ventricular ectopy without clinically apparent heart disease. Am Heart J 104:57–65PubMedCrossRefGoogle Scholar
  37. 37.
    Hoffman BF, Bartelstone HJ, Scherlag BJ, Cranefield PF (1965) Effects of postextrasystolic potentiation on normal and failing hearts. Bull NY Acad Med 41:498–534Google Scholar
  38. 38.
    Akkaya M, Roukoz H, Adabag S, Benditt DG, Anand I, Li JM, Zakharova M, Tholakanahalli V (2013) Improvement of left ventricular diastolic function and left atrial reverse remodeling after catheter ablation of premature ventricular complexes. J Interv Card Electrophysiol 38:179–185PubMedCrossRefGoogle Scholar
  39. 39.
    Kim YH, Park SM, Lim HE, Pak HN, Kim YH, Shim WJ (2010) Chronic frequent premature ventricular complexes originating from right and non-right ventricular outflow tracts. Int Heart J 51:388–393PubMedCrossRefGoogle Scholar
  40. 40.
    Rienstra M, Van Gelder IC (2006) Left atrial volume predicts cardiovascular events in patients originally diagnosed with lone atrial fibrillation: three-decade follow-up. Eur Heart J 27:756PubMedCrossRefGoogle Scholar
  41. 41.
    Saha SK, Anderson PL, Caracciolo G, Kiotsekoglou A, Wilansky S, Govind S, Mori N, Sengupta PP (2011) Global left atrial strain correlates with CHADS2 risk score in patients with atrial fibrillation. J Am Soc Echocardiogr 24(5):506–512PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Ahmet Barutçu
    • 1
  • Emine Gazi
    • 1
  • Ahmet Temiz
    • 1
  • Adem Bekler
    • 1
  • Burak Altun
    • 1
  • Bahadır Kırılmaz
    • 1
  • Uğur Küçük
    • 1
  1. 1.Faculty of MedicineÇanakkale Onsekiz Mart UniversityÇanakkaleTurkey

Personalised recommendations