Comparative analysis of left and right atrial myocardial deformation indices in adult patients with congenital septal defects

Abstract

Aim. To compare myocardial deformation indicators between the left (LA) and right atria (RA) using speckle tracking echocardiography in adult patients with septal defects and to identify parameters associated with the atrial fibrillation (AF). Materials and methods. A prospective study conducted from 2022 to 2025 included 120 patients with congenital heart disease and left-to-right blood shunting (mean age 51.0±13.1 years). The congenital heart defects in the cohort included atrial septal defect in 82.5% (n=99), partial anomalous pulmonary vein drainage with atrial septal defect in 11.7% (n=14), and partial atrioventricular canal in 5.8% (n=7); in all cases, a significant arteriovenous shunt was observed. Paroxysmal AF was diagnosed in 29.8% of patients. Results. Notable RA dilation was observed with indexed RA volume of 49.9±18 mL/m2, while the indexed LA volume was borderline at 32.6±12.4 mL/m2, showing a significant difference between the two (p0.001). Additionally, deformation parameters during the contraction phase also differed significantly (p0.002). Moderate to strong correlations were established between the volumetric and deformation parameters of both chambers. The independent predictors of AF, identified through multivariate analysis, included the left atrial volume index (LAVI) (odds ratio 1.098, 95% confidence interval 1.029–1.171; p=0.005) and the estimated right ventricular systolic pressure (eRVSP) (odds ratio 1.080, 95% confidence interval 1.004–1.163; p=0.040). Conclusion. Morphofunctional changes associated with septal defects are characteristic of both RA and LA. LAVI and eRVSP are independent predictors of AF development, highlighting the importance of a comprehensive assessment of both the right and left heart chambers.