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Utilizing Left Atrial Strain to Identify Patients at Risk for Atrial Fibrillation on Ibrutinib
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  • Arushi Singh,
  • Nadia El Hangouche,
  • Katherine McGee,
  • Fei Fei Gong,
  • Robert Lentz,
  • Joseph Feinglass,
  • Nausheen Akhter
Arushi Singh
Northwestern University Feinberg School of Medicine
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Nadia El Hangouche
Northwestern University Feinberg School of Medicine
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Katherine McGee
Northwestern University Feinberg School of Medicine
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Fei Fei Gong
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Robert Lentz
University of Colorado Denver - Anschutz Medical Campus
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Joseph Feinglass
Northwestern University Feinberg School of Medicine
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Nausheen Akhter
Bluhm Cardiovascular Institute of Northwestern
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Background: Ibrutinib is associated with atrial fibrillation (AF), though echocardiographic predictors of AF have not been studied in this population. We sought to determine whether left atrial (LA) strain on transthoracic echocardiography could identify patients at risk for developing ibrutinib-related atrial fibrillation (IRAF). Methods: We performed a retrospective review of 66 patients who had an echocardiogram prior to ibrutinib treatment. LA strain was measured with TOMTEC Imaging Systems, obtaining peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) on 4-chamber and 2-chamber views. Statistical analysis was performed with Chi-square analysis, T-test, or binomial regression analysis, with a p-value < 0.05 considered statistically significant. Results: Twenty-two patients developed IRAF (33%). Age at initiation of ibrutinib was significantly associated with IRAF (65.1 years vs. 74.1 years, p = 0.002). Mean ibrutinib dose was lower among patients who developed IRAF (388.2 ± 121.7 vs. 448.6 ± 88.4, p = 0.025). E/e’ was significantly higher among patients who developed IRAF (11.5 vs. 9.3, p = 0.04). PALS was significantly lower in patients who developed AF (30.3% vs. 36.3%, p = 0.01). On multivariate regression analysis, age, PALS and PACS were significantly associated with IRAF. On multivariate regression analysis, only PACS remained significantly associated with IRAF while accounting for age. Conclusions: Age, ibrutinib dose, E/e’, and PALS on pre-treatment echocardiogram were significantly associated with development of IRAF. On multivariate regression analyses, age, PALS and PACS remained significantly associated with IRAF. Impaired LA mechanics add to the assessment of patients at risk for IRAF

Peer review status:Published

21 Aug 2020Submitted to Echocardiography
24 Aug 2020Submission Checks Completed
24 Aug 2020Assigned to Editor
25 Aug 2020Reviewer(s) Assigned
05 Oct 2020Review(s) Completed, Editorial Evaluation Pending
06 Oct 2020Editorial Decision: Revise Major
16 Oct 20201st Revision Received
20 Oct 2020Assigned to Editor
20 Oct 2020Submission Checks Completed
Mar 2020Published in Journal of the American College of Cardiology volume 75 issue 11 on pages 1779. 10.1016/S0735-1097(20)32406-2