Comparative impact of persistent and paroxysmal atrial fibrillation on myocardial strain: a retrospective cohort study.

Background: Atrial fibrillation (AF) impairs cardiac structure and function, increasing adverse cardiovascular outcomes. Myocardial strain analysis provides a sensitive measure of myocardial deformation and has emerged as a valuable tool in detecting subclinical cardiac dysfunction. However, comparative data on myocardial strain between paroxysmal AF (PAF) and persistent AF (PsAF) remain limited. This study aimed to investigate the independent effects of different AF subtypes on myocardial strain.

Methods: We conducted a retrospective analysis of 128 non-valvular AF patients between January 2023 and January 2025. Patients were classified into PAF (n = 77) and PsAF (n = 51) groups based on preoperative 24-h Holter monitoring. Speckle-tracking echocardiography was used to assess myocardial strain. Multivariate linear regression models were constructed to evaluate the association between AF subtype and the global longitudinal peak strain average (GLPS_AVG). Subgroup analyses were conducted across age, gender, BMI, hypertension, hypertriglyceridemia and diabetes.

Results: Patients with PsAF exhibited significantly lower GLPS_AVG values compared to those with PAF (- 14.00 ± 3.24 vs. - 17.71 ± 3.07, P < 0.001). In multivariable-adjusted models, PsAF remained independently associated with reduced GLPS_AVG (Model III: β = 2.70, 95% CI 1.11 ~ 4.29, P < 0.001). Subgroup analysis confirmed that this association exists in every subgroups.

Conclusion: Persistent AF is associated with more severe impairment in myocardial strain compared to paroxysmal AF. These findings suggest that myocardial strain analysis may aid in early detection of AF-related cardiac dysfunction and support the need for timely intervention in patients with PsAF.