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Van't Hof JR, Parikh R, Moser ED, Inciardi RM, Matsushita K, Soliman EZ, Alonso A, Shah AM, Solomon SD, Lutsey PL, Chen LY. Association of Cumulative Systolic Blood Pressure With Left Atrial Function in the Setting of Normal Left Atrial Size: The Atherosclerosis Risk in Communities (ARIC) Study. J Am Soc Echocardiogr 2024; 37:884-893. [PMID: 38740273 PMCID: PMC11377167 DOI: 10.1016/j.echo.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Lower left atrial (LA) function is associated with increased risk for cardiovascular disease events; data on risk factors for impaired LA function are limited. We evaluated the effect of cumulative systolic blood pressure (cSBP) from midlife to older age on LA strain in adults with normal LA size. METHODS We included participants in the Atherosclerosis Risk in Communities study with LA strain measured on the visit 5 echocardiogram (2011-13), excluding those with atrial fibrillation and LA volume index >34 mL/m2. The cSBP was calculated from visit 1 (1987-89) through visit 5. Linear regression models were used to evaluate associations between cSBP and LA strain measures. RESULTS A total of 3,859 participants with a mean (SD) age of 75.2 (5.0) years were included in the analysis; 725 (18.8%) were Black and 2,342 (60.7%) were women. After adjusting for demographics, cardiovascular disease risk factors, heart failure, and coronary heart disease, each 10 mm Hg increase in cSBP was associated with 0.32% (95% CI, -0.52%, -0.13%) and 0.37% (95% CI, -0.51%, -0.22%) absolute reduction in LA reservoir and conduit strain, respectively. Associations were attenuated after adjustment for left ventricular (LV) systolic and diastolic function and mass (-0.12%: 95% CI, -0.31, 0.06 for reservoir strain; and -0.24%: 95% CI -0.38%, -0.10% for conduit strain). In subgroup analyses, the association of cSBP with conduit strain was statistically significant among those with normal LV systolic and diastolic function. CONCLUSIONS Cumulative exposure to elevated blood pressure from midlife to late life was modestly associated with lower LA reservoir and conduit strain in older adults with normal LA size, mostly related to the effect of blood pressure on LV function and mass. However, the association of cSBP and LA conduit strain in subgroups with normal LV function suggests that LA remodeling in response to hypertension occurs before LV dysfunction is detected on echocardiography.
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Affiliation(s)
- Jeremy R Van't Hof
- Cardiovascular Division and Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis Minnesota.
| | - Romil Parikh
- Cardiovascular Division and Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis Minnesota; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Ethan D Moser
- Cardiovascular Division and Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis Minnesota; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Riccardo M Inciardi
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elsayed Z Soliman
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Lin Yee Chen
- Cardiovascular Division and Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis Minnesota
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Kjeldsberg HA, Albors C, Mill J, Medel DV, Camara O, Sundnes J, Valen-Sendstad K. Impact of left atrial wall motion assumptions in fluid simulations on proposed predictors of thrombus formation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3825. [PMID: 38629309 DOI: 10.1002/cnm.3825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/18/2024] [Accepted: 04/05/2024] [Indexed: 06/11/2024]
Abstract
Atrial fibrillation (AF) poses a significant risk of stroke due to thrombus formation, which primarily occurs in the left atrial appendage (LAA). Medical image-based computational fluid dynamics (CFD) simulations can provide valuable insight into patient-specific hemodynamics and could potentially enhance personalized assessment of thrombus risk. However, the importance of accurately representing the left atrial (LA) wall dynamics has not been fully resolved. In this study, we compared four modeling scenarios; rigid walls, a generic wall motion based on a reference motion, a semi-generic wall motion based on patient-specific motion, and patient-specific wall motion based on medical images. We considered a LA geometry acquired from 4D computed tomography during AF, systematically performed convergence tests to assess the numerical accuracy of our solution strategy, and quantified the differences between the four approaches. The results revealed that wall motion had no discernible impact on LA cavity hemodynamics, nor on the markers that indicate thrombus formation. However, the flow patterns within the LAA deviated significantly in the rigid model, indicating that the assumption of rigid walls may lead to errors in the estimated risk factors. In contrast, the generic, semi-generic, and patient-specific cases were qualitatively similar. The results highlight the crucial role of wall motion on hemodynamics and predictors of thrombus formation, and also demonstrate the potential of using a generic motion model as a surrogate for the more complex patient-specific motion. While the present study considered a single case, the employed CFD framework is entirely open-source and designed for adaptability, allowing for integration of additional models and generic motions.
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Affiliation(s)
- Henrik A Kjeldsberg
- Department of Computational Physiology, Simula Research Laboratory, Oslo, Norway
| | - Carlos Albors
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jordi Mill
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Oscar Camara
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Joakim Sundnes
- Department of Computational Physiology, Simula Research Laboratory, Oslo, Norway
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3
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Clark A, Ferkh A, Vandenberg J, Elhindi J, Thomas L. Altered left atrial metrics in patients with cryptogenic stroke: A systematic review and meta-analysis. Eur J Clin Invest 2024; 54:e14175. [PMID: 38308431 DOI: 10.1111/eci.14175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND There is no defined cause for cryptogenic stroke/embolic stroke of undetermined source (CS-ESUS). As atrial fibrillation (AF) develops in a significant proportion of these patients, it has been suggested that left atrial (LA) myopathy may predispose to CS-ESUS. We investigated alterations in echocardiographic measures of LA size and function in patients with CS-ESUS. METHODS A systematic literature review and meta-analysis was performed. PubMed, EMBASE, Cochrane Library, Web of Science and SCOPUS were searched for articles published between 1 January 1990 and 10 February 2023. All observational studies of adult CS-ESUS patients with LA volume or function measurements performed by transthoracic echocardiogram were included. Individual random effects meta-analyses were performed on LA measurements in the CS-ESUS patients using subgroup analysis of comparator groups. RESULTS We included 29 articles with 3927 CS-ESUS patients. Analysis of weighted mean differences showed CS-ESUS patients had altered LA structure and function parameters, with a larger maximum indexed LA volume, reduced LA emptying fraction and/or LA reservoir strain, compared to healthy controls and noncardioembolic stroke patients. Conversely, CS-ESUS patients had a smaller left atrium with better function, compared to cardioembolic stroke patients and CS-ESUS patients who subsequently developed atrial fibrillation. CONCLUSIONS LA volume and function are altered in CS-ESUS patients compared to healthy controls and other stroke aetiologies. An underlying atrial myopathy in a subset of CS-ESUS patients may be involved in both thrombogenesis and dysrhythmia (specifically AF). While LA functional assessment is not currently recommended following stroke, it may offer an opportunity for recurrent stroke risk stratification.
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Affiliation(s)
- Amy Clark
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Aaisha Ferkh
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Jamie Vandenberg
- Mark Cowley Lidwill Research Program in Cardiac Electrophysiology, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - James Elhindi
- WSLHD Research and Education Network, Westmead Hospital, Westmead, New South Wales, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Camperdown, Sydney, New South Wales, Australia
- South West Clinical School, University of New South Wales, Kensington, New South Wales, Australia
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Sumiyoshi H, Tasaka H, Yoshida K, Yoshino M, Kadota K. Heart Failure score and outcomes in patients with preserved ejection fraction after catheter ablation for atrial fibrillation. ESC Heart Fail 2024. [PMID: 38822750 DOI: 10.1002/ehf2.14876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/22/2024] [Accepted: 05/12/2024] [Indexed: 06/03/2024] Open
Abstract
AIMS Atrial fibrillation (AF) is frequently associated with heart failure with preserved ejection fraction (HFpEF), but the diagnosis and prediction of the outcomes of HFpEF are difficult. Notably, the Heart Failure Association of the European Society of Cardiology proposed the use of the HFA-PEFF score in the diagnosis of HFpEF. This study aimed to assess the prognostic value of the pre- and post-procedural HFA-PEFF scores in patients with preserved ejection fraction (EF) after catheter ablation (CA) for AF. The primary endpoint was a composite of cardiac hospitalization for cardiovascular events and all-cause mortality. The secondary endpoint was AF recurrence. METHODS AND RESULTS Overall, 354 patients with AF and preserved EF who underwent CA as well as blood tests and transthoracic echocardiography 2 weeks before and 6 months after CA from January 2018 to December 2019 were retrospectively enrolled in the study. In the 354 participants, univariate analysis showed that the post-procedural HFA-PEFF score was associated with a 3-year risk of the primary endpoint (hazard ratio [HR] = 3.73; 95% confidence interval [CI] = 2.07-6.73; P < 0.001), whereas the pre-procedural HFA-PEFF score was not (HR = 1.24, 95% CI = 0.82-1.86, P = 0.307). Further, the association between the post-procedural HFA-PEFF score and primary endpoint was not modified even after including other relevant variables into the score. Similar to the primary endpoint, the post-procedural HFA-PEFF score was associated with the 3-year risk of AF recurrence (P < 0.001). CONCLUSIONS In patients with preserved EF undergoing AF ablation, the HFA-PEFF score at 6 months after CA was associated with the primary endpoint and AF recurrence at the 3-year follow-up.
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Affiliation(s)
- Hironobu Sumiyoshi
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroshi Tasaka
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenta Yoshida
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Mitsuru Yoshino
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
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5
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Yang Y, Lu M, Guan X, Zhao S, Long L. Left Atrial Dysfunction in Apical Hypertrophic Cardiomyopathy: Assessed by Cardiovascular Magnetic Resonance Feature-tracking. J Thorac Imaging 2024; 39:157-164. [PMID: 37341629 PMCID: PMC11027970 DOI: 10.1097/rti.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE To evaluate the left atrial (LA) function in participants with apical hypertrophic cardiomyopathy (AHCM) by cardiovascular magnetic resonance feature tracking (CMR-FT). MATERIALS AND METHODS Thirty typical AHCM (TAHCM) patients, 23 subclinical AHCM (SAHCM) patients and 32 normal healthy volunteers who underwent CMR exam were retrospectively analyzed. LA reservoir, conduit, and contractile function were quantified by volumetric and CMR-FT derived strain and strain rate (SR) parameters from 2-chamber and 4-chamber cine imaging. RESULTS Compared with healthy participants, both TAHCM and SAHCM patients had impaired LA reservoir function (total strain [%]: TAHCM 31.3±12.2, SAHCM 31.8±12.3, controls 40.4±10.7, P <0.01; total SR [/s]: TAHCM 1.1±0.4, SAHCM 1.1±0.5, controls 1.4 ± 0.4, P <0.01) and conduit function (passive strain [%]: TAHCM 14.4±7.6, SAHCM 16.4±8.8, controls 23.3±8.1, P <0.01; passive SR [/s]: TAHCM -0.5±0.3, SAHCM -0.6±0.3, controls -1.0±0.4, P <0.01). Regarding contraction function, although TAHCM and SAHCM patients had preserved active emptying fraction and strain (all P >0.05), patients with TAHCM had the lowest active SR value among the 3 groups ( P= 0.03). LA reservoir and conduit strain were both significantly associated with left ventricular mass index and maximal wall thickness (all P <0.05). A moderate correlation between LA passive SR and left ventricular cardiac index ( P <0.01). CONCLUSIONS The LA reservoir and conduit function are predominately impaired and appeared in both SAHCM and TAHCM patients.
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Affiliation(s)
- Yingxia Yang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University
- Department of Radiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Beijing, China
| | - Xuechun Guan
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Beijing, China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University
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6
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Sillett C, Razeghi O, Lee AWC, Solis Lemus JA, Roney C, Mannina C, de Vere F, Ananthan K, Ennis DB, Haberland U, Xu H, Young A, Rinaldi CA, Rajani R, Niederer SA. A three-dimensional left atrial motion estimation from retrospective gated computed tomography: application in heart failure patients with atrial fibrillation. Front Cardiovasc Med 2024; 11:1359715. [PMID: 38596691 PMCID: PMC11002108 DOI: 10.3389/fcvm.2024.1359715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background A reduced left atrial (LA) strain correlates with the presence of atrial fibrillation (AF). Conventional atrial strain analysis uses two-dimensional (2D) imaging, which is, however, limited by atrial foreshortening and an underestimation of through-plane motion. Retrospective gated computed tomography (RGCT) produces high-fidelity three-dimensional (3D) images of the cardiac anatomy throughout the cardiac cycle that can be used for estimating 3D mechanics. Its feasibility for LA strain measurement, however, is understudied. Aim The aim of this study is to develop and apply a novel workflow to estimate 3D LA motion and calculate the strain from RGCT imaging. The utility of global and regional strains to separate heart failure in patients with reduced ejection fraction (HFrEF) with and without AF is investigated. Methods A cohort of 30 HFrEF patients with (n = 9) and without (n = 21) AF underwent RGCT prior to cardiac resynchronisation therapy. The temporal sparse free form deformation image registration method was optimised for LA feature tracking in RGCT images and used to estimate 3D LA endocardial motion. The area and fibre reservoir strains were calculated over the LA body. Universal atrial coordinates and a human atrial fibre atlas enabled the regional strain calculation and the fibre strain calculation along the local myofibre orientation, respectively. Results It was found that global reservoir strains were significantly reduced in the HFrEF + AF group patients compared with the HFrEF-only group patients (area strain: 11.2 ± 4.8% vs. 25.3 ± 12.6%, P = 0.001; fibre strain: 4.5 ± 2.0% vs. 15.2 ± 8.8%, P = 0.001), with HFrEF + AF patients having a greater regional reservoir strain dyssynchrony. All regional reservoir strains were reduced in the HFrEF + AF patient group, in whom the inferior wall strains exhibited the most significant differences. The global reservoir fibre strain and LA volume + posterior wall reservoir fibre strain exceeded LA volume alone and 2D global longitudinal strain (GLS) for AF classification (area-under-the-curve: global reservoir fibre strain: 0.94 ± 0.02, LA volume + posterior wall reservoir fibre strain: 0.95 ± 0.02, LA volume: 0.89 ± 0.03, 2D GLS: 0.90 ± 0.03). Conclusion RGCT enables 3D LA motion estimation and strain calculation that outperforms 2D strain metrics and LA enlargement for AF classification. Differences in regional LA strain could reflect regional myocardial properties such as atrial fibrosis burden.
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Affiliation(s)
- Charles Sillett
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
| | - Angela W. C. Lee
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jose Alonso Solis Lemus
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Caroline Roney
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
| | - Carlo Mannina
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Felicity de Vere
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Kiruthika Ananthan
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Daniel B. Ennis
- Department of Radiology, Stanford University, Stanford, CA, United States
| | | | - Hao Xu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Alistair Young
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Turing Research and Innovation Cluster: Digital Twins, The Alan Turing Institute, London, United Kingdom
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7
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Hirose K, Nakanishi K, Daimon M, Iwama K, Yoshida Y, Mukai Y, Yamamoto Y, Nakao T, Oshima T, Matsubara T, Shimizu Y, Oguri G, Kojima T, Hasumi E, Fujiu K, Morita H, Komuro I. Association of Atrial Fibrillation Progression With Left Atrial Functional Reserve and Its Reversibility. J Am Heart Assoc 2024; 13:e032215. [PMID: 38156556 PMCID: PMC10863802 DOI: 10.1161/jaha.123.032215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) progression is closely related to heart failure occurrence, and catheter ablation carries a beneficial effect for heart failure prevention. Recently, particular attention has been given to left atrial (LA) function and functional reserve in the pathogenesis linking AF and heart failure, although its significance and reversibility is not well studied. METHODS AND RESULTS We prospectively investigated 164 patients with AF with normal left ventricular systolic function and free from heart failure who underwent first catheter ablation and pre-/postprocedural echocardiography. Conventional and speckle-tracking echocardiography were performed at rest and during passive leg lifting to assess LA size, LA reservoir strain (LARS), and functional reserve calculated as passive leg lifting-LARS - rest-LARS. Patients were categorized into 3 AF subtypes: paroxysmal AF (N=95), persistent AF (PeAF; N=50), and long-standing persistent AF (LS-PeAF; N=19). The PeAF and LS-PeAF groups had larger LA size and reduced LARS compared with the paroxysmal AF group (all P<0.05). LA functional reserve was significantly impaired in the LS-PeAF group (P=0.003). In multivariable analysis, LS-PeAF and advanced age were significantly associated with impaired LA functional reserve. Among 149 patients with sinus rhythm 1 to 2 days after catheter ablation, LARS was significantly improved in both PeAF and LS-PeAF groups but was still lower than that in the paroxysmal AF group. Sinus rhythm restoration also led to amelioration of LA functional reserve in patients with LS-PeAF. CONCLUSIONS AF progression was related to impaired LARS and LA functional reserve, and restoration of sinus rhythm might contribute to early LA reverse remodeling.
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Affiliation(s)
| | - Koki Nakanishi
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Masao Daimon
- Department of Cardiovascular MedicineUniversity of TokyoJapan
- Department of Clinical LaboratoryUniversity of TokyoJapan
| | - Kentaro Iwama
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Yuriko Yoshida
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Yasuhiro Mukai
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Yuko Yamamoto
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Tomoko Nakao
- Department of Cardiovascular MedicineUniversity of TokyoJapan
- Department of Clinical LaboratoryUniversity of TokyoJapan
| | - Tsukasa Oshima
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | | | - Yu Shimizu
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Gaku Oguri
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Toshiya Kojima
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Eriko Hasumi
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Katsuhito Fujiu
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Hiroyuki Morita
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Issei Komuro
- Department of Cardiovascular MedicineUniversity of TokyoJapan
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8
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Lamy J, Taoutel R, Chamoun R, Akar J, Niederer S, Mojibian H, Huber S, Baldassarre LA, Meadows J, Peters DC. Atrial fibrosis by cardiac MRI is a correlate for atrial stiffness in patients with atrial fibrillation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:107-117. [PMID: 37857929 PMCID: PMC11378145 DOI: 10.1007/s10554-023-02968-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
A relationship between left atrial strain and pressure has been demonstrated in many studies, but not in an atrial fibrillation (AF) cohort. In this work, we hypothesized that elevated left atrial (LA) tissue fibrosis might mediate and confound the LA strain vs. pressure relationship, resulting instead in a relationship between LA fibrosis and stiffness index (mean LA pressure/LA reservoir strain). Sixty-seven patients with AF underwent a standard cardiac MR exam including long-axis cine views (2 and 4-ch) and a free-breathing high resolution three-dimensional late gadolinium enhancement (LGE) of the atrium (N = 41), within 30 days prior to AF ablation, at which procedure invasive mean left atrial pressure (LAP) was measured. LV and LA Volumes, EF, and comprehensive analysis of LA strains (strain and strain rates and strain timings during the atrial reservoir, conduit and active, i.e. active atrial contraction, phases) were measured and LA fibrosis content (LGE (ml)) was assessed from 3D LGE volumes. LA LGE was well correlated to atrial stiffness index overall (R = 0.59, p < 0.001), and among patient subgroups. Pressure was only correlated to maximal LA volume (R = 0.32) and the time to peak reservoir strain rate (R = 0.32) (both p < 0.01), among all functional measurements. LA reservoir strain was strongly correlated with LAEF (R = 0.95, p < 0.001) and LA minimum volume (r = 0.82, p < 0.001). In our AF cohort, pressure is correlated to maximum LA volume and time to peak reservoir strain. LA pressure/ LA reservoir strain, a metric of stiffness, correlates with LA fibrosis (LA LGE), reflecting Hook's Law.
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Affiliation(s)
- Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA
| | - Roy Taoutel
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Romy Chamoun
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Joseph Akar
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | | | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA
| | - Lauren A Baldassarre
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Judith Meadows
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA.
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9
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Moroni A, Tondi L, Milani V, Pieroni M, Pieruzzi F, Bevilacqua F, Pasqualin G, Chow K, Pica S, Lombardi M, Camporeale A. Left atrial remodeling in hypertrophic cardiomyopathy and Fabry disease: A CMR-based head-to-head comparison and outcome analysis. Int J Cardiol 2023; 393:131357. [PMID: 37696360 DOI: 10.1016/j.ijcard.2023.131357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/19/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) and Fabry disease cardiomyopathy (FD) are phenocopies, as they show left ventricular hypertrophy (LVH). The left atrium (LA) is emerging as a potential marker of disease severity in both cardiomyopathies. The present study compares HCM and FD cardiomyopathy with similar degree of LVH, exploring LA morpho-functional parameters and the correlates of clinical outcome. METHODS We performed a comprehensive CMR-based comparison between 30 HCM and 30 FD patients matched on age, sex, BSA, LV mass and major cardiovascular risk factors affecting LA remodeling (arterial hypertension and diabetes). 30 healthy controls were also included. CMR feature tracking (CMR-FT) analysis, T1 mapping and conventional parameters were evaluated. Patients also underwent transthoracic echocardiography for LV diastolic function assessment. Clinical events at follow-up were collected (atrial and ventricular events, bradyarrhythmia, heart failure (HF) hospitalization and death). RESULTS HCM patients showed greater LA remodeling compared to FD patients, namely higher LA end-systolic volume index (LAVi max), lower LA-ejection fraction (LA-EF) and worse reservoir (εs) and booster function (εa) (all p < 0.05). Accordingly, these parameters have demonstrated good potential for distinguishing between FD and HCM (AUC 0.68-0.73, all p < 0.05), with LAVi max being an independent predictor for HCM diagnosis (OR 1.07, 95%CI 1.011-1.132, p 0.02). Moreover, in HCM patients a significant association between εs and HF occurrence was observed at 2-year follow-up (OR 0.85, 95%CI 0.72-0.99, p 0.04). CONCLUSIONS In HCM, LA remodeling is greater than in FD cardiomyopathy with similar LVH, and reservoir strain is associated with HF at follow-up.
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Affiliation(s)
- Alice Moroni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Federico Pieruzzi
- Department of Medicine and Surgery, University of Milano Bicocca, Nephrology and Dialysis Unit, ASST-Monza San Gerardo Hospital, Monza, Italy
| | - Francesca Bevilacqua
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giulia Pasqualin
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Kelvin Chow
- Siemens Medical Solutions USA, Inc., Chicago, United States
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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10
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Liu H, Chen L, Song Y, Xu Y, Zhang C. Evaluation of Left Atrial Function in Patients with Paroxysmal Atrial Fibrillation Using Left Atrial Automatic Myocardial Functional Imaging Ultrasonography. Cardiol Res Pract 2023; 2023:6924570. [PMID: 38020946 PMCID: PMC10681773 DOI: 10.1155/2023/6924570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/27/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Aim To evaluate volume and strain of the left atrium (LA) in people suffering from paroxysmal atrial fibrillation which is not valvular (NVPAF) using the new technology of left atrial automatic myocardial function imaging (AFILA) and to analyze prognostic factors in patients with NVPAF by follow-up. Methods Between August 2019 and August 2022, a total of 80 NVPAF patients and 60 normal control patients who were hospitalized in the Department of Cardiology were included in the study. The LA volume and strain parameters of the two groups were analyzed. The differences in LA function (LAF) parameters were compared between the two groups to generate the receiver operating characteristic curve (ROC) and calculate the area under the curve (AUC), sensitivity, and specificity of each parameter. Follow-up was conducted on the 80 NVPAF patients included, their treatment methods after admission and their rehospitalization due to heart events were recorded, and independent risk factors influencing the prognosis of NVPAF were obtained. Results A total of 140 patients participated in the study, including 80 in the NVPAF group and 60 in the normal control group. There was no statistically significant difference in age and sex between the two groups. Compared to the normal group, the LA minimum volume (LAVmin), LA maximum volume (LAVmax), and volume at onset of LA contraction (LAVpreA) in the NVPAF group were significantly increased. The LA emptying fraction (LAEF) was significantly decreased, and LA reservoir strain (S_R), LA conduit strain (S_CD), and LA contractile strain (S_CT) were significantly compromised (P < 0.05). There was no significant difference in LA evacuation volume (LAEV) reduction (P > 0.05). Logistic regression analysis of LAF parameters in NVPAF patients showed that LAEF and S_R were independently correlated with NVPAF (odds ratio values: 0.883 (0.827-0.943), P < 0.001; 0.916 (0.569-1.474), P = 0.047). The ROC curve results showed that LAEF had a high efficiency in the diagnosis of NVPAF, with P < 0.001, AUC of 0.843, sensitivity of 0.788, and specificity of 0.867. For the LA strain parameters, the S_R test efficiency was higher, with P < 0.001, AUC of 0.762, sensitivity of 0.713, and specificity of 0.783. There was a strong correlation between S_R and LAEF in patients with no end event and those with end event. The ROC curve revealed that the S_R was better than LAEF in predicting prognosis of patients with AF (AUC = 0.914, P < 0.0001 vs. AUC = 0.876, P < 0.0001). S_R of 10.5 and LAEF of 21 were the cut-off values for endpoint events in NVPAF patients, with sensitivity of 0.909 and 0.727 and specificity of 0.904 and 0.901, respectively. Conclusions AFILA ultrasound technology comprehensively evaluated the LA size and function in patients with NVPAF. The LAEF and S_R were independently correlated with NVPAF and can determine the prognosis of patients with NVPAF.
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Affiliation(s)
- Hailan Liu
- Department of Ultrasound, Nanchang First Hospital, Nanchang 330006, Jiangxi, China
| | - Lili Chen
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Yan Song
- Department of Ultrasound, Nanchang First Hospital, Nanchang 330006, Jiangxi, China
| | - Yingying Xu
- Department of Ultrasound, Nanchang First Hospital, Nanchang 330006, Jiangxi, China
| | - Chunquan Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
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11
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Anagnostopoulos I, Kousta M, Kossyvakis C, Paraskevaidis NT, Schizas N, Vrachatis D, Deftereos S, Giannopoulos G. Atrial strain and occult atrial fibrillation in cryptogenic stroke patients: a systematic review and meta-analysis. Clin Res Cardiol 2023; 112:1600-1609. [PMID: 37154833 DOI: 10.1007/s00392-023-02218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Cryptogenic stroke (CS) remains a significant cause of morbidity. Failure to identify the underlying pathology increases the rate of recurrence. Atrial fibrillation (AF) seems to be responsible for a substantial proportion of CS. Thus, there is an unmet need to identify and properly treat those with silent AF. PURPOSE To investigate the association between left atrial strain and newly diagnosed AF in CS patients. OBJECTIVES We searched major electronic databases for articles assessing the relationship between either peak left atrial longitudinal (PALS) or peak contractile (PACS) strain-quantified using speckle tracking echocardiography-and the incidence of occult AF during the diagnostic work-up of CS patients. RESULTS Eleven studies (two thousand and eighty-one patients) were analyzed. Incidence of occult AF was 19%. Both PALS and PACS were significantly lower in patients with newly diagnosed AF (MD - 8.6%, 95%CI - 10.7 to - 6.4, I2 86.4% and MD - 5.5, 95%CI - 6.8 to - 4.2, I2 80.8%). According to the diagnostic accuracy meta-analysis, PALS < 20% present 71% (95%CI 47-87%) sensitivity and 71% (95%CI 60-81%) specificity for the diagnosis of occult AF, assuming a prevalence of 20%. The corresponding values for PACS < 11% are 83% (95%CI 57-94%) and 78% (95%CI 56-91%). CONCLUSION Both PALS and PACS are significantly lower in patients with CS and silent AF. It seems that the cut-off values mentioned above could help physicians in identifying patients who may benefit more from prolonged rhythm monitoring. More studies are needed to confirm these findings.
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Affiliation(s)
- Ioannis Anagnostopoulos
- Cardiology Department, Athens General Hospital "G. Gennimatas", 154 Mesogion Avenue, 11527, Athens, Greece.
| | - Maria Kousta
- Cardiology Department, Athens General Hospital "G. Gennimatas", 154 Mesogion Avenue, 11527, Athens, Greece
| | - Charalampos Kossyvakis
- Cardiology Department, Athens General Hospital "G. Gennimatas", 154 Mesogion Avenue, 11527, Athens, Greece
| | | | - Nikolaos Schizas
- Department of Cardiothoracic Surgery, Hygeia Hospital, Athens, Greece
| | - Dimitrios Vrachatis
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Giannopoulos
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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12
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Varadarajan V, Gidding S, Wu C, Carr J, Lima JA. Imaging Early Life Cardiovascular Phenotype. Circ Res 2023; 132:1607-1627. [PMID: 37289903 PMCID: PMC10501740 DOI: 10.1161/circresaha.123.322054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/30/2023] [Indexed: 06/10/2023]
Abstract
The growing epidemics of obesity, hypertension, and diabetes, in addition to worsening environmental factors such as air pollution, water scarcity, and climate change, have fueled the continuously increasing prevalence of cardiovascular diseases (CVDs). This has caused a markedly increasing burden of CVDs that includes mortality and morbidity worldwide. Identification of subclinical CVD before overt symptoms can lead to earlier deployment of preventative pharmacological and nonpharmacologic strategies. In this regard, noninvasive imaging techniques play a significant role in identifying early CVD phenotypes. An armamentarium of imaging techniques including vascular ultrasound, echocardiography, magnetic resonance imaging, computed tomography, noninvasive computed tomography angiography, positron emission tomography, and nuclear imaging, with intrinsic strengths and limitations can be utilized to delineate incipient CVD for both clinical and research purposes. In this article, we review the various imaging modalities used for the evaluation, characterization, and quantification of early subclinical cardiovascular diseases.
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Affiliation(s)
- Vinithra Varadarajan
- Division of Cardiology, Department of Medicine Johns Hopkins University, Baltimore, MD
| | | | - Colin Wu
- Department of Medicine, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Jeffrey Carr
- Department Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN
| | - Joao A.C. Lima
- Division of Cardiology, Department of Medicine Johns Hopkins University, Baltimore, MD
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13
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Hopman LHGA, Mulder MJ, van der Laan AM, Bhagirath P, Demirkiran A, von Bartheld MB, Kemme MJB, van Rossum AC, Allaart CP, Götte MJW. Left atrial strain is associated with arrhythmia recurrence after atrial fibrillation ablation: Cardiac magnetic resonance rapid strain vs. feature tracking strain. Int J Cardiol 2023; 378:23-31. [PMID: 36804765 DOI: 10.1016/j.ijcard.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/17/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE The present study assesses different left atrial (LA) strain approaches in relation to atrial fibrillation (AF) recurrence after ablation and compares LA feature tracking (FT) strain to novel rapid LA strain approaches in AF patients. METHODS This retrospective single-center study comprised of 110 prospectively recruited AF patients who underwent cardiac magnetic resonance (CMR) imaging in sinus rhythm prior to their first pulmonary vein isolation ablation. LA rapid strain (long axis strain and atrioventricular (AV)-junction strain), LA FT strain, and LA volumes were derived from 2-chamber and 4-chamber cine images. AF recurrence was followed up for 12 months using either 12‑lead ECGs or rhythm Holter monitoring. RESULTS Arrhythmia recurrence was observed in 39 patients (36%) after the 90-day blanking period, occurring at a median of 181 (122-286) days. LA long axis strain, AV-junction strain, and FT strain were all more impaired in patients with AF recurrence compared to patients without AF recurrence (long axis strain: P < 0.01; AV-junction strain: P < 0.001; FT strain: P < 0.01, respectively). Area under the curve (AUC) values for LA remodeling parameters in association with AF recurrence were 0.68 for long axis strain, 0.68 for AV-junction strain, 0.66 for FT strain, 0.66 for LA volume index. Phasic FT LA strain demonstrated that contractile strain had the highest AUC (0.70). CONCLUSION Both LA rapid strain and LA FT strain are associated with arrhythmia recurrence after ablation in AF patients. LA rapid strain can be a convenient and reproducible alternative for LA FT strain to assess LA function in clinical practice.
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Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | | | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
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14
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Lamy J, Taoutel R, Chamoun R, Akar J, Niederer S, Mojibian H, Huber S, Baldassarre LA, Meadows J, Peters DC. Atrial Fibrosis by cardiac MRI is a correlate for atrial stiffness in patients with atrial fibrillation. RESEARCH SQUARE 2023:rs.3.rs-2818190. [PMID: 37131741 PMCID: PMC10153380 DOI: 10.21203/rs.3.rs-2818190/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Aims A relationship between left atrial strain and pressure has been demonstrated in many studies, but not in an atrial fibrillation (AF) cohort. In this work, we hypothesized that elevated left atrial (LA) tissue fibrosis might mediate and confound the LA strain vs. pressure relationship, resulting instead in a relationship between LA fibrosis and stiffness index (mean pressure/LA reservoir strain). Methods and Results Sixty-seven patients with AF underwent a standard cardiac MR exam including long-axis cine views (2 and 4-ch) and a free-breathing high resolution three-dimensional late gadolinium enhancement (LGE) of the atrium (N=41), within 30 days prior to AF ablation, at which procedure invasive mean left atrial pressure (LAP) was measured. LV and LA Volumes, EF, and comprehensive analysis of LA strains (strain and strain rates and strain timings during the atrial reservoir, conduit and active phases) were measured and LA fibrosis content (LGE (ml)) was assessed from 3D LGE volumes. LA LGE was well correlated to atrial stiffness index (LA mean pressure/LA reservoir strain) overall (R=0.59, p<0.001), and among patient subgroups. Pressure was only correlated to maximal LA volume (R=0.32) and the time to peak reservoir strain rate (R=0.32), among all functional measurements. LA reservoir strain was strongly correlated with LAEF (R=0.95, p<0.001) and LA minimum volume (r=0.82, p<0.001). Conclusion In our AF cohort, pressure is correlated to maximum LA volume and time to peak reservoir strain. LA LGE is a strong marker of stiffness.
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15
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López-Galvez R, Rivera-Caravaca JM, Roldán V, Orenes-Piñero E, Esteve-Pastor MA, López-García C, Saura D, González J, Lip GYH, Marín F. Imaging in atrial fibrillation: A way to assess atrial fibrosis and remodeling to assist decision-making. Am Heart J 2023; 258:1-16. [PMID: 36526006 DOI: 10.1016/j.ahj.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/22/2022] [Accepted: 12/10/2022] [Indexed: 05/11/2023]
Abstract
The 2020 ESC atrial fibrillation (AF) guidelines suggest the novel 4S-AF scheme for the characterization of AF. Imaging techniques could be helpful for this objective in everyday clinical practice, and information derived from these techniques reflects basic aspects of the pathophysiology of AF, which may facilitate treatment decision-making, and optimal management of AF patients. The aim of this review is to provide an overview of the mechanisms associated with atrial fibrosis and to describe imaging techniques that may help the management of AF patients in clinical practice. Transthoracic echocardiography is the most common procedure given its versatility, safety, and simplicity. Transesophageal echocardiography provides higher resolution exploration, and speckle tracking echocardiography can provide incremental functional and prognostic information over conventional echocardiographic parameters. In addition, LA deformation imaging, including LA strain and strain rate, are related to the extent of fibrosis. On the other hand, multidetector-row computed tomography and cardiac magnetic resonance provide higher resolution data and more accurate assessment of the dimensions, structure, and spatial relationships of the LA. Imaging is central when deciding on catheter ablation or cardioversion, and helps in selecting those patients who will really benefit from these procedures. Moreover, imaging enhances the understanding of the underlying mechanisms of atrial remodeling and might assists in refining the risk of stroke, which help to select the best medical therapies/interventions. In summary, evaluation of LA enlargement, LA remodeling and fibrosis with imaging techniques adds clinical and prognostic information and should be assessed as a part of routine comprehensive AF evaluation.
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Affiliation(s)
- Raquel López-Galvez
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - José Miguel Rivera-Caravaca
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain; School of Nursing, University of Murcia, Murcia, Spain; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
| | - Vanessa Roldán
- Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Esteban Orenes-Piñero
- Department of Biochemistry and Molecular Biology, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Cecilia López-García
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Daniel Saura
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Josefa González
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
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16
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Kessler Iglesias C, Pouliopoulos J, Thomas L, Hayward CS, Jabbour A, Fatkin D. Atrial cardiomyopathy: Current and future imaging methods for assessment of atrial structure and function. Front Cardiovasc Med 2023; 10:1099625. [PMID: 37063965 PMCID: PMC10102662 DOI: 10.3389/fcvm.2023.1099625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
Changes in atrial size and function have historically been considered a surrogate marker of ventricular dysfunction. However, it is now recognized that atrial cardiomyopathy (ACM) may also occur as a primary myocardial disorder. Emerging evidence that ACM is a major risk factor for atrial fibrillation, heart failure, and thromboembolic stroke, has highlighted the significance of this disorder and the need for better assessment of atrial metrics in clinical practice. Key barriers in this regard include a lack of standardized criteria or hierarchy for the diagnosis of ACM and lack of consensus for the most accurate phenotyping methods. In this article we review existing literature on ACM, with a focus on current and future non-invasive imaging methods for detecting abnormalities of atrial structure and function. We discuss the relative advantages and disadvantages of transthoracic echocardiography and cardiac magnetic resonance imaging for assessing a range of parameters, including atrial size and contractile function, strain, tissue characteristics, and epicardial adipose tissue. We will also present the potential application of novel imaging methods such as sphericity index and four- or five-dimensional flow.
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Affiliation(s)
- Cassia Kessler Iglesias
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Jim Pouliopoulos
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Liza Thomas
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology Westmead Hospital, Sydney, NSW, Australia
- South West Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Christopher S. Hayward
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Andrew Jabbour
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Diane Fatkin
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Correspondence: Diane Fatkin
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17
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Yang S, Chen X, Zhao K, Yu S, Dong W, Wang J, Yang K, Yang Q, Ma X, Dong Z, Liu L, Song Y, Lu M, Wang S, Zhao S. Reverse remodeling of left atrium assessed by cardiovascular magnetic resonance feature tracking in hypertrophic obstructive cardiomyopathy after septal myectomy. J Cardiovasc Magn Reson 2023; 25:13. [PMID: 36775820 PMCID: PMC9923913 DOI: 10.1186/s12968-023-00915-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/05/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Assessing the structure and function of left atrium (LA) is crucial in hypertrophic obstructive cardiomyopathy (HOCM) because LA remodeling correlates with atrial fibrillation. However, few studies have investigated the potential effect of myomectomy on LA phasic remodeling in HOCM after myectomy using cardiovascular magnetic resonance (CMR) feature tracking (FT). This study aims to evaluate the LA structural and functional remodeling with HOCM after myectomy by CMR-FT and to further investigate the determinants of LA reverse remodeling. METHODS In this single-center study, we retrospectively studied 88 patients with HOCM who received CMR before and after myectomy between January 2011 and June 2021. Preoperative and postoperative LA parameters derived from CMR-FT were compared, including LA reservoir function (total ejection fraction [EF], total strain [εs], peak positive strain rate [SRs]), conduit function (passive EF, passive strain [εe], peak early negative strain rate [SRe]) and booster function (booster EF, active strain [εa], late peak negative strain rate [SRa]). Eighty-six healthy participants were collected for comparison. Univariate and multivariate linear regression identified variables associated with the rate of change of εa. RESULTS Compared with preoperative parameters, LA reservoir function (total EF, εs, SRs), booster function (booster EF, εa, SRa), and SRe were significantly improved after myectomy (all P < 0.05), while no significant differences were observed in passive EF and εe. Postoperative patients with HOCM still had larger LA and worse LA function than healthy controls (all P < 0.05). After analyzing the rates of change in LA parameters, LA boost function, especially εa, showed the most dramatic improvement beyond the improvements in reservoir function, conduit function, and volume. In multivariable regression analysis, minimum LA volume index (adjusted β = - 0.39, P < 0.001) and Δleft ventricular outflow tract (LVOT) pressure gradient (adjusted β = - 0.29, P = 0.003) were significantly related to the rate of change of εa. CONCLUSIONS Patients with HOCM after septal myectomy showed LA reverse remodeling with a reduction in LA size and restoration in LA reservoir and booster function but unchanged LA conduit function. Among volumetric and functional changes, booster function had the greatest improvement postoperatively. Besides, preoperative LAVmin index and ΔLVOT might be potential factors associated with the degree of improvement in εa.
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Affiliation(s)
- Shujuan Yang
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Xiuyu Chen
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, 518055, China
| | - Shiqin Yu
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Wenhao Dong
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Jiaxin Wang
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Kai Yang
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Qiulan Yang
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Xuan Ma
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Zhixiang Dong
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Lele Liu
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Yanyan Song
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Minjie Lu
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Shuiyun Wang
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China.
| | - Shihua Zhao
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China.
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18
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Yao B, Wu R, Chen BH, Wesemann LD, Xu JR, Zhou Y, Wu LM. Cardiovascular magnetic resonance myocardial feature tracking for the determination of left atrial strain in hypertensive left ventricular hypertrophy and hypertrophic cardiomyopathy. Clin Radiol 2023; 78:e409-e416. [PMID: 36746719 DOI: 10.1016/j.crad.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/07/2022] [Accepted: 12/28/2022] [Indexed: 01/23/2023]
Abstract
AIM To measure the left atrial (LA) function in patients with hypertrophic cardiomyopathy (HCM; with [OHCM] and without obstruction [NOHCM]) and hypertension-related left ventricular hypertrophy (H-LVH) using cardiovascular magnetic resonance imaging feature tracking (CMR-FT). MATERIALS AND METHODS Patients who met the criteria for HCM (n=68), H-LVH (n=46), and 30 healthy controls participated. Left atrial strain was analysed using CMR-FT in cine images with two and four chambers. RESULTS The strain rate and LA strain measurements showed that patients with HCM, and H-LVH had impaired conduit and reservoir functions (versus controls). These capacities were more severely impaired in OHCM than those seen in NOHCM and H-LVH. The LA volume parameters (LAVIpac, LAVImin and LAVImax) from the OHCM group were higher than both the NOHCM and H-LVH groups (all p<0.05). There were differences between the OHCM and H-LVH groups in terms of the parameters for LA reservoir function (εs), booster pump function (SRa), and conduit function (SRe, LA passive EF, εe; p<0.05). The strongest correlations included the associations between LA total EF and εs, εe and LA passive EF, and SRe and LA passive EF. CONCLUSION CMR-FT can reliably identify LA dysfunction and deformation in the early stages of HCM and H-LVH.
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Affiliation(s)
- B Yao
- Department of Radiology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215000, China
| | - R Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - B-H Chen
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - L D Wesemann
- Department of Radiology, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - J-R Xu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Y Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - L-M Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
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19
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Atrial cardiomyopathy: Diagnosis, clinical implications and unresolved issues in anticoagulation therapy. J Electrocardiol 2023; 76:1-10. [PMID: 36370545 DOI: 10.1016/j.jelectrocard.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/15/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
Atrial cardiomyopathy (AC) is an evolving pathophysiological entity that has expanded our understanding regarding the atrium and its role in arrhythmogenesis and cardiac thromboembolism. The pathological myocardium in AC promotes arrhythmogenesis through mechanical dysfunction (hypocontractility, fibrosis), adverse alterations of the endothelium and secretion of prothrombotic factors (IL-6, IL-8, TNF-a). 'Red flags', indicative of AC, can be recognized either non-invasively by electrocardiography, echocardiography and cardiac magnetic resonance imaging or invasively by high-density electroanatomical mapping as low bipolar voltage areas of the affected myocardium. Signs of AC have been strongly associated with an increased risk of ischemic stroke, even embolic strokes of undetermined source, regardless of the coexistence of atrial fibrillation (AF). The underlying existence of AC has been negatively correlated with the success rate of catheter ablation of AF. The clinical value of AC is the provision of a novel pathway regarding the potential mechanisms of cerebrovascular events of cardiac thromboembolic origin. In addition, AC may serve as a risk stratification tool to predict the long-term responders of AF catheter ablation.
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20
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Maheshwari A, Norby FL, Inciardi RM, Wang W, Zhang MJ, Soliman EZ, Alonso A, Johansen MC, Gottesman RF, Solomon SD, Shah AM, Chen LY. Left Atrial Mechanical Dysfunction and the Risk for Ischemic Stroke in People Without Prevalent Atrial Fibrillation or Stroke : A Prospective Cohort Study. Ann Intern Med 2023; 176:39-48. [PMID: 36534978 DOI: 10.7326/m22-1638] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Atrial myopathy-characterized by changes in left atrial function and size-may precede and promote atrial fibrillation (AF) and cardiac thromboembolism. In people without prior AF or stroke, whether analysis of left atrial function and size can improve ischemic stroke prediction is unknown. OBJECTIVE To evaluate the association of echocardiographic left atrial function (reservoir, conduit, and contractile strain) and left atrial size (left atrial volume index) with ischemic stroke and determine whether these measures can improve the stroke prediction achieved by CHA2DS2-VASc score variables. DESIGN Prospective cohort study. SETTING ARIC (Atherosclerosis Risk in Communities) study. PARTICIPANTS 4917 ARIC participants without prevalent stroke or AF. MEASUREMENTS Ischemic stroke events (2011 to 2019) were adjudicated by physicians. Left atrial strain was measured using speckle-tracking echocardiography. RESULTS Over 5 years, the cumulative incidences of ischemic stroke in the lowest quintiles of left atrial reservoir, conduit, and contractile strain were 2.99% (95% CI, 1.89% to 4.09%), 3.18% (CI, 2.14% to 4.22%), and 2.15% (CI, 1.09% to 3.21%), respectively, and that of severe left atrial enlargement was 1.99% (CI, 0.23% to 3.75%). On the basis of the Akaike information criterion, left atrial reservoir strain plus CHA2DS2-VASc variables was the best predictive model. With the addition of left atrial reservoir strain to CHA2DS2-VASc variables, 11.6% of the 112 participants with stroke after 5 years were reclassified to higher risk categories and 1.8% to lower risk categories. Among the 4805 participants who did not develop stroke, 12.2% were reclassified to lower and 12.7% to higher risk categories. Decision curve analysis showed a predicted net benefit of 1.34 per 1000 people at a 5-year risk threshold of 5%. LIMITATION Underascertainment of subclinical AF. CONCLUSION In people without prior AF or stroke, when added to CHA2DS2-VASc variables, left atrial reservoir strain improves stroke prediction and yields a predicted net benefit, as shown by decision curve analysis. PRIMARY FUNDING SOURCE National Heart, Lung, and Blood Institute of the National Institutes of Health.
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Affiliation(s)
- Ankit Maheshwari
- Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (A.M.)
| | - Faye L Norby
- Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California (F.L.N.)
| | - Riccardo M Inciardi
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts (R.M.I., S.D.S., A.M.S.)
| | - Wendy Wang
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota (W.W.)
| | - Michael J Zhang
- Cardiovascular Division, Department of Medicine, and Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota (L.Y.C, M.J.Z.)
| | - Elsayed Z Soliman
- Department of Epidemiology, Wake Forest University, Winston-Salem, North Carolina (E.Z.S.)
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia (A.A.)
| | - Michelle C Johansen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland (M.C.J.)
| | - Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland (R.F.G.)
| | - Scott D Solomon
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts (R.M.I., S.D.S., A.M.S.)
| | - Amil M Shah
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts (R.M.I., S.D.S., A.M.S.)
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, and Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota (L.Y.C, M.J.Z.)
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21
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Olsen FJ, Bertelsen L, Vejlstrup N, Diederichsen SZ, Bjerregaard CL, Graff C, Brandes A, Krieger D, Haugan K, Køber L, Højberg S, Svendsen JH, Biering-Sørensen T. Association between four-dimensional echocardiographic left atrial measures and left atrial fibrosis assessed by left atrial late gadolinium enhancement. Eur Heart J Cardiovasc Imaging 2022; 24:152-161. [PMID: 34964463 DOI: 10.1093/ehjci/jeab275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/09/2021] [Indexed: 12/24/2022] Open
Abstract
AIMS Left atrial (LA) fibrosis is a hallmark of atrial cardiomyopathy, and non-invasive surrogate measures of LA fibrosis are therefore needed. We investigated the association between four-dimensional (4D) echocardiographic LA measures and LA fibrosis. METHODS AND RESULTS A multimodality imaging substudy was performed in a randomized clinical trial (LOOP study), recruiting elderly participants with cardiovascular risk factors. LA late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging was used as a surrogate for LA fibrosis. 4D echocardiographic LA quantification was used to measure maximal and minimal LA volume (LAVmax and LAVmin, respectively), LA emptying fractions (LAEFtotal), and strain. Logistic regression was used to relate LA measures to high LA LGE (≥17 cm2). Of the 44 participants (mean age 76 years, 64% men, median LA LGE 13.1 cm2), 14 exhibited high LA LGE. These participants exhibited abnormalities in several LA functional measures but not LAVmax. In linear regressions, only increasing LAVmin, and decreasing LAEFtotal, and reservoir strain were associated with increasing LA LGE. Furthermore, increasing LAVmin was associated with a higher likelihood of high LA LGE [odds ratio (OR) = 1.19 (1.04-1.37)]. Decreasing LAEFtotal and reservoir strain were also associated with higher likelihood of LA LGE [OR = 1.18 (1.05-1.33)] and OR = 1.15 (1.02-1.30), per 1% decrease in LAEFtotal and reservoir strain, respectively]. These findings were consistent after multivariable adjustments. LAEFtotal provided the highest performance for detecting high LA LGE (area under the curve of 0.78). CONCLUSION LAVmin, LAEFtotal, and reservoir strain measured by 4D echocardiography are significantly associated with LA LGE. LAEFtotal provides the best performance for detecting high LA LGE.
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Affiliation(s)
- Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Litten Bertelsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Søren Zöga Diederichsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Caroline Løkke Bjerregaard
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2, 9220 Aalborg, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
| | - Derk Krieger
- Department of Neurology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.,Department of Neurology, Stroke Unit, Mediclinic City Hospital, Building 37, 26th St, Dubai, United Arab Emirates
| | - Ketil Haugan
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Søren Højberg
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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22
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Karaliūtė R, Leleika A, Apanavičiūtė I, Kazakevičius T, Mizarienė V, Zabiela V, Kavoliūnienė A, Ragaišytė N, Urbonienė D, Šakalytė G. Risk Factors of Early Atrial Fibrillation Recurrence Following Electrical Cardioversion When Left Ventricular Ejection Fraction Is Preserved. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1053. [PMID: 36013520 PMCID: PMC9416115 DOI: 10.3390/medicina58081053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/22/2022] [Accepted: 07/30/2022] [Indexed: 11/24/2022]
Abstract
Background and objectives: To identify clinical, echocardiographic, and laboratory parameters that affect the early recurrence of atrial fibrillation (AF) after restoring sinus rhythm (SR) by electrical cardioversion (ECV), and to determine whether left atrial (LA) strain, as a noninvasive indicator reflecting fibrosis, is associated with laboratory indicators affecting the development of fibrosis, interleukin 6 (IL-6) or tumor necrosis factor α (TNF-α). Materials and Methods: The study included 92 persistent AF patients who underwent elective ECV. The effective maintenance of SR was evaluated after 40 ± 10 days of ECV. Echocardiography, inflammatory markers (high-sensitivity c-reactive protein (hs-CRP), IL-6, and TNF-α), and natriuretic peptides (N-terminal pro b-type natriuretic peptide (NT-proBNP) and N-terminal pro a-type natriuretic peptide (NT-proANP)) were assessed. Results: After a 40 ± 10 days observation period, 51 patients (55.4%) were in SR. Patients with AF recurrence had a significantly longer duration of AF (p = 0.008) and of arterial hypertension (p = 0.035), lower LA ejection fraction (p = 0.009), lower LA strain (p < 0.0001), higher left ventricular global longitudinal strain (p = 0.001), and a higher E/e‘ ratio (p < 0.0001). LA strain was an independent predictor of early AF recurrence (OR: 0.65; 95% Cl 0.5−0.9, p = 0.004). LA strain < 11.85% predicted AF recurrence with 70% sensitivity and 88% specificity (AUC 0.855, 95% CI 0.77−0.94, p < 0.0001). LA strain demonstrated the association with NT-proBNP (r = −0.489, p < 0.0001) and NT-proANP (r = −0.378, p = 0.002), as well as with hs-CRP (r = −0.243, p = 0.04). Conclusions: LA strain appeared to be the most accurate predictor of early AF recurrence after ECV in patients with persistent AF. LA strain inversely correlated with NT-proBNP and NT-proANP, but no significant association with any of the inflammatory markers was identified.
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Affiliation(s)
- Rasa Karaliūtė
- Laboratory of Behavioural Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Arnoldas Leleika
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
- Medicine Faculty, Medicine Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
| | - Ieva Apanavičiūtė
- Medicine Faculty, Medicine Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
| | - Tomas Kazakevičius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Vaida Mizarienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Vytautas Zabiela
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
| | - Aušra Kavoliūnienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Nijolė Ragaišytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
| | - Daiva Urbonienė
- Department of Laboratory Medicine, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
| | - Gintarė Šakalytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
- Kaunas Region Society of Cardiology, 50009 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
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23
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Gonçalves-Teixeira P, Costa T, Fragoso I, Ferreira D, Brandão M, Leite-Moreira A, Sampaio F, Ribeiro J, Fontes-Carvalho R. Screening, Diagnosis and Management of Atrial Fibrillation in Cancer Patients: Current Evidence and Future Perspectives. Arq Bras Cardiol 2022; 119:328-341. [PMID: 35946695 PMCID: PMC9363048 DOI: 10.36660/abc.20201362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population, carrying a high morbimortality burden, and this also holds true in cancer patients. The association between AF and cancer goes even further, with some studies suggesting that AF can be a marker of occult cancer. There is, however, a remarkable paucity of data concerning specific challenges of AF management in cancer patients. AF prompt recognition and management in this special population can lessen the arrhythmia-related morbidity and have an important prognostic benefit. This review will focus on current AF diagnosis and management challenges in cancer patients, with special emphasis on AF screening strategies and devices, and anticoagulation therapy with non-vitamin K antagonist oral anti-coagulants (NOACs) for thromboembolic prevention in these patients. Some insights concerning future perspectives for AF prevention, diagnosis, and treatment in this special population will also be addressed.
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Affiliation(s)
- Pedro Gonçalves-Teixeira
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal.,Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Telma Costa
- Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal.,Departamento de Oncologia, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Isabel Fragoso
- Unidade de Atenção Primária à Saúde Aracetti, Arazede - Portugal
| | - Diogo Ferreira
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - Mariana Brandão
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal
| | - Adelino Leite-Moreira
- Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal.,Departamento de Cirurgia Cardiotorácica, Hospital Universitário São João, Porto - Portugal.,Unidade de Pesquisa Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - Francisco Sampaio
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - José Ribeiro
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Ricardo Fontes-Carvalho
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
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24
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Wazzan AA, Galli E, Lacout M, Paven E, L'official G, Schnell F, Oger E, Donal E. Could echocardiographic left atrial characterization have additive value for detecting risks of atrial arrhythmias and stroke in patients with hypertrophic cardiomyopathy? Eur Heart J Cardiovasc Imaging 2022; 24:616-624. [PMID: 35793319 DOI: 10.1093/ehjci/jeac131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Atrial arrhythmia (AA) is considered a turning point for prognosis in patients with hypertrophic cardiomyopathy (HCM). We sought to assess whether the occurrence of AA and stroke could be estimated by an echocardiographic evaluation. METHODS AND RESULTS A total of 216 patients with HCM (52 ± 16 years old) were analysed. All patients underwent transthoracic echocardiography for the evaluation of left atrial volume (LAV), peak left atrial strain (PLAS), and peak atrial contraction strain. The patients were followed for 2.9 years for the occurrence of a composite endpoint including AA and/or stroke and peripheral embolism. Among the 216 patients, 78 (36%) met the composite endpoint. These patients were older (57.1 ± 14.4 vs. 50.3 ± 16.7 years; P = 0.0035), had a higher prevalence of arterial hypertension (62.3 vs. 42.3%; P = 0.005), and had higher NT-proBNP. The LAV (47 ± 20 vs. 37.2 ± 15.7 mL/m²; P = 0.0001) was significantly higher in patients who met the composite endpoint, whereas PLAS was significantly impaired (19.3 ± 9.54 vs. 26.6 ± 9.12%; P < 0.0001). After adjustment, PLAS was independently associated with events with an odds ratio of 0.42 (95% confidence interval 0.29-0.61; P < 0.0001). Stroke occurred in 67% of the patients without any clinical AA. The PLAS with a cut-off of under 15.5% provided event prediction with 91% specificity. Using a 15% cut-off, PLAS also demonstrated a predictive value for new-onset of AA. CONCLUSION The decrease in PLAS was strongly associated with the risk of stroke, even in patients without any documented AA. Its value for guiding the management of patients with HCM requires further investigation.
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Affiliation(s)
- Adrien Al Wazzan
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Elena Galli
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Marion Lacout
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Elise Paven
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | | | - Frederic Schnell
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Emmanuel Oger
- EA Reperes, CHU Rennes, University of Rennes, Rennes, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
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25
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Role of CMR-derived Atrial Deformation Analysis in the Prediction of Atrial Fibrillation Recurrence Rate after Pulmonary Vein Isolation. Eur J Radiol 2022; 155:110452. [DOI: 10.1016/j.ejrad.2022.110452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/04/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022]
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26
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Increased Blood Residence Time as Markers of High-Risk Patent Foramen Ovale. Transl Stroke Res 2022; 14:304-310. [PMID: 35690709 DOI: 10.1007/s12975-022-01045-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
Previous investigations have suggested that patients with patent foramen ovale (PFO) often have an atrial dysfunction, like to that observed in patients with atrial fibrillation (AF) which may concur to an increased risk of cryptogenic stroke. The aim of the study is to compare the atrial resident time (Rt) of PFO patients to those with sinus rhythm (SR) and AF using patient-specific 3D computational fluid dynamics (CFD) analysis. Models of left atrium (LA) hemodynamics were obtained from time-resolved CT scans and transthoracic echocardiography (TTE). Enrolled patients were divided into three groups: 30 healthy subjects with SR, 30 with PFO, and 30 with AF without PFO. Blood stasis was evaluated by determining the blood residence time (Rt) distribution in the LA and left atrial appendage (LAA). Overall, 90 patients (mean age 47.4 ± 7.5 years, 51 males) were included into the analysis. PFO patients exhibit higher mean Rt values compared to healthy subjects (2.65 ± 0.2 vs 1.5 ± 0.2 s). Conversely, AF patients presented higher Rt when compared to PFO patients (2.9 ± 0.3 vs 2.3 ± 0.2 s). Moreover, PFO patients presenting cerebral lesions at magnetic resonance imaging have a higher Rt compared to those without (2.9 ± 0.3 vs 2.3 ± 0.2 s, respectively, p < 0.001). PFO patients have a higher degree of atrial Rt compared to healthy subjects similar to that observed in AF patients. The higher mean LA Rt values offer an insight into the pathophysiological mechanism linking PFO with cryptogenic stroke and might be a marker of high-risk PFOs.
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Prognostic value of left atrial longitudinal strain by cardiac MRI feature tracking in atrial fibrillation patients with mitral valve disease. Clin Radiol 2022; 77:e643-e651. [PMID: 35676105 DOI: 10.1016/j.crad.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/09/2022] [Indexed: 11/21/2022]
Abstract
AIM To evaluate the prognostic value of left atrial global longitudinal strain (LAGLS) in atrial fibrillation (AF) patients with mitral valve disease (MVD). MATERIALS AND METHODS In this single-centre retrospective study, 48 consecutive AF patients with MVD who underwent cardiac magnetic resonance imaging (CMRI) before surgery were enrolled. The LAGLS was assessed by cine-CMRI images and feature tracking (CMRI-FT) technique. Logistic regression and receiver operating characteristic (ROC) analysis were performed to identify the value of LAGLS in predicting atrial tachyarrhythmia recurrence after surgery. RESULTS The LAGLS level of the total patients was 4.4% (interquartile range: 2.7-9.2%). LAGLS was significantly associated with many evaluated parameters of severity of disease including biventricular volumetric function, left atrial (LA) ejection fraction, and the European System for Cardiac Operative Risk Evaluation II score (all p<0.05). Multivariate Cox analysis showed that LAGLS (hazard ratio = 0.52, 95% confidence interval [CI]: 0.31, 0.87; p=0.013) was an independent predictor of atrial tachyarrhythmia recurrence after adjustment for LA diameter, LA and biventricular ejection fraction, aetiology of MVD (rheumatic or degenerative), and surgical procedure (valve surgery alone or valve surgery combined with Maze IV). The optimal cut-off value of LAGLS was 4.1% for predicting recurrent atrial tachyarrhythmia (sensitivity 81.8%, specificity 78.4%) and the area under the ROC curve was 0.854 (95% CI: 0.711, 0.996, p<0.001). CONCLUSION CMRI-FT-derived LAGLS may act as a novel non-invasive imaging biomarker with which to evaluate the severity of disease and offer independent prognostic information for atrial tachyarrhythmia recurrence after surgery in AF patients with MVD.
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Sidhu GD, Ayoub T, El Hajjar AH, Dhorepatil A, Nedunchezian S, Dagher L, Ferdinand K, Marrouche N. Atrial Fibrillation and Acute Ischemic Stroke: Evaluation of the Contemporary 2018 National Inpatient Sample Database. CJC Open 2022; 4:513-519. [PMID: 35734515 PMCID: PMC9207776 DOI: 10.1016/j.cjco.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Atrial fibrillation (AF) in acute ischemic stroke (AIS) is considered a binary entity regardless of AF type. We aim to investigate in-hospital morbidity and mortality among patients with nonparoxysmal AF-related AIS. Methods Patients hospitalized for AIS with associated paroxysmal or persistent AF were identified from the 2018 national inpatient sample database. We compared in-hospital mortality, stroke-related morbidity, hospital cost, length of stay, and discharge disposition in patients hospitalized with paroxysmal or persistent AF. Results A total of 26,470 patients were hospitalized for AIS with paroxysmal or persistent AF. Patient with AIS with persistent AF had a longer hospital length of stay (paroxysmal AF, mean [M] 5.7 days, standard deviation [SD] ±6.8 days; persistent AF, M 7.4 days, SD ±11.9 days, P < 0.001) and in-hospital costs (paroxysmal AF, M $15,449, SD ±$18,320; persistent AF, M $19,834 SD ±$23,312, P < 0.001). Patients with AIS with permanent AF had higher in-hospital mortality (paroxysmal AF, 4.6%, vs permanent AF, 6.2%, P < 0.001). Indirect markers of stroke-related disability, like intracranial hemorrhage (odds ratio [OR]: 1.9, 95% confidence interval (CI): 1.6-2.2), need for gastrostomy (OR: 2.1, 95% CI: 1.8-2.4), and tracheostomy (OR: 3.1, 95% CI: 2.1-4.4) were more associated with AIS from persistent AF. Conclusions Persistent AF is associated with poor in-hospital stroke-related outcome, possibly due to a worse thrombo-embolic phenomenon. AF pattern may be a harbinger of worse stroke-related morbidity.
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Affiliation(s)
- Gursukhman D.S. Sidhu
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Tarek Ayoub
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Abdel Hadi El Hajjar
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aneesh Dhorepatil
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Saihariharan Nedunchezian
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Lilas Dagher
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Keith Ferdinand
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Nassir Marrouche
- Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Mojica-Pisciotti ML, Panovský R, Masárová L, Pešl M, Stárek Z, Holeček T, Feitová V, Opatřil L, Doležalová K, Kincl V. Left atrium phasic impairments in paroxysmal atrial fibrillation patients assessed by cardiovascular magnetic resonance feature tracking. Sci Rep 2022; 12:7539. [PMID: 35534637 PMCID: PMC9085809 DOI: 10.1038/s41598-022-11233-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/06/2022] [Indexed: 11/12/2022] Open
Abstract
Atrial fibrillation (AF) is an abnormal and irregular heartbeat caused by uncoordinated electrical impulses in the left atrium (LA), which could induce lasting changes in the heart tissue or could be a consequence of underlying cardiac disease. This study aimed to assess the left atrial phasic function and deformation in paroxysmal AF (PAF) patients—who had not received radiofrequency ablation and had no signs of permanent AF—using the cardiovascular magnetic resonance (CMR) feature-tracking (FT) technique. Fifty subjects (27 PAF patients and 23 controls) were included and examined with CMR. Their LA volume, LA function, LA longitudinal strain (LS) and LA strain rate were assessed in the LA reservoir, conduit, and contractile phases. PAF patients exhibited higher LA volumes than controls, while their LA emptying fraction and LA LS was significantly lower in all three phases. In contrast, the corresponding emptying volumes (total, passive and active) were similar in both groups. The LA volumetric rates from CMR-derived volume curves differed significantly in PAF patients vs controls in the reservoir and contractile phases. In contrast, the equivalent LV volumetric rates were similar. This study suggests that assessing the LA phasic function could offer insight into early LA impairments for PAF patients.
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Cau R, Bassareo P, Suri JS, Pontone G, Saba L. The emerging role of atrial strain assessed by cardiac MRI in different cardiovascular settings: an up-to-date review. Eur Radiol 2022; 32:4384-4394. [PMID: 35451607 PMCID: PMC9213357 DOI: 10.1007/s00330-022-08598-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/24/2021] [Accepted: 01/15/2022] [Indexed: 11/25/2022]
Abstract
The left atrium (LA) has a crucial function in maintaining left ventricular filling, which is responsible for about one-third of all cardiac filling. A growing body of evidence shows that LA is involved in several cardiovascular diseases from a clinical and prognostic standpoint. LA enlargement has been recognized as a predictor of the outcomes of many diseases. However, LA enlargement itself does not explain the whole LA's function during the cardiac cycle. For this reason, the recently proposed assessment of atrial strain at advanced cardiac magnetic resonance (CMR) enables the usual limitations of the sole LA volumetric measurement to be overcome. Moreover, the left atrial strain impairment might allow several cardiovascular diseases to be detected at an earlier stage. While traditional CMR has a central role in assessing LA volume and, through cine sequences, a marginal role in evaluating LA function, feature tracking at advanced CMR (CMR-FT) has been increasingly confirmed as a feasible and reproducible technique for assessing LA function through strain. In comparison to atrial function evaluations via speckle tracking echocardiography, CMR-FT has a higher spatial resolution, larger field of view, and better reproducibility. In this literature review on atrial strain analysis, we describe the strengths, limitations, recent applications, and promising developments of studying atrial function using CMR-FT in clinical practice. KEY POINTS: • The left atrium has a crucial function in maintaining left ventricular filling; left atrial size has been recognized as a predictor of the outcomes of many diseases. • Left atrial strain has been confirmed as a marker of atrial functional status and demonstrated to be a sensitive tool in the subclinical phase of a disease. • A comprehensive evaluation of the three phases of atrial function by CMR-FT demonstrates an impairment before the onset of atrial enlargement, thus helping clinicians in their decision-making and improving patient outcomes.
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Affiliation(s)
- Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, 09045, Cagliari, Italy
| | - Pierpaolo Bassareo
- University College of Dublin, Mater Misericordiae University Hospital and Our Lady's Children's Hospital, Crumlin, Dublin, Republic of Ireland
| | - Jasjit S Suri
- Stroke Monitoring and Diagnosis Division, AtheroPoint(tm), Roseville, CA, USA
| | - Gianluca Pontone
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, 09045, Cagliari, Italy.
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31
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Lee HJ, Kim HK, Rhee TM, Choi YJ, Hwang IC, Yoon YE, Park JB, Lee SP, Kim YJ, Cho GY. Left Atrial Reservoir Strain-Based Left Ventricular Diastolic Function Grading and Incident Heart Failure in Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2022; 15:e013556. [PMID: 35439039 DOI: 10.1161/circimaging.121.013556] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The echocardiographic assessment of left ventricular (LV) diastolic dysfunction (LVDD) in patients with hypertrophic cardiomyopathy is complex and not well-established. We investigated whether the left atrial reservoir strain (LARS) could be used to categorize LVDD and whether this grading is predictive of heart failure (HF) events in hypertrophic cardiomyopathy. METHODS A total of 414 patients with hypertrophic cardiomyopathy (aged 58.3±12.8 years; 65.7% male) were categorized using LARS-defined LVDD (LARS-DD) grades: ≥35% (grade 0), ≥24% to <35%, ≥19% to <24%, and <19% (grade 3). Patients were followed for a median of 6.9 years to assess hospitalization for HF or HF-related death. RESULTS An increase in LARS-DD grade was associated with worse conventional echocardiographic parameters of LVDD, such as lower e', higher E/e' ratio, greater maximum tricuspid regurgitation velocity, and restrictive mitral inflow pattern. Higher LARS-DD grade was also associated with parameters reflecting increased LV filling pressure, such as greater LV wall thickness, greater extent of fibrosis, obstructive physiology, and decreased LV longitudinal strain. Furthermore, higher LARS-DD grade was associated with worse HF-free survival (log-rank P<0.001). Patients with LARS-DD grades 0, 1, 2, and 3 showed 10-year HF-free survival of 100%, 91.6%, 84.1%, and 67.5%, respectively. LARS-DD grade was an independent predictor of HF events after adjusting for clinical and echocardiographic variables (hazard ratio, 1.53 [95% CI, 1.03-2.28], per 1-grade increase). The LARS-DD grade also had incremental prognostic value for incident HF events over the traditional echocardiographic LVDD parameters and grading system. The prognostic value of advanced LARS-DD grade was consistent in sensitivity analyses and various patient subgroups. CONCLUSIONS LARS can be used as a simple single or supplemental index to categorize LV diastolic function and predict HF events in hypertrophic cardiomyopathy.
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Affiliation(s)
- Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Tae-Min Rhee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - You-Jung Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea (I.-C.H., Y.E.Y., G.-Y.C.)
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea (I.-C.H., Y.E.Y., G.-Y.C.)
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (H.-J.L., H.-K.K., T.-M.R., Y.-J.C., J.-B.P., S.-P.L., Y.-J.K.)
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea (I.-C.H., Y.E.Y., G.-Y.C.)
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Hou J, Sun Y, Zhang L, Wang W, You H, Zhang R, Yang B, Wang H. Assessing left atrial function in patients with atrial fibrillation and valvular heart disease using cardiovascular magnetic resonance imaging. Clin Cardiol 2022; 45:527-535. [PMID: 35289415 PMCID: PMC9045075 DOI: 10.1002/clc.23811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/11/2022] Open
Abstract
Background Atrial fibrillation (AF) is common arrhythmia in valvular heart disease (VHD) and is associated with adverse outcomes. Hypothesis To evaluate the left atrial (LA) function in patients with AF‐VHD by cardiovascular magnetic resonance imaging feature tracking (CMR‐FT) using LA strain (εs/εe/εa) and their corresponding strain rate (SRs/SRe/SRa). Methods This was a retrospective cross‐sectional inter‐reader and intra‐reader reproducibility conducted from July 1, 2020, to January 31, 2021. A total of 39 patients with AF‐VHD (rheumatic heart valvular disease [RHVD] [n = 22], degenerative heart valvular disease [DHVD] [n = 17]) underwent MRI scans performed with drug‐controlled heart rate before correcting the rhythm and valves through maze procedure. Fifteen participants with normal cardiac MRI were included as healthy control. εs/SRs, εe/SRe, and εa/SRa, corresponding to LA reservoir, conduit, and booster‐pump function, were assessed using Feature Tracking software (CVI42 v5.12.1). Results Compared with healthy controls, LA global strain parameters (εs/εe/εa/SRs/SRe/SRa) were significantly decreased (all p < 0.001), while LA size and volume were increased in AF‐VHD group (all p < 0.001). In the subgroup, RHVD group showed lower LA total ejection fraction (LATEF) and strain data than DHVD group (12.6% ± 3.3% vs. 19.4 ± 8.6, p = 0.001). Decreased LATEF was significantly related to altered LA strain and strain rate, especially in εs, εe, and SRs (Pearson/Spearman r/ρ = 0.856/0.837/0.562, respectively; all p < 0.001). Interstudy and intrastudy reproducibility were consistent for LA volumetry and strain parameters (intraclass correlation coefficient: 0.88–0.99). Conclusions CMR‐FT can be used to assess the LA strain parameters, and identify LA dysfunction and deformation noninvasively, which could be a helpful functional imaging biomarker in the clinical treatment of AF‐VHD.
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Affiliation(s)
- Jie Hou
- College of Medical and Biological Informatics Engineering, Northeastern University, Shenyang, China.,Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China.,Key Laboratory of Cardiovascular Imaging and Research of Liaoning Province, Shenyang, China
| | - Yu Sun
- College of Medical and Biological Informatics Engineering, Northeastern University, Shenyang, China.,Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China.,Key Laboratory of Cardiovascular Imaging and Research of Liaoning Province, Shenyang, China
| | - Libo Zhang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China.,Key Laboratory of Cardiovascular Imaging and Research of Liaoning Province, Shenyang, China
| | - Wei Wang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China.,Key Laboratory of Cardiovascular Imaging and Research of Liaoning Province, Shenyang, China
| | - Hongrui You
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China.,Key Laboratory of Cardiovascular Imaging and Research of Liaoning Province, Shenyang, China
| | - Rongrong Zhang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China.,Key Laboratory of Cardiovascular Imaging and Research of Liaoning Province, Shenyang, China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China.,Key Laboratory of Cardiovascular Imaging and Research of Liaoning Province, Shenyang, China
| | - Huishan Wang
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, China
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Wen S, Pislaru SV, Lin G, Scott CG, Lee AT, Asirvatham SJ, Pellikka PA, Kane GC, Pislaru C. Association of Post-procedural Left Atrial Volume and Reservoir Function with Outcomes in Patients with Atrial Fibrillation Undergoing Catheter Ablation. J Am Soc Echocardiogr 2022; 35:818-828.e3. [DOI: 10.1016/j.echo.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/04/2022] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
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Pezel T, Ambale-Venkatesh B, Quinaglia T, Heckbert SR, Kato Y, de Vasconcellos HD, Wu CO, Post WS, Henry P, Bluemke DA, Lima JAC. Change in Left Atrioventricular Coupling Index to Predict Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA). Radiology 2022; 303:317-326. [PMID: 35191736 PMCID: PMC9081516 DOI: 10.1148/radiol.210315] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic values as predictors of atrial fibrillation (AF). Purpose To investigate the prognostic value of a left atrioventricular coupling index (LACI) and average annualized change in LACI (hereafter, ΔLACI) measured by cardiac MRI to predict incident AF in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA). Materials and Methods In a secondary analysis of the prospective MESA, 1911 study participants without clinically recognized AF and cardiovascular disease at baseline had LACI assessed with cardiac MRI at baseline (examination 1, 2000-2002) and 10 years later (examination 5, 2010-2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average ΔLACI with incident AF. Results Among the 1911 participants (mean age, 59 years ± 9 [standard deviation]; 907 men), 87 incident AF events occurred over 3.9 years ± 0.9 after the second imaging (examination 5). After adjustment for traditional risk factors, greater LACI and ΔLACI were independently associated with AF (hazard ratio, 1.69 [95% CI: 1.46, 1.96] and 1.71 [95% CI: 1.50, 1.94], respectively; both P < .001). Adjusted models for LACI and ΔLACI showed improvement in model discrimination compared with currently used AF risk score (Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score) model (area under receiver operating characteristic curve [AUC], 0.78 vs 0.74; and AUC, 0.80 vs 0.74, respectively; both P < .001); and to the final model including individual LA or LV parameters for predicting AF incidence (AUC, 0.78 vs 0.76; and AUC, 0.80 vs 0.78, respectively; both P < .001). Conclusion Atrioventricular coupling (left atrioventricular coupling index [LACI]) and coupling change (annual change in LACI) were strong predictors for atrial fibrillation (AF) in a multiethnic population. Both had incremental prognostic value for predicting AF over traditional risk factors, and superior discrimination compared with the Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score and to individual left atrial or left ventricular parameters. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Leiner in this issue.
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Affiliation(s)
- Théo Pezel
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Bharath Ambale-Venkatesh
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Thiago Quinaglia
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Susan R Heckbert
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Yoko Kato
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Henrique Doria de Vasconcellos
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Colin O Wu
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Wendy S Post
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Patrick Henry
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - David A Bluemke
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - João A C Lima
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
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Left Atrial Dysfunction, Fibrosis and the Risk of Thromboembolism in Patients With Paroxysmal and Persistent Atrial Fibrillation. INTERNATIONAL JOURNAL OF HEART FAILURE 2022; 4:42-53. [PMID: 36262195 PMCID: PMC9383342 DOI: 10.36628/ijhf.2021.0043] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/15/2022] [Accepted: 01/21/2022] [Indexed: 12/02/2022]
Abstract
Background and Objectives Left atrial (LA) fibrosis is an important component of the arrhythmogenic substrate and is related to LA dysfunction in patients with atrial fibrillation (AF). However, its relationship with functional changes and the risk of thrombus in patients with paroxysmal AF (PAF) and persistent AF (PeAF) remains unclear. Methods We included 139 patients with preprocedural cardiac magnetic resonance imaging (CMR) and transesophageal echocardiography (TEE) for the first AF catheter ablation. Spontaneous echo contrast (SEC) and multiple parameters of LA were measured from TEE and CMR. LA fibrosis was evaluated by late gadolinium enhancement of LA (LA-LGE) of CMR. Results The presence of SEC was higher in patients with PeAF than in patients with PAF (26.4% vs. 11.9%, p=0.03). The patients with SEC had more enlarged LA size and impaired function of LA and LAA, regardless of AF type. However, the area of LA-LGE was more extensive in patients with SEC in PeAF (27.5±15.9 vs. 20.1±10.3, p=0.033), not in PAF. In PAF, maximal LA volume index was closely related to the presence of SEC with marginal trend toward significance (odd ratio [OR], 1.07; 95% confidence interval [CI], 0.99–1.16; p=0.072). Whereas, a larger area of LA-LGE and lower emptying flux of LA appendage were independently related with SEC (OR, 1.10; 95% CI, 1.0–1.20; p=0.049 and OR, 0.93; 95% CI, 0.86–0.99; p=0.022, respectively) after adjusting related cardiovascular risk factors of SEC Conclusions In this study, we suggest that the risk of thrombus is provoked by LA enlargement with dysfunction in early-stage AF and by stiffened LA with fibrosis rather than LA size when it becomes PeAF.
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Liu HT, Yang CH, Lee HL, Chang PC, Wo HT, Wen MS, Wang CC, Yeh SJ, Chou CC. Clinical Outcomes of low-voltage area-guided left atrial linear ablation for non-paroxysmal atrial fibrillation patients. PLoS One 2021; 16:e0260834. [PMID: 34855901 PMCID: PMC8638894 DOI: 10.1371/journal.pone.0260834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background The therapeutic effect of low-voltage area (LVA)-guided left atrial (LA) linear ablation for non-paroxysmal atrial fibrillation (non-PAF) is uncertain. We aimed to investigate the efficacy of LA linear ablation based on the preexisting LVA and its effects on LA reverse remodeling in non-PAF patients. Methods We retrospectively evaluated 145 consecutive patients who underwent radiofrequency catheter ablation for drug-refractory non-PAF. CARTO-guided bipolar voltage mapping was performed in atrial fibrillation (AF). LVA was defined as sites with voltage ≤ 0.5 mV. If circumferential pulmonary vein isolation couldn’t convert AF into sinus rhythm, additional LA linear ablation was performed preferentially at sites within LVA. Results After a mean follow-up duration of 48 ± 33 months, 29 of 145 patients had drugs-refractory AF/LA tachycardia recurrence. Low LA emptying fraction, large LA size and high extent of LVA were associated with AF recurrence. There were 136 patients undergoing LA linear ablation. The rate of linear block at the mitral isthmus was significantly higher via LVA-guided than non-LVA-guided linear ablation. Patients undergoing LVA-guided linear ablation had larger LA size and higher extent of LVA, but the long-term AF/LA tachycardia-free survival rate was higher than the non-LVA-guided group. The LA reverse remodeling effects by resuming sinus rhythm were noted even in patients with a diseased left atrium undergoing extensive LA linear ablation. Conclusions LVA-guided linear ablation through targeting the arrhythmogenic LVA and reducing LA mass provides a better clinical outcome than non-LVA guided linear ablation, and outweighs the harmful effects of iatrogenic scaring in non-PAF patients.
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Affiliation(s)
- Hao-Tien Liu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chia-Hung Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Hui-Ling Lee
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei Branch, Taipei, Taiwan
| | - Po-Cheng Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Hung-Ta Wo
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Ming-Shien Wen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Chieh Wang
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei Branch, Taipei, Taiwan
| | - San-Jou Yeh
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei Branch, Taipei, Taiwan
| | - Chung-Chuan Chou
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- * E-mail:
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Sawada N, Nakanishi K, Daimon M, Hirose K, Yoshida Y, Ishiwata J, Hirokawa M, Koyama K, Nakao T, Morita H, Di Tullio MR, Homma S, Komuro I. Independent effect of visceral fat on left atrial phasic function in the general population. Nutr Metab Cardiovasc Dis 2021; 31:3426-3433. [PMID: 34674907 DOI: 10.1016/j.numecd.2021.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/19/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Obesity increases the risk for atrial fibrillation (AF), although the impact of abdominal fat distribution on left atrial (LA) morphology and functional remodeling remains unclear. This study aimed to investigate whether increased abdominal adiposity is independently associated with impaired LA function and/or LA enlargement in a sample of the general population and to evaluate the role of adipokines in this association. METHODS AND RESULTS The study cohort consisted of 527 participants (362 men; 57 ± 10 years) without overt cardiac disease who underwent laboratory testing, abdominal computed tomographic examination and echocardiography. Abdominal adiposity was quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. Speckle-tracking echocardiography was performed to assess LA phasic function including reservoir, conduit and pump strain. LA reservoir and conduit strain decreased with increasing VFA quartiles (both p < 0.05), whereas no significant differences were observed in LA volume index and pump strain. When stratified by SFA, there were no significant differences in LA size and function across the quartiles. In multivariable analysis, VFA was significantly associated with LA conduit strain independent of cardiovascular risk factors, and pertinent laboratory and echocardiographic parameters (standardized β = -0.136, p = 0.019). VFA was correlated with serum adiponectin level (r = -0.51, p < 0.001), but there was no association between adiponectin level and three LA phasic strains. CONCLUSION In a sample of the general population, VFA accumulation was independently associated with worse LA conduit strain, which may be involved in the pathophysiological mechanism of obesity-related AF.
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Affiliation(s)
- Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Kazutoshi Hirose
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhiro Koyama
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY, USA
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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Hopman LHGA, Mulder MJ, van der Laan AM, Demirkiran A, Bhagirath P, van Rossum AC, Allaart CP, Götte MJW. Impaired left atrial reservoir and conduit strain in patients with atrial fibrillation and extensive left atrial fibrosis. J Cardiovasc Magn Reson 2021; 23:131. [PMID: 34758820 PMCID: PMC8582184 DOI: 10.1186/s12968-021-00820-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with profound structural and functional changes in the atria. In the present study, we investigated the association between left atrial (LA) phasic function and the extent of LA fibrosis using advanced cardiovascular magnetic resonance (CMR) imaging techniques, including 3-dimensional (3D) late gadolinium enhancement (LGE) and feature tracking. METHODS Patients with paroxysmal and persistent AF (n = 105) underwent CMR in sinus rhythm. LA global reservoir strain, conduit strain and contractile strain were derived from cine CMR images using CMR feature tracking. The extent of LA fibrosis was assessed from 3D LGE images. Healthy subjects underwent CMR and served as controls (n = 19). RESULTS Significantly lower LA reservoir strain, conduit strain and contractile strain were found in AF patients, as compared to healthy controls (- 15.9 ± 3.8% vs. - 21.1 ± 3.6% P < 0.001, - 8.7 ± 2.7% vs. - 12.6 ± 2.5% P < 0.001 and - 7.2 ± 2.3% vs. - 8.6 ± 2.2% P = 0.02, respectively). Patients with a high degree of LA fibrosis (dichotomized by the median value) had lower reservoir strain and conduit strain compared to patients with a low degree of LA fibrosis (- 15.0 ± 3.9% vs. - 16.9 ± 3.3%, P = 0.02 and - 7.9 ± 2.7% vs. - 9.5 ± 2.6%, P = 0.01, respectively). In contrast, no difference was found for LA contractile strain (- 7.1 ± 2.4% vs. - 7.4 ± 2.3%, P = 0.55). CONCLUSIONS Impaired LA reservoir and conduit strain are present in AF patients with extensive atrial fibrosis. Future studies are needed to examine the biologic nature of this association and possible therapeutic implications.
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Affiliation(s)
- Luuk H. G. A. Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Mark J. Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Anja M. van der Laan
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Albert C. van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Marco J. W. Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
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Arvanitis P, Johansson AK, Frick M, Malmborg H, Gerovasileiou S, Larsson EM, Blomström-Lundqvist C. Recent-onset atrial fibrillation: a study exploring the elements of Virchow's triad after cardioversion. J Interv Card Electrophysiol 2021; 64:49-58. [PMID: 34689250 PMCID: PMC9236986 DOI: 10.1007/s10840-021-01078-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/10/2021] [Indexed: 12/11/2022]
Abstract
Purpose Atrial fibrillation (AF) imposes an inherent risk for stroke and silent cerebral emboli, partly related to left atrial (LA) remodeling and activation of inflammatory and coagulation systems. The aim was to explore the effects of cardioversion (CV) and short-lasting AF on left atrial hemodynamics, inflammatory, coagulative and cardiac biomarkers, and the association between LA functional recovery and the presence of a prior history of AF. Methods Patients referred for CV within 48 h after AF onset were prospectively included. Echocardiography and blood sampling were performed immediately prior, 1–3 h after, and at 7–10 days after CV. The presence of chronic white matter hyperintensities (WMH) on magnetic resonance imaging was related to biomarker levels. Results Forty-three patients (84% males), aged 55±9.6 years, with median CHA2DS2-VASc score 1 (IQR 0–1) were included. The LA emptying fraction (LAEF), LA peak longitudinal strain during reservoir, conduit, and contractile phases improved significantly after CV. Only LAEF normalized within 10 days. Interleukin-6, high-sensitivity cardiac-troponin-T (hs-cTNT), N-terminal-pro-brain-natriuretic peptide, prothrombin-fragment 1+2 (PTf1+2), and fibrinogen decreased significantly after CV. There was a trend towards higher C-reactive protein, hs-cTNT, and PTf1+2 levels in patients with WMH (n=21) compared to those without (n=22). At 7–10 days, the LAEF was significantly lower in patients with a prior history of AF versus those without. Conclusion Although LA stunning resolved within 10 days, LAEF remained significantly lower in patients with a prior history of AF versus those without. Inflammatory and coagulative biomarkers were higher before CV, but subsided after 7–10 days, which altogether might suggest an enhanced thrombogenicity, even in these low-risk patients. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-01078-9.
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Affiliation(s)
- Panagiotis Arvanitis
- Department of Medical Science and Cardiology, Uppsala University, Sjukhusvägen 9, Ing 35, 75309, Uppsala, Sweden.
| | - Anna-Karin Johansson
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | - Helena Malmborg
- Department of Medical Science and Cardiology, Uppsala University, Sjukhusvägen 9, Ing 35, 75309, Uppsala, Sweden
| | - Spyridon Gerovasileiou
- Department of Medical Sciences, Uppsala University, Clinical Physiology and Cardiology, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Science, Radiology, Uppsala University, Uppsala, Sweden
| | - Carina Blomström-Lundqvist
- Department of Medical Science and Cardiology, Uppsala University, Sjukhusvägen 9, Ing 35, 75309, Uppsala, Sweden
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Raman B, Smillie RW, Mahmod M, Chan K, Ariga R, Nikolaidou C, Ormondroyd E, Thomson K, Harper AR, Tan G, Lewandowski AJ, Rodriguez Bajo F, Wicks EC, Casadei B, Watkins H, Neubauer S. Incremental value of left atrial booster and reservoir strain in predicting atrial fibrillation in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2021; 23:109. [PMID: 34635131 PMCID: PMC8504076 DOI: 10.1186/s12968-021-00793-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/08/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Left atrial (LA) size and function are known predictors of new onset atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) patients. Components of LA deformation including reservoir, conduit, and booster function provide additional information on atrial mechanics. Whether or not LA deformation can augment our ability to predict the risk of new onset AF in HCM patients beyond standard measurements is unknown. METHODS We assessed LA size, function, and deformation on cardiovascular magnetic resonance (CMR) in 238 genotyped HCM patients and compared this with twenty age, sex, blood pressure and body mass index matched control subjects. We further evaluated the determinants of new onset AF in HCM patients. RESULTS Compared to control subjects, HCM patients had higher LA antero-posterior diameter, lower LA ejection fraction and lower LA reservoir (19.9 [17.1, 22.2], 21.6 [19.9, 22.9], P = 0.047) and conduit strain (10.6 ± 4.4, 13.7 ± 3.3, P = 0.002). LA booster strain did not differ between healthy controls and HCM patients, but HCM patients who developed new onset AF (n = 33) had lower booster strain (7.6 ± 3.3, 9.5 ± 3.0, P = 0.001) than those that did not (n = 205). In separate multivariate models, age, LA ejection fraction, and LA booster and reservoir strain were each independent determinants of AF. Age ≥ 55 years was the strongest determinant (HR 6.62, 95% CI 2.79-15.70), followed by LA booster strain ≤ 8% (HR 3.69, 95% CI 1.81-7.52) and LA reservoir strain ≤ 18% (HR 2.56, 95% CI 1.24-5.27). Conventional markers of HCM phenotypic severity, age and sudden death risk factors were associated with LA strain components. CONCLUSIONS LA strain components are impaired in HCM and, together with age, independently predicted the risk of new onset AF. Increasing age and phenotypic severity were associated with LA strain abnormalities. Our findings suggest that the routine assessment of LA strain components and consideration of age could augment LA size in predicting risk of AF, and potentially guide prophylactic anticoagulation use in HCM.
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Affiliation(s)
- Betty Raman
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom.
| | - Robert W Smillie
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Masliza Mahmod
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Kenneth Chan
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Rina Ariga
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Chrysovalantou Nikolaidou
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Elizabeth Ormondroyd
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Kate Thomson
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew R Harper
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Gifford Tan
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Adam J Lewandowski
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Fernando Rodriguez Bajo
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Eleanor C Wicks
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Barbara Casadei
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Hugh Watkins
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
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Martínez-Sellés M, Bruña V, Lacalzada-Almeida J, Díez-Villanueva P, Ruiz-Ortiz M, Alzola E, Arnau MÁ, Tobar J, Hernández JM, Bonet A, Castro V, Rubín JM, García-Martín A, Pérez-David E. Rationale and design of the rigorous atrial analysis in advanced interatrial block (ARABIA) prospective study. J Electrocardiol 2021; 68:135-140. [PMID: 34419649 DOI: 10.1016/j.jelectrocard.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Advanced interatrial block (IAB) is present in 10% of subjects ≥75 years and is associated with the risk of clinical events. METHODS AND RESULTS Prospective multicenter study that will include subjects ≥75 years without exclusion criteria (indication for anticoagulation, cardiac devices, severe valve disease, systolic dysfunction, moderate or severe cognitive impairment, poor echocardiographic window, non-sinus rhythm or partial IAB, stroke, and life expectancy <2 years). A total of 356 subjects, 178 patients with advanced IAB (exposed) and 178 matched individuals with normal P-wave (non-exposed) will be included. Electrocardiogram and advanced transthoracic echocardiography will be performed. Two substudies will include magnetic resonance imaging: cardiac (86 subjects, 43 exposed, and 43 non-exposed) and brain (86 subjects, 43 exposed, and 43 non-exposed). The follow-up will be 2 years. Our main objective is to determine the association of advanced IAB, P-wave duration, and atrial imaging parameters (I] atrial global longitudinal strain, II] maximal left atrial volume index, III] left atrial ejection fraction, IV] left atrial fibrosis - % total left atrial area V] inter- and intra-atrial asynchrony/dyssynchrony) with clinical events (atrial fibrillation, stroke, cognitive impairment, and mortality). The secondary objective is to assess the association of the P-wave duration with atrial imaging parameters and of both with cerebral microemboli in magnetic resonance imaging. CONCLUSION Our study will provide data regarding the association of advanced IAB, P-wave duration, and atrial imaging parameters with clinical events. We will also assess the association P-wave duration-atrial imaging parameters-cerebral microemboli.
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Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea. Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain.
| | - Vanesa Bruña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain; Servicio de Cardiología, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Juan Lacalzada-Almeida
- Laboratorio de Imagen Cardíaca, Servicio de Cardiología, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | | | - Martin Ruiz-Ortiz
- Servicio de Cardiología, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Elisabete Alzola
- Servicio de Cardiología, Hospital Universitario de Cruces, Baracaldo, Bilbao, Spain
| | - Miguel Ángel Arnau
- Servicio de Cardiología, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Javier Tobar
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Jesús Manuel Hernández
- Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Ana Bonet
- Servicio de Cardiología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Victor Castro
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Jose Manuel Rubín
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ana García-Martín
- Servicio de Cardiología. Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Esther Pérez-David
- Servicio de Cardiología, Hospital Universitario de la Paz, Madrid, Spain
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Kuraoka A, Ishizu T, Sato M, Igarashi M, Sato K, Yamamoto M, Machino-Ohtsuka T, Ieda M. Left atrial regional strain assessed by novel dedicated three-dimensional speckle tracking echocardiography. J Cardiol 2021; 78:517-523. [PMID: 34334266 DOI: 10.1016/j.jjcc.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Left atrial (LA) global strain has been studied as an early marker of LA dysfunction, followed by LA dilatation. Recently, a novel dedicated software for LA 3-dimensional speckle tracking echocardiography (LA-3DSTE) has allowed us to assess anatomy-based six-segmental LA deformation. This study aimed to assess the accuracy of LA-3DSTE software in measuring LA volume and to reveal the characteristics of regional LA reservoir strain. METHODS Fifty patients with paroxysmal atrial fibrillation who underwent computed tomography (CT) and 3D-STE were enrolled. The LA volumes obtained by 3D-STE and CT were compared, and regional LA strain was analyzed. Six LA segments (anterior, septal, inferior, lateral, roof, and posterior) were determined on the basis of LA anatomy. RESULTS In 50 patients (mean age, 64 years; 62% male), the 3D-STE-derived LA volume index (LAVI) showed good correlation with the CT-derived index, (r = 0.78, p < 0.001) with an underestimate bias of 10.5 ± 11.0 ml/m2 (p < 0.001). The lateral LA strain was negatively correlated with LAVI and emptying fraction, while the anterior and septal strains were not. In the 1st quantile LA volume group, the segmental LA strain was heterogeneous, that is, the lateral and inferior strains were greater than the anterior strain. While in the 3rd quantile LA volume group, the lateral and inferior strains were decreased, and there was no regional difference. CONCLUSION LA volume obtained by 3D-STE and CT showed a good correlation. LA segmental analysis by 3D-STE enables early identification of how LA dysfunction affects lateral and inferior LA strains, consistent with anatomical features.
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Affiliation(s)
- Ayako Kuraoka
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
| | - Miho Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Miyako Igarashi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kimi Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Masayoshi Yamamoto
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Tomoko Machino-Ohtsuka
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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Truong VT, Palmer C, Wolking S, Sheets B, Young M, Ngo TNM, Taylor M, Nagueh SF, Zareba KM, Raman S, Mazur W. Normal left atrial strain and strain rate using cardiac magnetic resonance feature tracking in healthy volunteers. Eur Heart J Cardiovasc Imaging 2021; 21:446-453. [PMID: 31504357 DOI: 10.1093/ehjci/jez157] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/21/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS The aim of our study was to establish normal ranges for left atrial (LA) strain and strain rate using cardiac magnetic resonance feature tracking (CMR-FT), LA sphericity index, and to compare LA strain using CMR-FT with 2D-speckle tracking echocardiography (STE) in a healthy population. METHODS AND RESULTS A total of 112 volunteers (45 male, 67 female) had adequate tracking for analysis on CMR-FT (Circle Cardiovascular Imaging, Calgary, Canada). The median age was 42 years (range 19-79 years, interquartile range 30-53 years). LA reservoir, conduit, booster strain, strain rate using CMR-FT, and sphericity index were evaluated. Of the 112 volunteers, 91 patients had adequate tracking on 2D-STE using three commonly applied zero-baseline time reference methods: R-R gating, P-P gating, and volume gating (defining end-systole at the LA maximum and end-diastole at the LA minimum). The LA strain, strain rate using CMR-FT, and sphericity index were reported and comparable between both genders (P > 0.05 for all). The LA booster function including strain and strain rate increased significantly with age (P < 0.001 for all), while the LA conduit function gradually decreased. In comparison with STE, the LA reservoir strain was comparable between CMR and volume-gating methods (38.48 ± 9.31 vs. 36.77 ± 6.46; P = 0.13) but not with R-R and P-P gating methods (P < 0.001 for all). LA strain, strain rate, and sphericity index using CMR-FT had good intraobserver and interobserver reproducibility. CONCLUSION LA strain, strain rate using CMR-FT, and sphericity index can be quickly assessed with good intraobserver and interobserver reproducibility.
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Affiliation(s)
- Vien T Truong
- Cardiology Department, The Christ Hospital Health Network, 2139 Auburn Ave, Cincinnati, OH, 45219, USA.,Cardiology Department, The Sue and Bill Butler Research Fellow, The Linder Research Center, 2139 Auburn Ave, Cincinnati, OH, USA
| | - Cassady Palmer
- Cardiology Department, The Christ Hospital Health Network, 2139 Auburn Ave, Cincinnati, OH, 45219, USA
| | - Sarah Wolking
- Cardiology Department, The Christ Hospital Health Network, 2139 Auburn Ave, Cincinnati, OH, 45219, USA
| | - Brandy Sheets
- Cardiology Department, The Christ Hospital Health Network, 2139 Auburn Ave, Cincinnati, OH, 45219, USA
| | - Michael Young
- Cardiology Department, The Christ Hospital Health Network, 2139 Auburn Ave, Cincinnati, OH, 45219, USA
| | - Tam N M Ngo
- Cardiology Department, The Christ Hospital Health Network, 2139 Auburn Ave, Cincinnati, OH, 45219, USA
| | - Michael Taylor
- Cardiology Department, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Sherif F Nagueh
- Cardiology Department, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, 6565 Fannin St, Houston, TX, 77030, USA
| | - Karolina M Zareba
- Cardiology Department, Ohio State University Wexner Medical Center, 410W 10th Ave, Columbus, OH, 43210, USA
| | - Subha Raman
- Cardiology Department, Ohio State University Wexner Medical Center, 410W 10th Ave, Columbus, OH, 43210, USA
| | - Wojciech Mazur
- Cardiology Department, The Christ Hospital Health Network, 2139 Auburn Ave, Cincinnati, OH, 45219, USA
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Varadarajan V, Ambale-Venkatesh B, Hong SY, Habibi M, Ashikaga H, Wu CO, Chen LY, Heckbert SR, Bluemke DA, Lima JAC. Association of Longitudinal Changes in NT-proBNP With Changes in Left Atrial Volume and Function: MESA. Am J Hypertens 2021; 34:626-635. [PMID: 33491080 DOI: 10.1093/ajh/hpab018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/28/2020] [Accepted: 01/20/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The mechanism of left atrial (LA) remodeling is poorly understood. The aim of this longitudinal study was to investigate whether changes in NT-proBNP levels relate to alterations of LA structure and function over time in a multiethnic population. METHODS From the prospective cohort study, the Multi-Ethnic Study of Atherosclerosis, our analysis included 1,838 participants who underwent cardiac magnetic resonance imaging at the baseline and 10-year examinations, had NT-proBNP levels available at both time points, and did not develop heart failure, myocardial infarction, and/or atrial fibrillation. Multivariable linear regression was used to analyze the association between NT-proBNP level (log-transformed) at the 2 time points and change in LA volumes, LA emptying fractions (total, active, and passive), and LA longitudinal strain. Log NT-proBNP was categorized into Low-Low (N = 681), Low-High (N = 238), High-Low (N = 237), and High-High (N = 682) based on the median value at both time points. RESULTS With the Low-Low group as the reference group, the High-High group experienced a greater increase in LA maximum and minimum indexed volumes: 3.1 ml/m2 (95% confidence interval 1.98, 4.20) and 2.7 ml/m2 (1.89, 3.51), respectively. The High-High group also experienced a greater decrease in LA total, passive, active emptying fraction, and longitudinal strain: -3.3% (-4.46, -2.11), -0.9% (-1.80, -0.02), -4.2% (-5.55, -2.76), and -2.3% (-3.80, -0.72), respectively. The Low-High group had similar associations, but the effect sizes were not as high. CONCLUSIONS Adverse LA remodeling over 10 years of follow-up strongly correlates with prolonged elevated levels of intracardiac stress, as assessed by NT-proBNP levels.
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Affiliation(s)
| | | | - Seo Young Hong
- Office of the Director, Center for Scientific Review, National Institutes of Health, Bethesda, Maryland, USA
| | - Mohammadali Habibi
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hiroshi Ashikaga
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Colin O Wu
- Department of Medicine, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Joao A C Lima
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
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Lessick J, Mutlak D, Mutlak M, Sheik-Muhamad R, Naami R, Efraim R, Abadi S, Aronson D. Left atrial function by cardiac computed tomography is a predictor of heart failure and cardiovascular death. Eur Radiol 2021; 32:132-142. [PMID: 34136947 DOI: 10.1007/s00330-021-08093-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/17/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to evaluate cardiac CT angiography (CCTA)-based assessment of left atrial (LA) function as a predictor of hospitalizations for heart failure (HF) and cardiovascular (CV) mortality. METHODS LA function was evaluated using automatic derivation of LA volumes to calculate LA total emptying fraction (LATEF) in 788 consecutive patients with normal sinus rhythm who had undergone spiral CT scans. The relationship between LATEF evaluated by CCTA and the composite endpoint of admission for HF or CV mortality was analyzed using Cox models. RESULTS During a median follow-up of 4 years, there were 100 events, 62 HF hospitalizations, and 38 cardiovascular deaths. Mean LATEF was 30.7 ± 10.7% and 40.5 ± 11.2% in patients with and without events, respectively (p < 0.0001). A high LATEF (upper tertile > 46%) was associated with a very low event rate (3.5% at 6 years [95% CI 1.7-7.1%]). The adjusted HR for HF or CV mortality was 4.37 (95% CI 1.99-9.60) in the lowest LATEF tertile, and 2.29 (95% CI 1.03-5.14) in the middle tertile, relative to the highest tertile. For the endpoint of HF alone, adjusted HR for the lowest LATEF tertile was 5.93 (95% CI 2.23-15.82) and for the middle tertile 2.89 (95% CI 1.06-7.86). The association of LATEF with outcome was similar for patients with both reduced and preserved left ventricular (LV) ejection fraction (Pinteraction = 0.724). Reduced LATEF was associated with a high event rate, even when coupled with normal LA volume. CONCLUSION CCTA-derived LA function is a predictor of HF hospitalization or CV death, independent of clinical risk factors, LA volume, and LV systolic function. KEY POINTS • Left atrial function can be automatically derived from cardiac CTA scans. • Cardiac CTA-derived left atrial function is a predictor of hospitalization for heart failure and cardiovascular death. • Evaluation of left atrial function could be useful in identifying patients at risk of heart failure.
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Affiliation(s)
- Jonathan Lessick
- Cardiology Department, Rambam Health Care Campus, Haaliya Street, 31096, Haifa, Israel.
- Technion-Israel Institute of Technology, Haaliya Street, 31096, Haifa, Israel.
| | - Diab Mutlak
- Cardiology Department, Rambam Health Care Campus, Haaliya Street, 31096, Haifa, Israel
- Technion-Israel Institute of Technology, Haaliya Street, 31096, Haifa, Israel
| | - Michael Mutlak
- Cardiology Department, Rambam Health Care Campus, Haaliya Street, 31096, Haifa, Israel
- Technion-Israel Institute of Technology, Haaliya Street, 31096, Haifa, Israel
| | - Rabia Sheik-Muhamad
- Cardiology Department, Rambam Health Care Campus, Haaliya Street, 31096, Haifa, Israel
| | - Robert Naami
- Technion-Israel Institute of Technology, Haaliya Street, 31096, Haifa, Israel
| | - Roi Efraim
- Cardiology Department, Rambam Health Care Campus, Haaliya Street, 31096, Haifa, Israel
| | - Sobhi Abadi
- Technion-Israel Institute of Technology, Haaliya Street, 31096, Haifa, Israel
- Medical Imaging Department, Rambam Health Care Campus, Haaliya Street, 31096, Haifa, Israel
| | - Doron Aronson
- Cardiology Department, Rambam Health Care Campus, Haaliya Street, 31096, Haifa, Israel
- Technion-Israel Institute of Technology, Haaliya Street, 31096, Haifa, Israel
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Comprehensive assessment of left atrial and ventricular remodeling in paroxysmal atrial fibrillation by the cardiovascular magnetic resonance myocardial extracellular volume fraction and feature tracking strain. Sci Rep 2021; 11:10941. [PMID: 34035345 PMCID: PMC8149643 DOI: 10.1038/s41598-021-90117-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/28/2021] [Indexed: 01/18/2023] Open
Abstract
Atrial fibrillation (AF) is a progressive disease that starts with structural or functional changes in the left atrium and left ventricle, and evolves from paroxysmal toward sustained forms. Early detection of structural or functional changes in the left atrium and left ventricle in the paroxysmal stage could be useful for identifying a higher risk of progression to persistent AF and future cardio-cerebrovascular events. The aim of this study was to test the hypothesis that the feature tracking (FT) left atrial (LA) strain and left ventricular (LV) extracellular volume fraction (ECV) derived from cardiovascular magnetic resonance (CMR) could detect early changes in remodeling of the left atrium and ventricle in the paroxysmal AF (PAF) stage. The participants were comprised of 106 PAF patients (age, 66.1 ± 10.7 years; 66% male) who underwent clinical CMR before pulmonary vein isolation and 20 control subjects (age, 68.3 ± 8.6 years; 55% male). The CMR-FT LA strain/phasic function and LV-ECV were compared between the PAF and control groups. The total and passive LA empty fraction (LAEF) and LA strain (corresponding to LA reservoir and conduit function) were decreased in the PAF group as compared to the control group. However, active LAEF (corresponding to the LA booster pump function) did not differ significantly between the PAF group (33.9 ± 10.9%) and control group (37.9 ± 13.3%, p = 0.15), while the active LA strain (corresponding to the LA booster pump function) was significantly decreased in the PAF group (11.4 ± 4.3 vs. 15.2 ± 5.6%, p = 0.002). The LV-ECV was significantly greater in the PAF group (28.7 ± 2.8%) than control group (26.6 ± 2.0%, p = 0.002). In the PAF group, the LV-ECV correlated significantly with the E/e′ and LA volume index. Regarding the LA strain, correlations were seen between the LV-ECV and both the reservoir function and conduit function. CMR-FT LA strain in combination with the LV-ECV in a single clinical study offers a potential imaging marker that identifies LA/LV remodeling including subtle LA booster pump dysfunction undetectable by the conventional booster pump LAEF in the PAF stage.
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47
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The Indices of Cardiovascular Magnetic Resonance Derived Atrial Dynamics May Improve the Contemporary Risk Stratification Algorithms in Children with Hypertrophic Cardiomyopathy. J Clin Med 2021; 10:jcm10040650. [PMID: 33567718 PMCID: PMC7915130 DOI: 10.3390/jcm10040650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/23/2021] [Accepted: 02/02/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: The most efficient risk stratification algorithms are expected to deliver robust and indefectible identification of high-risk children with hypertrophic cardiomyopathy (HCM). Here we compare algorithms for risk stratification in primary prevention in HCM children and investigate whether novel indices of biatrial performance improve these algorithms. Methods and Results: The endpoints were defined as sudden cardiac death, resuscitated cardiac arrest, or appropriate implantable cardioverter-defibrillator discharge. We examined the prognostic utility of classic American College of Cardiology/American Heart Association (ACC/AHA) risk factors, the novel HCM Risk-Kids score and the combination of these with indices of biatrial dynamics. The study consisted of 55 HCM children (mean age 12.5 ± 4.6 years, 69.1% males); seven had endpoints (four deaths, three appropriate ICD discharges). A strong trend (DeLong p = 0.08) was observed towards better endpoint identification performance of the HCM Risk-Kids Model compared to the ACC/AHA strategy. Adding the atrial conduit function component significantly improved the prediction capabilities of the AHA/ACC Model (DeLong p = 0.01) and HCM Risk-Kids algorithm (DeLong p = 0.04). Conclusions: The new HCM Risk-Kids individualised algorithm and score was capable of identifying high-risk children with very good accuracy. The inclusion of one of the atrial dynamic indices improved both risk stratification strategies.
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Affiliation(s)
- Gregory F Michaud
- From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville
| | - William G Stevenson
- From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville
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Habibi M, Lima JAC, Gucuk Ipek E, Spragg D, Ashikaga H, Marine JE, Berger RD, Calkins H, Nazarian S. Short- and long-term associations of atrial fibrillation catheter ablation with left atrial structure and function: A cardiac magnetic resonance study. J Cardiovasc Electrophysiol 2020; 32:316-324. [PMID: 33350536 DOI: 10.1111/jce.14842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/24/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effects of atrial fibrillation (AF) catheter ablation on the left atrium (LA) are poorly understood. OBJECTIVES To examine short- and long-term associations of AF catheter ablation with LA function using cardiac magnetic resonance (CMR). METHODS Fifty-one AF patients (mean age 56 ± 8 years) underwent CMR at baseline, 1 day (n = 17) and 11 ± 2 months after ablation (n = 38). LA phasic volumes, emptying fractions (LAEF), and longitudinal strain were measured using feature-tracking CMR. LA fibrosis was quantified using late gadolinium enhancement (LGE). RESULTS There were no acute changes in volume; however, active, total LAEF, and peak LA strain decreased significantly compared to the baseline. During long-term follow-up, there was a decrease in maximum but not minimum LA volume (from 99 ± 5.2 ml to 89 ± 4.7 ml; p = .009) and a decrease in total LAEF (from 43 ± 1.8% to 39 ± 2.0%; p = .001). In patients with AF recurrence, LA volumes were unchanged. However, total LAEF decreased from 38 ± 3% to 33 ± 3%; p = .015. Patients without AF recurrence had no changes in LA functional parameters during follow-up. The amount of LA LGE at long-term follow-up was higher compared to the baseline, however, was significantly less compared to immediately post-procedure (37 ± 1.9% vs. 47 ± 2.8%; p = .015). A higher increase in LA LGE extent compared to the baseline was associated with a greater decrease in total LAEF (r = -.59; p < .001). CONCLUSIONS LA function is impaired acutely following AF catheter ablation. However, long-term changes of LA function are associated positively with the successful restoration of sinus rhythm and inversely with increased LA LGE.
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Affiliation(s)
- Mohammadali Habibi
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Valley Health System and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey, USA
| | - Joao A C Lima
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Esra Gucuk Ipek
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Spragg
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hiroshi Ashikaga
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joseph E Marine
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ronald D Berger
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hugh Calkins
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Saman Nazarian
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Division of Cardiology, Section for Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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50
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Aquaro GD, Morini S, Grigoratos C, Taborchi G, Di Bella G, Martone R, Vignini E, Emdin M, Olivotto I, Perfetto F, Cappelli F. Electromechanical dissociation of left atrium in patients with Cardiac Amyloidosis by Magnetic Resonance: Prognostic and clinical correlates. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2020; 31:100633. [PMID: 32995476 PMCID: PMC7501430 DOI: 10.1016/j.ijcha.2020.100633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Left atrial (LA) function is an important marker of hemodynamic status in cardiac amyloidosis (CA), and its characterization may provide relevant prognostic information. We sought to assess the prevalence and prognostic impact of LA dysfunction by cardiac magnetic resonance (CMR) in patients with CA. METHODS We performed CMR in 80 consecutive patients with CA, including 38 with AL (47%) and 42 with ATTR (53%). LA function was assessed by acquiring short axis cine steady-state free precession (SSFP) covering the entire chamber. The atrial emptying fraction (AEF) was calculated as the ratio between the difference of LA maximal and minimal volume to LA maximal volume, expressed as percentage. Severe atrial dysfunction was defined as AEF ≤ 14%. RESULTS Mean AEF was 18% (13-35%). Overall, AEF ≤ 14% was present in 19 patients (24%), including 21% of those in sinus rhythm (SR) with no history of atrial fibrillation (AF). After a median of 3 years (IQR 2-4), 36 patients (44%) died of cardiac causes. Patients with AEF ≤ 14% showed increased cardiac mortality, with an independent OR of 4.2 (95 IC 2.1-8.2, P < 0.0001). Of note, AEF ≤ 14% was the stronger independent predictor of cardiac death. Patients in SR with AEF ≤ 14% had worse outcome than those with AF. CONCLUSIONS Severe impairment of LA contractile function was present in three-quarters of patients with CA, and was prevalent irrespective of CA etiology, both in the presence and absence of AF. Severe LA dysfunction was associated with an independent 4-fold increase in risk for cardiac death at three years.
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Affiliation(s)
| | - Sofia Morini
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | | | - Giulia Taborchi
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | | | - Raffaele Martone
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Elisa Vignini
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | | | - Iacopo Olivotto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
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