101
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Zhang Y, Li XM, Shen MT, Huang S, Li Y, Yang ZG. Atrioventricular coupling and left atrial abnormality in type 2 diabetes mellitus with functional mitral regurgitation patients verified by cardiac magnetic resonance imaging. Cardiovasc Diabetol 2022; 21:100. [PMID: 35681217 PMCID: PMC9185866 DOI: 10.1186/s12933-022-01536-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/30/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Functional mitral regurgitation (FMR) in type 2 diabetes mellitus (T2DM) patients induced by left ventricular (LV) enlargement and mitral valve abnormality may aggravated the impairment in left atrial (LA) compliance. Thus, this study aimed to depict how FMR and LV dysfunction affect LA compliance in T2DM patients with FMR. MATERIALS AND METHODS A total of 148 patients with T2DM and 49 age- and sex-matched normal controls underwent cardiac magnetic resonance examination. LA longitudinal strain and LA and LV functional indices were compared among controls and different T2DM patients. The multivariate analysis was used to identify the independent indicators of LA longitudinal strain. RESULTS T2DM Patients without FMR had a lower total LA empty fraction (LAEF) compared with the controls (all P < 0.05). T2DM patients with mild and moderate FMR showed increased LA volume (LAV) and LV volume while decreased LAEF, LA strain, and LV ejection fraction (P < 0.05). T2DM patients with severe FMR showed markedly increased LAV and LV volume while decreased LAEF, LA strain, and LVEF (P < 0.05). In T2DM patients with FMR, reservoir strain (εs) was independently correlated with LV end-diastolic volume (LVEDV) (β = - 0.334) and regurgitation degree (β = - 0.256). The passive strain (εe) was independently correlated with regurgitation degree (β = - 0.297), whereas the active strain (εa) was independently correlated with LVESV (β = - 0.352) and glycated haemoglobin (β = - 0.279). CONCLUSION FMR may aggravate LA and LV dysfunction in T2DM patients. Regurgitation degree was an independent determinant of the εs and the εe, LVEDV was an independent determinant of the εs, and LVESV was an independent determinant of the εa in T2DM patients with FMR.
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Affiliation(s)
- Yi Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.,Department of Radiology, School of Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, 55# Lan 4 RenMing Road (South), Chengdu, 610041, Sichuan, China
| | - Xue-Ming Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.,Department of Radiology, School of Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, 55# Lan 4 RenMing Road (South), Chengdu, 610041, Sichuan, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Shan Huang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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102
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Vraka A, Moreno-Arribas J, Gracia-Baena JM, Hornero F, Alcaraz R, Rieta JJ. The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation. J Cardiovasc Dev Dis 2022; 9:176. [PMID: 35735805 PMCID: PMC9224671 DOI: 10.3390/jcdd9060176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 12/10/2022] Open
Abstract
Coronary sinus (CS) catheterization is critical during catheter ablation (CA) of atrial fibrillation (AF). However, the association of CS electrical activity with atrial substrate modification has been barely investigated and mostly limited to analyses during AF. In sinus rhythm (SR), atrial substrate modification is principally assessed at a global level through P-wave analysis. Cross-correlating CS electrograms (EGMs) and P-waves’ features could potentiate the understanding of AF mechanisms. Five-minute surface lead II and bipolar CS recordings before, during, and after CA were acquired from 40 paroxysmal AF patients. Features related to duration, amplitude, and heart-rate variability of atrial activations were evaluated. Heart-rate adjustment (HRA) was applied. Correlations between each P-wave and CS local activation wave (LAW) feature were computed with cross-quadratic sample entropy (CQSE), Pearson correlation (PC), and linear regression (LR) with 10-fold cross-validation. The effect of CA between different ablation steps was compared with PC. Linear correlations: poor to mediocre before HRA for analysis at each P-wave/LAW (PC: max. +18.36%, p = 0.0017, LR: max. +5.33%, p = 0.0002) and comparison between two ablation steps (max. +54.07%, p = 0.0205). HRA significantly enhanced these relationships, especially in duration (P-wave/LAW: +43.82% to +69.91%, p < 0.0001 for PC and +18.97% to +47.25%, p < 0.0001 for LR, CA effect: +53.90% to +85.72%, p < 0.0210). CQSE reported negligent correlations (0.6−1.2). Direct analysis of CS features is unreliable to evaluate atrial substrate modification due to CA. HRA substantially solves this problem, potentiating correlation with P-wave features. Hence, its application is highly recommended.
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Affiliation(s)
- Aikaterini Vraka
- BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain;
| | - José Moreno-Arribas
- Cardiology Department, Saint John’s University Hospital, 03550 Alicante, Spain;
| | - Juan M. Gracia-Baena
- Cardiovascular Surgery Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (J.M.G.-B.); (F.H.)
| | - Fernando Hornero
- Cardiovascular Surgery Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (J.M.G.-B.); (F.H.)
| | - Raúl Alcaraz
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 16071 Cuenca, Spain;
| | - José J. Rieta
- BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain;
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103
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Inciardi RM, Bonelli A, Biering‐Sorensen T, Cameli M, Pagnesi M, Lombardi CM, Solomon SD, Metra M. Left atrial disease and left atrial reverse remodelling across different stages of heart failure development and progression: a new target for prevention and treatment. Eur J Heart Fail 2022; 24:959-975. [PMID: 35598167 PMCID: PMC9542359 DOI: 10.1002/ejhf.2562] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/02/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
The left atrium is a dynamic chamber with peculiar characteristics. Stressors and disease mechanisms may deeply modify its structure and function, leading to left atrial remodelling and disease. Left atrial disease is a predictor of poor outcomes. It may be a consequence of left ventricular systolic and diastolic dysfunction and neurohormonal and inflammatory activation and/or actively contribute to the progression and clinical course of heart failure through multiple mechanisms such as left ventricular filling and development of atrial fibrillation and subsequent embolic events. There is growing evidence that therapy may improve left atrial function and reverse left atrial remodelling. Whether this translates into changes in patient's prognosis is still unknown. In this review we report current data about changes in left atrial size and function across different stages of development and progression of heart failure. At each stage, drug therapies, lifestyle interventions and procedures have been associated with improvement in left atrial structure and function, namely a reduction in left atrial volume and/or an improvement in left atrial strain function, a process that can be defined as left atrial reverse remodelling and, in some cases, this has been associated with improvement in clinical outcomes. Further evidence is still needed mainly with respect of the possible role of left atrial reverse remodelling as an independent mechanism affecting the patient's clinical course and as regards better standardization of clinically meaningful changes in left atrial measurements. Summarizing current evidence, this review may be the basis for further studies.
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Affiliation(s)
- Riccardo M. Inciardi
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Andrea Bonelli
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Tor Biering‐Sorensen
- Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Matteo Cameli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Matteo Pagnesi
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Carlo Mario Lombardi
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Scott D. Solomon
- Brigham and Women's Hospital and Harvard Medical SchoolBostonMAUSA
| | - Marco Metra
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
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104
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Figliozzi S, Georgiopoulos G, Pateras K, Sianis A, Previtero M, Tondi L, Petropoulos Ι, Bragato RM, Papachristidis A, Condorelli G, Takeuchi M. Normal ranges of left atrial volumes and ejection fraction by 3D echocardiography in adults: a systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1329-1340. [PMID: 34994882 DOI: 10.1007/s10554-021-02520-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/30/2021] [Indexed: 11/05/2022]
Abstract
Increased sizes and dysfunction of the left atrium have been related to adverse outcomes. 3D-echocardiography is more accurate than 2D-echocardiography in estimating LA volumes and ejection fraction. However, the use of 3DE for LA analysis is limited by the absence of established reference values. We performed a systematic review and meta-analysis to provide reference ranges of LA maximum and minimum volumes indexed for body surface area (LAVi max and LAVi min, respectively), and LA-EF assessed by 3DE in healthy adults. Data search was conducted from inception through September 15, 2021, using the following Medical Subject Heading terms: left atrial/atrium, three-dimensional/3D echocardiography. The study protocol was registered in the PROSPERO database (CRD42021252428). 15 studies including 4,226 healthy adults (51% males) and reporting 3DE values of LAVi max, LAVi min and LA-EF were selected. LAVi max, LAVi min and LA-EF mean and reference values were equal to 25.18 ml/m2 (95% CI 23.10, 27.26), 11.10 ml/m2 (10.01, 12.18) and 55.94% (51.92, 59.96), respectively. No influential studies were identified. Pooled estimates per age group- and sex were also estimated. By meta-regression analyses, we identified variability in LA volumes and LA-EF depending on participants' age, ethnicity and number of heart cycles at 3D multi-beat acquisition. At individual patient data analysis conducted on 374 subjects, a software effect on LA-EF was shown. This systematic review and meta-analysis provides reference values of LAVi max, LAVi min and LA-EF assessed by 3DE in healthy adults, encouraging 3DE evaluation of the LA evaluation in daily practice.
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Affiliation(s)
- Stefano Figliozzi
- Clinical Echocardiography Diagnostic Service, Cardio Center, Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy.
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kostantinos Pateras
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Faculty of Public Health, University of Thessaly, Volos, Greece
| | - Alexandros Sianis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Marco Previtero
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Lara Tondi
- Multimodality Imaging Section IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Ιoannis Petropoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Renato Maria Bragato
- Clinical Echocardiography Diagnostic Service, Cardio Center, Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy
| | | | - Gianluigi Condorelli
- Clinical Echocardiography Diagnostic Service, Cardio Center, Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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105
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Bianco F, De Caterina R, Chandra A, Aquila I, Claggett B, Johansen MC, Gonçalves A, Norby FL, Cogswell R, Soliman EZ, Gottesman R, Mosley T, Alonso A, Shah A, Solomon SD, Chen LY. Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC-NCS. J Am Heart Assoc 2022; 11:e024292. [PMID: 35491988 PMCID: PMC9238625 DOI: 10.1161/jaha.121.024292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/01/2022] [Indexed: 12/23/2022]
Abstract
Background Age-related left atrial (LA) structural and functional abnormalities may be related to subclinical cerebral infarcts (SCIs) and stroke. We evaluated the association of 3-dimensional echocardiographic LA contractility parameters with SCIs and stroke across the spectrum of tertiles of age increment in elderly patients with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation. Methods and Results We enrolled 407 participants (mean age, 76±8 years; 40% men) from ARIC-NCS (Atherosclerosis Risk in Communities Neurocognitive Study) undergoing a brain magnetic resonance imaging and 3-dimensional echocardiographic examinations in 2011 to 2013. The sample was analyzed among age tertiles and subgroups: no cerebral magnetic resonance imaging-detectable infarcts (n=315), magnetic resonance imaging-diagnosed SCIs (n=58), and clinically diagnosed stroke (n=34). The frequency of SCIs significantly increased over age tertiles (P trend 0.023). LA global longitudinal strain-a 3-dimensional echocardiographic index of LA reservoir function-and E/e' divided by LA global longitudinal strain-an index of LA stiffness-worsened across age tertiles (P trend 0.014 and 0.001, respectively), and only in the categories of SCIs (P trend <0.001 and 0.045, respectively) and stroke (P trend 0.001 and 0.011, respectively). LA global longitudinal strain was negatively associated with increased odds of SCIs (P=0.036, P=0.008, and P=0.001, respectively) and strokes (P=0.043, P=0.015, and P=0.001, respectively) over age tertiles, with a significant interaction between age tertiles (interaction P=0.043 and P=0.010, respectively). E/e' divided by LA global longitudinal strain was positively associated with the presence of SCIs (P=0.037, P=0.007, and P=0.001, respectively) and strokes (P=0.045, P=0.007, and P=0.003, respectively) over age tertiles, with a significant interaction only for SCIs (interaction P=0.040) and not for clinical stroke. Conclusions In a large cohort study of elderly patients, among participants with sinus rhythm, normal ejection fraction, and no history of atrial fibrillation, measures of worse age-related LA reservoir function and stiffness are associated with higher odds of SCIs and stroke.
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Affiliation(s)
- Francesco Bianco
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
| | - Raffaele De Caterina
- Cardio‐Thoracic and Vascular Department, Pisa University Hospital, University of PisaPisaItaly
| | - Alvin Chandra
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
| | - Iolanda Aquila
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
| | - Brian Claggett
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
| | - Michelle C. Johansen
- Department of NeurologyThe Johns Hopkins University School of MedicineBaltimoreMD
| | - Alexandra Gonçalves
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
- University of Porto Medical SchoolPortoPortugal
| | - Faye L. Norby
- Center for Cardiac Arrest Prevention, Department of Cardiology,Cedars‐Sinai Smidt Heart Institute,Los AngelesCA
| | - Rebecca Cogswell
- Lillehei Heart Institute and Cardiovascular DivisionDepartment of MedicineUniversity of MinnesotaMinneapolisMN
| | | | - Rebecca Gottesman
- Department of NeurologyThe Johns Hopkins University School of MedicineBaltimoreMD
| | - Thomas Mosley
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Alvaro Alonso
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - Amil Shah
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
| | - Scott D. Solomon
- Department of Cardiovascular MedicineBrigham and Women's HospitalBostonMA
| | - Lin Yee Chen
- Lillehei Heart Institute and Cardiovascular DivisionDepartment of MedicineUniversity of MinnesotaMinneapolisMN
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106
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Reverse Remodeling Assessed by Left Atrial and Ventricular Strain Reflects Treatment Response to Sacubitril/Valsartan. JACC: CARDIOVASCULAR IMAGING 2022; 15:1525-1541. [DOI: 10.1016/j.jcmg.2022.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 11/20/2022]
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107
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Inciardi RM, Claggett B, Minamisawa M, Shin SH, Selvaraj S, Gonçalves A, Wang W, Kitzman D, Matsushita K, Prasad NG, Su J, Skali H, Shah AM, Chen LY, Solomon SD. Association of Left Atrial Structure and Function With Heart Failure in Older Adults. J Am Coll Cardiol 2022; 79:1549-1561. [PMID: 35450571 DOI: 10.1016/j.jacc.2022.01.053] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Limited data exist to characterize novel measures of left atrial (LA) structure and function in older adults without prevalent heart failure (HF). OBJECTIVES The aim was to assess reference range of LA measures, their associations with N-terminal pro-B-type natriuretic-peptide (NT-proBNP) and the related risk for incident HF or death. METHODS We analyzed LA structure (LA maximal [LAViMax] and minimal volume indexed by body surface area) and function (LA emptying fraction, LA reservoir, conduit, and contraction strain) in 4,901 participants from the ARIC (Atherosclerosis Risk In Communities) study (mean age 75 ± 5 years, 40% male, and 19% Black) without prevalent HF. We assessed sex-specific 10th and 90th percentile ARIC-based reference limits in 301 participants free of prevalent cardiovascular disease, and related LA measures to NT-proBNP and incident HF or death (median follow-up of 5.5 years) in the whole ARIC cohort. RESULTS Approximately 20% of the overall population had LA abnormalities according to the ARIC-based reference limit. Each LA measure was associated with NT-proBNP and, except for LAViMax, with incident HF or death after multivariable adjustment (including left ventricular function and NT-proBNP). Results were consistent in participants with normal LAViMax (P for interaction > 0.05). LA measures were prognostic for both incident HF with preserved ejection fraction or death and incident HF with reduced ejection fraction or death. When added to HF risk factors and NT-proBNP (baseline C-statistics = 0.74) all LA measures, except for LAViMax, significantly enhanced the prognostic accuracy. CONCLUSIONS Novel measures of LA structure and function, but not standard assessment by LAViMax, are associated with increased risk of incident HF or death regardless of measures of left ventricular function and NT-proBNP.
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Affiliation(s)
- Riccardo M Inciardi
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health. University of Brescia, Brescia, Italy
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Masatoshi Minamisawa
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiovascular Medicine, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Sung-Hee Shin
- Cardiovascular Division, Inha University and Inha University Hospital, Incheon, South Korea
| | - Senthil Selvaraj
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexandra Gonçalves
- Philips Healthcare, Andover, Massachusetts, USA; University of Porto Medical School, Porto, Portugal
| | - Wendy Wang
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dalane Kitzman
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Narayana G Prasad
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jimmy Su
- Philips Healthcare, Andover, Massachusetts, USA
| | - Hicham Skali
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lin Yee Chen
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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108
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Songsangjinda T, Krittayaphong R. Impact of different degrees of left ventricular strain on left atrial mechanics in heart failure with preserved ejection fraction. BMC Cardiovasc Disord 2022; 22:160. [PMID: 35397510 PMCID: PMC8994220 DOI: 10.1186/s12872-022-02608-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/28/2022] [Indexed: 11/14/2022] Open
Abstract
Background Impairment of left atrial (LA) function is linked to left ventricle (LV) mechanics in patients with heart failure with preserved ejection fraction (HFpEF). In this study, we set forth to determine the difference in LA mechanics compared between HFpEF patients with different degrees of LV strains using the cardiac magnetic resonance feature tracking technique. Methods This retrospective study enrolled 79 patients with prior heart failure event and LV ejection fraction (LVEF) ≥ 50% (HFpEF group) together with 2:1 matched controls. LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS); LA emptying fraction (LAEF); and, LA strains consisting of reservoir phase strain (LASr), conduit phase strain (LAScd), and contraction phase strain (LASct) were derived from cine images. All LA parameters were compared between HFpEF subgroups (lower and higher LV strain stratified by the median of each LV strain value) and controls. Results A total of 237 subjects were included. HFpEF had a lower LAEF and LA strain values compared with controls. The mean GLS value was significantly different between HFpEF and controls (− 13.3 ± 3.4% vs. − 15.4 ± 2.2%, p < 0.001). HFpEF with lower GLS (value ≥ − 13.1%) had significantly impaired LA mechanical parameters compared with both HFpEF with higher GLS and controls independent of potential confounders, as follows: LAEF (38.8 ± 16.6% vs. 48.6 ± 15.7% and 54.2 ± 12.2%), LASr (14.6 ± 7.1% vs. 24.3 ± 9.6% and 26.7 ± 8.8%), and LAScd (− 6.6 ± 3.9% vs. − 12.9 ± 6.0% and − 14.7 ± 7.4%) (post hoc analysis of variance p < 0.05 for all comparisons). Similarly, HFpEF with lower GCS (value ≥ − 16.6%) or lower GRS (value < 27.9%) also had significant impairment of LASr and LAScd compared with the higher strain group and controls. Abnormal LAEF (< 50%) and abnormal LASr (< 23%) are independently associated with NYHA class ≥ II (Odds ratio [OR] 3.894 [95% CI 2.202–6.885] p < 0.001, adjusted OR 3.382 [1.791–6.389] p < 0.001 for abnormal LAEF; and OR 2.613 [1.497–4.562] p = 0.001, adjusted OR 2.064 [1.118–2.110] p = 0.021 for abnormal LASr). Conclusions Patients with HFpEF were found to have impaired LV and LA mechanics. Abnormal LA mechanics was highly prevalent in HFpEF patients with lower LV strain and significantly associated with the symptomatic status of the patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02608-7.
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109
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Yang CH, Liu HT, Lee HL, Lin FC, Chou CC. Left atrial booster-pump function as a predictive parameter for atrial fibrillation in patients with severely dilated left atrium. Quant Imaging Med Surg 2022; 12:2523-2534. [PMID: 35371928 PMCID: PMC8923837 DOI: 10.21037/qims-21-954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/12/2022] [Indexed: 03/22/2024]
Abstract
BACKGROUND Left atrial (LA) dimension ≥50 mm had approximately four times the risk of developing atrial fibrillation (AF). The aim of this study was to investigate whether the application of clinical and echocardiographic parameters could differentiate between the patients having severely dilated left atrium with and without AF. METHODS This retrospective cross-sectional study enrolled consecutive patients with LA dimension ≥50 mm and divided them into three groups: no AF (no-AF), paroxysmal AF (PAF) and non-paroxysmal AF (non-PAF) groups. For PAF and non-PAF groups, all patients underwent radiofrequency ablation, and the echocardiographic parameters were obtained on the next day after ablation. RESULTS Our study population comprised 160 patients, including 80, 53, and 27 patients in the non-AF, PAF and non-PAF groups, respectively. The no-AF group had a significantly higher body mass index (kg/m2) (29.31±6.27, 27.58±4.12 and 26.57±2.81, P=0.01), and a higher prevalence of diabetes mellitus (DM) [31 (38.80%), 13 (25.00%) and 4 (14.80%), P=0.01] and hypertension [67 (83.80%), 34 (65.40%), and 19 (70.40%), P=0.04], but a lower prevalence of rheumatic heart disease (RHD) [3 (3.80%), 6 (11.50%) and 5 (18.50%), P=0.02] and sick sinus syndrome [0 (0.00%), 6 (11.50%) and 4 (14.80%), P=0.045]. Echocardiographic studies showed that the non-AF group had significantly smaller LA minimal volume index (24.89±9.74, 34.06±19.38 and 42.83±17.44 mL/m2, P<0.01), higher LA emptying fraction (51.99%±13.97%, 38.40%±15.96% and 33.89%±10.73%, P<0.01), longitudinal strain (23.87%±7.72%, 17.11%±8.52% and 12.38%±4.28%, P<0.01) and strain rate than the AF groups. The multivariate analysis showed that the late diastolic component of LA strain rate was the only independent factor associated with the presence of AF (odds ratio, 21.69; 95% CI, 9.77-48.13, P<0.01). CONCLUSIONS LA function plays an important role in the absence of AF in patients with LA dimension ≥50 mm; the late diastolic component of LA strain rate was the only independent variable on multivariate analysis.
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Affiliation(s)
- Chia-Hung Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan
- Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei
| | - Hao-Tien Liu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan
| | - Hui-Ling Lee
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei Branch, Taipei
| | - Fen-Chiung Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan
| | - Chung-Chuan Chou
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan
- Chang Gung University College of Medicine, Taoyuan
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Comparison of the Mid-Term Outcomes of Robotic Magnetic Navigation-Guided Radiofrequency Ablation versus Cryoballoon Ablation for Persistent Atrial Fibrillation. J Cardiovasc Dev Dis 2022; 9:jcdd9030088. [PMID: 35323637 PMCID: PMC8953767 DOI: 10.3390/jcdd9030088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/01/2022] [Accepted: 03/15/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Currently, numerous ablation techniques are available for atrial fibrillation (AF), in addition to manual radio frequency ablation. The aim of this prospective, non-randomized concurrent controlled trial was to compare the mid-term efficacy and procedural outcomes of persistent AF (PerAF) using cryoballoon (CB) and robotic magnetic navigation (RMN). Methods: Two hundred PerAF patients were assigned, in a 1:1 ratio, to undergo catheter ablation using RMN (RMN group) or CB (CB group). The primary endpoint was freedom from AF recurrence following a 3-month period after the index ablation. The secondary endpoint was peri-procedural outcomes, including the total procedure time, left atrial procedure time, fluoroscopy time, and fluoroscopy dose. The Two-step cluster analysis was used to determine the efficacy of RMN and CB between the different groups. The Cox proportional hazard model and restricted cubic spline were used to determine predictors for AF recurrence. Results: At the mean follow-up of 28.1 ± 9.7 months, the primary endpoint was achieved in 71 PerAF patients in the RMN group and in 62 PerAF patients in the CB group (71% vs. 62%, p = 0.158). Compared with CB, RMN-guided ablation led to a longer procedure time (p < 0.001), but with less radiation (p < 0.001). Cluster analysis returned two clusters of patients and RMN was favorable for one cluster (p = 0.037), in which more patients presented with diabetes mellitus and smaller left atria. Conclusions: For patients with PerAF, CB is generally equivalent to RMN-guided ablation with regard to overall efficacy. RMN-guided ablation could be favorable in specific patient populations presenting with diabetes mellitus and smaller left atria.
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111
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Left atrial reverse remodeling improves risk stratification in patients with heart failure with recovered ejection fraction. Sci Rep 2022; 12:4473. [PMID: 35297403 PMCID: PMC8927594 DOI: 10.1038/s41598-022-08630-1] [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: 11/07/2021] [Accepted: 03/10/2022] [Indexed: 11/14/2022] Open
Abstract
We aimed to investigate the relationship between left atrial (LA) reverse remodeling and prognosis of heart failure (HF) with recovered ejection fraction (EF) (HFrecEF). Among 1,246 patients with acute heart failure enrolled in the prospective longitudinal follow-up study, 397 patients with HF with mildly-reduced EF and with reduced EF at discharge were analyzed. Echocardiography was performed during the index hospitalization and at the 6-month follow-up after discharge. They were divided into non-HFrecEF (n = 227) and HFrecEF (n = 170) groups. The primary outcome measure was a composite of all-cause death or hospitalization for HF. The cumulative 180-day incidence of the primary outcome measure after follow-up echocardiography was significantly lower in the HFrecEF group than in the non-HFrecEF group (8.9% versus 23.4%, log-rank P = 0.0002). LA reverse remodeling was associated with a lower cumulative 6-month incidence of the primary outcome measure in the HFrecEF group (4.7% versus 18.0%; HR: 0.27, 95%CI: 0.09–0.79, P = 0.01), but not in the non-HFrecEF group (24.4% versus 22.6%; HR: 1.13, 95%CI: 0.65–1.96, P = 0.28) with a significant LA reverse remodeling-by-HFrecEF interaction (P for interaction = 0.02). Combination of left ventricular and atrial reverse remodeling may help in improving HF risk stratification.
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112
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Soulat-Dufour L, Lang S, Addetia K, Ederhy S, Adavane-Scheuble S, Chauvet-Droit M, Jean ML, Nhan P, Ben Said R, Kamami I, Issaurat P, Capderou E, Arnaud C, Boccara F, Lang RM, Cohen A. Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation. J Am Coll Cardiol 2022; 79:951-961. [PMID: 35272799 DOI: 10.1016/j.jacc.2021.12.029] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiac chamber remodeling in atrial fibrillation (AF) reflects the progression of cardiac rhythm and may affect functional regurgitation. OBJECTIVES The purpose of this study was to explore the 3-dimensional echocardiographic variables of cardiac cavity remodeling and the impact on functional regurgitation in patients with AF with/without sinus rhythm restoration at 12 months. METHODS A total of 117 consecutive patients hospitalized for AF were examined using serial 3-dimensional transthoracic echocardiography at admission, at 6 months, and at 12 months (337 examinations). RESULTS During follow-up, 47 patients with active restoration of sinus rhythm (SR) (through cardioversion and/or ablation) had a decrease in all atrial indexed volumes (Vi), end-systolic (ES) right ventricular (RV) Vi, an increase in end-diastolic (ED) left ventricular Vi, and an improvement in 4-chambers function (P < 0.05). Patients with absence/failure of restoration of SR (n = 39) had an increase in ED left atrial Vi and ED/ES RV Vi without modification of 4-chambers function, except for a decrease in left atrial emptying fraction (P < 0.05). Patients with spontaneous restoration of SR (n = 31) had no changes in Vi or function. The authors found an improvement vs baseline in severity of functional regurgitation in patients with active restoration of SR (tricuspid and mitral regurgitation) and in spontaneous restoration of SR (tricuspid regurgitation) (P < 0.05). In multivariable analysis, right atrial and/or left atrial reverse remodeling exclusively correlated with intervention (cardioversion and/or ablation) during 12-month follow-up. CONCLUSIONS Management of AF should focus on restoration of SR to induce anatomical (all atrial Vi, ES RV Vi) and/or functional (4 chambers) cardiac cavity reverse remodeling and reduce severity of functional regurgitation. (Thromboembolic and Bleeding Risk Stratification in Patients With Non-valvular Atrial Fibrillation [FASTRHAC]; NCT02741349).
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Affiliation(s)
- Laurie Soulat-Dufour
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Unité INSERM UMRS 1166 Unité de recherche sur les maladies cardiovasculaires et métaboliques, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), F-75013, Sorbonne Université, Paris, France. https://twitter.com/lsoulatdufour
| | - Sylvie Lang
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Karima Addetia
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois, USA
| | - Stephane Ederhy
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | | | - Marion Chauvet-Droit
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Marie-Liesse Jean
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Pascal Nhan
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Rim Ben Said
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Iris Kamami
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Pauline Issaurat
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Elodie Capderou
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Camille Arnaud
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Franck Boccara
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Sorbonne Université, GRC n°22, C(2)MV-Complications Cardiovasculaires et Métaboliques chez les patients vivant avec le Virus de l'immunodéficience humaine, Inserm UMR_S 938, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Roberto M Lang
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois, USA
| | - Ariel Cohen
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Unité INSERM UMRS 1166 Unité de recherche sur les maladies cardiovasculaires et métaboliques, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), F-75013, Sorbonne Université, Paris, France.
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Arnăutu SF, Morariu VI, Arnăutu DA, Tomescu MC, Dan TF, Dragos Jianu C. Left Atrial Strain Helps Identifying the Cardioembolic Risk in Transient Ischemic Attacks Patients with Silent Paroxysmal Atrial Fibrillation. Ther Clin Risk Manag 2022; 18:213-222. [PMID: 35299625 PMCID: PMC8922319 DOI: 10.2147/tcrm.s359490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/03/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose Patients with transient ischemic attacks often present asymptomatic and paroxysmal atrial fibrillation. Since atrial fibrillation initiates in the atria, we aimed to identify whether the abnormalities in left atrial structure and function could identify the cardioembolic etiology of the transient ischemic attacks in patients at sinus rhythm. Patients and Methods A total of 190 patients over 50 years old with sinus rhythm discharged after a transient ischemic attack were included in the study and divided into two groups according to the presence (group I) or absence (group II) of documented paroxysmal atrial fibrillation. The documentation of paroxysmal atrial fibrillation was based on the examination of medical registers. Cardiac ultrasound assessment was performed at a minimum of 14 days after the onset of the transient ischemic attack, to avoid assessment of atrial stunning. Results The group I patients were older, more frequent women, with a history of stroke or transient ischemic attack and a higher CHA2DS2-VASc score. They also presented larger left atrial volumes, lower left atrial emptying fraction, and significantly impaired left atrial deformation patterns. Multivariate logistic regression identified three variables that were independently associated with paroxysmal atrial fibrillation: age, left atrial reservoir strain, and left atrial emptying fraction (P < 0.0001). The cut-off levels for the variables were age > 55 years, reservoir strain < −17%, and emptying fraction < 51%. Conclusion The present study demonstrates that the LA strain is independently associated with paroxysmal atrial fibrillation in transient ischemic attack patients and might be of great help in identifying their cardioembolic etiology and preventing subsequent strokes by the initiation of anticoagulant therapy.
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Affiliation(s)
- Sergiu Florin Arnăutu
- Neurology Department, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
- Neurology Clinic, Pius Brînzeu County Clinical Emergency Hospital, Timisoara, Romania
| | - Vlad Ioan Morariu
- Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Cardiology Clinic, Timisoara Municipal Clinical Emergency Hospital, Timisoara, Romania
| | - Diana Aurora Arnăutu
- Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Cardiology Clinic, Timisoara Municipal Clinical Emergency Hospital, Timisoara, Romania
- Correspondence: Diana Aurora Arnăutu; Mirela Cleopatra Tomescu, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, Timisoara, 300041, Romania, Tel +40 734600550; +40722979516, Fax +40 256220636, Email ;
| | - Mirela Cleopatra Tomescu
- Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Cardiology Clinic, Timisoara Municipal Clinical Emergency Hospital, Timisoara, Romania
| | - Traian Flavius Dan
- Neurology Department, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
- Neurology Clinic, Pius Brînzeu County Clinical Emergency Hospital, Timisoara, Romania
| | - Cătălin Dragos Jianu
- Neurology Department, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
- Neurology Clinic, Pius Brînzeu County Clinical Emergency Hospital, Timisoara, Romania
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Andersen DM, Sengeløv M, Olsen FJ, Marott JL, Jensen GB, Schnohr P, Platz E, Schou M, Mogelvang R, Biering-Sørensen T. Measures of left atrial function predict incident heart failure in a low-risk general population: the Copenhagen City Heart Study. Eur J Heart Fail 2022; 24:483-493. [PMID: 34931395 PMCID: PMC8986599 DOI: 10.1002/ejhf.2406] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/24/2021] [Accepted: 12/17/2021] [Indexed: 11/06/2022] Open
Abstract
AIMS This study investigated left atrial (LA) parameters as measured on transthoracic echocardiography as predictors of incident heart failure (HF) in a community cohort. METHODS AND RESULTS In a large general population study (n = 2221), participants underwent a health examination with echocardiography. The maximum and minimum LA volumes indexed to body surface area (LAVImax and LAVImin) were measured and the LA emptying fraction (LAEF) and LA expansion index (LAEI) were calculated. Among 1951 participants without atrial fibrillation or significant valve disease, the mean age was 59 ± 16 years and 58% were women. At baseline, 1% (n = 16) had a left ventricular ejection fraction of <50%, 44% had hypertension, and 10% had diabetes. During follow-up (median 15.8 years, interquartile range: 11.3-16.2 years), 187 (10%) participants were diagnosed with incident HF. Participants who were diagnosed with HF during follow-up had a larger LAVImax and LAVImin and a lower LAEF and LAEI compared to participants without HF. In unadjusted analysis, LAVImax, LAVImin, LAEF and LAEI were predictors of incident HF. After multivariable adjustment for clinical and echocardiographic parameters, only LAVImin remained an independent predictor of incident HF (hazard ratio per 1 standard deviation increase: 1.22 [95% confidence interval 1.01-1.47], p = 0.038). CONCLUSION In the general population, LAVImin is an independent predictor of incident HF. LAVImax, currently the only LA measure in a routine echocardiographic examination, was not an independent predictor of incident HF.
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Affiliation(s)
- Ditte Madsen Andersen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark,Corresponding author. Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, Gentofte Hospitalsvej 8, Post 835, DK-2900 Hellerup, Denmark. Tel: +45 40375736, Fax: +45 39777381,
| | - Morten Sengeløv
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Elke Platz
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Mogelvang
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Cardiovascular Research Unit, Svendborg, University of Southern Denmark, Odense, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark,The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark,Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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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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116
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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: 21] [Impact Index Per Article: 10.5] [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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Oh JK, Park JH. Role of strain echocardiography in patients with hypertension. Clin Hypertens 2022; 28:6. [PMID: 35164856 PMCID: PMC8845306 DOI: 10.1186/s40885-021-00186-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/19/2021] [Indexed: 01/19/2023] Open
Abstract
AbstractHypertension is a well-recognized risk factor for the development of cardiovascular disease, and the early detection of cardiac changes from hypertension can allow reversing these. Hypertensive heart diseases (HHD) refer to the complex and diverse change of the cardiac structure and function secondary to hypertension. Although conventional echocardiography is the most common imaging modality in detecting HHD, it cannot detect subtle changes of cardiac structure in subclinical states. Because strain echocardiography is another echocardiographic modality can detect subclinical myocardial dysfunction by measuring intrinsic myocardial deformation, it became more and more popular in clinical and research fields. In this review article, we described the basic concept of strain echocardiography and summarized several clinical studies showing its clinical utilities in the detection of HHD.
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Bissolino A, Andreis A, Magnano M, Budano C, Saglietto A, Angelini F, Roagna E, Mattivi S, Peyracchia M, Errigo D, Golzio PG, Castagno D, Giustetto C, De Ferrari GM. Prognostic role of left atrial enlargement in patients with implantable cardioverter defibrillators for primary prevention. Acta Cardiol 2022; 77:45-50. [PMID: 33308049 DOI: 10.1080/00015385.2020.1856491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Left atrial volume index (LAVI) is a predictor of heart failure and adverse events, irrespective of left ventricular systolic function. The role of LAVI in the prediction of appropriate implantable cardioverter-defibrillator (ICD) therapies is currently unclear and was the focus of this study. METHODS Consecutive heart failure patients with ischaemic (ICM) or idiopathic (DCM) aetiology receiving ICD for primary prevention were included. The primary endpoint was the occurrence of appropriate ICD therapies (ATs): shocks or antitachycardia pacing (ATP). Inappropriate ICD shocks were also assessed as secondary endpoint. RESULTS Among 198 included patients, severe left atrial dilatation (SLAE = LAVI ≥ 60 ml/m2) was present in 54 (27%). SLAE patients had a higher prevalence of NYHA class ≥ III, severe mitral regurgitation and atrial fibrillation history. During a median follow-up of 45 months (IQR 25-68), ATs occurred more frequently in SLAE group (33% vs. 15%, p = .007) as well as appropriate shocks (24% vs. 10%, p = .014). At multivariate analysis SLAE was an independent predictor of ATs (OR 3.19, 95% CI 1.38-7.38, p = .007). Inappropriate shocks were associated with AF during implantation (p = .03), but not with SLAE (p = .009). CONCLUSION In DCM or ICM patients candidate to receive an ICD for primary prevention, a severely enlarged left atrium is a predictive factor for ATs (shocks or ATP). The risk of inappropriate shocks was increased in patients with atrial fibrillation, rather than SLAE.
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Affiliation(s)
- Arianna Bissolino
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Massimo Magnano
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Carlo Budano
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Edoardo Roagna
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Simone Mattivi
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Mattia Peyracchia
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Daniele Errigo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Pier Giorgio Golzio
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Davide Castagno
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Carla Giustetto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
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Patel RB, Shah SJ, Inciardi RM. Collagen homeostasis of the left atrium: an emerging treatment target to prevent heart failure? Eur J Heart Fail 2022; 24:332-334. [PMID: 34989102 PMCID: PMC8900253 DOI: 10.1002/ejhf.2422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 01/03/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Ravi B. Patel
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sanjiv J. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Riccardo M. Inciardi
- Division of Cardiology, Civil Hospitals of Brescia; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy,Corresponding author. Civil Hospitals of Brescia; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy. Tel: +39 3281526343,
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Hiasa KI, Kaku H, Kawahara G, Inoue H, Yamashita T, Akao M, Atarashi H, Ikeda T, Koretsune Y, Okumura K, Shimizu W, Toyoda K, Hirayama A, Yasaka M, Yamaguchi T, Teramukai S, Kimura T, Kaburagi J, Takita A, Tsutsui H. Echocardiographic Structure and Function in Elderly Patients With Atrial Fibrillation in Japan - The ANAFIE Echocardiographic Substudy. Circ J 2022; 86:222-232. [PMID: 34937815 DOI: 10.1253/circj.cj-21-0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Echocardiographic data on the cardiac structure and function in elderly patients with atrial fibrillation (AF) and heart failure (HF) are limited. This subcohort study of the ANAFIE Registry analyzed echocardiographic parameters to identify cardiac structural and functional characteristics. METHODS AND RESULTS Of 32,726 subjects in the ANAFIE population, 1,494 (4.6%) were entered as the echocardiography subcohort. Half of the patients, including those with persistent and permanent AF, older age (≥80 years), and CHADS2score ≥2, had left atrial (LA) volume index ≥48 mL/m2, indicating severe LA enlargement. LA enlargement significantly correlated with impaired LA reservoir function, regardless of age and CHADS2score. Types of AF and rhythm were strongly related to LA volume and reservoir function (P<0.0001). Moderate-to-severe mitral and tricuspid regurgitation were significantly more common, and the early diastolic mitral inflow velocity to mitral annulus velocity ratio was significantly higher among patients with than without HF history (all, P<0.0001). CONCLUSIONS In this subcohort, LA enlargement correlated with impaired LA reservoir function. Elderly patients with non-valvular AF and a history of HF had LA enlargement and dysfunction, increased LV mass index, low LV ejection fraction, and high heart rate.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd
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Miyauchi S, Tokuyama T, Uotani Y, Miyamoto S, Ikeuchi Y, Okamura S, Okubo Y, Katayama K, Takasaki T, Nakatani N, Matsudaira Y, Furusho H, Miyauchi M, Takahashi S, Nakano Y. Association between Left Atrial Appendage Fibrosis and Thrombus Formation: A Histological Approach. J Cardiovasc Electrophysiol 2022; 33:677-687. [DOI: 10.1111/jce.15384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Shunsuke Miyauchi
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
- Health Service CenterHiroshima University1‐7‐1 KagamiyamaHigashihiroshimaJapan
| | - Takehito Tokuyama
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yukimi Uotani
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Shogo Miyamoto
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yoshihiro Ikeuchi
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Sho Okamura
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yousaku Okubo
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Keijiro Katayama
- Department of Cardiovascular SurgeryHiroshima University Hospital1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Taiichi Takasaki
- Department of Cardiovascular SurgeryHiroshima University Hospital1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Nobuhiro Nakatani
- Medical Division, Technical CenterHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yorisato Matsudaira
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Hisako Furusho
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yukiko Nakano
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
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Park Y, Cho GJ, Roh SY, Na JO, Oh MJ. Increased Cardiac Arrhythmia After Pregnancy-Induced Hypertension: A South Korean Nationwide Database Study. J Am Heart Assoc 2022; 11:e023013. [PMID: 35014853 PMCID: PMC9238534 DOI: 10.1161/jaha.121.023013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Although pregnancy‐induced hypertension (PIH) is associated with an elevated cardiovascular risk, long‐term studies or prepregnancy baseline data are scarce. Therefore, using a large nationwide cohort with prepregnancy periodic health screening data, we investigated whether clinically significant arrhythmia incidence increases after PIH. Methods and Results Data were extracted from the Korea National Health Insurance database and combined with the National Health Screening Examination database; women who gave birth between 2007 and 2015 and underwent the national health screening test within a year before pregnancy were followed up until 2016. We excluded women who had a diagnosis of arrhythmia within 1 year before pregnancy. The primary outcome was significant arrhythmia during the year after delivery. Secondary analysis included only specific diagnostic codes of arrhythmia with clinical significance. Additionally, the risk of arrhythmia was stratified by the use of magnesium sulfate. Of 2 035 684 women (PIH; n=37 297 versus normotensive pregnancy; n=1 998 387), the PIH group had a higher prepregnancy risk profile and showed a higher incidence of arrhythmia than women with normotensive pregnancies within 1 year. Women with PIH had a significantly higher risk of atrial flutter/fibrillation and atrioventricular block, but not lethal arrhythmias. Other predictors of arrhythmia development included advanced maternal age and cesarean section. Stratified analysis showed a higher risk of arrhythmia with magnesium sulfate use. Conclusions PIH was significantly associated with the development of arrhythmia within 1 year after delivery. Nevertheless, the incidence of lethal arrhythmias was not increased by PIH. Arrhythmia, especially atrial fibrillation, may largely contribute to increasing the future cardiovascular risk in women with a PIH history.
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Affiliation(s)
- Yoonjee Park
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology Korea University College of Medicine Seoul South Korea
| | - Seung-Young Roh
- Division of Cardiology Department of Internal Medicine Korea University Guro Hospital Seoul South Korea
| | - Jin Oh Na
- Division of Cardiology Department of Internal Medicine Korea University Guro Hospital Seoul South Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology Korea University College of Medicine Seoul South Korea
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Zhang R, Sun X, Li Y, He W, Zhu H, Liu B, Zhang A. The Efficacy and Safety of Sacubitril/Valsartan in Heart Failure Patients: A Review. J Cardiovasc Pharmacol Ther 2022; 27:10742484211058681. [PMID: 34994233 DOI: 10.1177/10742484211058681] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is one of the leading causes of morbidity and mortality worldwide. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has been approved for the treatment of HF. At present, there have been few systematic and detailed reviews discussing the efficacy and safety of sacubitril/valsartan in HF. In this review, we first introduced the pharmacological mechanisms of sacubitril/valsartan, including the reduction in the degradation of natriuretic peptides in the natriuretic peptide system and inhibition of the renin-angiotensin system. Then, we summarized the efficacy of sacubitril/valsartan in HF patients with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF) including the reduction in risks of mortality and hospitalization, reversal of cardiac remodeling, regulation of biomarkers of HF, improvement of the quality of life, antiarrhythmia, improving renal dysfunction and regulation of metabolism. Finally, we discussed the safety and tolerability of sacubitril/valsartan in the treatment of HFrEF or HFpEF. Compared with ACEIs/ARBs or placebo, sacubitril/valsartan showed good safety and tolerability, although the risk of hypotension might be high. In conclusion, the overwhelming majority of studies show that sacubitril/valsartan is effective and safe in the treatment of HFrEF patients but that it has little benefit in HFpEF patients. Sacubitril/valsartan will probably be a promising anti-HF drug in the near future.
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Affiliation(s)
- Rui Zhang
- Department of Cardiology, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China.,Cardiac Care Unit, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China.,Cardiac Rehabilitation Centre, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xiaotong Sun
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, Department of Anesthesiology, Weifang Medical University, Weifang, China
| | - Ya Li
- Department of Cardiology, Shanghai General Hospital, School of Medicine, 12474Shanghai Jiaotong University, Hongkou District, Shanghai, China
| | - Wenzheng He
- Intensive Care Unit, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Hongguang Zhu
- Dental Department, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Baoshan Liu
- Department of Cardiology, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China.,Cardiac Care Unit, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China.,Cardiac Rehabilitation Centre, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Aiyuan Zhang
- Department of Cardiology, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China.,Cardiac Care Unit, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China.,Cardiac Rehabilitation Centre, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China
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Pan J, Xu C, Xu B, Lou Y, Wang S, Xing Y. Relationship between the time point of left atrial size change and the outcomes of radiofrequency catheter ablation. J Interv Card Electrophysiol 2022; 64:669-675. [PMID: 34993723 DOI: 10.1007/s10840-021-01097-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The change in the left atrial anteroposterior diameter (LAD) after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has become an independent factor in predicting the postoperative curative effect; however, whether the specific time point of this change is related to the postoperative curative effect is unclear. The purpose of this study was to explore the correlation between the specific time point of LAD change and the recurrence of AF 1 year after RFCA. METHODS Patients with AF who underwent RFCA in our hospital from July 2016 to May 2020 were enrolled in the study. The patients were divided into four groups according to the time point when the LAD decreased by 10% after RFCA: group A, first month after RFCA; group B, second month after RFCA; group C, third month after RFCA; group D, unchanged or changed > 3 months after RFCA. RESULTS In the multivariable Cox analyses, the duration of AF, LAD, and persistent AF were independent risk factors for the recurrence of AF. The recurrence rate of AF 1 year after RFCA were significantly lower in groups A (odds ratio [OR], 0.160; 95% confidence interval [CI]: 0.073-0.352; P < 0.001) and C (OR, 0.388; 95% CI: 0.156-0.963; P = 0.041) than in the control group. CONCLUSIONS Reduction of LAD within 3 months after operation predicts the success rate of RFCA, with reduction within 1 month after operation having a higher success rate. This indicates the necessity of treatment in patients with AF who do not experience an early reduction in the LAD after RFCA.
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Affiliation(s)
- Jie Pan
- Department of Cardiology, Shaoxing University School of Medicine, 312000, Shaoxing, Zhejiang, People's Republic of China
| | - Chao Xu
- Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), 568 # Zhongxing North Road, Shaoxing, Zhejiang Province, 312000, People's Republic of China
| | - Buyun Xu
- Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), 568 # Zhongxing North Road, Shaoxing, Zhejiang Province, 312000, People's Republic of China
| | - Yuanqing Lou
- Department of Cardiology, Shaoxing University School of Medicine, 312000, Shaoxing, Zhejiang, People's Republic of China
| | - Shengkai Wang
- Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), 568 # Zhongxing North Road, Shaoxing, Zhejiang Province, 312000, People's Republic of China
| | - Yangbo Xing
- Department of Cardiology, The First Affiliated Hospital of Shaoxing University, 312000, Shaoxing, Zhejiang, People's Republic of China. .,Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), 568 # Zhongxing North Road, Shaoxing, Zhejiang Province, 312000, People's Republic of China.
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Guichard JB, Anselme F, Defaye P, Mansourati J, Pavin D, Pasquié JL, Saludas Y, Barthélémy JC, Roche F, Laporte S, Chapelle C, Garcin A, Romeyer C, Isaaz K, Da Costa A. Prevention of Atrial Fibrillation After Atrial Flutter Ablation With Ramipril (from the PREFACE Study). Am J Cardiol 2022; 162:73-79. [PMID: 34728062 DOI: 10.1016/j.amjcard.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 11/01/2022]
Abstract
The clinical efficacy of the inhibitors of the renin-angiotensin-aldosterone system (RAAS) as an upstream therapy for atrial fibrillation (AF) prevention is controversial. No study has itemized so far the role of RAAS inhibitors in AF prevention after atrial flutter (AFL) ablation. This trial aims to investigate the effect of ramipril compared with placebo on AF occurrence in patients hospitalized for AFL ablation without structural heart disease. The Prevention of Atrial Fibrillation by Inhibition Conversion Enzyme (ICE) After Radiofrequency Ablation of Atrial Flutter (PREFACE) trial was a prospective, multicenter, randomized, double-blind, double-dummy trial depicting the AF occurrence during a 12-month follow-up as the primary end point. A total of 198 patients hospitalized for AFL ablation were enrolled in the trial and randomized to placebo or ramipril 5 mg/day. Patients were followed up during 1 year after AFL ablation using 1-week Holter electrocardiogram at 3, 6, 9, and 12 months. The intention-to-treat population encompassed 97 patients in the ramipril group and 101 patients in the placebo group. The primary end point, such as AF occurrence during the 1-year follow-up, was not different between the 2 groups (p = 0.96). Secondary end points, including the occurrence of supraventricular arrhythmia (p = 0.50), heart failure, stroke, and death, were not different between the 2 groups. Safety outcome parameters, including serious adverse events leading to treatment disruption (p = 0.10), hypotension, impairment of renal function, and elevated serum potassium level, also were not different between the 2 groups. In conclusion, RAAS inhibition using ramipril does not reduce AF occurrence in patients facing AFL ablation during the 1-year follow-up.
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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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Effects of Acupuncture on Cardiac Remodeling in Patients with Persistent Atrial Fibrillation: Results of a Randomized, Placebo-Controlled, Patient- and Assessor-Blinded Pilot Trial and Its Implications for Future Research. Medicina (B Aires) 2021; 58:medicina58010041. [PMID: 35056349 PMCID: PMC8778603 DOI: 10.3390/medicina58010041] [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: 11/06/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: In this study, we attempted to determine the effects of acupuncture on cardiac remodeling and atrial fibrillation (AF) recurrence rates in patients with AF after electrical cardioversion (EC). Materials and Methods: We randomly assigned 44 patients with persistent AF to an acupuncture group or a sham acupuncture group. An electroacupuncture treatment session was administered once weekly for 12 weeks at four acupuncture points (left PC5, PC6, ST36, and ST37). Results: Among the 44 recruited participants, 16 (treatment group) and 15 (control group) completed the trial. The three-month AF recurrence rate (primary outcome) was not significantly different between the two groups. Following the completion of treatment, patients who had been treated with acupuncture had a significant reduction in left atrial volume index (42.2 ± 13.9 to 36.1 ± 9.7 mL/m2; p = 0.028), whereas no change in atrial size was observed in the sham acupuncture group. No serious adverse events were observed. The AF recurrence rate and cardiac function did not differ significantly between the two groups. At three months, the acupuncture treatment group showed more favorable atrial structural remodeling compared to the sham acupuncture group. Conclusion: In future research on acupuncture in AF management, it is recommended that the inclusion criteria be amended to include only symptomatic AF, that an appropriate control group is designed, and that the acupuncture treatment frequency is increased to several times per week.
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Park I, Jeong DS, Ahn JH, Park PW. Five-Year Outcomes of Concomitant Maze Procedure Using Nitrous Oxide versus Argon-Based Cryoablation. Ann Thorac Surg 2021; 114:2244-2252. [PMID: 34953787 DOI: 10.1016/j.athoracsur.2021.11.036] [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: 07/08/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cryoablation is effective for ablating the myocardium but maintaining the structure of the ablated tissue. However, data comparing nitrous oxide (N2O)-based and argon gas-based cryoprobes are limited. METHODS This study was a follow-up study of a single-center, prospective, randomized controlled trial in which 60 patients were randomly allocated to either the N2O group or the argon group. The primary endpoint of this study was sinus rhythm maintenance, and the key secondary endpoint was a composite of major adverse cardiovascular and cerebrovascular events (MACCEs) (i.e., cardiac death, stroke, major bleeding, and readmission for heart failure). RESULTS The baseline and operative characteristics of the patients in the N2O and argon groups were comparable. At the 5-year follow-up, the rate of sinus rhythm maintenance was 81.8% in the N2O group, whereas it was 78.5% in the argon group (p > 0.999). No significant differences in the rate of freedom from MACCEs (80.6% in the N2O group vs. 81.9% in the argon group; P = .978) was observed at the 5-year follow-up. The left atrial volume index decreased over time from 114.65 mL/m2 to 65.74 mL/m2 (P < .0001) and reached similar values in the two groups (P = .279) at the 5-year follow-up. CONCLUSIONS Both N2O- and argon gas-based cryoprobes showed similar rates of sinus rhythm maintenance and freedom from MACCEs at the 5-year follow-up. Both cryoprobes might have similar efficacy and safety in the arrested heart in the long term.
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Affiliation(s)
- Ilkun Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Joong Hyun Ahn
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Incheon Sejong Hospital, Incheon, Gyeonggi-do, Republic of Korea
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BLAGA SN, TODOR N, ZDRENGHEA D, ROȘU R, CISMARU G, PUIU M, GUȘETU G, POP D. The profile of patients with atrial fibrillation scheduled for cardioversion or catheter ablation hospitalized in a Romanian rehabilitation hospital. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives - Structural cardiac, mainly atrial remodeling in non-valvular atrial fibrillation (NVAF) creates conditions for thromboembolic complications, despite the optimization of oral anticoagulant treatment over the past years. This study aims to provide a comparative analysis of patients with NVAF, with and without atrial thrombotic masses, in an integrated approach using clinical, electrocardiographic, anatomohemodynamic cardiac findings assessed by echocardiography, as well as an evaluation of the inflammatory status based on the usual screening blood markers. Methods – The study was based on the anonymous analysis of the medical records of 50 patients with NVAF monitored in a center of cardiology in Cluj-Napoca between March 2019 – February 2020, who received optimal oral anticoagulant treatment, all undergoing transesophageal ultrasound prior to cardioversion or ablation therapy. The statistical data processing methods were based on the “chi square” test and overall model fit logistic regression. Results – Atrial thrombotic complications were found in 7 (14%) patients with NVAF. These had, compared to patients without thrombotic masses, a mean CHA2DS2-VASc scale of 3 versus 2.76 (p=0.05), more frequently other atrial tachyarrhythmias (p<0.01), a more expressed inflammatory reaction (p=0.02), as well as a reduction of LVEF (p<0.01) and the peak left atrial appendage emptying velocity (p<0.01). Conclusions – In addition to a high CHA2DS2-VASc score, left anatomohemodynamic cardiac alteration, atrial arrhythmic complexity and background inflammatory status create conditions for high thromboembolic risk in patients with NVAF.
Keywords: non-valvular atrial fibrillation, cardiac thrombosis, left ventricular ejection fraction, inflammatory status, peak left atrial appendage velocity,
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Affiliation(s)
| | - Nicolae TODOR
- Institutul Oncologic "Ion Chiricuță", Cluj-Napoca, Romania
| | - Dumitru ZDRENGHEA
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu ROȘU
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriel CISMARU
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai PUIU
- Cardiology-Rehabilitation Department, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Gabriel GUȘETU
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana POP
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Grassinger JM, Henrich M, Echevarría AC, März I, Henrich E, Bartel A, Schneider M, Aupperle-Lellbach H. Correlation of Histopathological Changes in the Left Atrium and Left Atrial Appendage with the Degree of Dilation in Cats. J Comp Pathol 2021; 189:8-25. [PMID: 34886990 DOI: 10.1016/j.jcpa.2021.09.001] [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: 12/30/2020] [Revised: 04/12/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
Although atrial dilation is a common finding in feline cardiac disease, detailed investigations of atrial pathology are rare in cats. The aim of the study was to investigate the correlation between pathohistological findings, morphometric data and the degree of dilation of the left atrial appendage (LAA) in 53 cats. Based on the LAA volume, the samples were grouped into normal/control (group 0, ≤1 ml [n = 9]), mildly dilated (group 1, >1 to ≤2 ml [n = 16]), moderately dilated (group 2, >2 to ≤3 ml [n = 14]) and markedly dilated (group 3, >3 ml [n = 14]) groups, independent of the underlying disease. Samples from the LAA and the left atrium (LA) were histologically evaluated using haematoxylin and eosin- and Picrosirius red-stained sections, and morphometrically analysed using an image analysis system. The degree of endo-, myo- and epicardial fibrosis was directly correlated with increased LAA dilation. Due to cardiomyocyte hyperplasia and hypertrophy, the mean thickness of the atrial wall was significantly greater in groups 1 and 2 than in group 0. Conversely, group 3 had a lower mean atrial wall thickness than groups 1 and 2, which was attributed to increased transmural fibrosis and cardiomyocyte atrophy. These findings reflect intensive dynamic remodelling processes during LA and LAA dilation, indicating that reversibility appears to be limited in cases of severe left atrial dilation.
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Affiliation(s)
- Julia M Grassinger
- LABOKLIN GmbH & Co. KG, Labor für Klinische Diagnostik, Bad Kissingen, Berlin, Germany.
| | - Manfred Henrich
- Institut für Veterinär-Pathologie, Veterinärmedizinische Fakultät der Justus-Liebig-Universität Gießen, Gießen, Berlin, Germany
| | - Argine C Echevarría
- LABOKLIN GmbH & Co. KG, Labor für Klinische Diagnostik, Bad Kissingen, Berlin, Germany
| | - Imke März
- Tierklinik Hofheim, Hofheim, Berlin, Germany
| | - Estelle Henrich
- Klinik für Kleintiere, Veterinärmedizinische Fakultät der Justus-Liebig-Universität Gießen, Gießen, Berlin, Germany
| | - Alexander Bartel
- Institut für Veterinär-Epidemiologie und Biometrie, Freie Universität Berlin, Berlin, Germany
| | - Matthias Schneider
- Klinik für Kleintiere, Veterinärmedizinische Fakultät der Justus-Liebig-Universität Gießen, Gießen, Berlin, Germany
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Guo F, Li C, Yang L, Chen C, Chen Y, Ni J, Fu R, Jiao Y, Meng Y. Impact of left atrial geometric remodeling on late atrial fibrillation recurrence after catheter ablation. J Cardiovasc Med (Hagerstown) 2021; 22:909-916. [PMID: 34506349 DOI: 10.2459/jcm.0000000000001255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS To quantitatively investigate the impact of left atrial geometric remodeling on atrial fibrillation recurrence after catheter ablation. METHODS A retrospective analysis of 105 patients with atrial fibrillation who underwent coronary computed tomographic angiography before catheter ablation. Risk factors for atrial fibrillation recurrence were identified by multivariable logistic regression analysis and used to create a nomogram. RESULTS After at least 12 months of follow-up, 30 patients (29%) developed recurrent atrial fibrillation. Patients with recurrence had higher left atrial volume, left atrial sphericity, and lower left atrial ejection fraction (LAEF) (P < 0.05). There was no significant difference in asymmetry index between the two groups (P = 0.121). Multivariable regression analysis showed that left atrial minimal volume index (LAVImin) [odds ratio (OR): 1.026, 95% confidence interval (CI): 1.002-1.050, P = 0.034], left atrial sphericity (OR: 1.222, 95% CI: 1.040-1.435, P = 0.015) and CHADS2 score (OR: 1.511, 95% CI: 1.024-2.229, P = 0.038) were independent predictors of atrial fibrillation recurrence. The combined model of the left atrial sphericity to the LAVImin substantially increased the predictive power for atrial fibrillation recurrence [area under the curve (AUC) = 0.736, 95% CI: 0.627-0.844, P < 0.001], with a sensitivity of 80% and a specificity of 61%. A nomogram was generated based on the contribution weights of the risk factors; the AUC was 0.772 (95% CI: 0.670-0.875) and had good internal validity. CONCLUSION The CHADS2 score, left atrial sphericity, and LAVImin were significant and independent predictors of atrial fibrillation recurrence after catheter ablation. Furthermore, the nomogram had a better predictive capacity for atrial fibrillation recurrence.
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Affiliation(s)
- Fuqian Guo
- Department of Medical Imaging, The Second Hospital, Hebei Medical University, Shijiazhuang, Hebei, China
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Sun Y, Song S, Zhang Y, Mo W, Zhang X, Wang N, Xia Y, Tse G, Liu Y. Effect of angiotensin receptor neprilysin inhibitors on left atrial remodeling and prognosis in heart failure. ESC Heart Fail 2021; 9:667-675. [PMID: 34779134 PMCID: PMC8787963 DOI: 10.1002/ehf2.13691] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/25/2021] [Accepted: 10/25/2021] [Indexed: 01/19/2023] Open
Abstract
Aims The angiotensin receptor–neprilysin inhibitor (ARNI), sacubitril/valsartan, confers additional protective effects compared with angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers (ACEIs/ARBs) in terms of reversed left ventricular (LV) remodelling and improves the prognosis of patients with heart failure (HF). However, few studies have examined the effects of ARNI on the left atrium. Accordingly, this study compared the effects of ARNI and ACEI/ARB on left atrial (LA) remodelling in heart failure with reduced ejection fraction (HFrEF). Methods and results This was a single‐centre retrospective study of patients with HFrEF hospitalized at the First Affiliated Hospital of Dalian Medical University between 26 February 2016 and 8 July 2020. Patients were classified into ARNI and ACEI/ARB groups and further subgroups based on the left atrial volume index (LAVI): mildly abnormal (29 mL/m2 ≤ LAVI < 34 mL/m2), moderately abnormal (34 mL/m2 ≤ LAVI < 40 mL/m2), and severely abnormal (LAVI ≥ 40 mL/m2). The primary endpoint was changes in LA parameters by echocardiography. The secondary endpoint was all‐cause mortality. A total of 336 patients (mean age: 64.11 ± 12.86, 30.06% female) were included. Except those lost to follow‐up, 274 HFrEF patients remained, with 144 cases in the ARNI group and 130 cases in the ACEI/ARB group. Greater reductions from baseline were seen with ARNI in LA diameter (LAD) (P = 0.013, t‐test), superior and LA superior–inferior diameter (LASID) (P < 0.0001), LA transverse diameter (LATD) (P < 0.0001), LA volume (LAV) (P < 0.0001), LAVI (P < 0.0001), and LA sphericity index (LASI) (P < 0.0001). Over a mean follow‐up of 19.40 months, 97 patients (67.3%) in the ARNI group and 29 patients (22.3%) in the ACEI/ARB group showed LA reverse remodelling (LARR). Kaplan–Meier analysis showed significantly lower overall mortality in the ARNI group compared with the ACEI/ARB group (P = 0.048, log‐rank test). The mildly abnormal LAVI group of ARNI patients showed a reduction in mortality compared with ACEI/ARB patients (P = 0.044). However, no significant difference was observed for the moderately abnormal (P = 0.571) or severely abnormal LAVI groups (P = 0.609), suggesting that early initiation of ARNI was associated with a better prognosis. Conclusions In this proof‐of‐concept study, ARNI use showed greater effects on LARR and was associated with a better prognosis compared with ACEI/ARB use in HFrEF. Early initiation of ARNI in the HF disease process may produce greater benefit, but this needs to be confirmed in future studies.
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Affiliation(s)
- Yuxi Sun
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Shuang Song
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Yanli Zhang
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Wenqiong Mo
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Xinxin Zhang
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Ning Wang
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Yunlong Xia
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Gary Tse
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China.,Kent and Medway Medical School, Canterbury, Kent, UK
| | - Ying Liu
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
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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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Rossi A, Carluccio E, Cameli M, Inciardi RM, Mandoli GE, D'Agostino A, Biagioli P, Maffeis C, Pugliese NR, Pastore MC, Mengoni A, Pedrinelli R, Henein M, Dini FL. Left atrial structural and mechanical remodelling in heart failure with reduced ejection fraction. ESC Heart Fail 2021; 8:4751-4759. [PMID: 34726345 PMCID: PMC8712899 DOI: 10.1002/ehf2.13654] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/13/2021] [Accepted: 10/01/2021] [Indexed: 01/20/2023] Open
Abstract
Aims In patients with heart failure with reduced ejection fraction (HFrEF), an association between left atrial (LA) dilatation and dysfunction is expected, but the degree of coexistence of the two abnormalities and their relative prognostic role is not known. Methods and results A total of 626 HFrEF patients formed the study population. All of them underwent a comprehensive echocardiographic evaluation. LA maximal volume was indexed to body surface area (LAVi); LA function was assessed using strain analysis during the reservoir phase: peak atrial longitudinal strain (PALS) analysis. Study primary endpoint was overall mortality or hospitalization for worsening heart failure. Four groups of patients were included in this study according to LAVi (≤34 or >34 mL/m2) and PALS (≤23% or >23%); 61 (10%) patients had normal LA volume and function (Group 1), 58 (9%) had LA dilatation but normal function (Group 2), 100 (16%) had normal volume but abnormal function (Group 3), and 407 (65%) had enlarged left atrium and abnormal function (Group 4). PALS was associated with primary endpoint in patients with both normal‐size [Groups 1 and 3: hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.88–0.96; P = 0.0006] and dilated left atria (Groups 2 and 4: HR 0.93, 95% CI 0.91–0.96; P < 0.0001). In contrast, LAVi was associated with the primary endpoint in patients with abnormal LA function (Groups 3 and 4: HR 1.018, 95% CI 1.011–1.024; P < 0.00001) but not in those with normal PALS (Groups 1 and 2: HR 1.023, 95% CI 0.99–1.057; P = 0.1). Conclusions Left atrial dilatation and dysfunction frequently but not invariably coexist. PALS emerged as a significant prognostic parameter in HFrEF even in the absence of LA dilation.
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Affiliation(s)
- Andrea Rossi
- Division of Cardiology, Azienda Ospedaliero Universitaria Verona, P.le Stefani 1, Verona, 37126, Italy
| | - Erberto Carluccio
- Cardiologia e Fisiopatologia Cardiovascolare, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Perugia, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Riccardo M Inciardi
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Paolo Biagioli
- Cardiologia e Fisiopatologia Cardiovascolare, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Perugia, Italy
| | - Caterina Maffeis
- Division of Cardiology, Azienda Ospedaliero Universitaria Verona, P.le Stefani 1, Verona, 37126, Italy
| | - Nicola R Pugliese
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Anna Mengoni
- Cardiologia e Fisiopatologia Cardiovascolare, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Perugia, Italy
| | - Roberto Pedrinelli
- Departmento di Patologia Chirurgica, Medica, Molecolare e dell' Area Critica University of Pisa, Pisa, Italy
| | - Michael Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Frank L Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
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Clinical Features of LMNA-Related Cardiomyopathy in 18 Patients and Characterization of Two Novel Variants. J Clin Med 2021; 10:jcm10215075. [PMID: 34768595 PMCID: PMC8584896 DOI: 10.3390/jcm10215075] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 01/11/2023] Open
Abstract
Dilated cardiomyopathy (DCM) refers to a spectrum of heterogeneous myocardial disorders characterized by ventricular dilation and depressed myocardial performance in the absence of hypertension, valvular, congenital, or ischemic heart disease. Mutations in LMNA gene, encoding for lamin A/C, account for 10% of familial DCM. LMNA-related cardiomyopathies are characterized by heterogeneous clinical manifestations that vary from a predominantly structural heart disease, mainly mild-to-moderate left ventricular (LV) dilatation associated or not with conduction system abnormalities, to highly pro-arrhythmic profiles where sudden cardiac death (SCD) occurs as the first manifestation of disease in an apparently normal heart. In the present study, we select, among 77 DCM families referred to our center for genetic counselling and molecular screening, 15 patient heterozygotes for LMNA variants. Segregation analysis in the relatives evidences other eight heterozygous patients. A genotype-phenotype correlation has been performed for symptomatic subjects. Lastly, we perform in vitro functional characterization of two novel LMNA variants using dermal fibroblasts obtained from three heterozygous patients, evidencing significant differences in terms of lamin expression and nuclear morphology. Due to the high risk of SCD that characterizes patients with lamin A/C cardiomyopathy, genetic testing for LMNA gene variants is highly recommended when there is suspicion of laminopathy.
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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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Hanna B, Akoum N. Assessment of Atrial Fibrosis and Its Implications in Atrial Fibrillation and Stroke. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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138
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Smiseth OA, Baron T, Marino PN, Marwick TH, Flachskampf FA. Imaging of the left atrium: pathophysiology insights and clinical utility. Eur Heart J Cardiovasc Imaging 2021; 23:2-13. [PMID: 34601594 DOI: 10.1093/ehjci/jeab191] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Indexed: 01/14/2023] Open
Abstract
Left atrial imaging and detailed knowledge of its pathophysiology, especially in the context of heart failure, have become an increasingly important clinical and research focus. This development has been accelerated by the growth of non-invasive imaging modalities, advanced image processing techniques, such as strain imaging, and the parallel emergence of catheter-based left atrial interventions like pulmonary vein ablation, left atrial appendage occlusion, and others. In this review, we focus on novel imaging methods for the left atrium, their pathophysiological background, and their clinical relevance for various cardiac conditions and diseases.
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Affiliation(s)
- Otto A Smiseth
- Department of Cardiology, Institute for Surgical Research, Oslo University Hospital, University of Oslo, Rikshospitalet, Oslo N-0027, Norway
| | - Tomasz Baron
- Department of Medical Sciences, Cardiology and Clinical Physiology, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Paolo N Marino
- School of Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Thomas H Marwick
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Ingång 40, Akademiska sjukhus, Uppsala 751 85, Sweden
| | - Frank A Flachskampf
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Ingång 40, Akademiska sjukhus, Uppsala 751 85, Sweden
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Association between the APOE gene polymorphism and lipid profile and the risk of atrial fibrillation. Lipids Health Dis 2021; 20:123. [PMID: 34587962 PMCID: PMC8482687 DOI: 10.1186/s12944-021-01551-4] [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] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/10/2021] [Indexed: 12/19/2022] Open
Abstract
Background The relationship between the APOE gene polymorphism and lipid profiles and atrial fibrillation (AF) remains controversial. The current study purposed to investigate how the APOE gene SNPs (rs429358 and rs7412) and lipid profile are associated with the risk for AF among the Hakka population in southern China. Methods Finally, 1367 patients were enrolled in this study, including 706 participants with AF (41 ~ 98 years old, 58.64 % male) and 661 non-AF subjects (28 ~ 95 years old, 59.46 % male). The collected data included baseline characteristics, medical history, laboratory tests and echocardiography parameters. A general linear model (two-way analysis of variance (ANOVA)) and Tukey post-hoc tests were applied to identify an APOE allele, AF group, and interaction effect on lipid profiles. Logistic regression analysis was performed to identify risk factors for AF. Results For AF group, the most common genotype was E3/E3 (53.82 %), followed by E3/E4 (28.19 %), E2/E3 (13.60 %), E4/E4 (1.98 %), E2/E4 (1.84 %) and E2/E2 (0.57 %). The two-way ANOVA followed by the Tukey procedure showed the following: the lipid levels depended significantly on AF and APOE allele groups for TG, TC, LDL-C and Apo-B (all P < 0.001), and statistically significant interactions between AF and APOE allele were observed in the above 4 variables (all P < 0.05). Multivariate regression analysis indicated that age ≥ 65years (P < 0.001), high diastolic blood pressure (DBP ≥ 90mm Hg, P = 0.018), a high levels of total cholesterol (TC ≥ 5.2mmol/L, P < 0.001) and triglyceride (TG ≥ 1.7mmol/L, P = 0.028), but not the two SNPs of the APOE gene (rs7412 and rs429358) (OR 1.079, P = 0.683), were significant independent risk factors for AF in the study population. Conclusions The principal findings of this study showed that individuals at high risk for AF were those over 65 years of age, higher DBP as well as high levels of TC and TG among the southern China Hakka population. The levels of TG, TC, LDL-C and Apo-B depended significantly on AF and APOE allele groups, and statistically significant interactions between AF and APOE allele were observed in the above 4 variables, although the APOE gene SNPs (rs429358 and rs7412) were no significant risk for AF incidence. Further investigation is needed to elucidate whether other SNPs of the APOE gene have a bearing on AF incidents.
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A Review of the Molecular Mechanisms Underlying Cardiac Fibrosis and Atrial Fibrillation. J Clin Med 2021; 10:jcm10194430. [PMID: 34640448 PMCID: PMC8509789 DOI: 10.3390/jcm10194430] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 01/03/2023] Open
Abstract
The cellular and molecular mechanism involved in the pathogenesis of atrial fibrosis are highly complex. We have reviewed the literature that covers the effectors, signal transduction and physiopathogenesis concerning extracellular matrix (ECM) dysregulation and atrial fibrosis in atrial fibrillation (AF). At the molecular level: angiotensin II, transforming growth factor-β1, inflammation, and oxidative stress are particularly important for ECM dysregulation and atrial fibrotic remodelling in AF. We conclude that the Ang-II-MAPK and TGF-β1-Smad signalling pathways play a major, central role in regulating atrial fibrotic remodelling in AF. The above signalling pathways induce the expression of genes encoding profibrotic molecules (MMP, CTGF, TGF-β1). An important mechanism is also the generation of reactive oxygen species. This pathway induced by the interaction of Ang II with the AT2R receptor and the activation of NADPH oxidase. Additionally, the interplay between cardiac MMPs and their endogenous tissue inhibitors of MMPs, is thought to be critical in atrial ECM metabolism and fibrosis. We also review recent evidence about the role of changes in the miRNAs expression in AF pathophysiology and their potential as therapeutic targets. Furthermore, keeping the balance between miRNA molecules exerting anti-/profibrotic effects is of key importance for the control of atrial fibrosis in AF.
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Rohrbach S, Dominik E, Mirow N, Vogt S, Böning A, Niemann B. Surgical Ablation of Permanent Atrial Fibrillation: Age, LV Dilatation, Obesity. Thorac Cardiovasc Surg 2021; 71:264-272. [PMID: 34521139 DOI: 10.1055/s-0041-1731772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Although concomitant surgical ablation can help to reach freedom from atrial fibrillation (FREEAF) even in patients with permanent atrial fibrillation (AF), some cardiac surgeons hesitate to perform concomitant ablation to avoid perioperative risk escalation. Here, we investigated outcome and predicators of therapeutic success of concomitant surgical ablation in an all-comers study. METHODS Ablation-naïve patients with formerly accepted permanent AF (FAP, n = 41) or paroxysmal AF (parAF, n = 24) underwent concomitant epicardial bipolar radio frequency ablation and implantable loop recorder (ILR) at two surgical departments. Follow-up examination for 24 months included electrocardiogram, ILR readout, 24h Holter monitoring, echocardiography, and blood sampling. RESULTS Eighty-six percent of parAF and 70% of FAP patients reached FREEAF (month 24). Mortality was low (parAF/FAP: 5.3 ± 0.2%/4.1 ± 0.3%; p < 0.05; EuroScoreII; 6.1 ± 0.7%/6.4 ± 0.4%, p = ns) and no strokes occurred. FREEAF induced atrial reverse remodeling (left atrial [LA] diameter: -6.7 ± 2.2 mm) and improved cardiac function (left ventricular ejection fraction [LVEF]: +7.3 ± 2.8%), while AF resulted in further atrial dilation (+8.0 ± 1.0 mm, p < 0.05) and LVEF reduction (-7.0 ± 1.3%, p < 0.05). Higher LV (odds ratio [OR]: 1.164) and LA diameter (OR: 1.218), age (OR: 1.180) and body mass index (BMI) (OR: 1.503) increased the risk factors of AF recurrence. Patients remaining in sinus rhythm (SR) demonstrated a decrease in BMI, while AF recurrence was associated with stable overweight. Further aging did not reduce FREEAF. CONCLUSIONS Long-term SR is achievable by concomitant surgical ablation even in FAP patients. Therefore, it should be offered routinely. Obesity influences therapeutic long-term success but may also offer addressable therapeutic targets to reach higher FREEAF rates.
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Affiliation(s)
- Susanne Rohrbach
- Institute of Physiology, Justus Liebig University Giessen, Hessen, Germany
| | - Elisabeth Dominik
- Department of Cardiac and Vascular Surgery, University Hospital of Giessen and Marburg, Giessen and Justus-Liebig-University Giessen, Giessen, Germany
| | - Nikolas Mirow
- Department of Cardiac and Vascular Surgery, University Hospital of Giessen and Marburg, Marburg Philipps University Marburg, Marburg, Germany
| | - Sebastian Vogt
- Department of Cardiac and Vascular Surgery, University Hospital of Giessen and Marburg, Marburg Philipps University Marburg, Marburg, Germany
| | - Andreas Böning
- Department of Cardiac and Vascular Surgery, University Hospital of Giessen and Marburg, Giessen and Justus-Liebig-University Giessen, Giessen, Germany
| | - Bernd Niemann
- Department of Cardiac and Vascular Surgery, University Hospital of Giessen and Marburg, Giessen and Justus-Liebig-University Giessen, Giessen, Germany
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Kalaycıoğlu E, Çetin M, Kırış T, Özyıldız AG. Paradoxical association between lipoprotein cholesterol levels and left atrial function in hypertensive diabetic patients: A speckle tracking study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:667-673. [PMID: 34137047 DOI: 10.1002/jcu.23032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Studies have shown that subclinical left atrial (LA) dysfunction can be diagnosed with two-dimensional speckle tracking echocardiography (2D-STE). Although low-density lipoprotein cholesterol (LDL-C) is a risk factor for cardiovascular diseases, recent studies have reported a paradoxical relationship between LDL-C level and atrial fibrillation. In this study, we investigated the relationship between LDL-C levels and LA function. METHODS In 168 patients with the diagnosis of hypertension and diabetes, transthoracic echocardiography with LA 2D-STE was performed. The patients were then divided into two groups: normal LA-strain (n = 94) or impaired LA-strain (n = 74). The relationship between LDL-C and LA function was analyzed. RESULTS Patients with impaired LA-strain had higher body mass index (BMI) (p = 0.029), higher statin usage (p = 0.003), and lower LDL-C levels (p = 0.001) than patients with normal LA-strain. They also had lower left ventricle ejection fraction (LVEF) (p = 0.047) and higher E-wave velocity (mitral e, m/s) (p = 0.020). Multivariate logistic regression analysis showed that lower LDL-C (p = 0.034), higher BMI (p = 0.004), lower LVEF (p = 0.004), and higher E-wave velocity (p = 0.003) values were independently associated with impaired LA-strain. The area under the receiver operating curve of LDL-C in predicting impaired LA-strain was 0.645 (0.564-0.730, p < 0.05). LDL-C ≤ 112.5 mg/dl was found to be the optimal cut-off value with 74.5% sensitivity and 51.2% specificity in predicting impaired LA strain. CONCLUSION In patients with hypertension and diabetes, LDC-C levels are moderately but independently and paradoxically associated with impaired LA function assessed by 2D-STE.
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Affiliation(s)
- Ezgi Kalaycıoğlu
- Department of Cardiology, University of Health Sciences Turkey, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
| | - Mustafa Çetin
- Department of Cardiology, Recep Tayyip Erdoğan University Faculty of Medicine Training and Research Hospital, Rize, Turkey
| | - Tuncay Kırış
- Department of Cardiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Ali Gökhan Özyıldız
- Department of Cardiology, Recep Tayyip Erdoğan University Faculty of Medicine Training and Research Hospital, Rize, Turkey
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Ma Z, Zhao L, Zhang YP, Zhong JC, Yang XC. Declined ELABELA plasma levels in hypertension patients with atrial fibrillation: a case control study. BMC Cardiovasc Disord 2021; 21:390. [PMID: 34384364 PMCID: PMC8359615 DOI: 10.1186/s12872-021-02197-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/04/2021] [Indexed: 02/22/2023] Open
Abstract
Background Atrial fibrillation (AF) is a common arrhythmia in patients with hypertension. ELABELA, which has cardioprotective effects, is decreased in the plasma of patients with hypertension and might be associated with AF in the hypertensive population. This study aims to measure the ELABELA plasma levels in hypertension patients with and without AF and to analyse the related factors. Methods A total of 162 hypertension patients with or without AF were recruited for our monocentric observational study. Subjects were excluded if they had a history of valvular heart disease, rheumatic heart disease, cardiomyopathy, thyroid diseases, or heart failure. The patients’ histories were recorded, and laboratory examinations were conducted. Plasma ELABELA was detected by immunoassay. Echocardiographs were performed, and parameters were collected by two experienced doctors. Binary logistic regression analysis was used to identify the association between ELABELA plasma level and AF in patients with hypertension. Results Plasma ELABELA levels were lower in hypertension patients with AF than in those without AF (2.0 [1.5, 2.8] vs. 4.0 [3.4, 5.0] ng/ml, P < 0.001). ELABELA levels were correlated with age, heart rate, BNP levels and left atrial dimension. In addition to the left atrial dimension, ELABELA plasma levels were associated with AF in patients with hypertension (OR 0.081, 95% CI 0.029–0.224, P < 0.001). ELABELA levels were further decreased in the persistent AF subgroup compared with the paroxysmal AF subgroup (1.8 [1.4, 2.5] vs. 2.2 [1.8, 3.0] ng/ml, P = 0.012) and correlated with HR, BNP and ESR levels. Conclusions ELALABELA levels were decreased in hypertension patients with AF and further lowered in the persistent AF subgroup. Decreased ELABELA plasma levels were associated with AF in hypertension patients and may be an underlying risk factor. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02197-x.
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Affiliation(s)
- Zheng Ma
- Department of Cardiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiao Minxiang, Dongcheng District, Beijing, 100730, China
| | - Lei Zhao
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Ye-Ping Zhang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jiu-Chang Zhong
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Xin-Chun Yang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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Ble M, Benito B, Cuadrado-Godia E, Pérez-Fernández S, Gómez M, Mas-Stachurska A, Tizón-Marcos H, Molina L, Martí-Almor J, Cladellas M. Left Atrium Assessment by Speckle Tracking Echocardiography in Cryptogenic Stroke: Seeking Silent Atrial Fibrillation. J Clin Med 2021; 10:jcm10163501. [PMID: 34441797 PMCID: PMC8397042 DOI: 10.3390/jcm10163501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 01/01/2023] Open
Abstract
Silent atrial fibrillation (AF) may be the cause of some cryptogenic strokes (CrS). The aim of the study was to analyse atrial size and function by speckle tracking echocardiography in CrS patients to detect atrial disease. Patients admitted to the hospital due to CrS were included prospectively. Echocardiogram analysis included left atrial ejection fraction (LAEF) and atrial strain. Insertable cardiac monitor was implanted, and AF was defined as an episode of ≥1 min in the first year after stroke. Left atrial enlargement was defined as indexed volume > 34 mL/m2. Seventy-five consecutive patients were included, aged 76 ± 9 years (arterial hypertension 75%). AF was diagnosed in 49% of cases. The AF group had higher atrial volume and worse atrial function: peak atrial longitudinal strain (PALs) 19.6 ± 5.7% vs. 29.5 ± 7.2%, peak atrial contraction strain (PACs) 8.9 ± 3.9% vs. 16.5 ± 6%, LAEF 46.8 ± 11.5% vs. 60.6 ± 5.2%; p < 0.001. AF was diagnosed in 20 of 53 patients with non-enlarged atrium, and in 18 of them, atrial dysfunction was present. The multivariate logistic regression analysis demonstrated an independent association between detection of AF and atrial volume, LAEF, and strain. Cut-off values were obtained: LAEF < 55%, PALs < 21.4%, and PACs < 12.9%. In conclusion, speckle tracking echocardiography in CrS patients improves silent atrial disease diagnosis, with or without atrial enlargement.
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Affiliation(s)
- Mireia Ble
- Medicine Department, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain;
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Correspondence: ; Tel.: +34-932-483-018
| | - Begoña Benito
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
- Neurology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
| | - Sílvia Pérez-Fernández
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
- CIBER of Cardiovascular Diseases (CIBERCV), 08003 Barcelona, Spain
| | - Miquel Gómez
- Cardiology Department, Hospital de Barcelona, 08034 Barcelona, Spain;
| | - Aleksandra Mas-Stachurska
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
| | - Helena Tizón-Marcos
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
| | - Lluis Molina
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
- Cardiology Department, Hospital de Barcelona, 08034 Barcelona, Spain;
| | - Julio Martí-Almor
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
| | - Mercè Cladellas
- Medicine Department, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain;
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
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Oka T, Koyama Y, Tanaka K, Hirao Y, Tanaka N, Okada M, Yoshimoto I, Kitagaki R, Okamura A, Iwakura K, Sakata Y, Fujii K, Inoue K. Post-ablation left atrial function impacts long-term recurrence of atrial fibrillation after ablation. Heart Vessels 2021; 37:315-326. [PMID: 34342674 DOI: 10.1007/s00380-021-01915-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/28/2021] [Indexed: 11/26/2022]
Abstract
Left atrial (LA) function can help predict various cardiovascular events. Catheter ablation for atrial fibrillation (AF) modifies baseline LA function through the maintenance of sinus rhythm and myocardial injury. We investigated the impact of post-ablation LA function on recurrence of AF after ablation and identified the predictors of reduced post-ablation LA function. A total of 616 patients who underwent AF ablation (paroxysmal, N = 310; non-paroxysmal, N = 306) were retrospectively examined with cardiac computed tomography at baseline and 3 months after the final ablation procedure. Post-ablation LA emptying fraction (LAEFpost) was calculated. We evaluated the association between LAEFpost and recurrence of AF after the final ablation procedure. Further, we assessed the predictors of reduced LAEFpost. The recurrence rate of AF was 72.7% after the final ablation procedure [median follow-up 48 months (48.0, 48.0), total number of ablation sessions: 1.4 ± 0.7]. Multivariate analysis revealed that LAEFpost was associated with the recurrence of AF (hazard ratio/10% increase: 0.62, 95% confidence interval: 0.51-0.75, P < 0.0001). LAEFpost had a mild predictive power for recurrence of AF (c-statistics: 0.670, optimal cutoff: 26.36%, P < 0.0001). The recurrence-free proportion among patients with reduced LAEFpost (< 26.36%, N = 100) and those with preserved LAEFpost (≥ 26.36%, N = 516) was 40% and 79%, respectively (P < 0.0001). The predictors of reduced LAEFpost were low pre-ablation LAEF, high pre-ablation LA volume, low body mass index (BMI), and female sex. Further, reduced LAEFpost was associated with the total number of ablation sessions and extra-pulmonary vein LA ablation. In conclusion, reduced LAEFpost was associated with recurrence of AF after ablation. Advanced LA remodeling, low BMI, and female sex could predict reduced LAEFpost. Although additional ablation was associated with reduced LAEFpost, it remains unclear whether reduced LAEFpost resulted from the additional ablation. Reduced LAEFpost might help stratify patients with ablation-refractory AF.
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Affiliation(s)
- Takafumi Oka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan.
| | - Yasushi Koyama
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Koji Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yuko Hirao
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Masato Okada
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Issei Yoshimoto
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Ryo Kitagaki
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Atsunori Okamura
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Katsuomi Iwakura
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenshi Fujii
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
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Yamamoto H, Shinke T, Otake H, Terashita D, Nagasawa A, Tanimura K, Matsumoto K, Tanaka H, Hirata KI. Hemodynamic changes during transcatheter atrial septal defect closure predict midterm heart failure deterioration in adults. Catheter Cardiovasc Interv 2021; 98:E715-E723. [PMID: 34227726 DOI: 10.1002/ccd.29859] [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: 01/23/2021] [Accepted: 06/20/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To investigate whether hemodynamic changes during balloon occlusion test (BOT) predict future heart failure (HF) deterioration after transcatheter atrial septal defect closure (tASD-closure). BACKGROUND Midterm HF deterioration can sometimes occur after tASD-closure in adults. Whether hemodynamic changes during tASD-closure can help identify patients at risk is unknown. METHODS This prospective observational study enrolled 86 consecutive adult patients who underwent tASD-closure. Hemodynamic parameters, including pulmonary capillary wedge pressure (PCWP), were measured at baseline, during BOT, and after tASD-closure. The changes in PCWP during BOT and after tASD-closure were defined as ΔPCWP (Occ-Pre) and ΔPCWP (Post-Pre), respectively. Clinical parameters were evaluated before tASD-closure and during the 3-month follow-up. We assessed the occurrence of HF deterioration (HF requiring hospitalization or additional diuretics) during a 2-year follow-up period and categorized patients into HF (+) and HF (-) groups accordingly. The aforementioned parameters were compared between groups. RESULTS Midterm HF deterioration occurred in 12 patients (13.9%). Compared to the HF (-) group, the HF (+) group presented a significantly higher ΔPCWP (Occ-Pre) (9.5 ± 4.4 mmHg vs. 3.0 ± 3.3 mmHg; p < 0.001) and ΔPCWP (Post-Pre) (4.0 ± 2.8 mmHg vs. 0.6 ± 1.8 mmHg; p = 0.004). Receiver operating characteristic curve analysis showed that the ΔPCWP (Occ-Pre) cutoff value of 5.5 mmHg had excellent ability to predict HF deterioration (Area under the curve 0.886 [0.779-0.993], p < 0.001; sensitivity 0.917, specificity 0.824). CONCLUSIONS Increases in PCWP during BOT predict midterm HF deterioration after tASD-closure. Close surveillance may be needed in patients with a ΔPCWP (Occ-Pre) >5 mmHg.
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Affiliation(s)
- Hiroyuki Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Terashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akira Nagasawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kousuke Tanimura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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147
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Panagides V, Alperi A, Mesnier J, Philippon F, Bernier M, Rodes-Cabau J. Heart failure following transcatheter aortic valve replacement. Expert Rev Cardiovasc Ther 2021; 19:695-709. [PMID: 34227916 DOI: 10.1080/14779072.2021.1949987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Over the past decade, the number of transcatheter aortic valve replacement (TAVR) procedures has increased exponentially. Despite major improvements in both device and successes, the rate of hospital readmission after TAVR remains high, with heart failure (HF) decompensation being one of the most important causes.Areas covered: This review provides an overview of the current status of HF following TAVR, including details about its incidence, clinical impact, contributing factors, and current and future treatment perspectives.Expert opinion: HF decompensation has been identified as the most common cause of rehospitalization following TAVR, and it has been associated with a negative prognosis. Multiple preexisting factors including low flow status, cardiac amyloidosis, myocardial fibrosis, multivalvular disease, pulmonary hypertension, coronary artery disease, and atrial fibrillation have been associated with an increased risk of HF events. Also, multiple post-procedural factors like the occurrence of significant paravalvular leaks, severe prosthesis-patient mismatch, and conduction disturbances have also contributed to increase this risk . Thus, reducing HF events in TAVR recipients would require a multifactorial and multidisciplinary effort including the optimization of the medical treatment and close follow-up and treatment of residual or concomitant valvular disease and conduction disturbance issues. Future studies in this challenging group of patients are warranted.
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Affiliation(s)
- Vassili Panagides
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alberto Alperi
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jules Mesnier
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Francois Philippon
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mathieu Bernier
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodes-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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148
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Tezuka Y, Iguchi M, Hamatani Y, Ogawa H, Esato M, Tsuji H, Wada H, Hasegawa K, Abe M, Lip GYH, Akao M. Association of relative wall thickness of left ventricle with incidence of thromboembolism in patients with non-valvular atrial fibrillation: The Fushimi AF Registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 6:273-283. [PMID: 31977011 DOI: 10.1093/ehjqcco/qcaa003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/31/2019] [Accepted: 01/10/2020] [Indexed: 12/21/2022]
Abstract
AIMS Atrial fibrillation (AF) increases the risk of thromboembolism, such as ischaemic stroke or systemic embolism (SE). The aim of this study was to investigate the relationship between left ventricular relative wall thickness (RWT) and the risk of thromboembolism in patients with non-valvular AF. METHODS AND RESULTS The Fushimi AF Registry is a community-based prospective survey of the patients with AF in Japan. Analyses were performed on 3067 non-valvular AF patients, in which RWT values determined by transthoracic echocardiography were available at the baseline. The high-RWT group (RWT above the median) was more often female, older, and had higher systolic blood pressure, CHADS2 and CHA2DS2-VASc scores, as compared with low-RWT group. During the median follow-up period of 1309 days, there was a higher incidence of ischaemic stroke/SE in the high-RWT group [unadjusted hazard ratio (HR), 1.91; 95% confidence interval (CI), 1.42-2.59]. On multivariate Cox regression analysis, including the components of CHA2DS2-VASc score, left atrial diameter, oral anticoagulant prescription at baseline, and type of AF, high RWT was independently associated with ischaemic stroke/SE (adjusted HR, 1.81; 95% CI, 1.34-2.47). Stratified analysis demonstrated no significant interaction for any subgroups. In Kaplan-Meier analysis, ordinal RWT quartiles stratified the incidence of ischaemic stroke/SE. Finally, addition of RWT to CHA2DS2-VASc score increased the performance of risk stratification for the incidence of stroke/SE. CONCLUSION Relative wall thickness was independently associated with ischaemic stroke/SE among Japanese patients with non-valvular AF, suggesting the importance of left ventricular morphology in contributing to adverse outcomes, particularly thromboembolism.
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Affiliation(s)
- Yuji Tezuka
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.,Department of Diabetes and Endocrinology, Kusatsu General Hospital, 1660 Yabase, Kusatsu, Shiga 525-8585, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Masahiro Esato
- Department of Arrhythmia, Ijinkai Takeda General Hospital, 28-1, Moriminami-cho, Ishida, Fushimi-ku, Kyoto 601-1495, Japan
| | - Hikari Tsuji
- Tsuji Clinic, 5-8, Kogahonmachi, Fushimi-ku, Kyoto 612-8492, Japan
| | - Hiromichi Wada
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Koji Hasegawa
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L69 3BX, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, Forskningens Hus, 9000 Aalborg, Denmark
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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149
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Park JH, Hwang IC, Park JJ, Park JB, Cho GY. Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm. J Am Heart Assoc 2021; 10:e020414. [PMID: 34187174 PMCID: PMC8403314 DOI: 10.1161/jaha.120.020414] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Stroke is a major comorbidity in patients with heart failure (HF), especially in those with decreased left atrial (LA) function, and thus, identifying patients highly at risk of stroke can prevent its occurrence. We evaluated the predictive value of global longitudinal strain of LA (LAGLS) in patients with acute HF and sinus rhythm. Methods and Results In this retrospective study, 2461 patients (53.3% men, 69.7±14.4 years old) with sinus rhythm and LAGLS among 4312 consecutive patients with acute HF from 3 tertiary hospitals were included. HF phenotypes were defined as HF with reduced ejection fraction (EF) (left ventricular EF ≤40%), HF with midrange EF (40% <left ventricular EF <50%), and HF with preserved ejection fraction (left ventricular EF ≥50%). Primary outcome was new‐onset stroke. The mean left ventricular EF was 39.4%±15.6%. Moreover, 1388 (57.5%), 342 (14.2%), and 682 (28.3%) were classified with HF with reduced EF, HF with midrange EF, and HF with preserved EF, retrospectively. LAGLS was 17.2%±10.4%. During the follow‐up duration (mean: 30.3±25.4 months), 100 patients experienced stroke. Patients with stroke had higher LA diameter (P=0.031) and lower LAGLS (P=0.010) than those without stroke. In the univariate analysis, age, diabetes mellitus, LA diameter, LA volume index, and LAGLS were significant risk factors for stroke. In the multivariate analysis, each 1% decrease in LAGLS was associated with a 3.8% increased risk for stroke (hazard ratio [HR], 1.038; 95% CI, 1.013–1.065; P=0.003). When applying a LAGLS cutoff point of 14.5%, patients with LAGLS <14.5% had approximately twice the risk for stroke after adjusting other significant variables (HR, 1.940; 95% CI, 1.269–2.965; P=0.002). Conclusions In patients with acute HF and sinus rhythm, decreased LAGLS (<14.5%) was associated with an increased risk for stroke, with an annual incidence of 2.38%.
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Affiliation(s)
- Jae-Hyeong Park
- Department of Cardiology in Internal Medicine Chungnam National University HospitalChungnam National University College of Medicine Daejeon Korea
| | - In-Chang Hwang
- Cardiovascular Center & Department of Internal Medicine Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam Korea
| | - Jin Joo Park
- Cardiovascular Center & Department of Internal Medicine Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam Korea
| | - Jun-Bean Park
- Department of Internal Medicine Seoul National University College of MedicineSeoul National University Hospital Seoul Korea
| | - Goo-Yeong Cho
- Cardiovascular Center & Department of Internal Medicine Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam Korea
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150
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Kloosterman M, Crijns HJGM, Mulder BA, Groenveld HF, Van Veldhuisen DJ, Rienstra M, Van Gelder IC. Sex-related differences in risk factors, outcome, and quality of life in patients with permanent atrial fibrillation: results from the RACE II study. Europace 2021; 22:1619-1627. [PMID: 31747018 PMCID: PMC7657385 DOI: 10.1093/europace/euz300] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/08/2019] [Indexed: 12/27/2022] Open
Abstract
AIMS Atrial fibrillation (AF) risk factors translate into disease progression. Whether this affects women and men differently is unclear. We aimed to investigate sex differences in risk factors, outcome, and quality of life (QoL) in permanent AF patients. METHODS AND RESULTS The Rate Control Efficacy in Permanent Atrial Fibrillation (RACE II) randomized 614 patients, 211 women and 403 men, to lenient or strict rate control. In this post hoc analysis risk factors, cardiovascular events during 3-year follow-up (cardiovascular death, heart failure hospitalization, stroke, systemic embolism, bleeding, and life-threatening arrhythmic events), outcome parameters, and QoL were compared between the sexes. Women were older (71 ± 7 vs. 66 ± 8 years, P < 0.001), had more hypertension (70 vs. 57%, P = 0.002), and heart failure with preserved ejection fraction (36 vs. 17%, P < 0.001), but less coronary artery disease (13 vs. 21%, P = 0.02). Women had more risk factors (3.7 ± 1.2 vs. 2.9 ± 1.4, P < 0.001) Cardiovascular events occurred in 46 (22%) women and 59 (15%) men (P = 0.03). Women had a 1.52 times [95% confidence interval (CI) 1.03-2.24] higher yearly cardiovascular event-rate [8.2% (6.0-10.9) vs. 5.4% (4.1-6.9), P = 0.03], but this was no longer significant after adjusting for the number of underlying risk factors. Women had reduced QoL, irrespective of age and heart rate but negatively influenced by their risk factors. CONCLUSION In this permanent AF population, women had more accumulation of AF risk factors than men. The observed higher cardiovascular event rate in women was no longer significant after adjusting for the number of risk factors. Further, QoL was negatively influenced by the higher number of risk factors in women. This suggests that sex differences may be driven by the greater risk factor burden in women.
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Affiliation(s)
- Mariëlle Kloosterman
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bart A Mulder
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Hessel F Groenveld
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Dirk J Van Veldhuisen
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
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