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Iyngkaran P, Anavekar NS, Neil C, Thomas L, Hare DL. Shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup. World J Methodol 2017; 7:117-128. [PMID: 29354484 PMCID: PMC5746665 DOI: 10.5662/wjm.v7.i4.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/29/2017] [Accepted: 11/22/2017] [Indexed: 02/06/2023] Open
Abstract
The symptom cluster of shortness of breath (SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.
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Affiliation(s)
- Pupalan Iyngkaran
- Department of Medicine, Northern Territory Medical School, Flinders University, Charles Darwin University Campus, Casuarina, NT 0815, Australia
| | - Nagesh S Anavekar
- Department of Cardiology, Northern Hospital, Northern Health, University of Melbourne, Melbourne, VIC 3076, Australia
| | - Christopher Neil
- Cardiology Unit Western Health, Department of Medicine, Western Precinct, University of Melbourne, Melbourne, VIC 3076, Australia
| | - Liza Thomas
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 214, Australia
- Westmead Hospital, Westmead Clincal School, University of Sydney, NSW 2145, Australia
| | - David L Hare
- Cardiovascular Research, University of Melbourne, Melbourne, VIC 3076, Australia
- Heart Failure Services, Austin Health, Melbourne, VIC 3084, Australia
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102
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Lee SC, Daimon M, Di Tullio MR, Homma S, Hasegawa T, Chiou SH, Nakao T, Hirokawa M, Mizuno Y, Yatomi Y, Yamazaki T, Komuro I. Beneficial effect of body weight control on left ventricular diastolic function in the general population: an analysis of longitudinal data from a health check-up clinic. Eur Heart J Cardiovasc Imaging 2017; 19:136-142. [PMID: 29237001 DOI: 10.1093/ehjci/jex219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/24/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seitetz C Lee
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
- Department of Medicine, Columbia University, 630 West 168th Street, New York 10032, NY, USA
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
- Department of Clinical Laboratory, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Marco R Di Tullio
- Department of Medicine, Columbia University, 630 West 168th Street, New York 10032, NY, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University, 630 West 168th Street, New York 10032, NY, USA
| | - Takahiro Hasegawa
- Department of Biostatistics, Shionogi & Co., Ltd, 1-8-3, Doshomachi, Chuo, Osaka 541-0045, Japan
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, 677 Huntington Ave, Boston, MA 02115, USA
| | - Sy Han Chiou
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, 677 Huntington Ave, Boston, MA 02115, USA
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
- Department of Clinical Laboratory, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
- Department of Clinical Epidemiology and Systems, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Tsutomu Yamazaki
- Clinical Research Support Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
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Medenwald D, Swenne CA, Frantz S, Nuding S, Kors JA, Pietzner D, Tiller D, Greiser KH, Kluttig A, Haerting J. Longitudinal association of short-term, metronome-paced heart rate variability and echocardiographically assessed cardiac structure at a 4-year follow-up: results from the prospective, population-based CARLA cohort. Europace 2017; 19:2027-2035. [PMID: 28371898 DOI: 10.1093/europace/euw296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/18/2016] [Indexed: 11/13/2022] Open
Abstract
Aims To assess the value of cardiac structure/function in predicting heart rate variability (HRV) and the possibly predictive value of HRV on cardiac parameters. Methods and results Baseline and 4-year follow-up data from the population-based CARLA cohort were used (790 men, 646 women, aged 45-83 years at baseline and 50-87 years at follow-up). Echocardiographic and HRV recordings were performed at baseline and at follow-up. Linear regression models with a quadratic term were used. Crude and covariate adjusted estimates were calculated. Missing values were imputed by means of multiple imputation. Heart rate variability measures taken into account consisted of linear time and frequency domain [standard deviation of normal-to-normal intervals (SDNN), high-frequency power (HF), low-frequency power (LF), LF/HF ratio] and non-linear measures [detrended fluctuation analysis (DFA1), SD1, SD2, SD1/SD2 ratio]. Echocardiographic parameters considered were ventricular mass index, diastolic interventricular septum thickness, left ventricular diastolic dimension, left atrial dimension systolic (LADS), and ejection fraction (Teichholz). A negative quadratic relation between baseline LADS and change in SDNN and HF was observed. The maximum HF and SDNN change (an increase of roughly 0.02%) was predicted at LADS of 3.72 and 3.57 cm, respectively, while the majority of subjects experienced a decrease in HRV. There was no association between further echocardiographic parameters and change in HRV, and there was no evidence of a predictive value of HRV in the prediction of changes in cardiac structure. Conclusion In the general population, LADS predicts 4-year alteration in SDNN and HF non-linearly. Because of the novelty of the result, analyses should be replicated in other populations.
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Affiliation(s)
- Daniel Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Cees A Swenne
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefan Frantz
- Department of Medicine III, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Sebastian Nuding
- Department of Medicine III, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Jan A Kors
- Department of Medical Informatics, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Diana Pietzner
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Daniel Tiller
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Karin H Greiser
- German Cancer Research Center, Division of Cancer Epidemiology, Heidelberg, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Johannes Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
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Leibowitz D, Koslowsky J, Gilon D, Jacobs JM, Stessman‐Lande I, Stessman J. Left atrial function and mortality in the oldest old. Clin Cardiol 2017; 40:1323-1327. [PMID: 29247517 PMCID: PMC6490369 DOI: 10.1002/clc.22831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Previous studies demonstrated that left atrium (LA) size is associated with mortality in an elderly population. It remains unclear whether indices of LA function including reservoir, conduit, or booster elements of LA function provide incremental prognostic information. HYPOTHESIS Echocardiographic measures of the various parameters of LA function would predict 5-year mortality in a community-dwelling population of 85 to 86 year olds independently of LA volume. METHODS Subjects ages 85 to 86 years old underwent home echocardiography. LA volumes were assessed by the biplane Simpson's method from apical views using measurements of phasic volumes and functions of the LA, including LA expansion index. LA passive and active emptying fractions were assessed. Survival status at 5-year follow-up was assessed. RESULTS Two hundred eighty-two subjects were included, of whom 87 (31%) had died at follow-up. Survival of the subjects in the lowest quartile of the LA expansion index as well as LA active filling index was significantly lower. When measurements of LA volume index were added to the model, the relationship between survival and indices of LA function remained significant. CONCLUSIONS This study demonstrated that elderly subjects aged 85 to 86 years with significantly impaired LA function had increased 5-year mortality independently of indices of LA volume.
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Affiliation(s)
- David Leibowitz
- Jerusalem Institute of Aging ResearchHadassah–Hebrew University Medical CenterJerusalemIsrael
- Heart InstituteHadassah–Hebrew University Medical CenterJerusalemIsrael
| | | | - Dan Gilon
- Heart InstituteHadassah–Hebrew University Medical CenterJerusalemIsrael
| | - Jeremy M. Jacobs
- Jerusalem Institute of Aging ResearchHadassah–Hebrew University Medical CenterJerusalemIsrael
- Department of Geriatrics and RehabilitationHadassah–Hebrew University Medical CenterJerusalemIsrael
| | | | - Jochanan Stessman
- Jerusalem Institute of Aging ResearchHadassah–Hebrew University Medical CenterJerusalemIsrael
- Department of Geriatrics and RehabilitationHadassah–Hebrew University Medical CenterJerusalemIsrael
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105
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Natale M, Behnes M, Kim SH, Hoffmann J, Reckord N, Hoffmann U, Budjan J, Lang S, Borggrefe M, Papavassiliu T, Bertsch T, Akin I. High sensitivity troponin T and I reflect left atrial function being assessed by cardiac magnetic resonance imaging. Ann Clin Biochem 2017; 55:264-275. [DOI: 10.1177/0004563217714004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Left atrial function (LAF) plays an interactive role between pulmonary and systemic circulation. Cardiac biomarkers, such as amino-terminal pro-brain natriuretic peptide (NT-proBNP) and troponins, might reflect cardiac function. This study aims to evaluate the association between high sensitivity troponins (hsTn) and left atrial function in patients undergoing cardiac magnetic resonance imaging (cMRI). Methods Patients undergoing cardiac magnetic resonance imaging (cMRI) were enrolled prospectively. Patients with right ventricular dysfunction (<50%) were excluded. Blood samples for measurements of hsTn and NT-proBNP were collected at the time of cMRI. Results Eighty-four patients were included. Median LVEF was 59% (IQR 51–64%). HsTn correlated inversely with LAF within multivariable linear regression models (hsTnI: Beta −0.46; T −4.44; P = 0.0001; hsTnT: Beta −0.29; T −3.06; P = 0.003). High sensitivity troponins increased significantly according to decreasing stages of impaired LAF ( P = 0.0001). High sensitivity troponins discriminated patients with impaired LAF < 55% (hsTnT: AUC = 0.80; P = 0.0001; hsTnI: AUC = 0.74; P = 0.0001) and <45% (hsTnT: AUC = 0.75; P = 0.0001; hsTnI: AUC = 0.73; P = 0.001) and were still significantly associated in multivariable logistic regression models (LAF < 55%: hsTnT: OR = 21.78; P = 0.0001; hsTnI: OR = 5.96; P = 0.009; LAF < 45%: hsTnT: OR = 10.27; P = 0.0001; hsTnI: OR = 12.56; P = 0.001). Conclusions This study demonstrates that hsTn are able to reflect LAF being assessed by cardiac magnetic resonance imaging.
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Affiliation(s)
- Michèle Natale
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Seung-Hyun Kim
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Julia Hoffmann
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nadine Reckord
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ursula Hoffmann
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Johannes Budjan
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Theano Papavassiliu
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
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106
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Left Atrial Strain to Address the Cryptogenic Puzzle. JACC Cardiovasc Imaging 2017; 11:1566-1568. [PMID: 29153565 DOI: 10.1016/j.jcmg.2017.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 01/25/2023]
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107
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Sardana M, Nah G, Tsao CW, Ogunsua AA, Vittinghoff E, Thomas RC, Cheng S, Vaze A, Aragam JR, Mitchell GF, Benjamin EJ, Vasan RS, Aurigemma GP, Schiller NB, McManus DD, Parikh NI. Clinical and Echocardiographic Correlates of Left Atrial Function Index: The Framingham Offspring Study. J Am Soc Echocardiogr 2017; 30:904-912.e2. [PMID: 28735892 PMCID: PMC6298216 DOI: 10.1016/j.echo.2017.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Left atrial (LA) remodeling is a predictor of cardiovascular disease (CVD). We performed measurement of the LA function index (LAFI), a composite measure of LA structure and function, in a community-based cohort and here report the distribution and cross-sectional correlates of LAFI. METHODS In 1,719 Framingham Offspring Study participants (54% women, mean age 66 ± 9 years), we derived LAFI from the LA emptying fraction, left ventricular (LV) outflow tract velocity time integral, and indexed maximal LA volume. We used multivariable linear regression to assess the clinical and echocardiographic correlates of LAFI adjusting for age, sex, anthropometric measurements, and CVD risk factors. RESULTS The average LAFI was 35.2 ± 12.1. Overall, LAFI declined with advancing age (β = -0.27, P < .001). LAFI was significantly higher (37.5 ± 11.6) in a subgroup of participants free of CVD and CVD risk factors compared with those with either of these conditions (34.5 ± 12.2). In multivariable models, LAFI was inversely related to antihypertensive use (β = -1.26, P = .038), prevalent atrial fibrillation (β = -4.46, P = .001), heart failure (β = -5.86, P = .008), and coronary artery disease (β = -2.01, P = .046). In models adjusting for echocardiographic variables, LAFI was directly related to LV ejection fraction (β = 14.84, P < .001) and inversely related to LV volume (β = -7.03, P < .001). CONCLUSIONS LAFI was inversely associated with antihypertensive use and prevalent CVD and was related to established echocardiographic traits of LV remodeling. Our results offer normative ranges for LAFI in a white community-based sample and suggest that LAFI represents a marker of pathological atrial remodeling.
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Affiliation(s)
- Mayank Sardana
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Gregory Nah
- Cardiology Division, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Connie W Tsao
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Adedotun A Ogunsua
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Eric Vittinghoff
- Cardiology Division, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Randell C Thomas
- Cardiology Division, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Susan Cheng
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham; and Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, and Department of Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts; Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Massachusetts
| | - Aditya Vaze
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jayashri R Aragam
- Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Massachusetts; Veterans Administration Medical Center, West Roxbury, and Harvard Medical School, Boston, Massachusetts
| | - Gary F Mitchell
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham; and Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, and Department of Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts; Cardiovascular Engineering, Norwood, Massachusetts
| | - Emelia J Benjamin
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham; and Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, and Department of Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts
| | - Ramachandran S Vasan
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham; and Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, and Department of Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts
| | - Gerard P Aurigemma
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nelson B Schiller
- Cardiology Division, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - David D McManus
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nisha I Parikh
- Cardiology Division, Department of Medicine, University of California, San Francisco, San Francisco, California.
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108
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Tadic M, Zlatanovic M, Cuspidi C, Stevanovic A, Kocijancic V, Pavlovic SU, Damjanov N, Celic V. Left atrial phasic function and heart rate variability in patients with systemic sclerosis: A new part of the old puzzle. Echocardiography 2017; 34:1447-1455. [PMID: 28782130 DOI: 10.1111/echo.13648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We aimed to research left atrial (LA) phasic function and heart rate variability (HRV), as well as their relationship, in subjects with uncomplicated systemic sclerosis (SSc). METHODS The investigation involved 44 SSc patients and 33 age-matched healthy controls. All participants underwent clinical examination, serological tests, 24-hours Holter monitoring, and echocardiographic examination including strain analysis. RESULTS Maximum, minimum, and pre-A LA volumes and volume indices were higher in the SSc patients than in the controls. The total emptying fraction, the parameter of the LA reservoir function, as well as passive LA emptying fraction, which represents the LA conduit function, were significantly lower in the SSc patients compared to the controls. Active LA emptying fraction, the parameter of the LA booster pump function, was significantly higher in the SSc participants. There was no difference in LA reservoir function between the diffuse and the limited SSc form. LA conduit function was significantly decreased, whereas LA booster pump function was compensatory increased in the diffuse SSc form compared to the limited SSc form. Similar results were obtained by LA strain analysis. HRV indices were significantly decreased in the SSc patients. Modified Rodnan skin score, the parameter of skin involvement in SSc, and HRV indices correlated well with LA phasic function in SSc. CONCLUSION Left atrial (LA) phasic function, assessed by both volumetric and strain method, as well as cardiac autonomic nervous function is significantly deteriorated in SSc patients. Skin score and HRV indices correlate with LA phasic function parameters.
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Affiliation(s)
- Marijana Tadic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje,", Belgrade, Serbia
| | | | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
| | - Ana Stevanovic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje,", Belgrade, Serbia
| | - Vesna Kocijancic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje,", Belgrade, Serbia
| | | | | | - Vera Celic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje,", Belgrade, Serbia
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109
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Tadic M, Cuspidi C, Pencic-Popovic B, Celic V, Mancia G. The relationship between nighttime hypertension and left atrial function. J Clin Hypertens (Greenwich) 2017; 19:1096-1104. [PMID: 28776931 DOI: 10.1111/jch.13066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/01/2017] [Accepted: 06/04/2017] [Indexed: 01/06/2023]
Abstract
The authors sought to investigate the association between different hypertensive phenotypes and left atrial (LA) function assessed by the volumetric method and the strain method in patients with untreated hypertension. This cross-sectional study involved 236 untreated patients who underwent 24-hour ambulatory blood pressure monitoring and two-dimensional echocardiographic examination. Our findings showed that LA function gradually deteriorated from patients with normotension, across patients with daytime hypertension, to patients with night- and day-nighttime hypertension. LA reservoir and conduit functions were particularly deteriorated in patients with nighttime and day-nighttime hypertension compared with patients with normotension and patients with daytime hypertension, whereas LA pump function was compensatorily increased only in the participants with day-nighttime hypertension. Only nighttime hypertension and day-nighttime hypertension were independently associated with the reduced reservoir and conduit LA function. The difference between patients with daytime and nighttime hypertension was found in reservoir and conduit LA but not LA pump function.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Clinical Hospital Center "Dr Dragisa Misovic-Dedinje", Belgrade, Serbia
| | - Cesare Cuspidi
- Clinical Research Unit, Istituto Auxologico Italiano, University of Milan-Bicocca, Meda, Italy
| | - Biljana Pencic-Popovic
- Department of Cardiology, University Clinical Hospital Center "Dr Dragisa Misovic-Dedinje", Belgrade, Serbia
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center "Dr Dragisa Misovic-Dedinje", Belgrade, Serbia
| | - Giuseppe Mancia
- Istituto Auxologico Italiano, University of Milan-Bicocca, Milano, Italy
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110
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Hoit BD. Evaluation of Left Atrial Function: Current Status. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1353718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Brian D. Hoit
- Professor of Medicine, Physiology and Biophysics, Case Western Reserve University, and Director of Echocardiography, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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111
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Left atrium passive ejection fraction is the most sensitive index of type 2 diabetes mellitus-related cardiac changes. Int J Cardiovasc Imaging 2017; 34:141-151. [PMID: 28721548 DOI: 10.1007/s10554-017-1213-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/13/2017] [Indexed: 12/30/2022]
Abstract
The aims of this study were to use cardiovascular magnetic resonance (CMR) cine to assess left atrium (LA) and left ventricle (LV) function and structure in normotensive type 2 diabetes mellitus (T2DM) patients and to identify the most sensitive index of those T2DM-related cardiac changes. Fifty T2DM patients with normotension (25 males, age 54.7 ± 8.7 years, duration of diabetes: 7.5 ± 5.1 years) and 35 controls (16 males, age: 52.2 ± 13.2 years) were prospectively enrolled. All patients were scanned using CMR four- and two-chamber long-axis cine to assess LA and LV structure and function. Normotensive T2DM patients were associated with decreased LA total ejection fraction (EF), passive EF and LV end diastolic volume, normal LA active EF and LV myocardial mass and increased LV mass/volume (M/V). LA total EF and passive EF correlated with body mass index, duration of diabetes and M/V. To differentiate between diabetic patients and healthy controls, area under the receiver operating characteristic (ROC) curve (AUC) values were calculated to be 0.763, 0.706, 0.647 and 0.649 for LA passive EF, total EF, LVEDV and M/V, respectively. The addition of LA total EF, LVEDV, M/V and the combination thereof did not significantly improve AUC values in a model containing LA passive EF. Normotensive T2DM patients were associated with LA decreased total ejection fraction, decreased passive EF and LV concentric remodeling. Among these indices, LA passive EF was the most sensitive to T2DM-related LA function changes.
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112
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Rijnierse MT, Kamali Sadeghian M, Schuurmans Stekhoven S, Biesbroek PS, van der Lingen ALC, van de Ven PM, van Rossum AC, Nijveldt R, Allaart CP. Usefulness of Left Atrial Emptying Fraction to Predict Ventricular Arrhythmias in Patients With Implantable Cardioverter Defibrillators. Am J Cardiol 2017; 120:243-250. [PMID: 28532781 DOI: 10.1016/j.amjcard.2017.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 01/20/2023]
Abstract
Impaired left atrial emptying fraction (LAEF) is an important predictor of mortality in patients with heart failure. As it may reflect increased LV wall stress, it might predict ventricular arrhythmia (VA) specifically. This study evaluated the predictive value of LAEF assessed with cardiovascular magnetic resonance (CMR) imaging with respect to appropriate device therapy (ADT) for VA and compared its role with CMR assessed scar size and other risk factors. In total, 229 patients (68% male, 63 ± 10 years, 61% ischemic cardiomyopathy) with LV ejection fraction ≤35% who underwent CMR and implantable cardioverter defibrillator (ICD) implantation for primary prevention in 2005 to 2012 were included. CMR was used to quantify LV volumes and function. LV scar size was quantified when late gadolinium enhancement was available (n = 166). Maximum and minimum left atrial volumes and LAEF were calculated using the biplane area-length method. The occurrence of ADT and mortality was assessed during a median follow-up of 3.9 years. Sixty-two patients (27%) received ADT. Univariable Cox analysis showed that male gender, creatinine level, minimum left atrial volume, LAEF, and total scar size were significant predictors of ADT. In multivariable Cox analysis, LAEF (hazard ratio 0.75 per 10%, p <0.01), and scar size (hazard ratio 1.03 per g, p = 0.03) remained the only independent predictors of ADT. Patients with both LAEF > median and scar size < median were at low risk (13% ADT at 5 years), whereas those with LAEF < median and scar size > median experienced 40% ADT at 5 years (log-rank p = 0.01). In conclusion, LAEF independently predicts ADT in patients with primary prevention ICDs. Combined assessment of LAEF and scar size identifies a group with low risk of ADT. Therefore, LAEF assessment could assist in risk stratification for VA to select patients with the highest benefit from ICD implantation.
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Affiliation(s)
- Mischa T Rijnierse
- Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Mehran Kamali Sadeghian
- Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Sophie Schuurmans Stekhoven
- Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - P Stefan Biesbroek
- Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Anne-Lotte C van der Lingen
- Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
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113
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Reference value of left and right atrial size and phasic function by SSFP CMR at 3.0 T in healthy Chinese adults. Sci Rep 2017; 7:3196. [PMID: 28600567 PMCID: PMC5466635 DOI: 10.1038/s41598-017-03377-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 04/27/2017] [Indexed: 02/05/2023] Open
Abstract
The size and function of the left atrium (LA) and right atrium (RA) are related closely with the prognosis of cardiovascular diseases. However, their normal reference values, as measured by cardiac magnetic resonance (CMR), are not well established in Chinese populations. Healthy Chinese subjects (n = 135, 66 males, age 23–83 years) without cardiovascular risk factors were recruited. We imaged the LA and RA of all subjects using short axis and long axis slices by steady-state free precession (SSFP) sequences using a 3.0T scanner. The size and functional parameters were measured. Age and gender differences in LA were further explored. The normal reference values of atrial dimensions, volumes, and empty fractions (EFs) were provided by short axis (SAX) and area-length methods. Volumes and EFs derived by the area-length method showed correlated well with those derived by the by SAX method, but significantly underestimated the volumes (all P < 0.001) and overestimated the LA EFs (all P < 0.001). Atrial dimensions and volumes were generally larger in males. Conduit EFs and total EFs showed gender differences. Most atrial parameters correlated with age. In general, our results showed that gender and age have considerable impact on LA and RA size and function.
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Yamano M, Yamano T, Iwamura Y, Nakamura T, Shiraishi H, Shirayama T, Matoba S. Impact of Left Ventricular Diastolic Property on Left Atrial Function from Simultaneous Left Atrial and Ventricular Three-Dimensional Echocardiographic Volume Measurement. Am J Cardiol 2017; 119:1687-1693. [PMID: 28363352 DOI: 10.1016/j.amjcard.2017.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 12/28/2022]
Abstract
Simultaneous left atrial (LA) and left ventricular (LV) 3-dimensional (3D) echocardiographic volume measurements enable the quantifying of precise LA function, by virtue of their independence on any geometric assumption and capability of measurement for net LA conduit volume. We sought to elucidate the impact of conventional Doppler LV diastolic property on LA volume and function derived from this method. Our study subjects consisted of 381 patients who underwent 3D echocardiography. From LA time-volume curve, maximum and minimum volume index (VI) and VI before atrial contraction (LAVIpre-c) were determined; subsequently, active emptying volume was calculated as LAVIpre-c - minimum LAVI. From LA and LV volume measurement, conduit volume was calculated as LV stroke VI - (maximum LAVI - minimum LAVI). LA volume increased depending on the severity of diastolic dysfunction. Compared with patients with normal diastolic function, LA booster pump function, as the contribution of active emptying volume to LV filling, was higher in those with mild diastolic dysfunction. Additionally, it gradually decreased as diastolic dysfunction was advanced from mild to moderate and moderate to severe degree (23.2 ± 15.5%, 29.5 ± 15.1%, 25.1 ± 16.2%, 14.9 ± 14.1%, respectively; p <0.001). Contrarily, conduit contribution was significantly higher in patients with severe diastolic dysfunction than in those with mild diastolic dysfunction; furthermore, conduit function tended to increase, reciprocally to booster pump function, as diastolic dysfunction grade was advanced (39.1 ± 28.8%, 36.8 ± 26.2%, 42.7 ± 25.6%, 52.9 ± 26.2%, respectively; p = 0.034). In conclusion, simultaneous LA and LV volumetric analyses through 3D echocardiography clearly demonstrate the characteristic LA functional alterations following LA dilation caused by LV diastolic dysfunction.
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115
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Oliver W, Matthews G, Ayers CR, Garg S, Gupta S, Neeland IJ, Drazner MH, Berry JD, Matulevicius S, de Lemos JA. Factors Associated With Left Atrial Remodeling in the General Population. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005047. [PMID: 28153949 DOI: 10.1161/circimaging.116.005047] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 12/09/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although contributors to remodeling of the left ventricle (LV) have been well studied in general population cohorts, few data are available describing factors influencing changes in left atrial (LA) structure. METHODS AND RESULTS Maximum LA volume was determined by cardiac magnetic resonance imaging among 748 participants in the Dallas Heart Study at 2 visits a mean of 8 years apart. Associations of changes in LA volume (ΔLAV) with traditional risk factors, biomarkers, LV geometry, and remodeling by cardiac magnetic resonance imaging and detailed measurements of global and regional adiposity (by magnetic resonance imaging and dual-energy x ray absorptiometry) were assessed using multivariable linear regression. Greater ΔLAV was independently associated with black and Hispanic race/ethnicity, change in systolic blood pressure, LV mass and ΔLV mass, N-terminal probrain natriuretic peptide and change in N-terminal probrain natriuretic peptide, and body mass index (P<0.05 for each). In subanalyses, the associations of ΔLAV with LV mass parameters were driven by associations with baseline and ΔLV end diastolic volume (P<0.0001 for each) and not wall thickness (P=0.21). Associations of ΔLAV with body mass index were explained exclusively by associations with visceral fat mass (P=0.002), with no association seen between ΔLAV and subcutaneous abdominal fat (P=0.47) or lower body fat (P=0.30). CONCLUSIONS Left atrial dilatation in the population is more common in black and Hispanic than in white individuals and is associated with parallel changes in the LV. LA dilatation may be mediated by blood pressure control and the development of visceral adiposity.
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Affiliation(s)
- Walter Oliver
- From the Cardiovascular Division, Department of Medicine (W.O., G.M., C.R.A., S. Garg, S. Gupta, I.J.N., M.H.D., J.D.B., S.M., J.A.d.L.), and Department of Clinical Sciences (C.R.A., J.D.B.), University of Texas Medical Center, Dallas
| | - Gwendolyn Matthews
- From the Cardiovascular Division, Department of Medicine (W.O., G.M., C.R.A., S. Garg, S. Gupta, I.J.N., M.H.D., J.D.B., S.M., J.A.d.L.), and Department of Clinical Sciences (C.R.A., J.D.B.), University of Texas Medical Center, Dallas
| | - Colby R Ayers
- From the Cardiovascular Division, Department of Medicine (W.O., G.M., C.R.A., S. Garg, S. Gupta, I.J.N., M.H.D., J.D.B., S.M., J.A.d.L.), and Department of Clinical Sciences (C.R.A., J.D.B.), University of Texas Medical Center, Dallas
| | - Sonia Garg
- From the Cardiovascular Division, Department of Medicine (W.O., G.M., C.R.A., S. Garg, S. Gupta, I.J.N., M.H.D., J.D.B., S.M., J.A.d.L.), and Department of Clinical Sciences (C.R.A., J.D.B.), University of Texas Medical Center, Dallas
| | - Sachin Gupta
- From the Cardiovascular Division, Department of Medicine (W.O., G.M., C.R.A., S. Garg, S. Gupta, I.J.N., M.H.D., J.D.B., S.M., J.A.d.L.), and Department of Clinical Sciences (C.R.A., J.D.B.), University of Texas Medical Center, Dallas
| | - Ian J Neeland
- From the Cardiovascular Division, Department of Medicine (W.O., G.M., C.R.A., S. Garg, S. Gupta, I.J.N., M.H.D., J.D.B., S.M., J.A.d.L.), and Department of Clinical Sciences (C.R.A., J.D.B.), University of Texas Medical Center, Dallas
| | - Mark H Drazner
- From the Cardiovascular Division, Department of Medicine (W.O., G.M., C.R.A., S. Garg, S. Gupta, I.J.N., M.H.D., J.D.B., S.M., J.A.d.L.), and Department of Clinical Sciences (C.R.A., J.D.B.), University of Texas Medical Center, Dallas
| | - Jarett D Berry
- From the Cardiovascular Division, Department of Medicine (W.O., G.M., C.R.A., S. Garg, S. Gupta, I.J.N., M.H.D., J.D.B., S.M., J.A.d.L.), and Department of Clinical Sciences (C.R.A., J.D.B.), University of Texas Medical Center, Dallas
| | - Susan Matulevicius
- From the Cardiovascular Division, Department of Medicine (W.O., G.M., C.R.A., S. Garg, S. Gupta, I.J.N., M.H.D., J.D.B., S.M., J.A.d.L.), and Department of Clinical Sciences (C.R.A., J.D.B.), University of Texas Medical Center, Dallas
| | - James A de Lemos
- From the Cardiovascular Division, Department of Medicine (W.O., G.M., C.R.A., S. Garg, S. Gupta, I.J.N., M.H.D., J.D.B., S.M., J.A.d.L.), and Department of Clinical Sciences (C.R.A., J.D.B.), University of Texas Medical Center, Dallas.
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Tadic M, Vukomanovic V, Cuspidi C, Suzic-Lazic J, Stanisavljevic D, Celic V. Left atrial phasic function and heart rate variability in asymptomatic diabetic patients. Acta Diabetol 2017; 54:301-308. [PMID: 28083658 DOI: 10.1007/s00592-016-0962-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/30/2016] [Indexed: 12/11/2022]
Abstract
AIMS We evaluated left atrial (LA) phasic function and heart rate variability (HRV) in asymptomatic diabetic patients, and the relationship between HRV indices and LA phasic function assessed by volumes and speckle tracking imaging. METHOD This cross-sectional study included 55 asymptomatic patients with type 2 diabetes and 50 healthy controls without cardiovascular risk factors. All study subjects underwent laboratory analyses, complete two-dimensional echocardiography examination (2DE) and 24-h Holter monitoring. RESULTS Maximum, minimum LA and pre-A LA volumes and volume indexes are significantly higher in diabetic patients. Total and passive LA emptying fractions (EF), representing the LA reservoir and conduit function, are significantly lower in diabetic subjects. Active LA EF, the parameter of the LA booster pump function, is compensatory increased in diabetic patients. Similar results were obtained by 2DE strain analysis. Cardiac autonomic function, assessed by HRV, is significantly deteriorated in diabetic patients. Time and frequency-domain HRV measures are significantly lower in diabetic subjects than in controls. HbA1c, LV mass index and HRV are associated with total LA EF and longitudinal LA strain independently of age, body mass index and LV diastolic function in the whole study population. CONCLUSIONS LA phasic function and cardiac autonomic nervous system assessed by HRV are impacted by diabetes. HbA1c and HRV are independently associated with LA reservoir function evaluated by volumetric and strain methods in the whole study population. This study emphasizes the importance of determination of LA function and HRV as important markers of preclinical cardiac damage and autonomic function impairment in diabetic patients.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia.
| | - Vladan Vukomanovic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Cesare Cuspidi
- Clinical Research Unit, Istituto Auxologico Italiano, University of Milan-Bicocca, Viale della Resistenza 23, 20036, Meda, Italy
| | - Jelena Suzic-Lazic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Doktora Subotica 15, 11000, Belgrade, Serbia
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
- Faculty of Medicine, Doktora Subotica 6, 11000, Belgrade, Serbia
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117
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Sardana M, Syed AA, Hashmath Z, Phan TS, Koppula MR, Kewan U, Ahmed Z, Chandamuri R, Varakantam S, Shah E, Gorz R, Akers SR, Chirinos JA. Beta-Blocker Use Is Associated With Impaired Left Atrial Function in Hypertension. J Am Heart Assoc 2017; 6:JAHA.116.005163. [PMID: 28159822 PMCID: PMC5523787 DOI: 10.1161/jaha.116.005163] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Impaired left atrial (LA) mechanical function is present in hypertension and likely contributes to various complications, including atrial arrhythmias, stroke, and heart failure. Various antihypertensive drug classes exert differential effects on central hemodynamics and left ventricular function. However, little is known about their effects on LA function. Methods and Results We studied 212 subjects with hypertension and without heart failure or atrial fibrillation. LA strain was measured from cine steady‐state free‐precession cardiac MRI images using feature‐tracking algorithms. In multivariable models adjusted for age, sex, race, body mass index, blood pressure, diabetes mellitus, LA volume, left ventricular mass, and left ventricular ejection fraction, beta‐blocker use was associated with a lower total longitudinal strain (standardized β=−0.21; P=0.008), and lower LA expansion index (standardized β=−0.30; P<0.001), indicating impaired LA reservoir function. Beta‐blocker use was also associated with a lower positive strain (standardized β=−0.19; P=0.012) and early diastolic strain rate (standardized β=0.15; P=0.039), indicating impaired LA conduit function. Finally, beta‐blocker use was associated with a lower (less negative) late‐diastolic strain (standardized β=0.15; P=0.049), strain rate (standardized β=0.18; P=0.019), and a lower active LA emptying fraction (standardized β=−0.27; P<0.001), indicating impaired booster pump function. Use of other antihypertensive agents was not associated with LA function. Conclusions Beta‐blocker use is significantly associated with impaired LA function in hypertension. This association could underlie the increased risk of atrial fibrillation and stroke seen with the use of beta‐blockers (as opposed to other antihypertensive agents) demonstrated in recent trials.
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Affiliation(s)
- Mayank Sardana
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Amer Ahmed Syed
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Zeba Hashmath
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Timothy S Phan
- Hospital of the University of Pennsylvania, Philadelphia, PA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Uzma Kewan
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Zoubair Ahmed
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ravikantha Chandamuri
- Hospital of the University of Pennsylvania, Philadelphia, PA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Swapna Varakantam
- Hospital of the University of Pennsylvania, Philadelphia, PA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ejaz Shah
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ryan Gorz
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Julio A Chirinos
- Hospital of the University of Pennsylvania, Philadelphia, PA .,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Corporal Michael J. Crescenz VAMC, Philadelphia, PA
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118
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Affiliation(s)
- Brian D. Hoit
- From the Department of Medicine, Case Western Reserve University, Cleveland, OH; and Harrington Heart and Vascular Center, University Hospitals Cleveland Medical Center, Cleveland, OH
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119
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Kamijima R, Suzuki K, Izumo M, Kuwata S, Mizukoshi K, Takai M, Kou S, Hayashi A, Kida K, Harada T, Akashi YJ. Predictors of Exercise-Induced Pulmonary Hypertension in Patients with Asymptomatic Degenerative Mitral Regurgitation: Mechanistic Insights from 2D Speckle-Tracking Echocardiography. Sci Rep 2017; 7:40008. [PMID: 28071674 PMCID: PMC5223189 DOI: 10.1038/srep40008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/30/2016] [Indexed: 01/19/2023] Open
Abstract
Presence of exercise-induced pulmonary hypertension (EIPH) in asymptomatic degenerative mitral regurgitation (DMR) determines prognosis. This study aimed to elucidate the mechanism and predictors of EIPH in asymptomatic DMR. Ninety-one consecutive asymptomatic patients with DMR who underwent exercise stress echocardiography were prospectively included. We obtained various conventional echocardiographic parameters at rest and during peak exercise, as well as left atrial (LA) function at rest using 2-dimensional speckle-tracking analysis. The 25 patients (33.3%) with EIPH were significantly older and had a greater ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity during peak exercise than those without EIPH. LA strain (LAS)-s and LAS-e, indices of LA reservoir and conduit function, respectively, were significantly lower in those with EIPH than in those without EIPH. Multivariate analysis indicated that LAS-s was the only resting echocardiographic parameter that independently predicted EIPH, with a cut-off value of 26.9%. Furthermore, Kaplan-Meier curve analysis showed that symptom-free survival was markedly lower among those with reduced LAS-s. In conclusion, decreased LA reservoir function contributes to EIPH, and LAS-s at rest is a useful indicator for predicting EIPH in asymptomatic patients with DMR.
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Affiliation(s)
- Ryo Kamijima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kengo Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shingo Kuwata
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kei Mizukoshi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Manabu Takai
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Seisyou Kou
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Akio Hayashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Keisuke Kida
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J. Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Kloosterman M, Rienstra M, Crijns HJ, Healey JS, Van Gelder IC. The left atrium: An overlooked prognostic tool. Eur J Prev Cardiol 2017; 24:389-391. [PMID: 28067538 DOI: 10.1177/2047487316686633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Mariëlle Kloosterman
- 1 Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- 1 Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Harry J Crijns
- 2 Department of Cardiology, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Jeff S Healey
- 3 Population Health Research Institute, McMaster University, Ontario, Canada
| | - Isabelle C Van Gelder
- 1 Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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121
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Kim JS, Im SI, Shin SY, Kang JH, Na JO, Choi CU, Kim SH, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ, Hwang C, Kim YH, Yong HS, Lim HE. Changes in Left Atrial Transport Function in Patients Who Maintained Sinus Rhythm After Successful Radiofrequency Catheter Ablation for Atrial Fibrillation: A 1-Year Follow-Up Multislice Computed Tomography Study. J Cardiovasc Electrophysiol 2016; 28:167-176. [PMID: 27859888 DOI: 10.1111/jce.13128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Functional remodeling of left atrium (LA) after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has not been fully elucidated. This study aimed to determine the impact of RFCA on LA transport function in patients who maintained sinus rhythm (SR) after AF ablation. METHODS AND RESULTS A total of 96 patients (paroxysmal AF [PAF] = 52) who maintained SR during 1 year after AF ablation were enrolled. Multislice computed tomography was performed to determine LA volume (LAV) and LA emptying fraction (LAEF) at pre-RFCA and 1-year post-RFCA. Creatine kinase-MB (CK-MB) and troponin-T levels were analyzed 1-day post-RFCA. At 1-year post-RFCA, mean LAV and LAEF decreased in overall patients. Based on LAEF change (ΔLAEF) cutoff of 5.0%, LAEF reduced in 41 patients (worsened group) and improved or showed no change in 55 patients (preserved group). Compared with preserved group, worsened group had a higher proportion of PAF, higher levels of CK-MB and troponin-T, and additional LA ablation. ΔLAEF was inversely correlated with CK-MB and troponin-T levels. Subgroup analysis showed that LAEF significantly decreased in PAF patients who underwent additional LA ablation. Multivariate analysis revealed that high baseline LAEF and additional LA ablation were independent predictors for worsened LAEF. CONCLUSIONS Although SR was maintained for 1 year after AF ablation, LAEF as well as LAV decreased. The extent of LAEF deterioration was significantly associated with the amount of iatrogenic myocardial damage. Our data indicate that extensive atrial ablation may lead to LA functional deterioration, especially in patients with PAF.
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Affiliation(s)
- Jin-Seok Kim
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Il Im
- Division of Cardiology, Kosin University Gospel Hospital, College of Medicine, Kosin University, Busan, Korea
| | - Seung Yong Shin
- Division of Cardiology, Heart Research Institute, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jun Hyuk Kang
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Oh Na
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol Ung Choi
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seong Hwan Kim
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eung Ju Kim
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung-Woon Rha
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang Gyu Park
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Seog Seo
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong Joo Oh
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chun Hwang
- Division of Cardiology, Utah Valley Regional Medical Center, Provo, Utah, USA
| | - Young-Hoon Kim
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Euy Lim
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Gandy SJ, Matthew S, Rekhraj S, Szwejkowski B, Crowe E, Struthers AD, Houston JG. MRI of the left atrium at 3T: evaluation of measurement reproducibility in healthy volunteers and patients with cardiovascular disease. Acta Radiol 2016; 57:1468-1475. [PMID: 26861203 DOI: 10.1177/0284185115627386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Left ventricular (LV) function has traditionally been the focus for cardiac magnetic resonance imaging (MRI) investigations, but similar methods can also be applied to the left atrium (LA). Previous studies elsewhere have almost entirely involved the use of 1.5T systems, but 3T MRI can provide faster data acquisition with thinner image slices, and may be more suitable for quantifying the structure and function of the LA. Purpose To evaluate 3T-MRI for LA volume assessments in: (i) healthy volunteers (HV); (ii) patients with LV-hypertrophy and ischemia (LVHI); and (iii) patients with LV-hypertrophy and diabetes (LVHD). Material and Methods Participants were imaged using a balanced steady-state free precession sequence. Healthy volunteers were scanned twice and patients were scanned on one occasion. Volumes were segmented by two observers, and coefficients of repeatability (CoR) were derived. Results For LA volumes (indexed to body surface area), CoRs were in the range of 1.3-4.6 mL/m2. The LVHI patients had enlarged LA volumes (diastolic, 46.4 mL/m2; systolic, 25.9 mL/m2) and reduced ejection fraction (EF) (44.9%) relative to the HV (diastolic, 39.0 mL/m2; systolic, 17.8 mL/m2; EF, 54.5%) and LVHD groups (diastolic, 41.4 mL/m2; systolic, 20.2 mL/m2; EF, 50.7%). LA volumes were moderately correlated with LV mass in the HV group (R2 = 0.59 for LA end-systolic volume), but became weaker (R2 ≤ 0.17) for patient groups. Conclusion 3T-MRI derived LA volume measurements are simple and repeatable, and can elicit clear differences between LVHI patients and HVs. These MRI endpoints provide scope for improved radiological interpretation of LA structure and function, and the high degree of repeatability validates their use for longitudinal investigations where precision work is essential.
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Affiliation(s)
- Stephen J Gandy
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
| | - Shona Matthew
- University of Dundee, Ninewells Hospital, Dundee, UK
| | | | | | - Elena Crowe
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
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123
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Nakanishi K, Jin Z, Russo C, Homma S, Elkind MS, Rundek T, Tugcu A, Sacco RL, Di Tullio MR. Association of chronic kidney disease with impaired left atrial reservoir function: A community-based cohort study. Eur J Prev Cardiol 2016; 24:392-398. [PMID: 27856809 DOI: 10.1177/2047487316679903] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Chronic kidney disease (CKD) is an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. This study investigated the relationship between CKD and left atrial (LA) volume and function in a sample of the general population without overt cardiac disease. Design and methods We examined 358 participants from the Cardiovascular Abnormalities and Brain Lesions study. The LA minimum volume index (LAVImin), LA maximum volume index (LAVImax), and LA emptying fraction (LAEF) were assessed by real-time three-dimensional echocardiography. Based on their estimated glomerular filtration rate (eGFR), the participants were divided into a CKD group (eGFR <60 ml/min/1.73 m2) and a non-CKD group (eGFR ≥60 ml/min/1.73 m2). Results Of the 358 participants, 69 (19%) were classified as having CKD and 289 (81%) as non-CKD. Participants with CKD were older, had a greater prevalence of hypertension and use of antihypertensive drugs, a larger left ventricular (LV) mass index, and a higher prevalence of diastolic dysfunction than those without CKD (all p < 0.05). There was no significant difference in LAVImax between the CKD and non-CKD groups (23.4 ± 7.1 vs. 22.8 ± 5.8 ml/m2, p = 0.47), whereas significant differences were observed for LAVImin (13.6 ± 5.5 vs. 12.0 ± 4.6 ml/m2, p = 0.01) and LAEF (42.7 ± 11.4 vs. 47.8 ± 11.5%, p = 0.001). Multivariate regression analysis revealed that the eGFR was significantly associated with LAEF independent of age, LV mass index, and diastolic dysfunction (all p < 0.05). Conclusions Participants with CKD in an unselected community-based cohort had significantly impaired LA reservoir function. Assessment of LA function may add important information in the prognostic assessment of patients with CKD even in the absence of overt cardiac disease.
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Affiliation(s)
| | - Zhezhen Jin
- 2 Department of Biostatistics, Columbia University, USA
| | - Cesare Russo
- 1 Department of Medicine, Columbia University, USA
| | | | - Mitchell Sv Elkind
- 3 Department of Neurology, Columbia University, USA.,4 Department of Epidemiology, Columbia University, USA
| | - Tatjana Rundek
- 5 Department of Neurology, Miller School of Medicine, University of Miami, USA.,6 Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, USA
| | - Aylin Tugcu
- 1 Department of Medicine, Columbia University, USA
| | - Ralph L Sacco
- 5 Department of Neurology, Miller School of Medicine, University of Miami, USA.,6 Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, USA.,7 Department of Human Genetics, Miller School of Medicine, University of Miami, USA
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124
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Hedberg P, Selmeryd J, Leppert J, Henriksen E. Long-term prognostic impact of left atrial volumes and emptying fraction in a community-based cohort. Heart 2016; 103:687-693. [DOI: 10.1136/heartjnl-2016-310242] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/08/2016] [Accepted: 10/18/2016] [Indexed: 01/26/2023] Open
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125
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Usefulness of the Atrial Emptying Fraction to Predict Maintenance of Sinus Rhythm After Direct Current Cardioversion for Atrial Fibrillation. Am J Cardiol 2016; 118:1345-1349. [PMID: 27658922 DOI: 10.1016/j.amjcard.2016.07.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 11/22/2022]
Abstract
Atrial volumes indexed to body surface area (AVI) are robust predictors of nonvalvular atrial fibrillation (AF) recurrence after direct current cardioversion (DCCV). The incremental value of atrial emptying fraction (EmF) compared with atrial volumes as a predictor for recurrent AF after DCCV has not been evaluated. We sought to compare the predictive ability of baseline left atrial (LA) EmF, right atrial (RA) EmF, LAVI, and RAVI for post-DCCV AF recurrence at 6 months. The first 95 patients enrolled in the AF Clinic Registry with adequate echocardiogram imaging constituted the study cohort. Each patient underwent echocardiogram within 6 months before cardioversion. Maximal LAVI and RAVI, LA EmF, and RA EmF were performed offline using 4-chamber single-plane Simpson's method, averaged over 5 cycles. The mean age of the study cohort was 64 ± 12 years, and 67% were men. Only 28 patients (29%) who underwent DCCV remained in sinus rhythm at 6 months of follow-up. The remaining, 67 (71%) had reverted to AF or underwent ablation during the 6 months of follow-up. The overall performance for prediction of AF recurrence was greatest for RA EmF, area under the receiver operator characteristic curve (AUC): RA EmF 0.92, LA EmF 0.89, RAVI 0.76, and LAVI 0.63. RA and LA EmF AUCs were significantly higher than for LAVI or RAVI (max p = 0.02). In conclusion, although RAVI and LAVI are strong predictors of AF recurrence after DCCV, RA and LA EmF outperformed in this cohort.
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126
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Zoppini G, Bonapace S, Bergamini C, Rossi A, Trombetta M, Lanzoni L, Bertolini L, Zenari L, Bonora E, Targher G. Evidence of left atrial remodeling and left ventricular diastolic dysfunction in type 2 diabetes mellitus with preserved systolic function. Nutr Metab Cardiovasc Dis 2016; 26:1026-1032. [PMID: 27352987 DOI: 10.1016/j.numecd.2016.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Prognosis of type 2 diabetes is associated with the occurrence of cardiovascular diseases. Left atrial (LA) size is a predictor of outcome in several diseases, including diabetes. Long duration of diabetes is an established risk factor of poor prognosis. No data are available on the relationship between LA size and duration of diabetes. The present study was aimed to investigate the relationship between LA volume index (LAVI) and the duration of diabetes to test the hypothesis that LA volume will increase as a function of diabetes duration. METHODS AND RESULTS Forty-four male patients with newly diagnosed and 172 male patients with established type 2 diabetes were recruited for this cross-sectional study. All patients were evaluated with a transthoracic echocardiographic Doppler. About 28.2% of patients had increased LAVI. Indices of both diastolic and systolic function were significantly lower in patients with larger left atrium. The values of LAVI increased across classes of duration of diabetes. In multivariable analysis, longer duration was a predictor of LAVI ≥34 ml/m2 (odds ratio 1.65, 95% CI 1.11-2.46, p = 0.014) after adjusting for age, hemoglobin A1c, hypertension, microvascular complication status, and relevant echocardiographic parameters of systolic and diastolic function. CONCLUSIONS These results indicate that duration of diabetes is strongly and positively associated with larger LAVI in type 2 diabetic men with preserved systolic function. Future studies are needed to better elucidate the biological mechanisms underlying linking type 2 diabetes with abnormally increased LAVI in subjects with type 2 diabetes.
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Affiliation(s)
- G Zoppini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.
| | - S Bonapace
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - C Bergamini
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - A Rossi
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - M Trombetta
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - L Lanzoni
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - L Bertolini
- Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - L Zenari
- Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - E Bonora
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - G Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
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127
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Rimbaş RC, Dulgheru RE, Vinereanu D. Methodological Gaps in Left Atrial Function Assessment by 2D Speckle Tracking Echocardiography. Arq Bras Cardiol 2016; 105:625-36. [PMID: 26761370 PMCID: PMC4693667 DOI: 10.5935/abc.20150144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The assessment of left atrial (LA) function is used in various cardiovascular
diseases. LA plays a complementary role in cardiac performance by modulating left
ventricular (LV) function. Transthoracic two-dimensional (2D) phasic volumes and
Doppler echocardiography can measure LA function non-invasively. However, evaluation
of LA deformation derived from 2D speckle tracking echocardiography (STE) is a new
feasible and promising approach for assessment of LA mechanics. These parameters are
able to detect subclinical LA dysfunction in different pathological condition. Normal
ranges for LA deformation and cut-off values to diagnose LA dysfunction with
different diseases have been reported, but data are still conflicting, probably
because of some methodological and technical issues. This review highlights the
importance of an unique standardized technique to assess the LA phasic functions by
STE, and discusses recent studies on the most important clinical applications of this
technique.
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128
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Maceira AM, Cosin-Sales J, Prasad SK, Pennell DJ. Characterization of left and right atrial function in healthy volunteers by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2016; 18:64. [PMID: 27719670 PMCID: PMC5056480 DOI: 10.1186/s12968-016-0284-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/15/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Left and right atrial function show a different pattern in advanced age in order to maintain adequate ventricular filling. It has been shown that left atrial (LA) function has a prognostic value in a number of heart conditions. Cardiovascular magnetic resonance (CMR) provides high quality images of the left and right atria using high temporal resolution steady state free precession (SSFP) cine sequences. We used SSFP cines to characterize atrial function in healthy, normotensive, volunteers. METHODS We measured maximum, preatrial contraction and minimum left and right atrial volumes in 120 healthy subjects after careful exclusion of cardiovascular abnormality (60 men, 60 women; 20 subjects per age decile from 20 to 80 years). Data were generated from 3-dimensional modeling, including tracking of the atrioventricular ring motion and time-volume curves analysis. With those measurements, all the usual parameters for left and right atrial function were calculated. RESULTS Gender had significant influence on some parameters of left and right atrial conduit and booster pump function. Age significantly influenced the majority of parameters of both left and right atrial function, with typically lower reservoir and conduit functions and higher booster pump function, both in males and females belonging to older age groups. CMR normal ranges were modelled for clinical use with normalization, where appropriate, for body surface area and gender, displaying parameters with respect to age. CONCLUSIONS CMR normal reference ranges for components of left and right atrial function are provided for males and females for a wide age range.
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Affiliation(s)
- Alicia M. Maceira
- Cardiovascular Imaging Unit, ERESA Medical Center, MR Unit, Hospital Arnau de Vilanova, Valencia, RIC Spain
- Department of Medicine, Health Sciences School, CEU Cardenal Herrera University, Valencia, Spain
| | - Juan Cosin-Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
| | - Sanjay K. Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Dudley J. Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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129
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Scherr J, Jung P, Schuster T, Pollmer L, Eisele G, Goss F, Schneider J, Halle M. Left ventricular diastolic function is strongly correlated with active emptying of the left atrium: a novel analysis using three-dimensional echocardiography. Cardiovasc Ultrasound 2016; 14:43. [PMID: 27717383 PMCID: PMC5055675 DOI: 10.1186/s12947-016-0085-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/28/2016] [Indexed: 01/11/2023] Open
Abstract
Background Increased left atrial (LA) dimensions are known to be a risk factor in predicting cardiovascular events and mortality and to be one key diagnostic tool to assess diastolic dysfunction. Currently, LA measurements are usually conducted using 2D-echocardiography, although there are well-known limitations. Real-time 3D-echocardiography is able to overcome these limitations, furthermore being a valid measurement tool compared to reference standards (e.g. cardiac magnetic resonance imaging). We investigated LA function and volume and their association to left ventricular (LV) diastolic function, using newly designed and validated software for 3D-echocardiographic analysis. This software is the first to allow for a sophisticated analysis of both passive and active LA emptying. Methods We analyzed 2D- and 3D-echocardiographic measurements of LA volume and function in 56 subjects and compared the results between patients with normal LV diastolic function (NDF) (n = 30, 52 ± 15 years, BMI 24.7 ± 2.6 kg/m2) and patients in which diastolic dysfunction (DDF) was suspected (n = 26, 65 ± 9 years, BMI 26.7 ± 3.7 kg/m2). Results Volumes during LA active emptying were significantly smaller in DDF compared to NDF (active atrial stroke volume (ASV): 3.0 (0.1–4.5) vs. 5.5 (2.7–7.8) ml, p = 0.005; True-EF: 7.3(0.1–11.5) vs. 16.2 (8.1–25.4) %, p = 0.002). Furthermore, ASV showed a stronger association to E/e’mean than all other measured LA volumes (β = − 0.35, p = 0.008). Neither total stroke LA volume, nor maximum or minimum LA volume differed significantly between the groups. Conclusions Diastolic LV dysfunction results in a reduction in active LA emptying, which is more strongly associated with LV filling pressure than other previously investigated LA parameters.
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Affiliation(s)
- Johannes Scherr
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Georg-Brauchle-Ring 56, D-80992, Munich, Germany.
| | - Philip Jung
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Tibor Schuster
- Department for Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Lars Pollmer
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Georg-Brauchle-Ring 56, D-80992, Munich, Germany
| | | | - Franz Goss
- Heart Center "Alter Hof", Munich, Germany
| | - Jens Schneider
- Universitäts Herz-Zentrum Freiburg - Bad Krozingen, Klinik für Kardiologie und Angiologie II, Bad Krozingen, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Georg-Brauchle-Ring 56, D-80992, Munich, Germany.,Munich Heart Alliance, Munich, Germany
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130
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Bossard M, Kreuzmann R, Hochgruber T, Krisai P, Zimmermann AJ, Aeschbacher S, Pumpol K, Kessel-Schaefer A, Stephan FP, Handschin N, Sticherling C, Osswald S, Kaufmann BA, Paré G, Kühne M, Conen D. Determinants of Left Atrial Volume in Patients with Atrial Fibrillation. PLoS One 2016; 11:e0164145. [PMID: 27701468 PMCID: PMC5049755 DOI: 10.1371/journal.pone.0164145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/20/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Left atrial (LA) enlargement is an important risk factor for incident stroke and a key determinant for the success of rhythm control strategies in patients with atrial fibrillation (AF). However, factors associated with LA volume in AF patients remain poorly understood. Methods Patients with paroxysmal or persistent AF were enrolled in this study. Real time 3-D echocardiography was performed in all participants and analyzed offline in a standardized manner. We performed stepwise backward linear regression analyses using a broad set of clinical parameters to determine independent correlates for 3-D LA volume. Results We included 210 patients (70.9% male, mean age 61±11years). Paroxysmal and persistent AF were present in 95 (45%) and 115 (55%) patients, respectively. Overall, 115 (55%) had hypertension, 11 (5%) had diabetes, and 18 (9%) had ischemic heart disease. Mean indexed LA volume was 36±12ml/m2. In multivariable models, significant associations were found for female sex (β coefficient -10.51 (95% confidence interval (CI) -17.85;-3.16), p = 0.0053), undergoing cardioversion (β 11.95 (CI 5.15; 18.74), p = 0.0006), diabetes (β 14.23 (CI 2.36; 26.10), p = 0.019), body surface area (BSA) (β 34.21 (CI 19.30; 49.12), p<0.0001), glomerular filtration rate (β -0.21 (CI -0.36; -0.06), p = 0.0064) and plasma levels of NT-pro brain natriuretic peptide (NT-proBNP) (β 6.79 (CI 4.05; 9.52), p<0.0001), but not age (p = 0.59) or hypertension (p = 0.42). Our final model explained 52% of the LA volume variability. Conclusions In patients with AF, the most important correlates with LA volume are sex, BSA, diabetes, renal function and NT-proBNP, but not age or hypertension. These results may help to refine rhythm control strategies in AF patients.
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Affiliation(s)
- Matthias Bossard
- Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.,Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.,Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland
| | - Rahel Kreuzmann
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland.,Division of Internal Medicine, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Thomas Hochgruber
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland.,Division of Internal Medicine, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Philipp Krisai
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland.,Division of Internal Medicine, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Andreas J Zimmermann
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland.,Division of Internal Medicine, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland.,Division of Internal Medicine, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Katrin Pumpol
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland.,Division of Internal Medicine, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Arnheid Kessel-Schaefer
- Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland
| | - Frank-Peter Stephan
- Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland
| | - Nadja Handschin
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland
| | - Christian Sticherling
- Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland
| | - Stefan Osswald
- Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland
| | - Beat A Kaufmann
- Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland
| | - Guillaume Paré
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, 1280 Main Street West, Hamilton ON, L8S 4K1, Canada
| | - Michael Kühne
- Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland
| | - David Conen
- Cardiology Division, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4031, Basel, Switzerland.,Division of Internal Medicine, Department of Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
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131
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Lee SL, Daimon M, Nakao T, Singer DE, Shinozaki T, Kawata T, Kimura K, Hirokawa M, Kato TS, Mizuno Y, Watanabe M, Yatomi Y, Yamazaki T, Komuro I. Factors influencing left atrial volume in a population with preserved ejection fraction: Left ventricular diastolic dysfunction or clinical factors? J Cardiol 2016; 68:275-81. [DOI: 10.1016/j.jjcc.2016.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/16/2016] [Accepted: 02/02/2016] [Indexed: 11/29/2022]
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132
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Yoshida K, Obokata M, Kurosawa K, Sorimachi H, Kurabayashi M, Negishi K. Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.004999. [DOI: 10.1161/circimaging.116.004999] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/31/2016] [Indexed: 12/31/2022]
Abstract
Background—
Embolic stroke in atrial fibrillation is more prevalent in women than in men, yet the basis for this difference remains unclear. This study seeks to elucidate whether there are any sex differences in the relationships between stroke risk (CHADS
2
score, CHA
2
DS
2
-VASc score without a sex category, and estimated stroke rate) and left atrial (LA) anatomy or mechanics in patients with atrial fibrillation.
Methods and Results—
LA emptying fraction and global peak atrial longitudinal strain were assessed in 414 subjects with paroxysmal or persistent atrial fibrillation (156 women and 258 men). Linear regression models with an interaction term were performed to test the effect of sex difference on associations between the embolic risk and LA function or anatomy. Sensitivity analyses were performed in 228 age, heart rate, and rhythm-matched subjects (114 women and men). Women were older and had larger LA volumes and lower LA mechanics than men. Significant negative association between the CHADS
2
score and LA emptying fraction was only demonstrated in women with a significant interaction between sexes. Similar significant interactions were found in global peak atrial longitudinal strain but not in LA volume. These findings were corroborated in the comparisons against CHA
2
DS
2
-VASc score without a sex category and the estimated stroke rate. Sensitivity analyses in the matched subgroup also confirmed the robustness of these sex differences in LA emptying fraction, but less so in global peak atrial longitudinal strain.
Conclusions—
Significant sex interactions on the association between global LA function and risk stratification schemes exist, which may be a reason for the higher prevalence of embolic stroke in women.
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Affiliation(s)
- Kuniko Yoshida
- From the Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan (K.Y., M.O., K.K., H.S., M.K., K.N.); and Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (K.N.)
| | - Masaru Obokata
- From the Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan (K.Y., M.O., K.K., H.S., M.K., K.N.); and Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (K.N.)
| | - Koji Kurosawa
- From the Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan (K.Y., M.O., K.K., H.S., M.K., K.N.); and Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (K.N.)
| | - Hidemi Sorimachi
- From the Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan (K.Y., M.O., K.K., H.S., M.K., K.N.); and Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (K.N.)
| | - Masahiko Kurabayashi
- From the Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan (K.Y., M.O., K.K., H.S., M.K., K.N.); and Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (K.N.)
| | - Kazuaki Negishi
- From the Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan (K.Y., M.O., K.K., H.S., M.K., K.N.); and Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (K.N.)
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Fuenmayor AJ, Solórzano MI, Gómez L. Epinephrine and left atrial and left ventricular diastolic function decrease in normal subjects. Int J Cardiol 2016; 220:333-6. [PMID: 27390951 DOI: 10.1016/j.ijcard.2016.06.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND We assessed the effect of epinephrine over left atrial and left ventricular diastolic function in subjects without structural heart disease. METHODS Twenty-seven, 34.6±17.2year-old patients without structural heart disease were included. Intravenous epinephrine (50 to 100ng/kg/min) was infused. Left atrial and ventricular functions were evaluated by means of echocardiography before and during the epinephrine infusion. RESULTS No complications were observed. Significant increases in heart rate and systolic blood pressure were recorded. Both left atrial (minimal and maximal) volumes increased but increase in the minimal volume was more pronounced, and the ejection fraction diminished. Left atrial expansion index decreased and the fraction of left ventricular inflow volume resulting from atrial contraction increased. Two patients displayed abnormal left ventricular diastolic function. During epinephrine infusion, E/A and e' decreased, and isovolumetric relaxation time increased. CONCLUSIONS In this group of young adults without structural heart disease, epinephrine infusion was safe, did not produce any complications, and induced a small but significant decrease in left atrial function and left ventricular diastolic function.
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Affiliation(s)
- Abdel J Fuenmayor
- Cardiovascular Research Institute "Abdel M. Fuenmayor P", University Hospital of The Andes, Mérida, Venezuela.
| | - Moisés I Solórzano
- Cardiovascular Research Institute "Abdel M. Fuenmayor P", University Hospital of The Andes, Mérida, Venezuela
| | - Luisangelly Gómez
- Cardiovascular Research Institute "Abdel M. Fuenmayor P", University Hospital of The Andes, Mérida, Venezuela
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Tadic M, Cuspidi C, Pencic B, Rihor B, Radojkovic J, Kocijanic V, Celic V. The influence of white-coat hypertension on left atrial phasic function. Blood Press 2016; 26:102-108. [PMID: 27599391 DOI: 10.1080/08037051.2016.1219223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We aimed to investigate the association between white-coat hypertension (WCH) and left atrial (LA) phasic function assessed by the volumetric and speckle tracking method. This cross-sectional study included 52 normotensive individuals, 49 subjects with WCH and 56 untreated hypertensive patients who underwent a 24-h ambulatory BP monitoring and complete two-dimensional echocardiographic examination (2DE). WCH was diagnosed if clinic blood pressure (BP) was elevated and 24-h BP was normal. We obtained that maximum, minimum LA and pre-A LAV volumes and volume indexes gradually and significantly increased from the normotensive subjects, throughout the white-coat hypertensive individuals to the hypertensive patients. Passive LA emptying fraction (EF), representing the LA conduit function, gradually reduced from normotensive to hypertensive subjects. Active LA EF and the parameter of the LA booster pump function increased in the same direction. Similar results were obtained by 2DE strain analysis. The LA stiffness index gradually increased from normotensive controls, throughout white-coat hypertensive subjects to hypertensive patients. Clinic systolic BP was associated with LA passive EF (β= -0.283, p = 0.001), LA active EF (β = 0.342, p < 0.001), LA total longitudinal strain (β= -0.356, p < 0.001), LA positive longitudinal strain (β= -0.264, p = 0.009) and LA stiffness index (β = 0.398, p < 0.001) without regard to age, BMI, left ventricular structure and diastolic function in the whole study population. In the conclusion, WCH significantly impacts LA phasic function and stiffness. Clinic systolic BP was associated with functional and mechanical LA remodeling in the whole study population.
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Affiliation(s)
- Marijana Tadic
- a Cardiology Department , University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje" , Belgrade , Serbia.,b Faculty of Medicine , Belgrade , Serbia
| | - Cesare Cuspidi
- c Clinical Research Unit , University of Milan-Bicocca and Istituto Auxologico Italiano , Meda , Italy
| | - Biljana Pencic
- a Cardiology Department , University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje" , Belgrade , Serbia.,b Faculty of Medicine , Belgrade , Serbia
| | - Branislav Rihor
- a Cardiology Department , University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje" , Belgrade , Serbia
| | - Jana Radojkovic
- a Cardiology Department , University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje" , Belgrade , Serbia
| | - Vesna Kocijanic
- a Cardiology Department , University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje" , Belgrade , Serbia
| | - Vera Celic
- a Cardiology Department , University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje" , Belgrade , Serbia.,b Faculty of Medicine , Belgrade , Serbia
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135
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Masked Hypertension and Left Atrial Dysfunction: A Hidden Association. J Clin Hypertens (Greenwich) 2016; 19:305-311. [DOI: 10.1111/jch.12901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 07/21/2016] [Accepted: 07/23/2016] [Indexed: 12/01/2022]
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Santos ABS, Roca GQ, Claggett B, Sweitzer NK, Shah SJ, Anand IS, Fang JC, Zile MR, Pitt B, Solomon SD, Shah AM. Prognostic Relevance of Left Atrial Dysfunction in Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2016; 9:e002763. [PMID: 27056882 DOI: 10.1161/circheartfailure.115.002763] [Citation(s) in RCA: 213] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left atrial (LA) size is an established marker of risk for adverse outcomes in heart failure with preserved ejection fraction (HFpEF). However, the independent prognostic importance of LA function in HFpEF is not known. METHODS AND RESULTS We assessed LA function measured by speckle-tracking echocardiography in 357 patients with HFpEF enrolled in the Treatment Of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial who were in sinus rhythm at the time of echocardiography. Lower peak LA strain, indicating LA dysfunction, was associated with older age, higher prevalence of atrial fibrillation and left ventricular (LV) hypertrophy, worse LV and right ventricular systolic function, and worse LV diastolic function. At a mean follow-up of 31 months (interquartile range, 18-43months), 91 patients (25.5%) experienced the primary composite end point of cardiovascular death, HF hospitalization, and aborted sudden death. Lower peak LA strain was associated with a higher risk of the composite end point (hazard ratio, 0.96 per unit of reduction in strain; 95% confidence interval, 0.94-0.99; P=0.009) and of HF hospitalization alone (hazard ratio, 0.95 per unit of reduction in strain; 95% confidence interval, 0.92-0.98; P=0.003). The association of LA strain with incident HF hospitalization remained significant after adjustment for clinical confounders, but not after further adjustment for LV global longitudinal strain and the E/E' ratio, parameters of LV systolic and diastolic function, respectively. CONCLUSIONS LA dysfunction in HFpEF is associated with a higher risk of HF hospitalization independent of potential clinical confounders, but not independent of LV strain and filling pressure. Impairment in LV systolic and diastolic function largely explains the association between impaired LA function and higher risk of HF hospitalization in HFpEF. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.
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Affiliation(s)
- Angela B S Santos
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Gabriela Querejeta Roca
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Brian Claggett
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Nancy K Sweitzer
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Sanjiv J Shah
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Inder S Anand
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - James C Fang
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Michael R Zile
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Bertram Pitt
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Scott D Solomon
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Amil M Shah
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.).
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Badano LP, Miglioranza MH, Mihăilă S, Peluso D, Xhaxho J, Marra MP, Cucchini U, Soriani N, Iliceto S, Muraru D. Left Atrial Volumes and Function by Three-Dimensional Echocardiography. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.004229. [DOI: 10.1161/circimaging.115.004229] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 05/18/2016] [Indexed: 02/05/2023]
Abstract
Background—
Our study sought to (1) identify reference values for left atrial (LA) volumes and phasic function indices by 3-dimensional echocardiography (3DE) and compare them with those measured by 2-dimensional echocardiography (2DE) and (2) analyze their relationship with age, sex, body size, and left ventricular function. Accuracy and reproducibility of 3DE and 2DE have been also tested to evaluate the robustness of our data.
Methods and Results—
We obtained maximal, minimal, and preA LA volumes by 3DE and 2DE in 276 healthy volunteers (18–79 years; 57% women). Limits of normality for LA volumes and total LA emptying fraction were larger with 3DE than with 2DE (maximal LA volume: 43 versus 35 mL/m
2
; preA LA volume: 31 versus 25 mL/m
2
; minimal LA volume: 18 versus 14 mL/m
2
; 53 versus 48%, respectively;
P
<0.001). 3DE LA volumes indexed by body surface area were similar in men and women and increased with age. On multivariable analysis, age, weight, and left ventricular systolic and diastolic function indices resulted as correlates of LA 3DE indices. LA volumes were tightly correlated with cardiac magnetic resonance measurements, yet more underestimated by 2DE versus 3DE (bias±SD: −17±16 versus −7±15 mL, respectively). Among all LA parameters, maximal LA volume and total emptying fraction were the most reproducible, including at test-retest and at expert versus trainee comparisons.
Conclusions—
This study provides reference values for LA 3DE volumes and function from a relatively large cohort of healthy subjects with a wide age range. Our data may help clinicians to identify LA remodeling and dysfunction.
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Affiliation(s)
- Luigi P. Badano
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (L.P.B., D.P., J.X, M.P.M., U.C., N.S., S.I., D.M.); Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil (M.H.M.); and Carol Davila University of Medicine and Pharmacy, Emergency University Hospital, Bucharest, Romania (S.M.)
| | - Marcelo H. Miglioranza
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (L.P.B., D.P., J.X, M.P.M., U.C., N.S., S.I., D.M.); Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil (M.H.M.); and Carol Davila University of Medicine and Pharmacy, Emergency University Hospital, Bucharest, Romania (S.M.)
| | - Sorina Mihăilă
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (L.P.B., D.P., J.X, M.P.M., U.C., N.S., S.I., D.M.); Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil (M.H.M.); and Carol Davila University of Medicine and Pharmacy, Emergency University Hospital, Bucharest, Romania (S.M.)
| | - Diletta Peluso
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (L.P.B., D.P., J.X, M.P.M., U.C., N.S., S.I., D.M.); Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil (M.H.M.); and Carol Davila University of Medicine and Pharmacy, Emergency University Hospital, Bucharest, Romania (S.M.)
| | - Jola Xhaxho
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (L.P.B., D.P., J.X, M.P.M., U.C., N.S., S.I., D.M.); Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil (M.H.M.); and Carol Davila University of Medicine and Pharmacy, Emergency University Hospital, Bucharest, Romania (S.M.)
| | - Martina Perazzolo Marra
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (L.P.B., D.P., J.X, M.P.M., U.C., N.S., S.I., D.M.); Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil (M.H.M.); and Carol Davila University of Medicine and Pharmacy, Emergency University Hospital, Bucharest, Romania (S.M.)
| | - Umberto Cucchini
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (L.P.B., D.P., J.X, M.P.M., U.C., N.S., S.I., D.M.); Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil (M.H.M.); and Carol Davila University of Medicine and Pharmacy, Emergency University Hospital, Bucharest, Romania (S.M.)
| | - Nicola Soriani
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (L.P.B., D.P., J.X, M.P.M., U.C., N.S., S.I., D.M.); Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil (M.H.M.); and Carol Davila University of Medicine and Pharmacy, Emergency University Hospital, Bucharest, Romania (S.M.)
| | - Sabino Iliceto
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (L.P.B., D.P., J.X, M.P.M., U.C., N.S., S.I., D.M.); Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil (M.H.M.); and Carol Davila University of Medicine and Pharmacy, Emergency University Hospital, Bucharest, Romania (S.M.)
| | - Denisa Muraru
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (L.P.B., D.P., J.X, M.P.M., U.C., N.S., S.I., D.M.); Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil (M.H.M.); and Carol Davila University of Medicine and Pharmacy, Emergency University Hospital, Bucharest, Romania (S.M.)
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Gonçalves A, Hung CL, Claggett B, Nochioka K, Cheng S, Kitzman DW, Shah AM, Solomon SD. Left Atrial Structure and Function Across the Spectrum of Cardiovascular Risk in the Elderly: The Atherosclerosis Risk in Communities Study. Circ Cardiovasc Imaging 2016; 9:e004010. [PMID: 26843540 DOI: 10.1161/circimaging.115.004010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although left atrial (LA) enlargement is a recognized risk factor for adverse cardiovascular outcomes, emerging evidence supports the importance of LA function. We examined LA emptying fraction (LAEF) across the spectrum of cardiovascular disease burden in a large cohort of elderly adults living in the community. METHODS AND RESULTS We studied 1142 participants in the Atherosclerosis Risk in Communities (ARIC) study who were in sinus rhythm, free of valvular disease, and had acceptable quality 3-dimensional echocardiograms (mean age, 76±5 years; 59% women). We determined the cross-sectional correlates of LAEF and compared LAEF among elderly adults without cardiovascular disease or cardiovascular risk factors (n=201), those with hypertension (n=734), and those with overt heart failure (HF; n=207). In multivariable analysis, lower LAEF was associated with higher LA volumes and worse left ventricular systolic and diastolic functions. Elderly participants free of cardiovascular disease or risk factors had smaller LA volumes than those with hypertension (LA volume max/ body surface area 30.2±6.6 versus 33.0±9.0 mL/m(2); P=0.001), but similar LAEF (55.2±10.3% versus 53.8±11.5%, respectively; P=0.357). Participants with HF had higher LA volume (39.8±13.3 mL/m(2)) and worse LAEF (47.6±14.6%) than participants with hypertension or participants free of cardiovascular disease or risk factors (all P<0.001). CONCLUSIONS In a community-based cohort, LA function was impaired in participants with prevalent HF, but there were no significant differences in LA function between participants with hypertension and those with free of cardiovascular disease or risk factors, despite greater LA size in the former.
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Affiliation(s)
- Alexandra Gonçalves
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., C.-L.H., B.C., K.N., S.C., A.M.S., S.D.S.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Porto, Portugal (A.G.); Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Chung-Lieh Hung
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., C.-L.H., B.C., K.N., S.C., A.M.S., S.D.S.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Porto, Portugal (A.G.); Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Brian Claggett
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., C.-L.H., B.C., K.N., S.C., A.M.S., S.D.S.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Porto, Portugal (A.G.); Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Kotaro Nochioka
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., C.-L.H., B.C., K.N., S.C., A.M.S., S.D.S.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Porto, Portugal (A.G.); Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Susan Cheng
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., C.-L.H., B.C., K.N., S.C., A.M.S., S.D.S.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Porto, Portugal (A.G.); Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Dalane W Kitzman
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., C.-L.H., B.C., K.N., S.C., A.M.S., S.D.S.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Porto, Portugal (A.G.); Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Amil M Shah
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., C.-L.H., B.C., K.N., S.C., A.M.S., S.D.S.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Porto, Portugal (A.G.); Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Scott D Solomon
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., C.-L.H., B.C., K.N., S.C., A.M.S., S.D.S.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Porto, Portugal (A.G.); Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
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Evaluation of single right atrial volume and function with magnetic resonance imaging in children with hypoplastic left heart. Pediatr Radiol 2016; 46:991-1002. [PMID: 27003135 DOI: 10.1007/s00247-015-3534-2] [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: 12/27/2014] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Standardized methods to evaluate atrial properties in single ventricles are lacking. OBJECTIVE To determine the feasibility of quantifying right atrial volumes and function in hypoplastic left heart using MRI. MATERIALS AND METHODS We studied 15 infants with hypoplastic left heart prior to Glenn surgery (mean age 4.2 months [standard deviation 0.3]) who underwent cardiac MRI with evaluation of atrial volumes and emptying fraction using monoplane two-chamber, monoplane four-chamber, and biplane methods, all of which were compared to the atrial short-axial oblique stack method. We compared atrial end-diastolic volume, end-systolic volume and emptying fraction among these methods. We analyzed reproducibility of the methods using Bland‒Altman plots. RESULTS Both four-chamber and biplane methods showed high correlations for atrial end-diastolic volume (r = 0.7 and r = 0.8, respectively; P < 0.01) and end-systolic volume (r = 0.8 and r = 0.9, respectively; P < 0.01) with small mean differences (-0.2 ± 2.9 standard deviation [SD] ml and -0.8 ± 1.6 ml, respectively, for atrial end-diastolic volume and -0.8 ± 1.5 ml and -0.9 ± 0.9 ml, respectively, for atrial end-systolic volume). The short-axial oblique method was the most reproducible, followed by the four-chamber method. CONCLUSION MRI assessment of atrial volume and function is feasible in hypoplastic left heart and might provide further insight into single-ventricle mechanics.
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Mohty D, Boulogne C, Magne J, Varroud-Vial N, Martin S, Ettaif H, Fadel BM, Bridoux F, Aboyans V, Damy T, Jaccard A. Prognostic value of left atrial function in systemic light-chain amyloidosis: a cardiac magnetic resonance study. Eur Heart J Cardiovasc Imaging 2016; 17:961-9. [PMID: 27194782 DOI: 10.1093/ehjci/jew100] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/15/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cardiac involvement in systemic light-chain amyloidosis (AL) imparts an adverse impact on outcome. The left atrium (LA), by virtue of its anatomical location and muscular wall, is commonly affected by the amyloid process. Although LA infiltration by amyloid fibrils leads to a reduction in its pump function, the infiltration of the left ventricular (LV) myocardium results in diastolic dysfunction with subsequent increase in filling pressures and LA enlargement. Even though left atrial volume (LAV) is an independent prognostic marker in many cardiomyopathies, its value in amyloid heart disease remains to be determined. In addition, few data are available as to the prognostic value of LA function in systemic AL. Using cardiac magnetic resonance (CMR), the current study aims to assess the prognostic significance of the maximal LAV and total LA emptying fraction (LAEF) in patients with AL. METHODS AND RESULTS Fifty-four consecutive patients (age 66 ± 10 years, 59% males) with confirmed systemic AL and mean LV ejection fraction of 60 ± 12% underwent CMR. As compared with patients with no or minimal cardiac involvement (Mayo Clinic [MC] stage I), those at moderate and high risk (MC stages II and III) had significantly larger indexed maximal LAV (36 ± 15 vs. 46 ± 13 vs. 52 ± 19 mL/m(2), P = 0.03) and indexed minimal LAV (20 ± 6 vs. 34 ± 11 vs. 44 ± 17 mL/m(2), P < 0.001), lower LAEF (42 ± 9 vs. 26 ± 13 vs. 16 ± 9%, P < 0.0001) but similar LVEF. Furthermore, myocardial late gadolinium enhancement (LGE) was more frequent and significantly associated with lower LAEF. LAEF was also significantly lower in symptomatic (NHYA ≥ II, 22 ± 14%) as compared with asymptomatic patients (NYHA class I, 33 ± 13%, P = 0.006). Two-year survival rate was lower in patients with LAEF ≤ 16% as compared with those with LAEF > 16% (37 ± 11 vs. 94 ± 4%, P = 0.001). In multivariate analysis, lower LAEF remained independently associated with a higher risk of 2-year mortality (HR = 1.08 per 1% decrease, 95% CI: 1.02-1.15, P = 0.003). CONCLUSION In patients with systemic AL, LAEF as assessed by CMR is associated with NYHA functional class, MC stage, myocardial LGE and 2-year mortality.
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Affiliation(s)
- Dania Mohty
- CHU Dupuytren, Limoges, France French National Reference Center for Light chains Amyloidosis and Other Diseases by Monoclonal Immunoglobulin Deposits, Limoges University, Limoges, France
| | | | | | | | | | | | - Bahaa M Fadel
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | | | | | | | - Arnaud Jaccard
- CHU Dupuytren, Limoges, France French National Reference Center for Light chains Amyloidosis and Other Diseases by Monoclonal Immunoglobulin Deposits, Limoges University, Limoges, France
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Cimadevilla C, Nadia B, Dreyfus J, Perez F, Cueff C, Malanca M, Brochet E, Iung B, Vahanian A, Messika-Zeitoun D. Echocardiographic measurement of left atrial volume: Does the method matter? Arch Cardiovasc Dis 2015; 108:643-9. [PMID: 26432275 DOI: 10.1016/j.acvd.2015.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/22/2015] [Accepted: 07/31/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Four two-dimensional echocardiographic methods (cube, ellipsoid, Simpson's and area-length) can be used to assess left atrial volume (LAV). AIMS To compare absolute LAV measurements and evaluate agreement regarding the semiquantitative assessment of degree of left atrial (LA) enlargement, between methods. METHODS We prospectively measured LAV in 51 healthy volunteers using the four methods, and defined thresholds for moderate (mean+2 standard deviations [SDs]) and severe (mean+4 SDs) LA enlargement for each method. In 372 patients referred for echocardiography, we compared absolute LAV measurements and agreement between methods. RESULTS LAV was significantly different between methods in the healthy volunteer group (11 ± 4, 17 ± 3, 26 ± 6 and 28 ± 7 mL/m(2), respectively; P<0.0001), resulting in different thresholds for moderate and severe LA enlargement. LAV was also significantly different in the 372 patients (30 ± 20, 47 ± 27, 61 ± 34 and 65 ± 36 mL/m(2), respectively; P<0.0001). Agreement regarding degree of LA enlargement (none, moderate, severe), using the area-length method as reference, was modest with the cube method (kappa=0.41), correct with the ellipsoid method (kappa=0.60) and excellent with Simpson's method (kappa=0.83). CONCLUSION The choice of the method had a major effect on assessment of degree of LA enlargement. Our results suggest that the cube and ellipsoid methods, which significantly underestimated LAV and provided modest agreement, should be disregarded. In contrast, Simpson's method and the area-length method were slightly different, but showed close agreement, and should be preferred, using dedicated thresholds (50 and 56 mL/m(2) respectively).
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Affiliation(s)
- Claire Cimadevilla
- AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France; University Paris 7, Bichat Hospital, Paris, France.
| | - Berjeb Nadia
- AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France
| | - Julien Dreyfus
- AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France; University Paris 7, Bichat Hospital, Paris, France
| | - Fanny Perez
- AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France
| | - Caroline Cueff
- AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France
| | - Michaela Malanca
- AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France
| | - Eric Brochet
- AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France
| | - Bernard Iung
- AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France; Inserm U698, Bichat Hospital, Paris, France; University Paris 7, Bichat Hospital, Paris, France
| | - Alec Vahanian
- AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France; Inserm U698, Bichat Hospital, Paris, France; University Paris 7, Bichat Hospital, Paris, France
| | - David Messika-Zeitoun
- AP-HP, Cardiovascular Division, Bichat Hospital, 46, rue Henri-Huchard, 75018 Paris, France; Inserm U698, Bichat Hospital, Paris, France; University Paris 7, Bichat Hospital, Paris, France
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Gucuk Ipek E, Marine JE, Habibi M, Chrispin J, Lima J, Rickard J, Spragg D, Zimmerman SL, Zipunnikov V, Berger R, Calkins H, Nazarian S. Association of left atrial function with incident atypical atrial flutter after atrial fibrillation ablation. Heart Rhythm 2015; 13:391-8. [PMID: 26416618 DOI: 10.1016/j.hrthm.2015.09.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Symptomatic left atrial (LA) flutter (LAFL) is common after atrial fibrillation (AF) ablation. OBJECTIVE The purpose of this study was to examine the association of baseline LA function with incident LAFL after AF ablation. METHODS The source cohort included 216 patients with cardiac magnetic resonance (CMR) before initial AF ablation between 2010 and 2013. Patients who underwent cryoballoon or laser ablation, patients with AF during CMR, and those with suboptimal CMR, or missing follow-up data were excluded. Baseline LA volume and function were assessed by feature-tracking CMR analysis. RESULTS The final cohort included 119 patients (mean age 58.9 ± 11 years; 76.5% men; 70.6% patients with paroxysmal AF). During a median follow-up of 421 days (interquartile range 235-751 days), 22 patients (18.5%) had incident LAFL. Baseline LA volume was similar between the 2 groups. In contrast, baseline reservoir, conduit, and contractile function of the LA were significantly impaired in patients with incident LAFL. Baseline global peak longitudinal atrial strain (PLAS) <22.65% predicted incident LAFL with 86% sensitivity and 68% specificity (C statistic 0.76). In a multivariable model adjusting for age, heart failure, and LA volume, PLAS (hazard ratio 0.9 per % increase in PLAS; P = .003) and LA linear lesions (hazard ratio 2.94; P = .020) were independently associated with incident LAFL. The coexistence of PLAS <22.65% and linear lesions was associated with 9-fold increased hazard of incident LAFL. CONCLUSION Baseline LA function and linear lesions were independently associated with incident LAFL after AF ablation. Linear lesions should be limited to selected cases, especially in patients with impaired LA function.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Saman Nazarian
- Departments of Cardiology; Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Siontis KC, Geske JB, Gersh BJ. Atrial fibrillation pathophysiology and prognosis: insights from cardiovascular imaging. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003020. [PMID: 26022381 DOI: 10.1161/circimaging.115.003020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Konstantinos C Siontis
- From Department of Medicine (K.C.S.), Division of Cardiovascular Diseases (J.B.G., B.J.G.), Mayo Clinic College of Medicine, Rochester, MN
| | - Jeffrey B Geske
- From Department of Medicine (K.C.S.), Division of Cardiovascular Diseases (J.B.G., B.J.G.), Mayo Clinic College of Medicine, Rochester, MN
| | - Bernard J Gersh
- From Department of Medicine (K.C.S.), Division of Cardiovascular Diseases (J.B.G., B.J.G.), Mayo Clinic College of Medicine, Rochester, MN.
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Tadic M, Cuspidi C, Pencic B, Kocijancic V, Celic V. The influence of left ventricular geometry on left atrial phasic function in hypertensive patients. Blood Press 2015. [PMID: 26212876 DOI: 10.3109/08037051.2015.1070563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We aimed to investigate left atrial (LA) phasic function in hypertensive patients with different geometric patterns using two-dimensional (2DE) and three-dimensional (3DE) echocardiography. METHODS This cross-sectional study included 213 hypertensive subjects who underwent a complete 2DE and 3DE examination. The new updated criteria for left ventricular (LV) geometry, which consider LV mass index, LV end-diastolic diameter and relative wall thickness, were applied. According to this classification, the subjects were divided into six groups: normal geometry, concentric remodeling, eccentric non-dilated left ventricular hypertrophy (LVH), concentric LVH, dilated LVH and concentric-dilated LVH. RESULTS 2DE and 3DE LA volumes gradually increased from normal LV geometry to concentric and concentric-dilated LVH. LA reservoir and conduit functions, estimated by 2DE and 3DE LA total and passive emptying fractions, were decreased in subjects with concentric and concentric-dilated LVH. LA booster pump function was increased in patients with concentric, dilated and concentric-dilated LVH compared to subjects with normal LV geometry. The same results regarding LA phasic function were provided by 2DE strain analysis. Concentric, dilated and non-concentric dilated LVH were associated with LA enlargement independently of main demographic and clinical features. CONCLUSION LV geometric patterns significantly influence LA phasic function. Concentric and dilated LVH patterns have the most prominent negative effect on LA enlargement assessed by both 2DE and 3DE.
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Affiliation(s)
- Marijana Tadic
- a Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje" , Belgrade , Serbia.,b Faculty of Medicine, University of Belgrade , Belgrade , Serbia
| | - Cesare Cuspidi
- c Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano , Meda , Italy
| | - Biljana Pencic
- a Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje" , Belgrade , Serbia
| | - Vesna Kocijancic
- a Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje" , Belgrade , Serbia
| | - Vera Celic
- a Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje" , Belgrade , Serbia.,b Faculty of Medicine, University of Belgrade , Belgrade , Serbia
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Schweitzer A, Agmon Y, Aronson D, Abadi S, Mutlak D, Carasso S, Walker JR, Lessick J. Assessment of left sided filling dynamics in diastolic dysfunction using cardiac computed tomography. Eur J Radiol 2015. [PMID: 26205972 DOI: 10.1016/j.ejrad.2015.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction (DD) often accompanies coronary artery disease but is difficult to assess since it involves a complex interaction between LV filling and left atrial (LA) emptying. OBJECTIVE To characterize simultaneous changes in LA and LV volumes using cardiac computed tomography (CT) in a group of patients with various grades of DD based on echocardiography. METHODS We identified 35 patients with DD by echocardiography, who had also undergone cardiac CT, and 35 age-matched normal controls. LV and LA volumes were measured every 10% of the RR interval, using semi-automatic software. From these, - systolic, early-diastolic and late-diastolic volume changes were calculated, and additional parameters of diastolic filling derived. Conduit volume was defined as the difference between the LV and LA early-diastolic volume change. RESULTS Patients with DD had significantly larger LV mass, and LA volumes, reduced early emptying volumes and increased conduit volume as percent of early LV filling (All p<0.001). LA function, manifesting as total emptying fraction (LATEF), decreased proportionately with worsening grades of DD (p<0.001). LA contractile function was maintained until advanced grade-3 DD. By receiver operating characteristic analysis, LATEF had an AUC of 0.88 to separate between normals and DD. At a threshold of <42.5%, LATEF has 97% sensitivity and 69% specificity to detect DD. CONCLUSIONS DD is characterized by reduced LA function and an alteration in the relative contributions of the atrial emptying and conduit volume components of early LV filling. In patients undergoing cardiac CT, it is possible to identify the presence and severity of DD.
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Affiliation(s)
| | - Yoram Agmon
- Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel.
| | - Doron Aronson
- Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel.
| | - Sobhi Abadi
- Medical Imaging Department, Rambam Health Care Campus, Haaliya Street, Haifa 31096, Israel.
| | - Diab Mutlak
- Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel.
| | - Shemy Carasso
- Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel.
| | - Jonathan R Walker
- Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel.
| | - Jonathan Lessick
- Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel.
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dal Piaz EC, Casagranda G, Ravanelli D, Marini M, Valentini A, Del Greco M. Extensive atrial fibrosis in a patient with systemic lupus erythematosus and atrial fibrillation. HeartRhythm Case Rep 2015; 1:206-208. [PMID: 28491549 PMCID: PMC5419331 DOI: 10.1016/j.hrcr.2015.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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147
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Putko BN, Yogasundaram H, Chow K, Pagano J, Khan A, Paterson DI, Thompson RB, Oudit GY. Normal left-atrial structure and function despite concentric left-ventricular remodelling in a cohort of patients with Anderson-Fabry disease. Eur Heart J Cardiovasc Imaging 2015; 16:1129-36. [PMID: 25750198 DOI: 10.1093/ehjci/jev057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/18/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Anderson-Fabry Disease (AFD) is an important cause of cardiomyopathy characterized by concentric left-ventricular hypertrophy (LVH). We evaluated the extent of left-atrial (LA) structural and functional remodelling in this group of patients given that LA remodelling is a marker of adverse outcomes in the presence of LVH. METHODS AND RESULTS Clinical profiles were obtained and cardiac MRI was performed in cohorts of patients with AFD (n = 31), healthy controls (n = 23), and a positive control cohort with known concentric remodelling and LVH (CR/H, n = 21). Of patients with AFD, 58% were on enzyme-replacement therapy (ERT), 84% were on renin-angiotensin system antagonism, and 65% were on statins. Despite a similar increase in LV mass index in the AFD when compared with the CR/H cohort, mean LA volumes for the AFD group were similar to those seen in the healthy control group. Following from this, we observed that the percentage contribution to LV stroke volume due to elastic/passive and active LA emptying was similar in the AFD and healthy control groups, while passive emptying was significantly lower in the CR/H group. The consequences of LVH in the AFD cohort were manifested in atrioventricular uncoupling, whereby the extent of elastic/passive and active LA emptying was not a function of the extent of longitudinal movement of the mitral annular plane, as it was in healthy control subjects. CONCLUSION Left-atrial structure and function were relatively normal in our cohort of patients with AFD, who were also judiciously treated with a contemporary strategy that includes renin-angiotensin system antagonism, statins, and ERT.
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Affiliation(s)
- Brendan N Putko
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Haran Yogasundaram
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Kelvin Chow
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Pagano
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Aneal Khan
- Department of Medical Genetics and Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - D Ian Paterson
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
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Ravassa S, Kuznetsova T, Varo N, Thijs L, Delles C, Dominiczak A, Díez J, Staessen JA. Biomarkers of cardiomyocyte injury and stress identify left atrial and left ventricular remodelling and dysfunction: A population-based study. Int J Cardiol 2015; 185:177-85. [PMID: 25796005 DOI: 10.1016/j.ijcard.2015.03.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 12/22/2014] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVES The validation of effective screening tools for the identification of patients with subclinical myocardial remodelling is a major clinical need. Thus, we explored the associations of circulating biomarkers of cardiomyocyte injury and stress with subclinical cardiac remodelling and dysfunction, and with biomarkers reflecting collagen turnover. METHODS We randomly recruited 727 subjects from a general population (51.2% women; mean age 51.3 years). Measurements included echocardiographic left atrial (LA) and left ventricular (LV) structure and function, quantification of high sensitivity cardiac Troponin T (hs-cTnT), NT-proBNP, and biomarkers of collagen types I and III turnover. RESULTS In unadjusted and adjusted analyses, the prevalence of LA enlargement (LAE), LV hypertrophy (LVH) and LV diastolic dysfunction (LVDD) increased with higher hs-cTnT (P ≤ 0.031). NT-proBNP was independently associated with LVDD (P=0.009). Both biomarkers combined yielded significant integrated discrimination and net reclassification improvements (P ≤ 0.014 and P ≤ 0.009, respectively) for LAE, LVH and LVDD, over the conventional risk factors, and were independently and positively associated with biomarkers of collagen type I turnover. In a sensitivity analysis, after excluding participants with previous cardiac diseases, our findings remained consistent. CONCLUSIONS Our population-based study suggested that subclinical LV and LA remodelling were associated with hs-cTnT, and that, in combination with NT-proBNP, hs-cTnT showed incremental diagnostic utility over the conventional risk factors. Both biomarkers were associated with biomarkers of collagen type I turnover. Thus, biomarkers of cardiomyocyte microinjury and hemodynamic stress may stimulate fibrosis-related mechanisms and facilitate the diagnosis of subclinical LA and LV remodelling and dysfunction in the general population.
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Affiliation(s)
- Susana Ravassa
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain
| | - Tatiana Kuznetsova
- The Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Nerea Varo
- Department of Biochemistry, University of Navarra Clinic, University of Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona Spain
| | - Lutgarde Thijs
- The Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, UK
| | - Anna Dominiczak
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, UK
| | - Javier Díez
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain; Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, University of Navarra, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain.
| | - Jan A Staessen
- The Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium; Department of Epidemiology, University of Maastricht, Maastricht, The Netherlands.
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Pellicori P, Zhang J, Lukaschuk E, Joseph AC, Bourantas CV, Loh H, Bragadeesh T, Clark AL, Cleland JGF. Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value. Eur Heart J 2015; 36:733-742. [DOI: 10.1093/eurheartj/ehu405] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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150
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Müller H, Lerch R. Three-dimensional Echocardiographic Analysis of left Atrial size and Volumetric Function — Clinical Implications and Comparison with Other Imaging Modalities. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9299-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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