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Xu Y, Zhou JW, Su B, Sun YJ, Zhou J, Liu Y, Zhou BY, Zou C. Left atrial strain parameters to predicting elevated left atrial pressure in patients with atrial fibrillation. Echocardiography 2024; 41:e15876. [PMID: 38980981 DOI: 10.1111/echo.15876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVES To assess the ability of left atrial (LA) strain parameters to discriminate patients with elevated left atrial pressure (LAP) from patients with atrial fibrillation (AF). METHODS AND RESULTS A total of 142 patients with non-valvular AF who underwent first catheter ablation (CA) between November 2022 and November 2023 were enrolled in the study. Conventional and speckle-tracking echocardiography (STE) were performed in all patients within 24 h before CA, and LAP was invasively measured during the ablation procedure. According to mean LAP, the study population was classified into two groups of normal LAP (LAP < 15 mmHg, n = 101) and elevated LAP (LAP ≥ 15 mmHg, n = 41). Compared with the normal LAP group, elevated LAP group showed significantly reduced LA reservoir strain (LASr) [9.14 (7.97-11.80) vs. 20 (13.59-26.96), p < .001], and increased LA filling index [9.60 (7.15-12.20) vs. 3.72 (2.17-5.82), p < .001], LA stiffness index [1.13 (.82-1.46) vs. .47 (.30-.70), p < .001]. LASr, LA filling index and LA stiffness index were independent predictors of elevated LAP after adjusted by the type of AF, EDT, E/e', mitral E, and peak acceleration rate of mitral E velocity. The receiver-operating characteristic curve (ROC) analysis showed LA strain parameters (area under curve [AUC] .794-.819) could provide similar or greater diagnostic accuracy for elevated LAP, as compared to conventional echocardiographic parameters. Furthermore, the novel algorithms built by LASr, LA stiffness index, LA filling index, and left atrial emptying fraction (LAEF), was used to discriminate elevated LAP in AF with good accuracy (AUC .880, accuracy of 81.69%, sensitivity of 80.49%, and specificity of 82.18%), and much better than 2016 ASE/EACVI algorithms in AF. CONCLUSION In patients with AF, LA strain parameters could be useful to predict elevated LAP and non-inferior to conventional echocardiographic parameters. Besides, the novel algorithm built by LA strain parameters combined with conventional parameters would improve the diagnostic efficiency.
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Affiliation(s)
- Ying Xu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jia-Wei Zhou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bo Su
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun-Juan Sun
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jing Zhou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yang Liu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bing-Yuan Zhou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cao Zou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Guo B, Mao T, Tao R, Fu S, Deng Y, Liu Z, Wang M, Wang R, Zhao W, Chai Y, Jiang C, Rao H. Test-retest reliability and time-of-day variations of perfusion imaging at rest and during a vigilance task. Cereb Cortex 2024; 34:bhae212. [PMID: 38771245 DOI: 10.1093/cercor/bhae212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/19/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024] Open
Abstract
Arterial spin-labeled perfusion and blood oxygenation level-dependent functional MRI are indispensable tools for noninvasive human brain imaging in clinical and cognitive neuroscience, yet concerns persist regarding the reliability and reproducibility of functional MRI findings. The circadian rhythm is known to play a significant role in physiological and psychological responses, leading to variability in brain function at different times of the day. Despite this, test-retest reliability of brain function across different times of the day remains poorly understood. This study examined the test-retest reliability of six repeated cerebral blood flow measurements using arterial spin-labeled perfusion imaging both at resting-state and during the psychomotor vigilance test, as well as task-induced cerebral blood flow changes in a cohort of 38 healthy participants over a full day. The results demonstrated excellent test-retest reliability for absolute cerebral blood flow measurements at rest and during the psychomotor vigilance test throughout the day. However, task-induced cerebral blood flow changes exhibited poor reliability across various brain regions and networks. Furthermore, reliability declined over longer time intervals within the day, particularly during nighttime scans compared to daytime scans. These findings highlight the superior reliability of absolute cerebral blood flow compared to task-induced cerebral blood flow changes and emphasize the importance of controlling time-of-day effects to enhance the reliability and reproducibility of future brain imaging studies.
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Affiliation(s)
- Bowen Guo
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai 201620, China
| | - Tianxin Mao
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai 201620, China
| | - Ruiwen Tao
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai 201620, China
| | - Shanna Fu
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai 201620, China
| | - Yao Deng
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai 201620, China
| | - Zhihui Liu
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai 201620, China
| | - Mengmeng Wang
- Business School, NingboTech University, Ningbo 315199, China
| | - Ruosi Wang
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai 201620, China
| | - Weiwei Zhao
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai 201620, China
| | - Ya Chai
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai 201620, China
- Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Caihong Jiang
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai 201620, China
| | - Hengyi Rao
- Center for Magnetic Resonance Imaging Research & Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai 201620, China
- Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, United States
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, United States
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3
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Mukai Y, Nakanishi K, Daimon M, Iwama K, Yoshida Y, Hirose K, Yamamoto Y, Seki H, Nakao T, Oshima T, Matsubara T, Shimizu Y, Oguri G, Kojima T, Hasumi E, Fujiu K, Morita H, Komuro I. Prevalence, Associated Factors, and Echocardiographic Estimation of Left Atrial Hypertension in Patients With Atrial Fibrillation. J Am Heart Assoc 2023; 12:e030325. [PMID: 37702280 PMCID: PMC10547270 DOI: 10.1161/jaha.123.030325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023]
Abstract
Background Elevated left atrial (LA) pressure predisposes individuals to the initiation and persistence of atrial fibrillation (AF), and LA hypertension is associated with AF recurrence after catheter ablation (CA). However, the exact frequency and factors associated with LA hypertension are unknown, and its noninvasive estimation is challenging. This study aimed to investigate the prevalence and determinants of LA hypertension in patients with AF who underwent first CA. Methods and Results We examined 183 patients with AF who underwent conventional and speckle-tracking echocardiography before CA to assess LA size, reservoir strain, and stiffness. Direct LA pressure was measured at the time of CA, and LA hypertension was defined as mean LA pressure >15 mm Hg. Thirty-three (18.0%) patients exhibited LA hypertension. Patients with LA hypertension had a significantly larger LA volume index (40.2 [28.4-52.1] versus 34.1 [26.9-42.4] mL/m2, P=0.025), reduced LA reservoir strain (15.1 [10.4-21.7] versus 22.7 [14.4-32.3] %, P=0.002) and increased LA stiffness (0.69 [0.34-0.99] versus 0.36 [0.24-0.54], P<0.001). Multivariable analyses showed that waist circumference, C-reactive protein level, LA reservoir strain, and LA stiffness were independently associated with LA hypertension (all P<0.05), while LA volume and E/e' ratio were not. Among echocardiographic parameters, receiver operating characteristic curve analysis identified LA stiffness as the best predictor of LA hypertension. Conclusions Approximately 20% of patients with AF who underwent CA had LA hypertension. Central obesity and inflammation might be involved in the pathophysiological mechanisms of LA hypertension, and echocardiography-derived LA stiffness may have clinical utility for the detection of LA hypertension before CA.
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Affiliation(s)
- Yasuhiro Mukai
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Koki Nakanishi
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Masao Daimon
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
- Department of Clinical LaboratoryThe University of TokyoTokyoJapan
| | - Kentaro Iwama
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Yuriko Yoshida
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Kazutoshi Hirose
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Yuko Yamamoto
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Hikari Seki
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Tomoko Nakao
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
- Department of Clinical LaboratoryThe University of TokyoTokyoJapan
| | - Tsukasa Oshima
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Takumi Matsubara
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Yu Shimizu
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Gaku Oguri
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Toshiya Kojima
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Eriko Hasumi
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Katsuhito Fujiu
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Hiroyuki Morita
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Issei Komuro
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
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Levent F, Kanat S, Tutuncu A. Predictive Value of C2HEST Score for Atrial Fibrillation Recurrence Following Successful Cryoballoon Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation. Angiology 2023; 74:273-281. [PMID: 35583221 DOI: 10.1177/00033197221102230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The C2HEST score ((coronary artery disease (CAD) or chronic obstructive pulmonary disease (COPD) [C2, 1 point each]; hypertension [H, 1 point]; elderly [E, age ≥75 years, 2 points]; systolic heart failure [S, 2 points]; thyroid disease [T, hyperthyroidism, 1 point]) has been validated for predicting incidental atrial fibrillation (AF) in both the general population and patients with ischemic stroke. The present study evaluated the performance of this score in predicting AF recurrence in 252 patients following cryoballoon ablation (CRYO) for paroxysmal AF. The AF recurrence rate in 3-12 months following CRYO was 20,2%. The predictive value of the C2HEST score was significantly better than that of the CHA2DS2-VASc score ((congestive heart failure, hypertension, age (>65 = 1 point, >75 = 2 points), diabetes, previous stroke/transient ischemic attack (2 points), vascular disease, age 65-74 years, and sex category)) (area under curve [AUC]: .881 vs .741; P = .0017). C2HEST score of ≥2, increased atrial diameter, and E/e' ratio as well as, the presence of COPD and systolic heart failure (SHF) were independent predictors for AF recurrence (P < .05). In patients undergoing CRYO for paroxysmal AF, the C2HEST, a simple clinical score, could be useful to assess the risk of AF recurrence.
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Affiliation(s)
- Fatih Levent
- Department of Cardiology, 147003Bursa Yüksek İhtisas Training and Research Hospital, İzmir, Turkey
| | - Selçuk Kanat
- Department of Cardiology, 147003Bursa Yüksek İhtisas Training and Research Hospital, İzmir, Turkey
| | - Ahmet Tutuncu
- Department of Cardiology, 147003Bursa Yüksek İhtisas Training and Research Hospital, İzmir, Turkey
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Motoc A, Scheirlynck E, Roosens B, Luchian ML, Chameleva H, Gevers M, Galloo X, von Kemp B, de Asmundis C, Magne J, Droogmans S, Cosyns B. Additional value of left atrium remodeling assessed by three-dimensional echocardiography for the prediction of atrial fibrillation recurrence after cryoballoon ablation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1103-1111. [PMID: 34919165 DOI: 10.1007/s10554-021-02493-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022]
Abstract
Cryoballoon ablation (CBA) is a safe and efficient therapeutic option for atrial fibrillation (AF). However, AF recurrence occurs in 25% of the patients, leading to repeated ablations and complications. Previous reports have shown that left atrium (LA) assessed by M-Mode and two-dimensional echocardiography (2DE) predicts AF recurrence. Nevertheless, these methods imply geometrical assumptions of the LA remodeling, which is a three-dimensional process. We hypothesized that LA remodeling by three-dimensional echocardiography (3DE) has an additional value for AF recurrence prediction post-CBA. 172 consecutive patients (62.2 ± 12.2 years, 61% male) were prospectively recruited. Echocardiography was performed before CBA. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period. 50 (29%) patients had AF recurrence. 3DE LA maximum volume index (LAVI) had the highest incremental predictive value for AF recurrence (HR 5.50, 95% CI 1.34 -22.45, p < 0.001). In patients with non-dilated LA diameter index and LAVI by 2DE, LAVI by 3DE was able to discriminate AF recurrence with a sensitivity of 90% and a specificity of 66%, for an optimal cut-off value of 30.4 ml/m2. LA remodeling by 3DE predicted AF recurrence, even in patients with non-dilated LA by M-Mode and 2DE, suggesting that 3DE might reflect better and earlier the asymmetric and variable nature of LA remodeling and it should be considered for systematic use to evaluate AF recurrence risk post-CBA.
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Affiliation(s)
- Andreea Motoc
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Esther Scheirlynck
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bram Roosens
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Maria-Luiza Luchian
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Hadischat Chameleva
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Maxim Gevers
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Xavier Galloo
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Berlinde von Kemp
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Faculté de Médecine de Limoges, 16 INSERM 1094, 2, rue Marcland, 87000, Limoges, France
| | - Steven Droogmans
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
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Motoc A, Luchian M, Scheirlynck E, Roosens B, Chameleva H, Gevers M, Galloo X, von Kemp B, Ramak R, Sieira J, de Asmundis C, Chierchia G, Magne J, Weytjens C, Droogmans S, Cosyns B. Incremental value of left atrial strain to predict atrial fibrillation recurrence after cryoballoon ablation. PLoS One 2021; 16:e0259999. [PMID: 34797844 PMCID: PMC8604362 DOI: 10.1371/journal.pone.0259999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Atrial fibrillation (AF) recurrence occurs in approximately 25% of the patients undergoing cryoballoon ablation (CBA), leading to repeated ablations and complications. Left atrial (LA) dilation has been proposed as a predictor of AF recurrence. However, LA strain is a surrogate marker of LA mechanical dysfunction, which might appear before the enlargement of the LA. The purpose of this study was to evaluate the additional predictive value of LA function assessed using strain echocardiography for AF recurrence after CBA. Methods 172 consecutive patients (62.2 ± 12.2 years, 61% male) were prospectively analyzed. Echocardiography was performed before CBA. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period. Results 50 (29%) patients had AF recurrence. In the overall study population, peak atrial longitudinal strain (PALS) ≤ 17% had the highest incremental predictive value for AF recurrence (HR = 9.45, 95%CI: 3.17–28.13, p < 0.001). In patients with non-dilated LA, PALS≤17% remained an independent predictor of AF recurrence (HR = 5.39, 95%CI: 1.66–17.52, p = 0.005). Conclusions This study showed that LA function assessed by PALS provided an additional predictive value for AF recurrence after CBA, over LA enlargement. In patients with non—dilated LA, PALS also predicted AF recurrence. These findings emphasize the added value of LA strain, suggesting that it should be implemented in the systematic evaluation of AF patients before CBA.
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Affiliation(s)
- Andreea Motoc
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
- * E-mail:
| | - Maria–Luiza Luchian
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Esther Scheirlynck
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bram Roosens
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Hadischat Chameleva
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maxim Gevers
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Xavier Galloo
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Berlinde von Kemp
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Robbert Ramak
- Heart Rhythm Management Centre, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Gian–Battista Chierchia
- Heart Rhythm Management Centre, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Julien Magne
- Service Cardiologie, CHU Limoges, Hôpital Dupuytren, Limoges, France
- 16 INSERM 1094, Faculté de Médecine de Limoges, Limoges, France
| | - Caroline Weytjens
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Steven Droogmans
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
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7
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Gottlieb LA, Vaillant F, Abell E, Belterman C, Loyer V, El Hamrani D, Naulin J, Constantin M, Quesson B, Boukens BJ, Coronel R, Dekker LRC. Localized Pulmonary Vein Scar Promotes Atrial Fibrillation in High Left Atrial Pressure. Front Physiol 2021; 12:709844. [PMID: 34512384 PMCID: PMC8424033 DOI: 10.3389/fphys.2021.709844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Pulmonary vein (PV) ablation is unsuccessful in atrial fibrillation (AF) patients with high left atrial (LA) pressure. Increased atrial stretch by increased pressure is proarrhythmic for AF, and myocardial scar alters wall deformation. We hypothesized that localized PV scar is proarrhythmic for AF in high LA pressure. Methods Radiofrequency energy was delivered locally in the right PV of healthy sheep. The sheep recovered for 4 months. Explanted hearts (n = 9 PV scar, n = 9 controls) were perfused with 1:4 blood:Tyrode's solution in a four-chamber working heart setup. Programmed PV stimulation was performed during low (∼12 mmHg) and high (∼25 mmHg) LA pressure. An AF inducibility index was calculated based on the number of induction attempts and the number of attempts causing AF (run of ≥ 20 premature atrial complexes). Results In high LA pressure, the presence of PV scar increased the AF inducibility index compared with control hearts (0.83 ± 0.20 vs. 0.38 ± 0.40 arb. unit, respectively, p = 0.014). The diastolic stimulation threshold in high LA pressure was higher (108 ± 23 vs. 77 ± 16 mA, respectively, p = 0.006), and its heterogeneity was increased in hearts with PV scar compared with controls. In high LA pressure, the refractory period was shorter in PV scar than in control hearts (178 ± 39 vs. 235 ± 48 ms, p = 0.011). Conclusion Localized PV scar only in combination with increased LA pressure facilitated the inducibility of AF. This was associated with changes in tissue excitability remote from the PV scar. Localized PV ablation is potentially proarrhythmic in patients with increased LA pressure.
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Affiliation(s)
- Lisa A Gottlieb
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.,AUMC, Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands
| | - Fanny Vaillant
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Emma Abell
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Charly Belterman
- AUMC, Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands
| | - Virginie Loyer
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Dounia El Hamrani
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Jérôme Naulin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Marion Constantin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Bruno Quesson
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Bastiaan J Boukens
- AUMC, Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands.,AUMC, Academic Medical Center, Department of Medical Biology, Amsterdam, Netherlands
| | - Ruben Coronel
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.,AUMC, Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands
| | - Lukas R C Dekker
- Department of Electrical Engineering, University of Technology, Eindhoven, Netherlands.,Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
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8
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Gilge JL, Ahmed A, Clark BA, Slaten A, Devathu R, Olson JA, Padanilam BJ, Nair GV, Joshi SA, Ravichandran AK, Patel PJ. Left atrial hypertension and the risk of early incident heart failure after atrial fibrillation ablation. J Cardiovasc Electrophysiol 2020; 32:325-332. [PMID: 33270311 DOI: 10.1111/jce.14829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/03/2020] [Accepted: 11/22/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Elevated left atrial pressure (LAP) during catheter ablation of atrial fibrillation (AF) is associated with an increased risk of AF recurrence, but it is unknown if this correlates with heart failure (HF). The objective of the study was to determine if elevated LAP after AF ablation correlates with HF events. METHODS Prospective, single-center, cohort study measuring LAP and right atrial pressure (RAP) during AF ablation in 100 patients. The primary endpoint was clinical HF within 30 days of ablation. The secondary outcome was AF-free HF. RESULTS One hundred patients (63% male, mean age 64.5) were enrolled and 20% had clinical HF within 30 days. Bivariate correlates included mitral valve (MV) disease, persistent AF, class III antiarrhythmics, LAP, and recurrent AF. Multivariate analysis revealed class III antiarrhythmics were protective (odds ratio [OR]: 0.24 [0.1-0.5], p = .04), while MV disease (OR: 8.7 [3.3-23], p = .03) and loop diuretics (OR: 4.8 [2.6-9.1], p = .01) were hazardous. AF-free HF occurred in 9% of patients and correlated with higher LAP and RAP, and chronic kidney disease. CONCLUSION Patients with HF after AF ablation had higher LAP. MV disease, diuretic use, and class III antiarrhythmics also correlated to HF. These present opportunities to target future interventions to reduce a common complication of AF ablation.
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Affiliation(s)
- Jasen L Gilge
- Division of Cardiology, Department of Internal Medicine, St. Vincent Medical Group, Indianapolis, Indiana, USA
| | - Asim Ahmed
- Division of Cardiology, Department of Internal Medicine, St. Vincent Medical Group, Indianapolis, Indiana, USA
| | - Brad A Clark
- Division of Cardiology, Department of Internal Medicine, St. Vincent Medical Group, Indianapolis, Indiana, USA
| | - Alexander Slaten
- Division of Cardiology, Department of Internal Medicine, St. Vincent Medical Group, Indianapolis, Indiana, USA
| | - Rahul Devathu
- Division of Cardiology, Department of Internal Medicine, St. Vincent Medical Group, Indianapolis, Indiana, USA
| | - Jeffrey A Olson
- Division of Cardiology, Department of Internal Medicine, St. Vincent Medical Group, Indianapolis, Indiana, USA
| | - Benzy J Padanilam
- Division of Cardiology, Department of Internal Medicine, St. Vincent Medical Group, Indianapolis, Indiana, USA
| | - Girish V Nair
- Division of Cardiology, Department of Internal Medicine, St. Vincent Medical Group, Indianapolis, Indiana, USA
| | - Sandeep A Joshi
- Division of Cardiology, Department of Internal Medicine, St. Vincent Medical Group, Indianapolis, Indiana, USA
| | - Ashwin K Ravichandran
- Division of Cardiology, Department of Internal Medicine, St. Vincent Medical Group, Indianapolis, Indiana, USA
| | - Parin J Patel
- Division of Cardiology, Department of Internal Medicine, St. Vincent Medical Group, Indianapolis, Indiana, USA
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Vaishnav AS, Alderwish E, Coleman KM, Saleh M, Makker P, Bhasin K, Bernstein NE, Skipitaris NT, Mountantonakis SE. Anatomic predictors of recurrence after cryoablation for atrial fibrillation: a computed tomography based composite score. J Interv Card Electrophysiol 2020; 61:293-302. [PMID: 32602004 DOI: 10.1007/s10840-020-00799-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Effective pulmonary vein isolation (PVI) with cryoablation depends on adequate occlusion of pulmonary veins (PV) by the cryoballoon and is therefore likely to be affected by PV and left atrial (LA) anatomical characteristics and variants. Thus, the objective of this study was to investigate the effect of LA and PV anatomy, evaluated by computed tomography (CT), on acute and long-term outcomes of cryoablation for atrial fibrillation (AF). METHODS Fifty-eight patients (64.72 + 9.44 years, 60.3% male) undergoing cryoablation for paroxysmal or early persistent AF were included. Pre-procedural CT images were analyzed to evaluate LA dimensions and PV anatomical characteristics. Predictors of recurrence were identified using regression analysis. RESULTS 60.3% of patients had two PVs on each side with separate ostia, whereas 29.3% and 10.3% had right middle and left common PVs, respectively. The following anatomic characteristics were found to be independent predictors of recurrence: right superior PV ostial max:min diameter ratio > 1.32, left superior PV ostial max:min diameter ratio > 1.2, right superior PV antral circumference > 69.1 mm, right inferior PV antral circumference > 61.38 mm, right superior PV angle > 22.7°. Using these factors, LA diameter and right middle PV, a scoring model was created for prediction of "unfavorable" LA-PV anatomy (AUC = 0.867, p = 0.000009, score range = 0-7). Score of ≥ 4 predicted need for longer cryoenergy ablation (p = 0.039) and more frequent switch to radiofrequency energy (p = 0.066) to achieve PVI, and had a sensitivity of 83.3% and specificity of 82.5% to predict clinical recurrence. CONCLUSION CT-based scoring system is useful to identify "unfavorable" anatomy prior to cryo-PVI, which can result in procedural difficulty and poor outcomes.
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Affiliation(s)
- Aditi S Vaishnav
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Edris Alderwish
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Kristie M Coleman
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Moussa Saleh
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Parth Makker
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Kabir Bhasin
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Neil E Bernstein
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Nicholas T Skipitaris
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Stavros E Mountantonakis
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA.
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10
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Bajraktari G, Bytyçi I, Henein MY. Left atrial structure and function predictors of recurrent fibrillation after catheter ablation: a systematic review and meta-analysis. Clin Physiol Funct Imaging 2020; 40:1-13. [PMID: 31556215 DOI: 10.1111/cpf.12595] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Catheter ablation (CA) has become a conventional treatment for atrial fibrillation (AF), but remains with high recurrence rate. The aim of this meta-analysis was to determine left atrial (LA) structure and function indices that predict recurrence of AF. METHODS We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to September 2017 in order to select clinical trials and observational studies which reported echocardiographic predictors of AF recurrence after CA. Eighty-five articles with a total of 16 126 patients were finally included. RESULTS The pooled analysis showed that after a follow-up period of 21 ± 12 months, patients with AF recurrence had larger LA diameter with weighted mean difference (WMD: 2·99 ([95% CI 2·50-3·47], P<0·001), larger LA volume index (LAVI) maximal and LAVI minimal (P<0·0001 for both), larger LA area (P<0·0001), lower LA strain (P<0·0001) and lower LA total emptying fraction (LA EF) (P<0·0001) compared with those without AF recurrence. The most powerful LA predictors (in accuracy order) of AF recurrence were as follows: LA strain <19% (OR: 3·1[95% CI, -1.3-10·4], P<0·0001), followed by LA diameter ≥50 mm (OR: 2·75, [95% CI 1·66-4·56,] P<0·0001), and LAVmax >150 ml (OR: 2·25, [95% CI, 1.1-5·6], P = 0·0002). CONCLUSIONS Based on this meta-analysis results, a dilated left atrium with diameter more than 50 mm and volume above 150 ml or myocardial strain below 19% reflect an unstable LA that is unlikely to hold sinus rhythm after catheter ablation for atrial fibrillation.
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Affiliation(s)
- Gani Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Molecular & Clinical Sciences Research Institute, St George University, London, UK
- Brunel University, London, UK
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11
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Packer M. Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment. Eur J Heart Fail 2019; 22:214-227. [PMID: 31849132 DOI: 10.1002/ejhf.1646] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/14/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023] Open
Abstract
Obesity and diabetes can lead to heart failure with preserved ejection fraction (HFpEF), potentially because they both cause expansion and inflammation of epicardial adipose tissue and thus lead to microvascular dysfunction and fibrosis of the underlying left ventricle. The same process also causes an atrial myopathy, which is clinically evident as atrial fibrillation (AF); thus, AF may be the first manifestation of HFpEF. Many patients with apparently isolated AF have latent HFpEF or subsequently develop HFpEF. Most patients with obesity or diabetes who have AF and exercise intolerance have increased left atrial pressures at rest or during exercise, even in the absence of diagnosed HFpEF. Among patients with AF, those who also have latent HFpEF have increased risk for systemic thromboembolism and death. The identification of HFpEF in patients with obesity or diabetes alters the risk-to-benefit relationship of commonly prescribed treatments. Bariatric surgery and statins can ameliorate AF and reduce the risk for HFpEF. Conversely, antihyperglycaemic drugs that promote adipogenesis or cause sodium retention (insulin and thiazolidinediones) may increase the risk for heart failure in patients with an underlying ventricular myopathy. Patients with obesity and diabetes who undergo catheter ablation for AF are at increased risk for AF recurrence and for post-ablation increases in pulmonary venous pressures and worsening heart failure, especially if HFpEF coexists. Therefore, AF may be the earliest indicator of HFpEF in patients with obesity or type 2 diabetes, and recognition of HFpEF alters the management of these patients.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA.,Imperial College London, London, UK
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12
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Chen F, Sun Q, Li H, Qu S, Yu W, Jiang S, Tian J. Value of dual Doppler echocardiography for prediction of atrial fibrillation recurrence after radiofrequency catheter ablation. BMC Cardiovasc Disord 2019; 19:257. [PMID: 31729953 PMCID: PMC6858698 DOI: 10.1186/s12872-019-1233-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/23/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Increasing evidence has been presented which suggests that left ventricular (LV) diastolic dysfunction may play an important role in the development of atrial fibrillation (AF). However, the potential for LV diastolic dysfunction to serve as a predictor of AF recurrence after radiofrequency catheter ablation remains unresolved. METHODS Dual Doppler and M-PW mode echocardiography were performed in 67 patients with AF before ablation and 47 patients with sinus rhythm. The parameters measured within identical cardiac cycles included, the time interval between the onset of early transmitral flow peak velocity (E) and that of early diastolic mitral annular velocity (e') (TE-e'), the ratio of E to color M-mode Doppler flow propagation velocity (Vp)(E/Vp), the Tei index, the ratio of E and mitral annular septal (S) peak velocity in early diastolic E/e'(S) and the ratio of E and mitral annular lateral (L) peak velocity E/e'(L). A follow-up examination was performed 1 year after ablation and patients were divided into two groups based on the presence or absence of AF recurrence. Risk estimations for AF recurrence were performed using univariate and multivariate logistic regression. RESULTS TE-e', E/Vp, the Tei index, E/e'(S) and E/e'(L) were all increased in AF patients as compared with the control group (p < 0.05). At the one-year follow-up examination, a recurrence of AF was observed in 21/67 (31.34%) patients. TE-e' and the Tei index within the recurrence group were significantly increased as compared to the group without recurrence (p < 0.001). Results from multivariate analysis revealed that TE-e' can provide an independent predictor for AF recurrence (p = 0.001). CONCLUSIONS Dual Doppler echocardiography can provide an effective and accurate technique for evaluating LV diastolic function within AF patients. The TE-e' obtained within identical cardiac cycles can serve as an independent predictor for the recurrence of AF as determined at 1 year after ablation.
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Affiliation(s)
- Fengjiao Chen
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China
| | - Qinliang Sun
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China
| | - Hairu Li
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China
| | - Shaohui Qu
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China
| | - Weidong Yu
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China
| | - Shuangquan Jiang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China
| | - Jiawei Tian
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Baojian Rd. 148, Harbin, 150086, China.
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13
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J Albano A, Bush J, L Parker J, Corner K, W Lim H, P Brunner M, I Dahu M, Dandamudi S, Elmouchi D, Gauri A, Woelfel A, Chalfoun NT. Left Atrial Volume Index Predicts Arrhythmia-Free Survival in Patients with Persistent Atrial Fibrillation Undergoing Cryoballoon Ablation. J Atr Fibrillation 2019; 12:2192. [PMID: 32002112 DOI: 10.4022/jafib.2192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/14/2019] [Accepted: 03/26/2019] [Indexed: 11/10/2022]
Abstract
Background Pulmonary vein isolation (PVI) using cryoballoon ablation (PVI-C) is increasingly performed as a first-line strategy for the treatment of patients with persistent atrial fibrillation (PersAF); however, follow-up data and predictors of procedural success are lacking. Objective To study the efficacy of PVI-C in patients with PersAF, focusing on predictors of procedural success. Methods By retrospective review, 148 consecutive patients with PersAF who underwent PVI-C were analyzed. The impact of several variables on outcome was evaluated in univariate and multivariate analyses and Cox proportional hazards regression models. Results After a mean follow-up of 19.2±10.9 months, 75 (50.7%) patients remained arrhythmia-free without the need for antiarrhythmic drug therapy. Patients with a normal left atrial volume index (LAVI) achieved a 71.0% arrhythmia-free survival. LAVI was the most powerful predictor of procedural success. Conclusions Arrhythmia-free survival after PVI-C in select patients with PersAF are promising. Moreover, LAVI is a valuable measurement to help guide ablation strategy and predict outcome when using cryoballoon ablation.
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Affiliation(s)
- Alfred J Albano
- Department of Cardiology, Spectrum Health Heart and Vascular, Grand Rapids, Michigan
| | - Jared Bush
- Department of Cardiology, Spectrum Health Heart and Vascular, Grand Rapids, Michigan
| | - Jessica L Parker
- Department of Cardiology, Spectrum Health Heart and Vascular, Grand Rapids, Michigan
| | - Kristin Corner
- Department of Cardiology, Spectrum Health Heart and Vascular, Grand Rapids, Michigan
| | - Hae W Lim
- Medtronic, Inc., Minneapolis, Minnesota
| | - Michael P Brunner
- Department of Cardiology, Spectrum Health Heart and Vascular, Grand Rapids, Michigan
| | - Musa I Dahu
- Department of Cardiology, Spectrum Health Heart and Vascular, Grand Rapids, Michigan
| | - Sanjay Dandamudi
- Department of Cardiology, Spectrum Health Heart and Vascular, Grand Rapids, Michigan
| | - Darryl Elmouchi
- Department of Cardiology, Spectrum Health Heart and Vascular, Grand Rapids, Michigan
| | - Andre Gauri
- Department of Cardiology, Spectrum Health Heart and Vascular, Grand Rapids, Michigan
| | - Alan Woelfel
- Department of Cardiology, Spectrum Health Heart and Vascular, Grand Rapids, Michigan
| | - Nagib T Chalfoun
- Department of Cardiology, Spectrum Health Heart and Vascular, Grand Rapids, Michigan
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14
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Yang FN, Xu S, Spaeth A, Galli O, Zhao K, Fang Z, Basner M, Dinges DF, Detre JA, Rao H. Test-retest reliability of cerebral blood flow for assessing brain function at rest and during a vigilance task. Neuroimage 2019; 193:157-166. [PMID: 30894335 DOI: 10.1016/j.neuroimage.2019.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 12/22/2022] Open
Abstract
Arterial spin labeled (ASL) perfusion magnetic resonance imaging (MRI) is increasingly used to assess regional brain activity and cerebrovascular function in both healthy and clinical populations. ASL perfusion imaging provides a quantitative measure of regional brain activity by determining absolute cerebral blood flow (CBF) values at a resting state or during task performance. However, the comparative reliability of these ASL measures is not well characterized. It is also unclear whether the test-retest reliability of absolute CBF or task-induced CBF change measures would be comparable to the reliability of task performance. In this study, fifteen healthy participants were scanned three times in a strictly controlled in-laboratory study while at rest and during performing a simple and reliable psychomotor vigilance test (PVT). The reliability of absolute CBF and task-induced CBF changes was evaluated using the intraclass correlation coefficient (ICC) and compared to that of task performance. Absolute CBF showed excellent test-retest reliability across the three scans for both resting and PVT scans. The reliability of regional absolute CBF was comparable to that of behavioral measures of PVT performance, and was slightly higher during PVT scans as compared with resting scans. Task-induced regional CBF changes demonstrated only poor to moderate reliability across three scans. These findings suggest that absolute CBF measures are more reliable than task-induced CBF changes for characterizing regional brain function, especially for longitudinal and clinical studies.
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Affiliation(s)
- Fan Nils Yang
- Department of Psychology, Sun Yat-sen University, Guangzhou, China; Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sihua Xu
- Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, Shanghai, China; Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Andrea Spaeth
- Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Olga Galli
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ke Zhao
- Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Zhuo Fang
- Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, Shanghai, China; Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mathias Basner
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David F Dinges
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John A Detre
- Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hengyi Rao
- Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, Shanghai, China; Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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15
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Clinical outcome of the 2nd generation cryoballoon for pulmonary vein isolation in patients with persistent atrial fibrillation - A sub-study of the randomized trial evaluating single versus dual cryoballoon applications. Int J Cardiol 2018; 278:120-125. [PMID: 30409738 DOI: 10.1016/j.ijcard.2018.10.097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 11/20/2022]
Abstract
AIMS To assess the efficacy of the 2nd generation Cryoballoon for pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (PersAF), and to compare it to patients with paroxysmal atrial fibrillation (PAF). METHODS The outcome (arrhythmia recurrence at 12 months) was prospectively assessed in patients with PersAF(n = 77) and compared to that in patients with PAF(n = 62), who underwent PVI within a randomized trial evaluating single versus dual applications with the 2nd generation cryoballoon. Other endpoints included symptoms of AF, quality of life, procedure related characteristics, redo ablation rates and adverse events. Variables predicting recurrences were studied including all patients. RESULTS Freedom from arrhythmia recurrence was 64.9% after a single ablation and 68.8% after one or more procedures, which was significantly lower compared to PAF patients; 82.2% (p = 0.029) and 83.9% (p = 0.048) respectively, at 12 months. The improvements in EHRA score (-1.3 ± 0.8, p < 0.0001), symptom severity score (SSQ) (-5.0 ± 4.2, p < 0.0001) and EQ5D-5 L global score (+10.4 ± 20.3, p = 0.0002) after ablation was significant compared to baseline. The re-ablation rate was 7/77 (9.1%) which did not differ from that in PAF patients, 9/62 (14.5%), p = 0.42. Procedure duration, 104.8 ± 37.4 versus 113 ± 31.2 min (p = 0.129), application time, 1605 ± 659 versus 1521 ± 557 s (p = 0.103) and total adverse events after 12 months, 8/77 (10.4%) versus 5/62 (8.1%) (p = 0.77) did not differ in PersAF versus PAF patients. CONCLUSION Both symptoms and QoL improved significantly in patients with PersAF after ablation. Freedom from AF was clinically significant but lower than in PAF patients. The cryoballoon seems an effective technique also in patients with persistent AF.
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16
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Motoc A, Abugattas JP, Roosens B, Scheirlynck E, Heyndrickx B, de Asmundis C, Chierchia GB, Droogmans S, Cosyns B. Left atrium remodeling predicts late recurrence of paroxysmal atrial fibrillation after second generation cryoballoon ablation. Cardiovasc Ultrasound 2018; 16:19. [PMID: 30249263 PMCID: PMC6154403 DOI: 10.1186/s12947-018-0137-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/03/2018] [Indexed: 11/18/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common arrhythmia worldwide. Nowadays, AF ablation is a valuable treatment option. It has been shown that the left atrium (LA) diameter is a predictor of AF recurrence after cryoballoon ablation (CBA). Since it does not reflect the true LA size, we compared the role of different LA anatomical parameters using echocardiography for the prediction of AF recurrence after CBA. Methods We retrospectively included 209 patients (mean age 56.1 ± 13.6 years, male 62%) with paroxysmal AF undergoing CBA. A transthoracic echocardiography was performed in all patients. Results At a mean follow-up of 16.9 ± 6.3 months, AF recurred in 25.4% of the patients. LA anterior - posterior diameter (LAD), LA minimum volume (LAmin) and early AF recurrence were independent predictors of recurrence. Based on receiver operating characteristics, cut – off values for LAD and, LAmin were 41 mm, 23.69 mL, respectively. The negative predictive values for recurrence were 73% and 87.3% respectively. In patients with AF recurrence, a significant proportion (30.2%) showed LA longitudinal remodeling (LA superior – inferior diameter) even though classically measured LAD was normal. Conclusions Longitudinal LA remodeling plays an additional role for predicting AF recurrence after CBA, in patients without LAD dilation. Moreover, LAmin had a high negative predictive value and was an independent predictor of AF recurrence. Therefore, a more complete LA anatomical assessment allows a better prediction of AF recurrences after CBA.
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Affiliation(s)
- Andreea Motoc
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Juan-Pablo Abugattas
- Heart Rhythm Management Centre, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bram Roosens
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Esther Scheirlynck
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Benedicte Heyndrickx
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | | | - Steven Droogmans
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bernard Cosyns
- Centrum Voor Hart-en Vaatziekten (CHVZ), Department of Cardiology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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Arques S. Clinical Relevance of the Spectral Tissue Doppler E/e' Ratio in the Management of Patients with Atrial Fibrillation: a Comprehensive Review of the Literature. J Atr Fibrillation 2018; 11:2038. [PMID: 30505378 DOI: 10.4022/jafib.2038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/19/2018] [Accepted: 07/24/2018] [Indexed: 01/19/2023]
Abstract
Atrial fibrillation is the most common cardiac rhythm disorder observed in clinical practice. It carries high morbidity and mortality rates, primarily related to heart failure, stroke and death. Validation of noninvasive markers in the diagnosis of heart failure with preserved ejection fraction and risk stratification is relevant in this clinical setting. The spectral tissue Dopplerderived E/e' ratio is a simple and reproducible index, which has been validated in noninvasive assessment of left ventricular diastolic pressures, regardless of rhythm. Septal E/e' >11 is a good predictor of invasively determined left ventricular diastolic pressure >15 mmHg in patients with atrial fibrillation. Several studies have validated the clinical relevance of abnormal values for E/e' at rest and during exercise in the diagnosis and risk stratification of heart failure with preserved ejection fraction in patients with atrial fibrillation. Increased E/e' value is associated with adverse outcome (death, left atrial appendage thrombus, stroke and heart failure) in patients with atrial fibrillation and predicts arrhythmia recurrence after cardioversion and catheter ablation. In conclusion, E/e' by spectral tissue Doppler is clinically relevant in the clinical management of any patients with atrial fibrillation referred for transthoracic Doppler echocardiography.
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Affiliation(s)
- Stephane Arques
- Department of Cardiology, Centre hospitalier Edmond Garcin, Aubagne, France
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Arques S, Roux E. [Usefulness of spectral tissue Doppler (E/e' ratio) in the management of patients with atrial fibrillation]. Ann Cardiol Angeiol (Paris) 2017; 66:303-308. [PMID: 29025686 DOI: 10.1016/j.ancard.2017.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
Atrial fibrillation is the most common cardiac rhythm disorder encountered in daily clinical practice. It carries high morbidity and mortality rates, mainly related to sudden death, heart failure and stroke. Validation of noninvasive markers in the diagnosis of heart failure with preserved ejection fraction and risk stratification is therefore attractive in this clinical setting. The spectral tissue Doppler-derived E/e' ratio is a simple and user-friendly index which has been validated in the assessment of left ventricular diastolic pressures, regardless of rhythm. A septal E/e' >11 is associated with invasive left ventricular diastolic pressures >15mmHg in patients with atrial fibrillation. Several studies have reported the clinical relevance of abnormal values of E/e' at rest and during exercise in the diagnosis and risk stratification of heart failure with preserved ejection fraction in patients with atrial fibrillation. There is now convincing evidence that increased E/e' is associated with adverse outcome in patients with atrial fibrillation and predicts the recurrence of arrhythmia after cardioversion or catheter ablation. In conclusion, we recommend the measurement of E/e' in each patient with atrial fibrillation referred for clinically indicated transthoracic Doppler echocardiography.
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Affiliation(s)
- S Arques
- Service de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France.
| | - E Roux
- Service de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France
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Relationship between left ventricular diastolic dysfunction and very late recurrences after multiple procedures for atrial fibrillation ablation. Heart Vessels 2017; 33:41-48. [PMID: 28766046 DOI: 10.1007/s00380-017-1027-y] [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: 01/06/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
Abstract
Although very late recurrences (VLRs) (first recurrence >12 months after the last catheter ablation) of atrial fibrillation (AF) after multiple catheter ablation procedures are rare, it remains a critical issue. The risk factors for VLRs remain largely unclear. From December 2011 to April 2014, 253 patients underwent an initial catheter ablation. Of the 253 patients, 21 had AF recurrences within 1 year after the last catheter ablation. The study was conducted in the remaining 232 patients. Left ventricular diastolic dysfunction (LVDD) was assessed by echocardiography using composite categories with tissue Doppler imaging and left atrial volume measurements, i.e., a septal e' < 8 cm/s, lateral e' < 10 cm/s, and left atrium volume index (LAV/body surface area) (LAVI) ≥34 mL/m2. LVDD was observed in 40 patients. Sinus rhythm was preserved in 220 patients after multiple catheter procedures, and 12 had VLRs. The clinical factors possibly related to VLRs were examined, and a multivariate regression analysis showed that LVDD was the only independent risk factor for VLRs (hazard ratio: 10.31, 95% confidence interval: 2.78-38.18, P < 0.0001). LVDD at baseline is a risk factor for a VLR after multiple catheter ablation procedures for AF.
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Abugattas JP, Iacopino S, Moran D, De Regibus V, Takarada K, Mugnai G, Ströker E, Coutiño-Moreno HE, Choudhury R, Storti C, De Greef Y, Paparella G, Brugada P, de Asmundis C, Chierchia GB. Efficacy and safety of the second generation cryoballoon ablation for the treatment of paroxysmal atrial fibrillation in patients over 75 years: a comparison with a younger cohort. Europace 2017; 19:1798-1803. [DOI: 10.1093/europace/eux023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/25/2017] [Indexed: 01/21/2023] Open
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