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Ahn Y, Koo HJ, Lee SA, Jung D, Kang JW, Yang DH. Reference ranges of computed tomography-derived strains in four cardiac chambers. PLoS One 2024; 19:e0303986. [PMID: 38843302 PMCID: PMC11156317 DOI: 10.1371/journal.pone.0303986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/04/2024] [Indexed: 06/09/2024] Open
Abstract
Research on cardiovascular diseases using CT-derived strain is gaining momentum, yet there is a paucity of information regarding reference standard values beyond echocardiography, particularly in cardiac chambers other than the left ventricle (LV). We aimed to compile CT-derived strain values from the four cardiac chambers in healthy adults and assess the impact of age and sex on myocardial strains. This study included 101 (mean age: 55.2 ± 9.0 years, 55.4% men) consecutive healthy individuals who underwent multiphase cardiac CT. CT-derived cardiac strains, including LV global and segmental longitudinal, circumferential, and transverse strains, left atrial (LA), right atrial (RA), and right ventricle (RV) strains were measured by the commercially available software. Strain values were classified and compared by their age and sex. The normal range of CT-derived LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were -20.2 ± 2.7%, -27.9 ± 4.1%, and 49.4 ± 12.1%, respectively. For LA, reservoir strain, pump strain, and conduit strain were 28.6 ± 8.5%, 13.2 ± 6.4%, and 15.5 ± 8.6%, respectively. The GLS of RA and RV were 27.9 ± 10.9% and -22.0 ± 5.7%, respectively. The absolute values of GLS of RA and RV of women were higher than that in men (32.4 ± 11.4 vs. 24.3 ± 9.1 and -25.2 ± 4.7 vs. -19.4 ± 5.0, respectively; p<0.001, both). Measurement of CT-derived strain in four cardiac chambers is feasible. The reference ranges of CT strains in four cardiac chambers can be used for future studies of various cardiac diseases using the cardiac strains.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, Republic of Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Republic of Korea
| | - Seung Ah Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - DaSol Jung
- Department of Radiology and Research Institute of Radiology, Republic of Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Republic of Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Republic of Korea
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2
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Whitman M, Tilley P, Padayachee C, Jenkins C, Challa P. Energy wavelet signal processed ECG and standard 12 lead ECG: Diagnosis of early diastolic dysfunction. J Electrocardiol 2024; 85:1-6. [PMID: 38762938 DOI: 10.1016/j.jelectrocard.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/23/2024] [Accepted: 05/03/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction (LVDD) is the result of impaired LV relaxation and identifies those at risk of developing heart failure. Echocardiography has been used as the gold standard to identify early LVDD. The signal processed electrocardiogram (hsECG) has demonstrated effectiveness to detect early LVDD. Whether or not the standard 12‑lead electrocardiogram (ECG) can accurately predict early LVDD is not known. METHODS A standard 12‑lead ECG including signal processing (hsECG) was performed in 569 patients. Patients with atrial fibrillation, bundle branch block, pre-excitation, left ventricular hypertrophy or known cardiovascular disease were excluded, leaving 464 examinations for analysis. Early LVDD was diagnosed by established methods using echocardiography. Repolarization abnormalities (T wave discordance) in V1, V6, I and aVL and the hsECG were compared to the echocardiographic findings to establish diagnostic accuracy. RESULTS A total of 84 (18.1%) patients were diagnosed with early LVDD. A combination of a borderline or abnormal finding on the hsECG produced the best diagnostic model (sensitivity 84.5%, specificity 47.9%). The best performing ECG lead was V1 with a sensitivity of 38.1% and specificity of 92.1%. Regression analysis demonstrated increasing age and V1 to be predictive of LVDD. CONCLUSIONS The hsECG displayed reasonable ability to detect early LVDD. Other than V1, repolarization abnormalities on the standard 12‑lead ECG did not. While lead V1 showed promise in detecting LVDD, whether this or any other simple ECG variable can predict future LVDD would be of further interest.
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Affiliation(s)
- Mark Whitman
- Cardiac Investigations Unit, Logan Hospital, Meadowbrook, Australia; School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia.
| | - Prue Tilley
- Cardiac Investigations Unit, Logan Hospital, Meadowbrook, Australia
| | | | - Carly Jenkins
- Cardiac Investigations Unit, Logan Hospital, Meadowbrook, Australia
| | - Prasad Challa
- Division of Cardiology, Logan Hospital, Meadowbrook, Australia
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3
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Van't Hof JR, Parikh R, Moser ED, Inciardi RM, Matsushita K, Soliman EZ, Alonso A, Shah AM, Solomon SD, Lutsey PL, Chen LY. Association of Cumulative Systolic Blood Pressure With Left Atrial Function in the Setting of Normal Left Atrial Size: The Atherosclerosis Risk in Communities (ARIC) Study. J Am Soc Echocardiogr 2024:S0894-7317(24)00220-7. [PMID: 38740273 DOI: 10.1016/j.echo.2024.04.015] [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: 02/12/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Lower left atrial (LA) function is associated with increased risk for cardiovascular disease events; data on risk factors for impaired LA function are limited. We evaluated the effect of cumulative systolic blood pressure (cSBP) from midlife to older age on LA strain in adults with normal LA size. METHODS We included participants in the Atherosclerosis Risk in Communities study with LA strain measured on the visit 5 echocardiogram (2011-13), excluding those with atrial fibrillation and LA volume index >34 mL/m2. The cSBP was calculated from visit 1 (1987-89) through visit 5. Linear regression models were used to evaluate associations between cSBP and LA strain measures. RESULTS A total of 3,859 participants with a mean (SD) age of 75.2 (5.0) years were included in the analysis; 725 (18.8%) were Black and 2,342 (60.7%) were women. After adjusting for demographics, cardiovascular disease risk factors, heart failure, and coronary heart disease, each 10 mm Hg increase in cSBP was associated with 0.32% (95% CI, -0.52%, -0.13%) and 0.37% (95% CI, -0.51%, -0.22%) absolute reduction in LA reservoir and conduit strain, respectively. Associations were attenuated after adjustment for left ventricular (LV) systolic and diastolic function and mass (-0.12%: 95% CI, -0.31, 0.06 for reservoir strain; and -0.24%: 95% CI -0.38%, -0.10% for conduit strain). In subgroup analyses, the association of cSBP with conduit strain was statistically significant among those with normal LV systolic and diastolic function. CONCLUSIONS Cumulative exposure to elevated blood pressure from midlife to late life was modestly associated with lower LA reservoir and conduit strain in older adults with normal LA size, mostly related to the effect of blood pressure on LV function and mass. However, the association of cSBP and LA conduit strain in subgroups with normal LV function suggests that LA remodeling in response to hypertension occurs before LV dysfunction is detected on echocardiography.
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Affiliation(s)
- Jeremy R Van't Hof
- Cardiovascular Division and Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis Minnesota.
| | - Romil Parikh
- Cardiovascular Division and Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis Minnesota; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Ethan D Moser
- Cardiovascular Division and Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis Minnesota; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Riccardo M Inciardi
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elsayed Z Soliman
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Lin Yee Chen
- Cardiovascular Division and Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis Minnesota
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4
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Spencer L, Wright L, Foulkes SJ, Rowe SJ, Dillon HT, Climie R, Bigaran A, Janssens K, Mitchell A, Wallace I, Lindqvist A, Burnham L, Prior DL, Howden EJ, La Gerche A. Characterizing the influence of cardiorespiratory fitness on left atrial size and function in the general population. Am J Physiol Heart Circ Physiol 2024; 326:H1269-H1278. [PMID: 38457351 DOI: 10.1152/ajpheart.00422.2023] [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: 07/11/2023] [Revised: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 03/10/2024]
Abstract
Increased left atrial (LA) size and reduced LA function have been associated with heart failure and atrial fibrillation (AF) in at-risk populations. However, atrial remodeling has also been associated with exercise training and the relationship between fitness, LA size, and function has not been defined across the fitness spectrum. In a cross-sectional study of 559 ostensibly healthy participants, comprising 304 males (mean age, 46 ± 20 yr) and 255 females (mean age, 47 ± 15 yr), we sought to define the relationship between cardiorespiratory fitness (CRF), LA size, and function. We also aimed to interrogate sex differences in atrial factors influencing CRF. Echocardiographic measures included biplane measures of LA volumes indexed to body surface area (LAVi) and atrial deformation using two-dimensional speckle tracking. CRF was measured as peak oxygen consumption (V̇o2peak) during cardiopulmonary exercise testing (CPET). Using multivariable regression, age, sex, weight, and LAVi (P < 0.001 for all) predicted V̇o2peak (P < 0.001, R2 = 0.66 for combined model). After accounting for these variables, heart rate reserve added strength to the model (P < 0.001, R2 = 0.74) but LA strain parameters did not predict V̇o2peak. These findings add important nuance to the perception that LA size is a marker of cardiac pathology. LA size should be considered in the context of fitness, and it is likely that the adverse prognostic associations of increased LA size may be confined to those with LA enlargement and low fitness.NEW & NOTEWORTHY Left atrial (LA) structure better predicts cardiorespiratory fitness (CRF) than LA function. LA function adds little statistical value to predictive models of peak oxygen uptake (V̇o2peak) in healthy individuals, suggesting limited discriminatory for CRF once LA size is factored. In the wider population of ostensibly healthy individuals, the association between increased LA volume and higher CRF provides an important counter to the association between atrial enlargement and heart failure symptoms in those with cardiac pathology.
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Affiliation(s)
- Luke Spencer
- St Vincent's Institute, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Leah Wright
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Stephanie J Rowe
- St Vincent's Institute, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Hayley T Dillon
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Rachel Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Kristel Janssens
- St Vincent's Institute, Fitzroy, Victoria, Australia
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Amy Mitchell
- St Vincent's Institute, Fitzroy, Victoria, Australia
| | - Imogen Wallace
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Lauren Burnham
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David L Prior
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Erin J Howden
- University of Melbourne, Parkville, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Victor Chang Cardiac Research Centre, Darlinghurst, New South Wales, Australia
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5
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Buendía-Fuentes F, Lozano-Edo S, Jover-Pastor P, Sánchez-Martínez JC, Martínez-Sole J, Rodríguez-Serrano M, Aguero J, Arnau-Vives MA, Osa-Sáez A, Martínez-Dolz LV, Rueda J. Left atrial strain in adults after the arterial switch operation for transposition of the great arteries. Echocardiography 2024; 41:e15750. [PMID: 38284674 DOI: 10.1111/echo.15750] [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: 07/17/2023] [Revised: 11/16/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND No study has focused on left atrial (LA) function assessed by echocardiography in adult patients with simple D-TGA after arterial switch operation (ASO). We aimed to describe LA strain parameters in these patients. METHODS A prospective cohort study including 42 adult patients with simple D-TGA after ASO and 33 aged-matched controls. Phasic LA and LV global longitudinal strain (GLS) were obtained by transthoracic 2D-speckle tracking echocardiography (STE). Volumetric and functional analysis of LA and LV were also evaluated by 2D and 3D analysis. A multivariable model was performed to investigate the variables that best differentiate patients with D-TGA from healthy controls. RESULTS LA strain parameters in D-TGA patients were within the normal range described for healthy subjects. However, the three LA strain parameters (Reservoir, Conduit, and Contraction) were lower in patients (LASr: 31.13 ± 7.67 vs. 49.71 ± 8.38; LAS cd: -22.91 ± 5.69 vs. -34.55 ± 6.54; LASct: -8.14 ± 4.93 vs. -15.15 ± 6.07, p < .001 for all three comparisons). LA volumes were similar between patients and controls. LV-GLS remained significantly lower in the D-TGA group than in controls (-17.29 ± 2.68 vs. -21.98 ± 1.84, p < .001). D-TGA patients had evidence of worse LV ejection fraction measured by the Teichholz method (63.38 ± 8.23 vs. 69.28 ± 5.92, p = .001) and 3D analysis (57.97% ± 4.16 vs. 60.67 ± 3.39, p = .011) and diastolic dysfunction as compared to healthy controls. LV-GLS and conduit LAS were the variables best differentiating patients with D-TGA from healthy controls. CONCLUSIONS LA strain is impaired in young adults with simple D-TGA late after the ASO, probably in agreement with some degree of LV dysfunction previously described.
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Affiliation(s)
- Francisco Buendía-Fuentes
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Silvia Lozano-Edo
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Pablo Jover-Pastor
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Julia Martínez-Sole
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Jaume Aguero
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Miguel A Arnau-Vives
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ana Osa-Sáez
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Luis V Martínez-Dolz
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Joaquín Rueda
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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6
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Zimmermann P, Schierbauer J, Kopf N, Sourij H, Oliver N, Aberer F, Wachsmuth NB, Moser O. Speckle-Tracking Analysis of the Right and Left Heart after Peak Exercise in Healthy Subjects with Type 1 Diabetes: An Explorative Analysis of the AppEx Trial. J Cardiovasc Dev Dis 2023; 10:467. [PMID: 37998525 PMCID: PMC10672090 DOI: 10.3390/jcdd10110467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
In eight healthy participants with Type 1 diabetes (T1D) exercise-related dynamic cardiac remodeling was analyzed by performing two-dimensional echocardiography, including deformation analysis of the left-ventricular (LV) global longitudinal strain (LV-GLS), and the deformation pattern of the left atrium (LA) and right ventricle (RV) at rest and post-peak performance on a bicycle. The feasibility echocardiographic speckle-tracking analysis was performed on eight asymptomatic participants with T1D (n = 8, male n = 5, age: 23-65 years). The obtained echocardiographic data were compared for various echocardiographic parameters at rest and post exercise. Across our participating T1D individuals no structural echocardiographic abnormalities of concern could be revealed. All participating T1D subjects showed preserved contractile reserve of the LV and no significant diastolic dysfunction. Significant differences were found for the phasic LA contractile strain pattern at rest and post exercise (p < 0.001), whereby the dynamic RV (p = 0.5839 and p = 0.7419) and LV strain pattern (p = 0.5952) did not reveal significant differences in comparison to resting conditions. This descriptive secondary outcome analysis describes preserved contractile reserve of the LV and elucidates dynamic modification of the phasic LA contractile deformation pattern in asymptomatic T1D individuals after exhaustive exercise on a bicycle.
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Affiliation(s)
- Paul Zimmermann
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (P.Z.); (J.S.); (N.K.); (N.B.W.)
- Interdisciplinary Center of Sportsmedicine Bamberg, Klinikum Bamberg, 96049 Bamberg, Germany
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany
| | - Janis Schierbauer
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (P.Z.); (J.S.); (N.K.); (N.B.W.)
| | - Niklas Kopf
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (P.Z.); (J.S.); (N.K.); (N.B.W.)
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (H.S.); (F.A.)
| | - Nick Oliver
- Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK;
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (H.S.); (F.A.)
| | - Nadine B. Wachsmuth
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (P.Z.); (J.S.); (N.K.); (N.B.W.)
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (P.Z.); (J.S.); (N.K.); (N.B.W.)
- Interdisciplinary Metabolic Medicine Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (H.S.); (F.A.)
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7
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Diomede D, Terazzi E, Diomede N, Alcidi G, Pugliese R, Ioannoni S, Romano M, Granatiero M, Di Terlizzi V, Correale M, Di Biase M, Brunetti ND, Iacoviello M. Relationship between the strain measures of left atrial function and heart failure worsening. Echocardiography 2023; 40:942-951. [PMID: 37503767 DOI: 10.1111/echo.15659] [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: 04/11/2023] [Revised: 07/02/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Two-dimensional speckle tracking evaluation (2D-STE) is a useful tool to evaluate the complexity of atrial function by the analysis of the different phases of atrial deformation and by the combination with Doppler measurements of diastolic function. AIM OF THE STUDY To evaluate the role of the left atrial (LA) strain parameters to predict worsening chronic heart failure (CHF). METHODS We enrolled outpatients affected by CHF referred to our heart failure unit. Each patient underwent a medical visit, an electrocardiogram (ECG), and an echocardiographic examination. LA function was assessed by 2D-STE. The three phases of LA strain, that is, the reservoir (LAr), the conduit (LAcd), and the contraction (LAct)-were evaluated. Moreover, the ratio between E and LAr (E/LAr) and those between LAr and septal (LAr/Ees), lateral (LAr/Eel), and septal-lateral (LAr/Eem) E/e' were measured. During follow-up, the events related to worsening of heart failure were evaluated. RESULTS Two hundred eleven patients were enrolled. During a mean follow-up of 14 ± 7 months, 37 patients showed at least one event related to heart failure worsening. At univariate Cox regression analysis, LAr, LAcd, LAct, E/LAr, LAr/Ees, LAr/Eel, and LAr/Eem were all associated with events related to heart failure worsening, but at multivariate regression analyses, only LAr (Hazard Ratio, HR: .95; 95% Confidence Interval, CI: .92-.99; p: .031), LAct (HR: 1.06; 95% CI: 1.01-1.12; p: .027), E/LAr (HR: 1.10; 95%CI: 1.0-1.16; p < .001), LAr/Ees (HR: .57; 95% CI: .37-.87; p: .010), and LAr/Eem (HR: .71; 95% CI: .53-.96; p: .026) remained significantly associated with the events. Finally, in a predictive model including the other relevant echocardiographic parameters LAr < 18%, LAct > -10.0%, LAr/Ees < 1.28, and E/LAr > 3.70 were associated with a statistically significant overall net reclassification improvement. CONCLUSIONS In CHF patients, the measure of the LA reservoir and contraction by 2D-STE is independently associated with heart failure worsening, but the accuracy in predicting the events is even greater when the reservoir is combined with the Doppler measures of diastolic function.
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Affiliation(s)
- Davide Diomede
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Erica Terazzi
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Nicolangelo Diomede
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gianmarco Alcidi
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Rosanna Pugliese
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Sara Ioannoni
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Matteo Romano
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Michele Granatiero
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Vito Di Terlizzi
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
| | - Michele Correale
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
| | - Matteo Di Biase
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Natale Daniele Brunetti
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
| | - Massimo Iacoviello
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
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8
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Brand A, Romero Dorta E, Wolf A, Blaschke-Waluga D, Seeland U, Crayen C, Bischoff S, Mattig I, Dreger H, Stangl K, Regitz-Zagrosek V, Landmesser U, Knebel F, Stangl V. Phasic left atrial strain to predict worsening of diastolic function: Results from the prospective Berlin Female Risk Evaluation follow-up trial. Front Cardiovasc Med 2023; 10:1070450. [PMID: 36891246 PMCID: PMC9986257 DOI: 10.3389/fcvm.2023.1070450] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
Purpose The predictive value of maximum left atrial volume index (LAVI), phasic left atrial strain (LAS) and other standard echocardiographic parameters assessing left ventricular (LV) diastolic function to discriminate a future worsening of diastolic function (DD) in patients at risk is unclear. We aimed to prospectively assess and compare the clinical impact of these parameters in a randomly selected study sample of the general urban female population. Methods and results A comprehensive clinical and echocardiographic evaluation was performed in 256 participants of the Berlin Female Risk Evaluation (BEFRI) trial after a mean follow up time of 6.8 years. After an assessment of participants' current DD status, the predictive impact of an impaired LAS on the course of DD was assessed and compared with LAVI and other DD parameters using receiver operating characteristic (ROC) curve and multivariate logistic regression analyses. Subjects with no DD (DD0) who showed a decline of diastolic function by the time of follow-up showed a reduced LA reservoir (LASr) and conduit strain (LAScd) compared to subjects who remained in the healthy range (LASr 28.0% ± 7.0 vs. 41.9% ± 8.5; LAScd -13.2% ± 5.1 vs. -25.4% ± 9.1; p < 0.001). With an area under the curve (AUC) of 0.88 (95%CI 0.82-0.94) and 0.84 (95%CI 0.79-0.89), LASr and LAScd exhibited the highest discriminative value in predicting worsening of diastolic function, whereas LAVI was only of limited prognostic value [AUC 0.63 (95%CI 0.54-0.73)]. In logistic regression analyses, LAS remained a significant predictor for a decline of diastolic function after controlling for clinical and standard echocardiographic DD parameters, indicating its incremental predictive value. Conclusion The analysis of phasic LAS may be useful to predict worsening of LV diastolic function in DD0 patients at risk for a future DD development.GRAPHICAL ABSTRACT.
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Affiliation(s)
- Anna Brand
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Elena Romero Dorta
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Adrian Wolf
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Daniela Blaschke-Waluga
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Ute Seeland
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany.,Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Crayen
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Sven Bischoff
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Isabel Mattig
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Henryk Dreger
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Karl Stangl
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Vera Regitz-Zagrosek
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany.,Institute of Gender in Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Ulf Landmesser
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Fabian Knebel
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany.,Clinical Department of Cardiology, Internal Medicine II, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Verena Stangl
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
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9
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Hadadi M, Mohseni-Badalabadi R, Hosseinsabet A. Effects of obesity on left atrial phasic functions in patients with chronic ischemic heart disease and preserved left ventricular ejection fraction without recent myocardial infarction: a two-dimensional speckle-tracking echocardiography study. J Ultrasound 2022; 25:521-527. [PMID: 34855185 PMCID: PMC9402816 DOI: 10.1007/s40477-021-00616-5] [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: 04/30/2021] [Accepted: 07/29/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Left atrial (LA) phasic functions in various subgroups of subjects with obesity are differently impaired, suggesting that obesity may have diverse effects in dissimilar subgroups of subjects with obesity. We aimed to compare the effects of obesity on LA phasic functions in patients suffering from chronic ischemic heart disease with a preserved left ventricular ejection fraction and without a recent myocardial infarction. METHODS In our cross-sectional study, 145 consecutive candidates for isolated coronary artery bypass graft (CABG) surgery were divided according to the presence of obesity into 2 groups: obese (36 patients) and nonobese (103 patients), and LA phasic functions were evaluated by two-dimensional speckle-tracking echocardiography (2D STE). RESULTS The longitudinal strain rate during the reservoir phase (3.0 ± 0.7 s-1 vs 2.7 ± 0.6 s-1; P = 0.032), longitudinal strain during the contraction phase (19.2 ± 4.7% vs 17.2 ± 4.1%; P = 0.022), and the longitudinal strain rate during the contraction phase (4.4 ± 1.2 s-1 vs 3.9 ± 1.2 s-1; P = 0.036) decreased in the obese group compared with the nonobese group. The other longitudinal 2D STE-derived markers of the LA phasic functions were not different between the 2 groups. CONCLUSIONS Among patients suffering from chronic ischemic heart disease with a preserved left ventricular ejection fraction and without a recent myocardial infarction, LA reservoir and contraction functions as measured by 2D STE were impaired in patients with obesity compared with those without it.
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Affiliation(s)
- Marjan Hadadi
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Karegar Shomali Street, Tehran, I.R. of Iran
| | - Reza Mohseni-Badalabadi
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Karegar Shomali Street, Tehran, I.R. of Iran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Karegar Shomali Street, Tehran, I.R. of Iran
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10
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Left atrial strain determinants and clinical features according to the heart failure stages. New insight from EACVI MASCOT registry. Int J Cardiovasc Imaging 2022; 38:2635-2644. [DOI: 10.1007/s10554-022-02669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/30/2022] [Indexed: 11/05/2022]
Abstract
AbstractFew studies analyzed left atrial (LA) peak atrial longitudinal strain (PALS) determinants, particularly across heart failure (HF) stages. We aimed to analyze the pathophysiological and clinical PALS correlates in a large multicentric prospective study. This is a multicenter prospective observational study enrolling 745 patients with HF stages. Data included PALS and left ventricular global longitudinal strain (LV-GLS). Exclusion criteria were: valvular prosthesis; atrial fibrillation; cardiac transplantation; poor acoustic window. Median global PALS was 17% [24–32]. 29% of patients were in HF-stage 0/A, 35% in stage-B, and 36% in stage-C. Together with age, the echocardiographic determinants of PALS were LA volume and LV-GLS (overall model R2 = 0.50, p < 0.0001). LV-GLS had the strongest association with PALS at multivariable analysis (beta: −3.60 ± 0.20, p < 0.0001). Among HF stages, LV-GLS remained the most important PALS predictor (p < 0.0001) whereas age was only associated with PALS in lower HF-stage 0/A or B (R = − 0.26 p < 0.0001, R = − 0.23 p = 0.0001). LA volume increased its association to PALS moving from stage 0/A (R = − 0.11; P = 0.1) to C (R = − 0.42; P < 0.0001). PALS was the single most potent echocardiographic parameter in predicting the HF stage (AUC for B vs. 0/A 0.81, and AUC vs. 0/A for C 0.76). PALS remained independently associated with HF stages after adjusting for ejection fraction, E/e′ ratio, and mitral regurgitation grade (p < 0.0001). Although influenced by LV-GLS and LA size across HF stages, PALS is incrementally and independently associated with clinical status. LA function may reflect a substantial part of the hemodynamic consequences of ventricular dysfunction.
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11
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Gonzalez FA, Ângelo-Dias M, Martins C, Gomes R, Bacariza J, Fernandes A, Borrego LM, Group E. Characteristic Immune Dynamics in COVID-19 Patients with Cardiac Dysfunction. J Clin Med 2022; 11:jcm11071880. [PMID: 35407485 PMCID: PMC8999785 DOI: 10.3390/jcm11071880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/13/2022] [Accepted: 03/26/2022] [Indexed: 12/19/2022] Open
Abstract
Background: We aimed to explore immune parameters in COVID-19 patients admitted to the intensive care unit (ICU) to identify distinctive features in patients with cardiac injury. Methods: A total of 30 COVID-19 patients >18 years admitted to the ICU were studied on days D1, D3 and D7 after admission. Cardiac function was assessed using speckle-tracking echocardiography (STE). Peripheral blood immunophenotyping, cardiac (pro-BNP; troponin) and inflammatory biomarkers were simultaneously evaluated. Results: Cardiac dysfunction (DYS) was detected by STE in 73% of patients: 40% left ventricle (LV) systolic dysfunction, 60% LV diastolic dysfunction, 37% right ventricle systolic dysfunction. High-sensitivity cardiac troponin (hs-cTn) was detectable in 43.3% of the patients with a median value of 13.00 ng/L. There were no significant differences between DYS and nDYS patients regarding mortality, organ dysfunction, cardiac (including hs-cTn) or inflammatory biomarkers. Patients with DYS showed persistently lower lymphocyte counts (median 896 [661−1837] cells/µL vs. 2141 [924−3306] cells/µL, p = 0.058), activated CD3 (median 85 [66−170] cells/µL vs. 186 [142−259] cells/µL, p = 0.047) and CD4 T cells (median 33 [28−40] cells/µL vs. 63 [48−79] cells/µL, p = 0.005), and higher effector memory T cells (TEM) at baseline (CD4%: 10.9 [6.4−19.2] vs. 5.9 [4.2−12.8], p = 0.025; CD8%: 15.7 [7.9−22.8] vs. 8.1 [7.7−13.7], p = 0.035; CD8 counts: 40 cells/µL [17−61] vs. 10 cells/µL [7−17], p = 0.011) than patients without cardiac dysfunction. Conclusion: Our study suggests an association between the immunological trait and cardiac dysfunction in severe COVID-19 patients.
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Affiliation(s)
- Filipe André Gonzalez
- Intensive Care Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (R.G.); (J.B.); (A.F.)
- Correspondence: ; Tel.: +351-91-793-2502
| | - Miguel Ângelo-Dias
- CEDOC—Chronic Diseases Research Center, NOVA Medical School, NOVA University of Lisbon, 1099-085 Lisbon, Portugal; (M.Â.-D.); (C.M.); (L.M.B.)
| | - Catarina Martins
- CEDOC—Chronic Diseases Research Center, NOVA Medical School, NOVA University of Lisbon, 1099-085 Lisbon, Portugal; (M.Â.-D.); (C.M.); (L.M.B.)
| | - Rui Gomes
- Intensive Care Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (R.G.); (J.B.); (A.F.)
| | - Jacobo Bacariza
- Intensive Care Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (R.G.); (J.B.); (A.F.)
| | - Antero Fernandes
- Intensive Care Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (R.G.); (J.B.); (A.F.)
| | - Luís Miguel Borrego
- CEDOC—Chronic Diseases Research Center, NOVA Medical School, NOVA University of Lisbon, 1099-085 Lisbon, Portugal; (M.Â.-D.); (C.M.); (L.M.B.)
- Immunoallergy Department, Hospital da Luz Lisboa, 1500-650 Lisbon, Portugal
| | - EchoCrit Group
- Intensive Care Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (R.G.); (J.B.); (A.F.)
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12
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Sun M, Xing Y, Guo Y, Cao X, Nie Y, Shu X. Left atrial reservoir strain is an outstanding predictor of adverse cardiovascular outcomes in patients undergoing maintenance hemodialysis: Assessment via three-dimensional speckle tracking echocardiography. Clin Cardiol 2022; 45:549-557. [PMID: 35312072 PMCID: PMC9045074 DOI: 10.1002/clc.23815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/14/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background There is a paucity of literature focusing left atrium (LA) in patients undergoing maintenance hemodialysis (MHD). Hypothesis We used three‐dimensional speckle tracking echocardiography (3DSTE) to evaluate LA in MHD patients and to explore its predictive value for adverse outcomes. Methods Echocardiography was performed on 130 consecutively enrolled MHD patients without previous cardiac diseases. Conventional and 3DSTE parameters of LA were obtained. The MHD cohort was then followed and the end point was major adverse cardiovascular events (MACEs). LA strain indices, including reservoir strain (LASr), conduit strain (LAScd), and contractile strain (LASct), were measured and compared between patients with and without MACEs. Results Patients were prospectively followed up for a median of 40.5 (interquartile range: 26.3–48.0) months. During follow‐up, 43 patients met the end point. These patients had larger LA size and reduced LA strains (LA maximal volume indexed: 45.1 ± 11.9 vs. 33.8 ± 6.9ml/m2; LASr: 20.2 ± 3.5 vs. 27.2 ± 3.3%; LAScd: −12.3 ± 5.2 vs. −14.5±4.0%; LASct: −8.0 ± 4.2 vs. −13.2 ± 3.7%; all p<.05), compared with those without MACEs. Multivariable regression analysis showed LASr was the strongest predictor of MACEs (hazard ratio, 0.69; 95% confidence interval, 0.54–0.89; p=.004). Univarite Kaplan–Meier analysis revealed the incidence of MACEs in the impaired LASr (<24.2%) group was significantly higher than in the normal LASr group (log rank p<.001). Conclusions LASr derived from 3DSTE is an independent predictor of MACEs and cardiac death in MHD patients, superior to LV parameters and LA volume indices.
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Affiliation(s)
- Minmin Sun
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yumeng Xing
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yao Guo
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xuesen Cao
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuxin Nie
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
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13
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Katogiannis K, Makavos G, Tsilivarakis D, Plotas P, Lambadiari V, Parissis J, Noutsias M, Ikonomidis I. Left atrial deformation in heart failure: a clinical update. Curr Probl Cardiol 2022:101183. [DOI: 10.1016/j.cpcardiol.2022.101183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/15/2022]
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14
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Alonso Gómez AM, Sierra LT, Mora MN, Toledo E, Alonso A, Uriarte MG, Sanchez CS, Portillo MP, Rodriguez LL, Arellano EE, Schröder H, Salas-Salvadó J. Left atrial strain improves echocardiographic classification of diastolic function in patients with metabolic syndrome and overweight-obesity. Int J Cardiol 2022; 348:169-174. [PMID: 34890763 PMCID: PMC8980725 DOI: 10.1016/j.ijcard.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Current recommendations for echocardiographic assessment of diastolic function (2016 guidelines of the American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) in patients with metabolic syndrome and overweight/obesity result in a significant number of patients with indeterminate diastolic dysfunction (LVDD). The aim of this article is to study whether the use of the left atrial strain criterion (LALS) reduces the number of indeterminate patients. METHODS 229 patients were studied with a complete echocardiographic study that included left ventricular longitudinal strain (LVLS) analysis, LALS and a maximal ergospirometry test with assessment of oxygen uptake (VO2max). RESULTS The mean age was 65 ± 5 years, 153 (67%) males, with a mean EF of 60 ± 5%. The mean LVLS was -19.4 ± 2% and the LALS Reservoir was 23.8 ± 7%. There were 140 patients who did not meet LVDD criteria and 82 who did meet the indeterminate LVDD criterion. When the left atrial volume index (LAVI) >34 ml/m2 criterion was replaced in the 2016 ASE/EACVI algorithm by LALS Reservoir ≤20%, the number of indeterminate patients was reduced from 36% to 23% (p < 0.001) at the expense of increasing normal studies (61% and 74%). Adding the LALS Reservoir criterion ≤23% in the 82 patients of the indeterminate group resulted in two groups with a different VO2max (11.6 ± 3 and 18 ± 5 ml/kg/min, p:0.081). CONCLUSIONS This study confirms the low prevalence of diastolic dysfunction in overweight/obese patients with metabolic syndrome. Adding left atrial strain criterion to the current recommendations significantly reduces the number of indeterminate patients by reclassifying them as normal.
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Affiliation(s)
- Angel M Alonso Gómez
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Lucas Tojal Sierra
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Marta Noris Mora
- Balearic Islands Health Research Institute. Cardiology Department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Estefanía Toledo
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - María Garrido Uriarte
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain
| | - Carolina Sorto Sanchez
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain
| | - María P Portillo
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain.,Nutrition and Obesity Group, Dept. Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU) and Lucio Lascaray Research Centre, Vitoria, Spain
| | - Luis López Rodriguez
- Balearic Islands Health Research Institute. Cardiology Department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | | | - Helmut Schröder
- Cardiovascular Risk and Nutrition Research Group (CARIN). Hospital del Mar. Barcelona. Spain.,Medical Research Institute (IMIM), Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Madrid, Spain
| | - Jordi Salas-Salvadó
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain.,Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Sant Joan de Reus University Hospital, IISPV, Rovira i Virgili University, c/Sant Llorenç 21, 43201 Reus, Spain
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15
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Affiliation(s)
- Brian D Hoit
- Departments of Medicine, Physiology, and Biophysics, Case Western Reserve University, Cleveland, Ohio, USA; Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
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16
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Vincenti A, Porcu L, Sonaglioni A, Genovesi S. Proposal for a clinical and an echocardiographic score for prediction of left atrial thrombosis in atrial fibrillation patients undergoing early electrical cardioversion. Int J Clin Pract 2021; 75:e14706. [PMID: 34363727 PMCID: PMC9286836 DOI: 10.1111/ijcp.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/05/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS Left atrial thrombosis (LAT) is usually detected by transesophageal echocardiography (TEE). The aim of the present study was to identify clinical and echocardiographic factors associated with left atrial thrombosis in atrial fibrillation (AF) patients undergoing early electrical cardioversion (ECV) in order to create scores that can predict LAT, in a non-invasive way. METHODS A consecutive cohort of patients with persistent AF scheduled for ECV was evaluated by transthoracic echocardiography and TEE. By a logistic regression model, variables significantly associated with LAT were assessed and introduced in predictive models to develop both a clinical and an echocardiographic prediction score for the presence of LAT. RESULTS In total, 125 patients [median 71 (range 49-88) years, 60.0% males] were enrolled. Transesophageal echocardiography showed LAT in 35 patients (28%). The clinical variables significantly associated with LAT were previous stroke (OR = 4.17), higher CHA2 DS2 -VASc score (OR = 1.93), lower estimated glomerular filtration rate (OR = 0.80), and higher brain natriuretic peptide levels (OR = 1.44). Among echocardiographic parameters, E/e' ratio was directly associated with LAT (OR = 2.25), while an inverse correlation was detected with left ventricular ejection fraction (OR = 0.43) and total global left atrial strain (OR = 0.59). Two prediction scores (clinical and echocardiographic) were developed. The positive predictive values of the clinical and the echocardiographic score were 80% and 100%, respectively, while the negative predictive values were 98% and 94%, respectively. Combined use of the scores reached a positive and negative predictive value of 100%. CONCLUSIONS When providing concordant information the two scores are able to correctly identify patients with or without LAT. An external validation is necessary to demonstrate their usefulness in the clinical practice.
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Affiliation(s)
- Antonio Vincenti
- Department of CardiologyOspedale San Giuseppe, MultiMedica IRCCSMilanItaly
| | - Luca Porcu
- Department of OncologyIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Andrea Sonaglioni
- Department of CardiologyOspedale San Giuseppe, MultiMedica IRCCSMilanItaly
| | - Simonetta Genovesi
- School of Medicine and SurgeryUniversity of Milano ‐ BicoccaMilanItaly
- Department of Cardiovascular, Neural, and Metabolic SciencesIstituto Auxologico Italiano IRCCSMilanItaly
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17
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Hagendorff A, Helfen A, Flachskampf FA, Ewen S, Kruck S, La Rosée K, Knierim J, Voigt JU, Kreidel F, Fehske W, Brandt R, Zahn R, Knebel F. Manual zur Indikation und Durchführung spezieller echokardiographischer Anwendungen. DER KARDIOLOGE 2021. [PMCID: PMC8521495 DOI: 10.1007/s12181-021-00509-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Das zweite Manual zur Indikation und Durchführung der Echokardiographie bezieht sich auf spezifische Anwendungen der Echokardiographie und besondere Fragestellungen bei speziellen Patientengruppen. Dabei stehen v. a. praktische Aspekte im Vordergrund. Methodisch etabliert sind die transösophageale Echokardiographie, die Stressechokardiographie und die Kontrastechokardiographie. Bei nahezu allen echokardiographischen Untersuchungen spielen aktuell 3‑D-Echokardiographie und Deformationsbildgebung eine Rolle. Das gesamte Spektrum der echokardiographischen Möglichkeiten wird derzeit in Notfall- und Intensivmedizin, bei der Überwachung und Führung von Katheterinterventionen, bei strukturellen Herzerkrankungen, bei herzchirurgischen Operationen, bei der Nachsorge von kardialen Unterstützungssystemen, bei kongenitalen Vitien im Erwachsenenalter und bei der Versorgung von hochinfektiösen Patienten in Pandemiezeiten angewandt. Die diagnostischen Fortschritte der konventionellen und modernen echokardiographischen Anwendungen stehen im Fokus dieses Manuals. Die 3‑D-Echokardiographie zur Charakterisierung der kardialen Morphologie und die Deformationsbildgebung zur Objektivierung der kardialen Funktion sind bei vielen Indikationen im klinischen Alltag etabliert. Die Stressechokardiographie zur Ischämie‑, Vitalitäts- und Vitiendiagnostik, die Bestimmung der koronaren Flussreserve und die Kontrastechokardiographie bei der linksventrikulären Wandbewegungsanalyse und kardialen Tumordetektion finden zunehmend klinische Anwendung. Wie für die konventionelle Echokardiographie im ersten Manual der Echokardiographie 2009 beschrieben, erfordert der Einsatz moderner echokardiographischer Verfahren die standardisierte Dokumentation und Akquisition bestimmter Bildsequenzen bei optimierter Geräteeinstellung, da korrekte und reproduzierbare Auswertungen nur bei guter Bildqualität möglich sind.
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Affiliation(s)
- Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Deutschland
| | - Andreas Helfen
- Medizinische Klinik I, Katholisches Klinikum Lünen Werne GmbH St. Marien-Hospital Lünen, Lünen, Deutschland
| | - Frank A. Flachskampf
- Department of Medical Sciences, Universität Uppsala, und Klinisk fysiologi och kardiologi, Uppsala University Hospital, Uppsala, Schweden
| | - Sebastian Ewen
- Klinik für Innere Medizin III – Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Sebastian Kruck
- Cardio Centrum Ludwigsburg Bietigheim, Ludwigsburg, Deutschland
| | - Karl La Rosée
- Gemeinschaftspraxis Dr. La Rosée & Prof. Dr. Müller, Bonn, Deutschland
| | - Jan Knierim
- Klinik für Herz‑, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Deutschland
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Gasthuisberg und Department of Cardiovascular Sciences, Cath. University Leuven, Leuven, Belgien
| | - Felix Kreidel
- Zentrum für Kardiologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Wolfgang Fehske
- Klinik III für Innere Medizin, Universitätsklinikum Köln – Herzzentrum, Universität zu Köln, Köln, Deutschland
| | - Roland Brandt
- Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim, Deutschland
| | - Ralf Zahn
- Medizinische Klinik B – Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein, Deutschland
- Kommission für Klinische Kardiovaskuläre Medizin, Deutsche Gesellschaft für Kardiologie, Düsseldorf, Deutschland
| | - Fabian Knebel
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland
- Sana Klinikum Lichtenberg, Berlin, Deutschland
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18
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Strzelczyk J, Kalinowski P, Zieniewicz K, Szmigielski C, Byra M, Styczyński G. The Influence of Surgical Weight Reduction on Left Atrial Strain. Obes Surg 2021; 31:5243-5250. [PMID: 34550536 PMCID: PMC8595175 DOI: 10.1007/s11695-021-05710-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022]
Abstract
Background Obesity increases and surgical weight reduction decreases the risk of atrial fibrillation (AF) and heart failure (HF). We hypothesized that surgically induced weight loss may favorably affect left atrial (LA) mechanical function measured by longitudinal strain, which has recently emerged as an independent imaging biomarker of increased AF and HF risk. Methods We retrospectively evaluated echocardiograms performed before and 12.2 ± 2.2 months after bariatric surgery in 65 patients with severe obesity (mean age 39 [36; 47] years, 72% of females) with no known cardiac disease or arrhythmia. The LA mechanical function was measured by the longitudinal strain using the semi-automatic speckle tracking method. Results After surgery, body mass index decreased from 43.72 ± 4.34 to 30.04 ± 4.33 kg/m2. We observed a significant improvement in all components of the LA strain. LA reservoir strain (LASR) and LA conduit strain (LASCD) significantly increased (35.7% vs 38.95%, p = 0.0005 and − 19.6% vs − 24.4%, p < 0.0001) and LA contraction strain (LASCT) significantly decreased (− 16% vs − 14%, p = 0.0075). There was a significant correlation between an increase in LASR and LASCD and the improvement in parameters of left ventricular diastolic and longitudinal systolic function (increase in E’ and MAPSE). Another significant correlation was identified between the decrease in LASCT and an improvement in LA function (decrease in A’). Conclusions The left atrial mechanical function improves after bariatric surgery. It is partially explained by the beneficial effect of weight reduction on the left ventricular diastolic and longitudinal systolic function. This effect may contribute to decreased risk of AF and HF after bariatric surgery. Graphical abstract ![]()
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Affiliation(s)
- Jakub Strzelczyk
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Stefana Banacha Street 1A, 02-097, Warsaw, Poland.
| | - Piotr Kalinowski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Stefana Banacha Street 1A, 02-097, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Stefana Banacha Street 1A, 02-097, Warsaw, Poland
| | - Cezary Szmigielski
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Stefana Banacha Street 1A, 02-097, Warsaw, Poland
| | - Michał Byra
- Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences, Adolfa Pawińskiego Street 5B, 02-106, Warsaw, Poland
| | - Grzegorz Styczyński
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Stefana Banacha Street 1A, 02-097, Warsaw, Poland
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19
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Sonaglioni A, Cara MD, Nicolosi GL, Eusebio A, Bordonali M, Santalucia P, Lombardo M. Rapid Risk Stratification of Acute Ischemic Stroke Patients in the Emergency Department: The Incremental Prognostic Role of Left Atrial Reservoir Strain. J Stroke Cerebrovasc Dis 2021; 30:106100. [PMID: 34525440 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To determine the prognostic value of positive global left atrial strain (LA-GSA+), measured by two-dimensional speckle tracking echocardiography (2D-STE) in a population of acute ischemic stroke (AIS) patients without atrial fibrillation (AF), in the setting of Emergency Department (ED). METHODS All consecutive AIS patients with sinus rhythm on ECG and without AF history entered this prospective study. All patients underwent complete blood tests and transthoracic echocardiography implemented with 2D-STE analysis of LA strain parameters within 6-12 h after symptoms onset. At 6-months follow-up, we evaluated the composite endpoint of all-cause mortality plus cardiovascular re-hospitalizations. RESULTS A total of 102 AIS patients (76.4 ± 10.8 yrs, 47% males) were prospectively included. LA-GSA+ was markedly reduced in AIS patients (20.8 ± 7.7%), without any statistically significant difference between the stroke subtypes. At 6-months follow-up, 7 deaths and 27 re-hospitalizations occurred. On multivariate Cox regression analysis, variables independently associated with outcome were: LA-GSA+ (per unit) (HR 0.29, 95% CI 0.19-0.39) and C-reactive protein (CRP) (per 0.1 mg/dl) (HR 1.45, 95% CI 1.15-1.75) as continuous variables; statin therapy (HR 0.45, 95%CI 0.28-0.62), and type 2 diabetes (HR 1.65, 95% CI 1.15-2.35) as categorical variables. A LA-GSA+ ≤20.0% predicted the occurrence of the above-mentioned outcome at 6-months follow-up with 94% sensitivity and 81% specificity (AUC=0.84). Interestingly, GSA+ showed a strong inverse correlation with CRP levels (r = -0.86). CONCLUSIONS A LA-GSA+ ≤20% reflects a more advanced atrial cardiomyopathy and might provide a rapid and reliable prognostic risk stratification of AIS patients without AF history in the setting of ED.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, MultiMedica IRCCS, San Giuseppe Hospital, Milan, Italy.
| | - Marianna Di Cara
- Emergency Medicine Unit, MultiMedica IRCCS, San Giuseppe Hospital, Milan, Italy
| | | | - Alessandro Eusebio
- Emergency Medicine Unit, MultiMedica IRCCS, San Giuseppe Hospital, Milan, Italy
| | - Marco Bordonali
- Emergency Medicine Unit, MultiMedica IRCCS, San Giuseppe Hospital, Milan, Italy
| | - Paola Santalucia
- Department of Neurology, MultiMedica IRCCS, San Giuseppe Hospital, Milan, Italy
| | - Michele Lombardo
- Department of Cardiology, MultiMedica IRCCS, San Giuseppe Hospital, Milan, Italy
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20
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Brand A, Frumkin D, Hübscher A, Dreger H, Stangl K, Baldenhofer G, Knebel F. Phasic left atrial strain analysis to discriminate cardiac amyloidosis in patients with unclear thick heart pathology. Eur Heart J Cardiovasc Imaging 2021; 22:680-687. [PMID: 32243500 DOI: 10.1093/ehjci/jeaa043] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/14/2020] [Accepted: 02/27/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS Traditional echocardiographic parameters for the assessment of suspected cardiac amyloidosis (CA) are of limited diagnostic accuracy. We sought to explore differences and the discriminative value of phasic left atrial strain (LAS) reductions and of regional longitudinal left ventricular (LV) strain alterations (relative apical sparing; RELAPS) in CA and other causes of LV wall thickening (LVH). METHODS AND RESULTS We included 54 patients with unclear LVH (mean septal diastolic wall thickness 17.8 ± 3.5 mm); CA was bioptically confirmed in 35 patients (8 mATTR, 6 wtATTR, 20 AL, and 1 AA amyloidosis) and LVH in 19 subjects. We analysed RELAPS as well as LA reservoir (LASr), conduit (LAScd), and contraction strain (LASct) using 2D speckle tracking echocardiography (EchoPAC software, GE). RELAPS was higher (1.37 ± 0.94 vs. 0.86 ± 0.29, P < 0.007), whereas atrial mechanics were significantly reduced in CA (LASr, LAScd, and LASct: 9.7 ± 5.2%, -6.5 ± 3.5%, and -5.0 ± 4.1% in CA; and 22.7 ± 7.8%, -13.9 ± 5.2%, and -13.0 ± 5.5% in LVH, respectively; P < 0.001 each). With an area under the curve (AUC) of 0.91 [95% confidence interval (CI) 0.82-0.99], LASr showed a higher diagnostic accuracy in discriminating CA than RELAPS (AUC 0.74, 95% CI 0.59-0.88). LASr and LAScd remained significantly associated with CA in a multivariate regression model. CONCLUSION Phasic LAS was significantly reduced in patients with CA and showed a higher diagnostic accuracy in discriminating CA than RELAPS. The additional assessment of phasic LAS may be useful to rule in the possible diagnosis of CA in patients with unclear LVH.
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Affiliation(s)
- Anna Brand
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - David Frumkin
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Anne Hübscher
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Henryk Dreger
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Karl Stangl
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Gerd Baldenhofer
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Fabian Knebel
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
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21
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Ünlü S, Yamak BA, Sezenöz B, Şahinarslan A, Arınsoy ST. Left atrial contractile longitudinal strain determines intrinsic left atrial function regardless of load status and left ventricular deformation. Int J Cardiovasc Imaging 2021; 37:3245-3253. [PMID: 34176030 DOI: 10.1007/s10554-021-02324-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Left atrial (LA) longitudinal strain (S) has been proposed as a superior, non-invasive parameter over LA volumetric assessment. LAS has diagnostic and prognostic value in many cardiovascular pathologies. Nevertheless, the acute effect of hemodynamic changes on LAS indices is not well-established. We sought to identify volume independent physiomechanical changes in LA and interrelation between LA and left ventricular (LV) strain indices following a large amount of fluid loss provided by hemodialysis. METHODS Seventy-five patients between 18 and 85 years of age under hemodialysis therapy were included. The echocardiographic images were obtained before and after hemodialysis. Phasic LAS and LV global longitudinal strain (GLS) were calculated. The impact of volume depletion on echocardiographic measurements and their temporal correlation were calculated. RESULTS LV and LA dimensions,volumes and LV, LA reservoir, and conduit deformation showed a significant decrease after hemodialysis. No significant change was observed for LAScontraction (p = 0.203). The ultrafiltrated volume was significantly correlated with the changes in LVGLS (r = 0.75, p < 0.001), and LASreservoir (r = 0.81, p < 0.001) and LA total emptying volume (r = 0.80, p < 0.001). Absolute changes in LASreservoir and LVGLS were strongly correlated (r = 0.83, p < 0.001). There was no correlation between absolute changes in LAScontraction and LVGLS or ultrafiltrated volume (p = NS, both). CONCLUSION LA reservoir and conduit LS are highly volume dependent strain parameters and are strongly correlated with LV deformation along with ultrafiltrated volume. Acute excessive volume depletion or LV deformation have no influence on LAScontraction. It is important to identify independent easily accessible functional parameters for the LA which would improve clinical evaluation.
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Affiliation(s)
- Serkan Ünlü
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Betül Ayça Yamak
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Burak Sezenöz
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Asife Şahinarslan
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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22
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Abstract
Unlike the left ventricle (LV), the left atrium (LA) has a thin-walled structure and has been regarded as a simple conduit chamber. However, the unique function of the LA to modulate LV filling has recently drawn much attention. Because LA structure and function are directly influenced by the LV filling pressure, LA assessment is an essential step in the diagnosis of diastolic dysfunction that can help predict new-onset atrial fibrillation, assess the risk of further embolic events, and identify high-risk patients for adverse cardiovascular events. Even in the recent era of multimodality imaging, 2-dimensional (2D) echocardiography is the most common imaging method and the central modality for evaluation of LA function. LA strain derived from 2D echocardiography can help assess LA function objectively and demonstrates the 3 distinct phasic motions of the LA cycle. Further, LA strain provides invaluable pathophysiologic information and helps to predict clinical prognosis in various cardiovascular diseases. In this review article, we focus on LA strain: basic concepts, advantages over conventional parameters, and some unresolved issues. Additionally, we present a brief history of the clinical evidence for LA strain. Through this review, we suggest echocardiography for LA strain assessment in clinical practice.
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Affiliation(s)
- Byung Joo Sun
- Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital
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23
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Current clinical applications of speckle tracking echocardiography for assessment of left atrial function. J Echocardiogr 2021; 19:129-140. [PMID: 33687616 DOI: 10.1007/s12574-021-00519-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/22/2021] [Indexed: 01/18/2023]
Abstract
Two-dimensional speckle tracking echocardiography (2D-STE) enables assessment of left atrial (LA) function with better reproducibility and less load dependence than those with conventional methods. Data regarding LA functions determined by 2D-STE in patients with various cardiovascular diseases have recently been accumulating. LA strain has emerged as a novel parameter with the potential of improving the diagnostic accuracy of left ventricular diastolic dysfunction and the prognostic value in patients with heart failure and stroke. Furthermore, LA dysfunction determined by 2D STE can provide incremental prognostic information to conventional echocardiographic parameters in patients with cardiovascular diseases. Hence, 2D-STE appears to be a promising technique for diagnosis and therapeutic decision-making. Data regarding LA functions determined by three-dimensional speckle tracking echocardiography (3D-STE) have also been accumulating. Here, I review recent studies, especially those published after 2016, on clinical applications of LA function assessed by 2D-STE and 3D-STE and summarize the remaining problems to be solved for improving the clinical utility of these techniques.
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24
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Doria de Vasconcellos H, Win TT, Chamera E, Hong SY, Venkatesh BA, Young P, Yang X, Ciuffo L, Sharma RK, Imai M, Habibi M, Wud CO, Heckbert SR, Bluemke DA, Lima JAC. References Values for Left Atrial Volumes, Emptying Fractions, Strains, and Strain Rates and Their Determinants by Age, Gender, and Ethnicity: The Multiethnic Study of Atherosclerosis (MESA). Acad Radiol 2021; 28:356-363. [PMID: 32279912 DOI: 10.1016/j.acra.2020.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/03/2020] [Accepted: 02/14/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES Left Atrial (LA) adverse remodeling is an important predictor of morbidity and mortality in several cardiovascular (CV) diseases. Our goals were to quantify and provide reference ranges for LA structure and function using feature tracking cine cardiac magnetic resonance. MATERIALS AND METHODS 2526 participants of the Multiethnic Study of Atherosclerosis study who had feature tracking cine cardiac magnetic resonance derived LA data and were free of atrial fibrillation/flutter and prior CV events at year five follow-up examination (2010-2012) were included in this study. LA phasic indexed volumes: maximum (LAVi max), minimum (LAVi min), and preatrial contraction (LAVi preA); LA empty fractions: total, passive, and active (LAtEF, LApEF, and LAaEF); LA longitudinal strain: maximum and preatrial contraction (S max and S preA); and LA longitudinal strain rate: systolic (SR max) and early/late diastolic (SR e and SR a) were measured. Age, gender, and race/ethnicity-specific reference ranges were identified. Also, reference values in a select subgroup of healthy participants free of traditional CV risk factors at the time of exam date were reported. RESULTS The mean ± SD for LAVi max, LAVi min, LAVi preA, S max, SR e, and SR a were in the 45-65-year-old participants: (33.8 ± 10 mL/m2), (14.5 ± 6.4 mL/m2), (24.8 ± 8.2 mL/m2), (34.6 ± 13.8 %), (-1.4 ± 0.7 s-1), (-2.1 ± 1 s-1) and in the ≥ 65-year-old participants: (35 ± 11.5 mL/m2), (16.6 ± 8.3 mL/m2), (27.6 ± 9.9 mL/m2), (31.2 ± 14.3 %), (-1 ± 0.6 s-1), (-2.1 ± 1 s-1) respectively. Younger individuals had Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation smaller LA volumes and better LA function compared to their older counterparts. Similar findings were observed in Chinese-Americans as compared to Whites. CONCLUSION This study provides reference values of LA structure and function parameters from a healthy multiethnic community-based population aged 53-94 years evaluated by FTMRI.
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Affiliation(s)
- Henrique Doria de Vasconcellos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524, Baltimore, Maryland 21287-8222
| | - Theingi Tiffany Win
- Division of Cardiology, Department of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Ela Chamera
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524, Baltimore, Maryland 21287-8222
| | - Seo Young Hong
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524, Baltimore, Maryland 21287-8222
| | - Bharath Ambale Venkatesh
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524, Baltimore, Maryland 21287-8222
| | - Patrick Young
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524, Baltimore, Maryland 21287-8222
| | - Xiaoying Yang
- Department of Statistics, The George Washington University, Washington, District of Columbia
| | - Luisa Ciuffo
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, United States
| | - Ravi K Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524, Baltimore, Maryland 21287-8222
| | - Masamichi Imai
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524, Baltimore, Maryland 21287-8222
| | - Mohammadali Habibi
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524, Baltimore, Maryland 21287-8222
| | - Colin O Wud
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington, District of Columbia
| | - David A Bluemke
- Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524, Baltimore, Maryland 21287-8222.
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25
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Stefani LD, Trivedi SJ, Ferkh A, Altman M, Thomas L. Changes in left atrial phasic strain and mechanical dispersion: Effects of age and gender. Echocardiography 2021; 38:417-426. [PMID: 33594734 DOI: 10.1111/echo.14997] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Left atrial (LA) function by two-dimensional (2D) strain is an emerging tool with increasing clinical utility. Age and gender are key modulators of strain parameters; however, the specific time course for LA structural and functional changes is not clearly defined. METHODS A total of 147 healthy individuals (20-69 years) underwent transthoracic echocardiography; subjects were evaluated by age (decade) and gender. LA and left ventricular (LV) volumetric and strain measurements were performed. RESULTS Left atrial reservoir (ƐR) and conduit strain (ƐCD) with negatively correlated with age (r =-.36; r = -.56; P < .001, respectively) being significantly lower by the 6th and 5th decades, respectively. Contractile strain (ƐCT) positively correlated with age (r = .36; P < .001), being significantly higher by the 6th decade. ƐR and ƐCD were higher in young females (20-34 years) compared to young males (P = .033 and P < .001, respectively). ƐCT was significantly higher in middle-aged adult males (35-50yrs; P = .010), though seen later in females (≥51 years; P = .005). Standard deviation of time to positive strain (SD-TPS) significantly higher by the 5th decade and correlated with age in both males (r = .44; P <.001) and females (r = .40; P = .001). CONCLUSION We demonstrate that ƐR and ƐCD are lower with age, with differing rates between males and females. As a compensatory mechanism for decline in ƐCD, ƐCT is higher, more notably in males; comparatively, females display a more prominent decline in ƐR and ƐCD with age. Alteration in electromechanical properties occurred in both genders with SD-TPS becoming higher with age.
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Affiliation(s)
- Luke D Stefani
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - Siddharth J Trivedi
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, NSW, Australia
| | - Aaisha Ferkh
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, NSW, Australia
| | - Mikhail Altman
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, NSW, Australia
| | - Liza Thomas
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, NSW, Australia.,South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
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26
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Lin KB, Chen KK, Li S, Cai MQ, Yuan MJ, Wang YP, Zhang X, Wei M, Yan ML, Ma XX, Zheng DY, Wu QH, Li JB, Huang D. Impaired Left Atrial Performance Resulting From Age-Related Arial Fibrillation Is Associated With Increased Fibrosis Burden: Insights From a Clinical Study Combining With an in vivo Experiment. Front Cardiovasc Med 2021; 7:615065. [PMID: 33634168 PMCID: PMC7901954 DOI: 10.3389/fcvm.2020.615065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Atrial fibrillation (AF) is increasingly considered an age-related degenerative disease, whose process is associated with the development of impaired left atrial (LA) performance. However, the subtle dynamic changes of LA performance in AF during aging have yet to be fully elucidated. Atrial fibrosis is a key substrate for the development of AF, but the progression of fibrosis during aging and its relationship with LA dysfunction need to be further explored. Methods: A total of 132 control individuals and 117 persistent AF patients were prospectively studied. Subjects were further stratified into three age groups (age group 1: younger than 65 years, age group 2: between 65 and 79 years old, and age group 3: older than 80 years). The two-dimensional speckle tracking imaging was carried out for analyzing the alterations in LA function underlying LA remodeling, whereas electroanatomic mapping was performed to investigate LA fibrosis burden. In animal study, aged mice and young mice served as research subjects. Echocardiography and histological staining were used to assess LA performance and fibrosis burden, respectively. Results: Echocardiography showed progressive increases in LA dimension and LA stiffness index, and progressive decreases in LA global longitudinal strain and LA strain rates with advancing age in both AF and control cohorts, which was more prominent in AF cohort. Electroanatomic mapping showed progressive decrease in mean LA voltage and progressive increases in LA surface area, low-voltage area %, and LA volume with advancing age, whereas more significant alterations were observed in AF patients. Moreover, left atrial global longitudinal strain was positively correlated with mean LA voltage, whereas LA stiffness index was negatively related to mean LA voltage. In animal experiment, increased LA size and pulmonary artery dimension as well as longer P-wave duration and more prominent LA fibrosis were found in aged mice. Conclusions: This study provides new evidence of subtle changes in structure and performance of left atrium and their association with atrial fibrosis in both AF and non-AF subjects during physiological aging. In addition, our study also provides normal values for LA structure and performance in both AF and non-AF conditions during aging. These measurements may provide an early marker for onset of AF and LA adverse remodeling.
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Affiliation(s)
- Kai-Bin Lin
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Kan-Kai Chen
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shuai Li
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ming-Qi Cai
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Min-Jie Yuan
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yan-Peng Wang
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xue Zhang
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Meng Wei
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Mei-Ling Yan
- Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Xin-Xin Ma
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dong-Yan Zheng
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qi-Han Wu
- NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Jing-Bo Li
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dong Huang
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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27
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Sonaglioni A, Lombardo M, Nicolosi GL, Rigamonti E, Anzà C. Incremental diagnostic role of left atrial strain analysis in thrombotic risk assessment of nonvalvular atrial fibrillation patients planned for electrical cardioversion. Int J Cardiovasc Imaging 2021; 37:1539-1550. [PMID: 33389359 PMCID: PMC7778706 DOI: 10.1007/s10554-020-02127-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/30/2020] [Indexed: 01/18/2023]
Abstract
During the COVID-19 pandemic, transesophageal echocardiography (TEE) for left atrial appendage thrombosis (LAAT) detection should be limited to situations of absolute necessity. We sought to identify the main conventional and functional echocardiographic parameters associated with LAAT on TEE in non-valvular atrial fibrillation (NVAF) patients planned for electrical cardioversion (ECV). This retrospective study included 125 consecutive NVAF patients (71.5±7.8 yrs, 75 males), who underwent TEE at our Institution between April 2016 and January 2020, to exclude LAAT before scheduled ECV. All patients underwent a transthoracic echocardiography (TTE) implemented with speckle tracking echocardiography (STE) analysis of left atrial (LA) strain and strain rate (SR) parameters. 28% of patients were diagnosed with LAAT, while 72% without LAAT. Compared to controls, patients with LAAT had significantly higher CHA2DS2-Vasc Score and average E/e’ ratio, and significantly lower left ventricular ejection fraction (LVEF). Moreover, LA-peak positive global atrial strain (GSA+) and LA-SR parameters were significantly reduced in patients with LAAT. Multivariate logistic regression revealed that, differently from CHA2DS2-Vasc Score, LVEF (OR 0.88, 95%CI 0.81–0.97, p = 0.01), average E/e’ ratio (OR 2.36, 95%CI 1.41–3.98, p = 0.001), and LA-GSA+ (OR 0.57, 95%CI 0.36-0-90, p = 0.01) were independently associated with LAAT. LA-GSA+ (optimal cut-off ≤ 9.1%, AUC 0.95) showed the highest diagnostic performance. Finally, a strong linear correlation of LA peak-to-peak SR with both LA appendage filling (r = 0.86) and emptying (r = 0.83) velocities was demonstrated. TTE implemented with STE analysis of LA mechanics improves thrombotic risk assessment of NVAF patients.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy.
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | | | - Elisabetta Rigamonti
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Claudio Anzà
- Cardiovascular Department, MultiMedica IRCCS, Via Milanese 300, 20099, Sesto San Giovanni (MI), Italy
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Gan GCH, Bhat A, Chen HHL, Fernandez F, Byth K, Eshoo S, Thomas L. Determinants of LA reservoir strain: Independent effects of LA volume and LV global longitudinal strain. Echocardiography 2020; 37:2018-2028. [PMID: 33211337 DOI: 10.1111/echo.14922] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Left atrial (LA) deformation during the reservoir phase (LASr) has demonstrated strong prognostic value in different clinical settings. Although determinants of left atrial reservoir strain including left atrial relaxation, left atrial compliance, and left ventricular longitudinal systolic function are fairly well defined, there is incomplete information regarding the effect of left atrial volume on this relationship which is the focus of our study. METHOD Consecutive patients without prior cardiac disease referred for transthoracic echocardiography were prospectively recruited. All participants underwent clinical assessment, transthoracic echocardiography (TTE), and screening exercise stress test. Only patients with normal left ventricular ejection fraction (LVEF) without left ventricular hypertrophy (LVH) or myocardial ischemia on stress testing were included. RESULTS A total of 260 patients (57% male, mean age 59 ± 14 years) were included. 70% had hypertension, 33% had diabetes mellitus, and 31% had both HTN and DM. On multivariate analysis, age, e', LAVI, and LV GLS (P < .01 for all) showed an independent association with LASr. Of interest, at lower tertiles of LAVI, a linear decrease in LASr was observed parallel to worsening LV GLS, whilst at higher tertiles of LAVI, the reduction in LASr was non-linear implying that LA enlargement, consequent to LA remodeling, had an incremental effect on LASr. CONCLUSION Age, e', LV GLS, and LAVI were independently associated with LASr. LA remodeling reflected by larger LAVI had an incremental negative association with LASr independent of LV GLS.
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Affiliation(s)
- Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
| | - Fernando Fernandez
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Karen Byth
- Biostatistics Unit, Research and Education Network, Westmead Hospital and The University of Sydney, Sydney, NSW, Australia
| | - Suzanne Eshoo
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
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Thomas L, Muraru D, Popescu BA, Sitges M, Rosca M, Pedrizzetti G, Henein MY, Donal E, Badano LP. Evaluation of Left Atrial Size and Function: Relevance for Clinical Practice. J Am Soc Echocardiogr 2020; 33:934-952. [DOI: 10.1016/j.echo.2020.03.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 01/05/2023]
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30
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Incremental prognostic value of global left atrial peak strain in women with new-onset gestational hypertension. J Hypertens 2020; 37:1668-1675. [PMID: 30950977 DOI: 10.1097/hjh.0000000000002086] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Left atrial strain and strain rate parameters, measured by bidimensional-speckle tracking echocardiography, have been proposed as predictors of atrial fibrillation, stroke, congestive heart failure and cardiovascular death. However, they have not yet been tested in hypertensive disorders of pregnancy. The aim of this study was to assess the prognostic role of global left atrial peak strain (GLAPS) in a population of pregnant women with new-onset hypertension in a medium-term follow-up. METHODS Twenty-seven consecutive women with new-onset hypertension after 20 weeks pregnancy and 23 age-matched, race-matched and gestational week-matched consecutive normotensive pregnant women were enrolled in this prospective study. All participants underwent a complete echocardiographic study with bidimensional-speckle tracking echocardiography and carotid examination. At 1-year follow-up, we evaluated the occurrence of persistent hypertension. RESULTS In comparison with normotensive women, those hypertensive had a higher burden of cardiovascular risk factors, similar left atrial volume indexed (P = 0.14), but severely impaired left atrial strain (P < 0.0001) and strain rate values (P < 0.0001). At 1-year follow-up, persistent hypertension was documented in 59.3% of patients. At the univariate Cox analysis, the variables associated with the occurrence of the investigated outcome in all hypertensive pregnancies were SBP (hazard ratio 1.04, P = 0.04), DBP (hazard ratio 1.11, P = 0.01), mean arterial pressure (hazard ratio 1.09, P = 0.01) values and the GLAPS value (hazard ratio 0.85, P = 0.0019). The latter was significantly associated with the investigated outcome both in preeclamptic (hazard ratio 0.84, P = 0.02) and nonpreeclamptic pregnant women (hazard ratio 0.83, P = 0.04). The receiver operating characteristics curve analysis highlighted that a GLAPS value of 23.5% or less predicted persistent hypertension with sensitivity of 100% and specificity of 90.90%. CONCLUSION In hypertensive pregnant women a GLAPS value of 23.5% or less reveals a greater severity of atrial cardiomyopathy and might predict postpregnancy persistent hypertension.
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Sonaglioni A, Caminati A, Lipsi R, Nicolosi GL, Lombardo M, Anzà C, Harari S. Early left atrial dysfunction in idiopathic pulmonary fibrosis patients without chronic right heart failure. Int J Cardiovasc Imaging 2020; 36:1711-1723. [PMID: 32448985 DOI: 10.1007/s10554-020-01887-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/15/2020] [Indexed: 12/17/2022]
Abstract
No data are actually available regarding the left atrial (LA) functional assessment by two-dimensional speckle tracking echocardiography (2D-STE) in early-stage idiopathic pulmonary fibrosis (IPF). The primary end-point of our study was to assess whether global LA peak strain (GLAPS), measured by 2D-STE analysis, may detect early alterations in LA function in IPF patients without right heart failure (RHF). Between September 2017 and January 2019, 50 consecutive IPF patients (73.8 ± 6.8 years, 36 males) without chronic RHF and 30 controls matched by age, sex and cardiovascular risk factors, were enrolled in an observational retrospective case-control study. All patients underwent a complete echocardiographic study implemented with 2D-STE analysis. GLAPS, left ventricular (LV) global longitudinal strain (GLS), right atrial (RA) reservoir strain (GSA+) and right ventricular (RV)-GLS were obtained in each patient. LVFP were significantly increased in IPF patients in comparison to controls (average E/e' ratio 14.4 ± 3.0 vs 9.6 ± 1.5, p < 0.0001), while LV-GLS was slightly reduced in IPF patients compared to controls (19.4 ± 3.6% vs 21.0 ± 2.2%, p = 0.03).Moreover, GLAPS was significantly impaired in IPF patients in comparison to controls (18.4 ± 3.7% vs 28.4 ± 5.6%, p < 0.0001).Finally, the two groups of patients did not show any statistically significant difference in both RA-GSA + (23.9 ± 3.7% vs 24.5 ± 4.0%, p = 0.49) and RV-GLS (- 22.6 ± 3.3% vs - 23.5 ± 3.0%, p = 0.22). Notably, LV-GLS was strongly inversely correlated both with RV/LV basal diameter ratio and TRV in IPF patients (r = - 0.87 and - 0.82, respectively) but not in controls (r = - 0.29 and - 0.27, respectively). This finding highlights a likely process of ventricular interdependence in non-advanced IPF, with consequent LV diastolic dysfunction and secondary impairment in LV-GLS and GLAPS. Early LA reservoir dysfunction in IPF patients may be secondary to LV diastolic dysfunction induced by ventricular interdependence and may develop before RV diastolic and systolic dysfunction.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Antonella Caminati
- Semi-Intensive Care Unit, Department of Pneumology, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy.
| | - Roberto Lipsi
- Semi-Intensive Care Unit, Department of Pneumology, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Gian Luigi Nicolosi
- Department of Cardiology, Policlinico San Giorgio, Via Agostino Gemelli 10, 33170, Pordenone, Italy
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Claudio Anzà
- Cardiovascular Department, MultiMedica IRCCS, Via Milanese 300, Sesto San Giovanni, 20099, Milan, Italy
| | - Sergio Harari
- Semi-Intensive Care Unit, Department of Pneumology, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
- Department of Medical Sciences San Giuseppe Hospital MultiMedica IRCCS and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Normal reference values for left atrial strains and strain rates in school children assessed using two-dimensional speckle-tracking echocardiography. Heart Vessels 2020; 35:1270-1280. [DOI: 10.1007/s00380-020-01594-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/27/2020] [Indexed: 12/12/2022]
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Incremental value of three-dimensional echocardiography for evaluating left atrial function in patients with coronary slow flow phenomenon: a case control study. Cardiovasc Ultrasound 2020; 18:6. [PMID: 32054491 PMCID: PMC7020347 DOI: 10.1186/s12947-020-00189-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Coronary slow flow phenomenon (CSFP) involves the delayed opacification of the coronary distal vessel, in the absence of an obstructive lesion in the epicardial coronary artery during angiography. Since the link between left atrial (LA) function and decreased left ventricular function is still unclear, we evaluated LA function using real-time three-dimensional echocardiography (RT3DE) in patients with CSFP, and subsequently determined the incremental value of RT3DE. METHODS This study enrolled 60 patients with CSFP and 45 control subjects. CSFP was diagnosed based on thrombolysis in myocardial infarction frame count (TFC). The LA phasic volume and function was evaluated by both two-dimensional echocardiography (2DE) and RT3DE. RESULTS The LA maximal volume (Volmax), pre-systolic volume (Volp), and minimal volume (Volmin) increased, but LA total and active ejection fraction decreased in patients with CSFP. Based on our results, Volmax, Volp, Volmin, and LA total and active ejection fraction correlated with TFC, and with the number of arteries involved. The LA total ejection fraction by RT3DE was the only independent predictor for CSFP (odds ratio, 0.64 [95% confidence interval, 0.49-0.83]; P = 0.001). Also, the LA total ejection fraction by RT3DE demonstrated good predictive power for CSFP, with a cut-off value of 54.15% (area under curve, 0.85; sensitivity, 84%; specificity, 83%). CONCLUSIONS The LA reservoir and contractile function decreased in the patients with CSFP and correlated with coronary flow rate and with the number of arteries involved. The LA total ejection fraction by RT3DE can independently predict CSFP, and RT3DE demonstrated incremental value for evaluating LA phasic function in the patients with CSFP compared to 2DE.
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Saha S, Kiotsekoglou A, Govind S, Lindmark K. Left Atrial and Renal Functional Status as Drivers of Adverse Outcome in Heart Failure with Reduced Ejection Fraction: A Four-Chamber Deformation Study in a Small Cohort of Northern Sweden. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2020. [DOI: 10.4103/jiae.jiae_37_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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35
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Meimoun P, Stracchi V, Boulanger J, Martis S, Botoro T, Zemir H, Clerc J. The left atrial function is transiently impaired in Tako-tsubo cardiomyopathy and associated to in-hospital complications: a prospective study using two-dimensional strain. Int J Cardiovasc Imaging 2019; 36:299-307. [PMID: 31673849 DOI: 10.1007/s10554-019-01722-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/20/2019] [Indexed: 11/28/2022]
Abstract
Tako-tsubo cardiomyopathy (TTC) is characterized by the presence of transient left ventricular (LV) dysfunction. Whether left atrial (LA) function is also impaired in this setting is unclear. To assess prospectively LA peak systolic longitudinal strain (LAS) by two-dimensional strain at the acute phase of TTC and after recovery and its association with in-hospital complications. 40 patients with typical TTC (mean age 79.5 ± 10 years) underwent transthoracic-Doppler echocardiography at the acute phase and at follow-up (32 ± 18 days later), including the measurement of the LAS (mean of maximal strain from the 4-2 chamber views). A control group of 15 patients (75 ± 7 years, 13 women) without overt cardiovascular disease served as a comparative group. In-hospital complication was a composite of death, heart failure, cardiogenic shock, LV thrombus, and sustained ventricular arrhythmia. In the TTC group, LAS improved significantly between the two examinations from 15 ± 5.5% to 27 ± 8% (p < 0.01) whereas LA volume did not change (p = NS). In the control group LAS was 30 ± 4% (p < 0.01 vs. TTC acute phase, p = NS vs. TTC follow-up). In TTC, at the acute phase LAS was independently correlated to LV global longitudinal strain (LVGLS), and after recovery to E/e', and the change of LAS was independently correlated to the change of the LVGLS (all, p < 0.01). Furthermore LAS was independently correlated to in-hospital complications (p < 0.01). LA function (reservoir) is transiently impaired in TTC and associated to in-hospital complications. Furthermore, the improvement of LAS parallel the dynamic improvement of LVGLS suggests that TTC induces a transient global left heart dysfunction.
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Affiliation(s)
- P Meimoun
- Department of Cardiology, Centre Hospitalier de Compiègne, Compiègne Hospital, 8 rue Henri Adnot, 60200, Compiègne, France.
| | - V Stracchi
- Department of Cardiology, Centre Hospitalier de Compiègne, Compiègne Hospital, 8 rue Henri Adnot, 60200, Compiègne, France
| | - J Boulanger
- Department of Cardiology, Centre Hospitalier de Compiègne, Compiègne Hospital, 8 rue Henri Adnot, 60200, Compiègne, France
| | - S Martis
- Department of Cardiology, Centre Hospitalier de Compiègne, Compiègne Hospital, 8 rue Henri Adnot, 60200, Compiègne, France
| | - T Botoro
- Department of Cardiology, Centre Hospitalier de Compiègne, Compiègne Hospital, 8 rue Henri Adnot, 60200, Compiègne, France
| | - H Zemir
- Department of Cardiology, Centre Hospitalier de Compiègne, Compiègne Hospital, 8 rue Henri Adnot, 60200, Compiègne, France
| | - J Clerc
- Department of Cardiology, Centre Hospitalier de Compiègne, Compiègne Hospital, 8 rue Henri Adnot, 60200, Compiègne, France
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36
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Badano LP, Nagueh SF, Muraru D. Left atrial function: an overlooked metrics in clinical routine echocardiography. Eur J Heart Fail 2019; 21:901-903. [DOI: 10.1002/ejhf.1475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Luigi P. Badano
- Department of Cardiovascular, Neurologic and Metabolic SciencesIstituto Auxologico Italiano, IRCCS, Saint Luca Hospital Milan Italy
- Department of Medicine and SurgeryUniversity of Milano‐Bicocca Milan Italy
| | - Sherif F. Nagueh
- Methodist DeBakey Heart and Vascular CenterHouston Methodist Research Institute Houston TX USA
| | - Denisa Muraru
- Department of Cardiovascular, Neurologic and Metabolic SciencesIstituto Auxologico Italiano, IRCCS, Saint Luca Hospital Milan Italy
- Department of Medicine and SurgeryUniversity of Milano‐Bicocca Milan Italy
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Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G. Left atrial function in elite athletes: A meta-analysis of two-dimensional speckle tracking echocardiographic studies. Clin Cardiol 2019; 42:579-587. [PMID: 30907013 PMCID: PMC6523010 DOI: 10.1002/clc.23180] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/11/2019] [Accepted: 03/22/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We sought to investigate left atrial (LA) volume, function, and strain in elite athletes by a meta-analysis including echocardiographic studies that provided volumetric and strain analysis of LA phasic function. METHODS The OVID-MEDLINE, PubMed, and Cochrane CENTRAL databases were searched for English-language articles without time restriction up to February 2018 through focused and high sensitive search strategies. Studies were identified by crossing the following search terms: "athletes," "left atrial size," "left atrial volume," "atrial function," "atrial strain," "atrial strain rate," "echocardiography," "2D speckle echocardiography." RESULTS Meta-analysis included 403 athletes and 314 active but not trained healthy controls from 9 studies. Pooled data showed that average LA volume index was higher in athletes than in healthy controls (28.0 ± 1.0 vs 20.7 ± 0.8 mL/m2 , P < 0.001). Global LA longitudinal strain, showing LA reservoir function, was lower in the athletes than in healthy controls with borderline significance (37.0 ± 1.2 vs 38.3 ± 1.5%, P = 0.044). Late diastolic LA strain rate, resembling LA contractile function, was also lower in elite athletes than in control group (-1.56 ± 0.08 vs -1.74 ± 0.09 seconds -1, P = 0.007). CONCLUSIONS Our meta-analysis shows that LA volume is higher, while LA reservoir and contractile functions are impaired in elite athletes during active training compared to untrained controls. Whether these changes persist during deconditioning periods remains to be determined. These alterations may be related to the higher risk of arrhythmias, in particular atrial fibrillation, reported among middle/old aged athletes.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
- Clinical Research UnitIstituto Auxologico Italiano, IRCCSMilanItaly
| | - Marijana Tadic
- Clinical Research UnitUniversity Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje”MilanItaly
| | - Carla Sala
- Department of Clinical Sciences and Community HealthUniversity of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di MilanoMilanItaly
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community HealthUniversity of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di MilanoMilanItaly
| | - Guido Grassi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
- IRCCS MultimedicaSesto San GiovanniMilanItaly
| | - Giuseppe Mancia
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
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Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP. Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73:1961-1977. [PMID: 31000000 DOI: 10.1016/j.jacc.2019.01.059] [Citation(s) in RCA: 358] [Impact Index Per Article: 71.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/15/2019] [Indexed: 01/31/2023]
Abstract
Defining left atrial (LA) function has recently emerged as a powerful parameter, particularly in evaluation of left ventricular (LV) diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction. Echocardiographic assessment of LVDD by echocardiography remains a challenging task; recent recommendations provide a simpler approach than previous. However, the shortcomings of the proposed approach (including transmitral flow, tissue velocity, maximum left atrial volume [LAV], and estimated pulmonary artery systolic pressure), lead to the presence and severity of LVDD remaining undetermined in a significant proportion of patients. Maximum LAV is a surrogate measure of the chronicity and severity of LVDD, but LAV alone is an insensitive biomarker of early phases of LVDD, because the LA may take time to remodel. Because the primary function of the LA is to modulate LV filling, it is not surprising that functional LA changes become evident at the earliest stages of LVDD. Moreover, LA function may provide additive value, not only in diagnosing LVDD, but also in grading its severity and in monitoring the effects of treatment. The current review provides a critical appraisal on the existing evidence for the role of LA metrics in evaluation of LVDD and consequent heart failure with preserved ejection fraction.
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Affiliation(s)
- Liza Thomas
- University of Sydney, Sydney, NSW, Australia; Department of Cardiology Westmead Hospital; South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Thomas H Marwick
- Baker IDI heart and Diabetes Institute and the Alfred Hospital, Melbourne, Victoria, Australia
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Department of Cardiology, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu," Bucharest, Romania
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Luigi P Badano
- University of Milano-Bicocca, Milan, Italy; IRCCS, Istituto Auxologico Italiano, S. Luca Hospital, Milan, Italy
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Left atrial phasic function in hypertensive patients with significant aortic stenosis and preserved ejection fraction. Hypertens Res 2019; 42:1200-1208. [PMID: 30944414 DOI: 10.1038/s41440-019-0256-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/12/2019] [Accepted: 03/05/2019] [Indexed: 11/08/2022]
Abstract
The purpose of this investigation was to evaluate the influence of hypertension on left atrial (LA) function in patients with moderate and severe AS. This cross-sectional study included 121 patients with moderate and severe AS and preserved left ventricular (LV) ejection fraction ( > 50%) and 79 age-matched controls who underwent a comprehensive echocardiographic examination. LA phasic function was determined by both volumetric and strain methods. Our findings showed that the LV ejection fraction was similar between hypertensive and normotensive AS patients. Maximal, minimal, and pre-A LA volume indexes gradually increased from controls to moderate-to-severe AS patients. The total, passive and active LA emptying fraction (EF) gradually decreased in the same direction. LA phasic function estimated with strain analysis showed that reservoir, conduit, and pump LA phasic functions were lower in all AS patients than in normotensive controls. However, there was no significant difference between moderate and severe AS except in LA pump function, which was lower in severe AS. Differences in LA phasic function were more prominent in volumetric than in strain analyses. Blood pressure, LV mass index, and AS severity were independent of other clinical and echocardiographic parameters associated with LA phasic function in patients with AS. In conclusion, hypertension has an additive impact on LA phasic function in patients with moderate and severe AS. Blood pressure and AS severity were independently associated with LA phasic function parameters in AS patients. Volumetric assessment of LA phasic function should not be completely replaced with strain analysis.
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40
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Meimoun P, Djebali M, Botoro T, Djou Md U, Bidounga H, Elmkies F, Martis S, Clerc J. Left atrial strain and distensibility in relation to left ventricular dysfunction and prognosis in aortic stenosis. Echocardiography 2019; 36:469-477. [PMID: 30726555 DOI: 10.1111/echo.14258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/15/2018] [Accepted: 12/18/2018] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To test the relationship between left atrial (LA) distensibility (LAD), LA strain (LAS), and left ventricular (LV) dysfunction and prognosis in aortic stenosis (AS). METHODS Transthoracic Doppler echocardiography was performed prospectively in 102 consecutive patients with AS (77 with severe, 25 with moderate, mean age 77 years). LA volume was calculated by the area-length method in apical four- and two-chamber views, immediately before mitral valve opening (Volmax ) and at mitral valve closure (Volmin ). LAD was defined as (Volmax - Volmin ) × 100%/Volmin . LAS (mean of maximal strain from the 4-2 chamber views) was conducted using a dedicated software package. The endpoint was hospitalization for heart failure and death from any cause. RESULTS Left atrial strain, LAD, and LA vol/m² were significantly correlated with LV diastolic parameters, and PASP (all, P < 0.05). However, LAD and LAS but not LA vol/m² were significantly correlated with Charlson score, LV global longitudinal strain, and to transaortic mean gradient (all, P < 0.05). At a median follow-up of 25 months, 53 patients had an event. LAS, LAD, LA vol/m², and Charlson index were associated with events (all, P < 0.05). In multivariate analysis, LAD, LAS, and Charlson index (all, P < 0.01) remained independently associated with events. Using a ROC curve analysis, LAD ≤ 69% and LAS ≤ 17% were the best cutoffs associated with an event. CONCLUSION In patients with moderate to severe AS, LAD and LAS are associated with LV dysfunction, AS severity, and are independently linked to events.
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Affiliation(s)
- Patrick Meimoun
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | - Manel Djebali
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | - Thierry Botoro
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | - Urbain Djou Md
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | | | | | - Sonia Martis
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | - Jérome Clerc
- Department of Cardiology, Compiègne Hospital, Compiègne, France
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Abstract
Left atrial size and function parameters are associated with adverse outcomes in multiple disease states, including heart failure with reduced and preserved ejection fraction. Recent data suggest that phasic left atrial function and left atrial stain measurements also hold prognostic information. Three-dimensional echocardiography provides more accurate and reproducible quantification of left atrial volumes than 2-dimensional echocardiography when compared with cardiac magnetic resonance reference standards. Greater accessibility to these advanced imaging techniques allows for the integration of these parameters into routine clinical practice.
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Affiliation(s)
- Kalie Y Kebed
- Section of Cardiology, University of Chicago Medicine, The University of Chicago Medical Center, 5758 South Maryland Avenue, MC 9067, DCAM 5502, Chicago, IL 60637, USA
| | - Karima Addetia
- Section of Cardiology, University of Chicago Medicine, The University of Chicago Medical Center, 5758 South Maryland Avenue, MC 9067, DCAM 5504, Chicago, IL 60637, USA
| | - Roberto M Lang
- Noninvasive Cardiac Imaging Laboratories, Section of Cardiology, Heart & Vascular Center, University of Chicago Medicine, The University of Chicago Medical Center, 5758 South Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA.
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Bai Y, Zhao Y, Li J, Zhang Y, Bai R, Du X, Dong JZ, He YH, Ma CS. Association of peak atrial longitudinal strain with atrial fibrillation recurrence in patients with chronic lung diseases following radiofrequency ablation. Intern Med J 2018; 48:851-859. [PMID: 29460463 DOI: 10.1111/imj.13768] [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: 11/23/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Strain was shown associated with atrial fibrillation (AF) recurrence after radiofrequency ablation (RFA), but data on AF patients complicated with chronic lung diseases (CLD) were rare. AIM This study was designed to evaluate the relationship of baseline atrial function with AF recurrence in these patients using speckle-tracking echocardiography. METHODS Average strain values (median: 2 days before RFA) were calculated for 87 AF patients (Mean age: 61.91 years, male: 71.26%) with CLD undergoing RFA from 2013 to 2014. Of these patients, 25 (28.74%) experienced AF recurrence during a mean follow up of 10.3 months. RESULTS Peak right atrial longitudinal strain (R-PALS) was associated with peak left atrial longitudinal strain (L-PALS, Standardised β = 0.45, P < 0.001) in multivariate linear regression. Multivariate Cox regression analysis showed R-PALS was associated with AF recurrence (hazard ratio, 0.86; 95% confidence interval (CI), 0.78-0.96, P = 0.005) in CLD. Patients with R-PALS ≥14.69% had higher AF free rate compared with R-PALS<14.69% using Kaplan-Meier analysis (log-rank, P < 0.001). R-PALS had similar C-index compared to L-PALS (difference: 0.03, 95%CI: -0.06-0.12, P = 0.53) and combined R-PALS and L-PALS (difference: 0.005, 95%CI: -0.04-0.05, P = 0.84) associated with AF recurrence in CLD. CONCLUSION R-PALS, L-PALS and combined R-PALS and L-PALS are important factors associated with AF recurrence following RFA in patients with CLD.
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Affiliation(s)
- Ying Bai
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying Zhao
- Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Li
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yi-Hua He
- Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chang-Sheng Ma
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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Prognostic value of global left atrial peak strain in patients with acute ischemic stroke and no evidence of atrial fibrillation. Int J Cardiovasc Imaging 2018; 35:603-613. [PMID: 30377893 DOI: 10.1007/s10554-018-1485-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/24/2018] [Indexed: 12/18/2022]
Abstract
Prognostic stratification of acute ischemic stroke (AIS) patients without atrial fibrillation (AF) remains a challenge. Two-dimensional speckle tracking echocardiography (2D-STE) has recently been introduced for dynamic evaluation of left atrial function. However only few data are actually available regarding the application of 2D-STE in AIS patients. The aim of our study was to assess the prognostic role of global left atrial peak strain (GLAPS), measured by 2D-STE, in AIS patients without AF history. Eighty-five AIS patients (mean age 74.1 ± 12.1 years, 49 males) with normal sinus rhythm on ECG and without AF history were enrolled in the prospective study. All patients underwent a complete echocardiographic study with 2D-STE. At 1 year follow-up, we evaluated the occurrence of a composite endpoint of all-cause mortality plus cardiovascular re-hospitalizations. GLAPS was markedly reduced in AIS patients (15.71 ± 4.70%), without any statistically significant difference between the stroke subtypes. At 1-year follow-up, 14 deaths and 17 hospital readmissions were detected in AIS subjects. On a multivariate Cox model, variables independently associated with the occurrence of the composite endpoint were the "Rankin in" Scale (HR 1.69, p = 0.001), GFR (HR 0.98, p = 0.03) and the GLAPS value (HR 0.78, p < 0.0001). A GLAPS value ≤ 15.5% predicted the composite endpoint with sensitivity of 100% and specificity of 80%. A GLAPS value ≤ 15.5% reflects a more advanced atrial cardiomyopathy and might provide a reliable and useful prognostic risk stratification of AIS patients without AF history.
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van Grootel RWJ, Strachinaru M, Menting ME, McGhie J, Roos-Hesselink JW, van den Bosch AE. In-depth echocardiographic analysis of left atrial function in healthy adults using speckle tracking echocardiography and volumetric analysis. Echocardiography 2018; 35:1956-1965. [PMID: 30376599 PMCID: PMC6587812 DOI: 10.1111/echo.14174] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 12/21/2022] Open
Abstract
Purpose Left atrial (LA) dilatation is predictive for complications in a multitude of cardiac diseases; therefore, adequate assessment is essential. Technological advances have made it possible to quantify LA function with Speckle Tracking Echocardiography (STE); however, there are currently no recommendations for normal values with regard to LA function. We aimed to assess LA myocardial and volumetric function in a healthy cohort and investigate correlations with baseline characteristics. Methods This prospective cohort study included 147 (aged 20–72) healthy individuals and assessed LA volumetric function using maximum, minimum and pre‐a‐wave volumes and myocardial function using reservoir function using peak strain in LA relaxation (LA‐strain), conduit function using peak strain rate in early LA contraction (LA‐SRe) and pump function using peak strain rate in late LA contraction (LA‐SRa). Results Mean LA‐strain was 39.7 ± 6.2%, LA‐SRe −2.78 ± 0.62 s−1 and LA‐SRa −2.56 ± 0.62 s−1. Subjects were divided into 5 age decades (each 50% female). LA‐strain and LA‐SRe were lower in the oldest groups, whereas LA‐SRa was higher. LA‐SRa was higher in males(−2.69 ± 0.68 s−1 vs −2.42 ± 0.52 s−1). Age‐specific values are provided. Age proved to be an independent predictor for LA‐SRa after correction for blood pressure and heart rate. LA expansion index and passive emptying fraction decreased with age, while active emptying fraction increased with age. LA maximum volume did not increase with age. Conclusion This study provides normal values for the three phasic functions of the LA, assessed with STE and volumetric function. Our results suggest the need for age‐specific reference ranges, and normal values for this cohort have been calculated.
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Affiliation(s)
| | | | | | - Jackie McGhie
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
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de Waal K, Phad N, Boyle A. Left atrium function and deformation in very preterm infants with and without volume load. Echocardiography 2018; 35:1818-1826. [PMID: 30225864 DOI: 10.1111/echo.14140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/12/2018] [Accepted: 08/25/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Left atrium (LA) function can be assessed by volumetric measurements, conventional and tissue Doppler, and more recently, deformation imaging using two-dimensional speckle tracking echocardiography (2DSTE). 2DSTE allows for measurement of volume and deformation and can quantify the contribution of the reservoir, conduit, and contraction phase. A common cause for LA dysfunction in very preterm infants is volume overload with a patent ductus arteriosus (PDA). The aim of this study was to explore the feasibility and reliability of LA 2DSTE in preterm infants, and describe LA function with and without PDA volume load. METHODS We prospectively recruited preterm infants <30 weeks of gestation referred for assessment of a possible PDA. A cardiac ultrasound was performed at day 3 and in week 4 of life and analyzed using conventional techniques and 2DSTE. RESULTS Forty-eight infants (32 with PDA) were included. LA 2DSTE analysis was feasible in 96% of measurements with good reliability of strain and volume parameters. Strain rate was less reliable. Poorer LA contraction and reservoir function was associated with larger LA volume index, higher inflow over the mitral valve at early diastole, higher EA ratio, and higher Ee' ratio. Poorer conduit function was associated with higher Ee' ratio. A larger PDA diameter was found to be an independent contributor to deteriorating LA contraction and reservoir function. CONCLUSION LA 2DSTE analysis is feasible in preterm infants and provides detailed information on atrium mechanics. Further studies are needed to explore the clinical value of these new parameters in this population.
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Affiliation(s)
- Koert de Waal
- Department of Neonatology, John Hunter Children's Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Nilkant Phad
- Department of Neonatology, John Hunter Children's Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Andrew Boyle
- Department of Cardiology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
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Genovese D, Singh A, Volpato V, Kruse E, Weinert L, Yamat M, Mor-Avi V, Addetia K, Lang RM. Load Dependency of Left Atrial Strain in Normal Subjects. J Am Soc Echocardiogr 2018; 31:1221-1228. [PMID: 30205909 DOI: 10.1016/j.echo.2018.07.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Left atrial (LA) longitudinal strain is a novel parameter used for the evaluation of LA function, with demonstrated prognostic value in several cardiac diseases. However, the extent of load dependency of LA strain is not well known. The aim of this study was to evaluate the impact of acute changes in preload on LA strain, side by side with LA volume, in normal subjects. METHODS Twenty-five healthy volunteers (13 men; mean age, 31 ± 2 years) were prospectively enrolled, who underwent two-dimensional and three-dimensional echocardiographic imaging during acute stepwise reductions in preload using a tilt maneuver: baseline at 0°, followed by 40° and 80°. Left ventricular and LA size and function parameters were measured using standard methodology, and LA strain-time curves were obtained using speckle-tracking software (TomTec), resulting in reservoir, conduit, and contractile strain components. All parameters were compared among the three loading conditions using one-way analysis of variance for repeated measurements. RESULTS Although there were no significant changes in blood pressure, heart rate increased significantly with tilt. As expected, LA volumes, left ventricular volumes, and left ventricular ejection fraction, as well as E wave, A wave, and e' significantly decreased with progressive inclination. In parallel, LA reservoir, conduit, and contractile strain values decreased with reduction in preload (reservoir: 42.9 ± 3.9% to 27.5 ± 3.8%, P < .001; conduit: 29.3 ± 2.7% to 20.2 ± 5.0%, P < .001; contractile: 13.6 ± 2.9% to 7.3 ± 3.5%, P < .001). Paired post hoc analysis showed that all LA strain values were significantly different among all three tilt phases. Of note, percentage change in LA reservoir strain was significantly smaller than that in LA maximum volume. CONCLUSIONS In normal subjects, LA strain is preload dependent but to a lesser degree than LA volume. This difference underscores the relative advantage of LA strain over maximum volume, when LA assessment is used as part of the diagnostic paradigm.
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Affiliation(s)
- Davide Genovese
- University of Chicago Medical Center, Chicago, Illinois; Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Amita Singh
- University of Chicago Medical Center, Chicago, Illinois
| | - Valentina Volpato
- University of Chicago Medical Center, Chicago, Illinois; Department of Cardiovascular Sciences, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Eric Kruse
- University of Chicago Medical Center, Chicago, Illinois
| | - Lynn Weinert
- University of Chicago Medical Center, Chicago, Illinois
| | - Megan Yamat
- University of Chicago Medical Center, Chicago, Illinois
| | | | | | - Roberto M Lang
- University of Chicago Medical Center, Chicago, Illinois.
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Sugimoto T, Robinet S, Dulgheru R, Bernard A, Ilardi F, Contu L, Addetia K, Caballero L, Kacharava G, Athanassopoulos GD, Barone D, Baroni M, Cardim N, Hagendorff A, Hristova K, Lopez T, de la Morena G, Popescu BA, Penicka M, Ozyigit T, Rodrigo Carbonero JD, van de Veire N, Von Bardeleben RS, Vinereanu D, Zamorano JL, Go YY, Marchetta S, Nchimi A, Rosca M, Calin A, Moonen M, Cimino S, Magne J, Cosyns B, Galli E, Donal E, Habib G, Esposito R, Galderisi M, Badano LP, Lang RM, Lancellotti P. Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2018; 19:630-638. [PMID: 29529180 DOI: 10.1093/ehjci/jey018] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 10/16/2023] Open
Abstract
AIMS To obtain the normal ranges for echocardiographic measurements of left atrial (LA) function from a large group of healthy volunteers accounting for age and gender. METHODS AND RESULTS A total of 371 (median age 45 years) healthy subjects were enrolled at 22 collaborating institutions collaborating in the Normal Reference Ranges for Echocardiography (NORRE) study of the European Association of Cardiovascular Imaging (EACVI). Left atrial data sets were analysed with a vendor-independent software (VIS) package allowing homogeneous measurements irrespective of the echocardiographic equipment used to acquire data sets. The lowest expected values of LA function were 26.1%, 48.7%, and 41.4% for left atrial strain (LAS), 2D left atrial emptying fraction (LAEF), and 3D LAEF (reservoir function); 7.7%, 24.2%, and -0.53/s for LAS-active, LAEF-active, and LA strain rate during LA contraction (SRa) (pump function) and 12.0% and 21.6% for LAS-passive and LAEF-passive (conduit function). Left atrial reservoir and conduit function were decreased with age while pump function was increased. All indices of reservoir function and all LA strains had no difference in both gender and vendor. However, inter-vendor differences were observed in LA SRa despite the use of VIS. CONCLUSION The NORRE study provides contemporary, applicable echocardiographic reference ranges for LA function. Our data highlight the importance of age-specific reference values for LA functions.
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Affiliation(s)
- Tadafumi Sugimoto
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Sébastien Robinet
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Raluca Dulgheru
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Anne Bernard
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
- Cardiology Department, CHU Tours, France et Université de Tours, 2 Boulevard Tonnellé, 37000 Tours, France
| | - Federica Ilardi
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Laura Contu
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Karima Addetia
- Department of Medicine University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, 60637 IL, USA
| | - Luis Caballero
- Unidad de Imagen Cardiaca, Servicio de Cardiologia, Hospital Clinico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - George Kacharava
- Echocardiography Laboratory of Adult Cardiology Department of the JO ANN Medical Center, 21 Lubliana str. 0159, Tbilisi, Georgia
| | - George D Athanassopoulos
- Noninvasive Diagnostics Department, Onassis Cardiac Surgery Center, Leof. Andrea Siggrou 356, 176 74 Kallithea, Athens, Greece
| | - Daniele Barone
- Laboratory of Cardiovascular Ecography, Cardiology Department, S. Andrea Hospital, Via Vittorio Veneto, 197, 19121 La Spezia SP, Italy
| | - Monica Baroni
- Laboratorio Di Ecocardiografia Adulti, Fondazione Toscana 'G.Monasterio'-Ospedale Del Cuore, Via Giuseppe Moruzzi, 1, 56124 Pisa PI, Massa, Italy
| | - Nuno Cardim
- Echocardiography Laboratory, Hospital da Luz, Av. Lusíada 100, 1500-650 Lisboa, Portugal
| | - Andreas Hagendorff
- Department of Cardiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Krasimira Hristova
- Department of Noninvasive Functional Diagnostic and Imaging, University National Heart Hospital, ul. "Konyovitsa" 65, 1309 g.k. Ilinden, Sofia, Bulgaria
| | - Teresa Lopez
- Cardiology Department, La Paz Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Gonzalo de la Morena
- Unidad de Imagen Cardiaca, Servicio de Cardiologia, Hospital Clinico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Bogdan A Popescu
- University of Medicine and Pharmacy 'Carol Davila', Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sector 1, Strada Dionisie Lupu 37, 030167 Bucuresti, Romania
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan 164, 9300 Aalst, Belgium
| | - Tolga Ozyigit
- VKV Amerikan Hastanesi, Kardiyoloji Bölümü, Tesvikiye, Güzelbahçe Sk. No:20, 34365 Sisli/Istanbul, Turkey
| | | | - Nico van de Veire
- Echocardiography Unit, AZ Maria Middelares Gent, Buitenring-Sint-Denijs 30, 9000 Gent, Belgium
| | - Ralph Stephan Von Bardeleben
- Medical Department Cardiology, Universitätsmedizin of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Dragos Vinereanu
- Cardiovascular Research Unit, University and Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Sector 1, Strada Dionisie Lupu 37, 030167 Bucuresti, Romania
| | - Jose Luis Zamorano
- University Alcala, Hospital Ramón y Cajal, Ctra. De Colmenar Viejo, km. 9, 100, 28034 Madrid, Spain
| | - Yun Yun Go
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Stella Marchetta
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Alain Nchimi
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Monica Rosca
- University of Medicine and Pharmacy 'Carol Davila', Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sector 1, Strada Dionisie Lupu 37, 030167 Bucuresti, Romania
| | - Andreea Calin
- University of Medicine and Pharmacy 'Carol Davila', Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sector 1, Strada Dionisie Lupu 37, 030167 Bucuresti, Romania
| | - Marie Moonen
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Sara Cimino
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Julien Magne
- CHU Dupuytren, 2 Avenue Martin Luther King, 87000 Limoges, France
| | - Bernard Cosyns
- CHVZ (Centrum voor Hart en Vaatziekten), Universitair ziekenhuis Brussel and ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Avenue du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - Elena Galli
- CIC-IT U 1414, CHU Rennes, Université Rennes 1, Service de Cardiologie, CHU Rennes, 2 Rue Henri le Guilloux, 35000 Rennes, France
| | - Erwan Donal
- CIC-IT U 1414, CHU Rennes, Université Rennes 1, Service de Cardiologie, CHU Rennes, 2 Rue Henri le Guilloux, 35000 Rennes, France
| | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Marseille France
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S.Pansini, 5, 80131 Napoli NA, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S.Pansini, 5, 80131 Napoli NA, Italy
| | - Luigi P Badano
- Department of Cardiac, Thoracic and Vascular Sciences University of Padova, School of Medicine, Via 8 Febbraio 1848, 2, 35122 Padova PD, Italy
| | - Roberto M Lang
- Department of Medicine University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, 60637 IL, USA
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Via Camillo Rosalba, 35, 70124 Bari BA, Italy
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D’Andrea A, Radmilovic J, Caselli S, Carbone A, Scarafile R, Sperlongano S, Tocci G, Formisano T, Martone F, Liccardo B, D’Alto M, Bossone E, Galderisi M, Golino P. Left atrial myocardial dysfunction after chronic abuse of anabolic androgenic steroids: a speckle tracking echocardiography analysis. Int J Cardiovasc Imaging 2018; 34:1549-1559. [DOI: 10.1007/s10554-018-1370-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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49
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Atrial Enlargement in the Athlete's Heart: Assessment of Atrial Function May Help Distinguish Adaptive from Pathologic Remodeling. J Am Soc Echocardiogr 2018; 31:148-157. [DOI: 10.1016/j.echo.2017.11.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Indexed: 01/26/2023]
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Ghelani SJ, Brown DW, Kuebler JD, Perrin D, Shakti D, Williams DN, Marx GR, Colan SD, Geva T, Harrild DM. Left Atrial Volumes and Strain in Healthy Children Measured by Three-Dimensional Echocardiography: Normal Values and Maturational Changes. J Am Soc Echocardiogr 2018; 31:187-193.e1. [DOI: 10.1016/j.echo.2017.10.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Indexed: 01/20/2023]
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