1
|
Duggal NM, Engoren M, Chadderdon SM, Rodriguez E, Morse MA, Vannan MA, Yadav PK, Morcos M, Li F, Reisman M, Garcia-Sayan E, Raghunathan D, Sodhi N, Sorajja P, Chen L, Rogers JH, Calfon MA, Kovach CP, Gill EA, Zahr FE, Chetcuti SJ, Yuan Y, Mentz GB, Lim DS, Ailawadi G. Mortality Associated With Proportionality of Secondary Mitral Regurgitation After Transcatheter Mitral Valve Repair: North American Mitraclip for Functional Mitral Regurgitation Registry. Am J Cardiol 2024; 213:99-105. [PMID: 38110022 DOI: 10.1016/j.amjcard.2023.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/17/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023]
Abstract
The association, if any, between the effective regurgitant orifice area (EROA) to left ventricular end-diastolic volume (LVEDV) ratio and 1-year mortality is controversial in patients who undergo mitral transcatheter edge-to-edge repair (m-TEER) with the MitraClip system (Abbott Vascular, Santa Clara, CA). This study's objective was to determine the association between EROA/LVEDV and 1-year mortality in patients who undergo m-TEER with MitraClip. In patients with severe secondary (functional) mitral regurgitation (MR), we analyzed registry data from 11 centers using generalized linear models with the generalized estimating equations approach. We studied 525 patients with secondary MR who underwent m-TEER. Most patients were male (63%) and were New York Heart Association class III (61%) or IV (21%). Mitral regurgitation was caused by ischemic cardiomyopathy in 51% of patients. EROA/LVEDV values varied widely, with median = 0.19 mm2/ml, interquartile range [0.12,0.28] mm2/ml, and 187 patients (36%) had values <0.15 mm2/ml. Postprocedural mitral regurgitation severity was substantially alleviated, being 1+ or less in 74%, 2+ in 20%, 3+ in 4%, and 4+ in 2%; 1-year mortality was 22%. After adjustment for confounders, the logarithmic transformation (Ln) of EROA/LVEDV was associated with 1-year mortality (odds ratio 0.600, 95% confidence interval 0.386 to 0.933, p = 0.023). A higher Society of Thoracic Surgeons risk score was also associated with increased mortality. In conclusion, lower values of Ln(EROA/LVEDV) were associated with increased 1-year mortality in this multicenter registry. The slope of the association is steep at low values but gradually flattens as Ln(EROA/LVEDV) increases.
Collapse
Affiliation(s)
- Neal M Duggal
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
| | - Milo Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Scott M Chadderdon
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Evelio Rodriguez
- Department of Cardiothoracic Surgery, Ascension Saint Thomas Heart, Nashville, Tennessee
| | - M Andrew Morse
- Division of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee
| | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Pradeep K Yadav
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Michael Morcos
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Flora Li
- Department of Anesthesiology, University of Washington, Seattle, Washington
| | - Mark Reisman
- Division of Cardiology, Weill Cornell Medical Center, New York, New York
| | - Enrique Garcia-Sayan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Deepa Raghunathan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Nishtha Sodhi
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute, Abbott Northwestern Medical Center, Minneapolis, Minnesota
| | - Lily Chen
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California
| | - Marcella A Calfon
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
| | | | - Edward A Gill
- Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Firas E Zahr
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Stanley J Chetcuti
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Yuan Yuan
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Graciela B Mentz
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - D Scott Lim
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
2
|
Genovese D, De Michieli L, Prete G, De Lazzari M, Previtero M, Mele D, Cernetti C, Tarantini G, Iliceto S, Perazzolo Marra M. Left atrial expansion index measured with cardiovascular magnetic resonance estimates pulmonary capillary wedge pressure in dilated cardiomyopathy. J Cardiovasc Magn Reson 2023; 25:71. [PMID: 38031092 PMCID: PMC10688459 DOI: 10.1186/s12968-023-00977-2] [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: 07/10/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Pulmonary capillary wedge pressure (PCWP) assessment is fundamental for managing dilated cardiomyopathy (DCM) patients. Although cardiovascular magnetic resonance (CMR) has become the gold-standard imaging technique for evaluating cardiac chamber volume and function, PCWP is not routinely assessed with CMR. Therefore, this study aimed to validate the left atrial expansion index (LAEI), a LA reservoir function parameter able to estimate filling pressure with echocardiography, as a novel CMR-measured parameter for non-invasive PCWP estimation in DCM patients. METHODS We performed a retrospective, single-center, cross-sectional study. We included electively admitted DCM patients referred to our tertiary center for further diagnostic evaluation that underwent a clinically indicated right heart catheterization (RHC) and CMR within 24 h. PCWP invasively measured during RHC was used as the reference. LAEI was calculated from CMR-measured LA maximal and minimal volumes as LAEI = ( (LAVmax-LAVmin)/LAVmin) × 100. RESULTS We enrolled 126 patients (47 ± 14 years; 68% male; PCWP = 17 ± 9.3 mmHg) randomly divided into derivation (n = 92) and validation (n = 34) cohorts with comparable characteristics. In the derivation cohort, the log-transformed (ln) LAEI showed a strong linear correlation with PCWP (r = 0.81, p < 0.001) and remained a strong independent PCWP determinant over clinical and conventional CMR parameters. Moreover, lnLAEI accurately identified PCWP ≥ 15 mmHg (AUC = 0.939, p < 0.001), and the optimal cut-off identified (lnLAEI ≤ 3.85) in the derivation cohort discriminated PCWP ≥ 15 mmHg with 82.4% sensitivity, 88.2% specificity, and 85.3% accuracy in the validation cohort. Finally, the equation PCWP = 52.33- (9.17xlnLAEI) obtained from the derivation cohort predicted PCWP (-0.1 ± 5.7 mmHg) in the validation cohort. CONCLUSIONS In this cohort of DCM patients, CMR-measured LAEI resulted in a novel and useful parameter for non-invasive PCWP evaluation.
Collapse
Affiliation(s)
- Davide Genovese
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy.
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy.
| | - Laura De Michieli
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giacomo Prete
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Manuel De Lazzari
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Marco Previtero
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Donato Mele
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Carlo Cernetti
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| |
Collapse
|
3
|
Kaimori R, Iwakawa H, Suzuki N, Aokawa M, Tashiro H, Terata K, Watanabe H. Asymmetric remodeling between the left and right atria in patients with advanced interatrial block and atrial fibrillation. J Electrocardiol 2023; 80:63-68. [PMID: 37257248 DOI: 10.1016/j.jelectrocard.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/01/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Advanced interatrial block (A-IAB) on electrocardiography (ECG) represents the conduction delay between the left and right atria. We investigated the association of A-IAB with left and right atrial (LA/RA) remodeling in patients with atrial fibrillation (AF). METHODS We enrolled 74 patients who underwent ECG, cardiac computed tomography (CCT), and echocardiography during sinus rhythm before catheter ablation of AF. A-IAB was defined as P-wave duration ≥120 ms with a biphasic morphology in leads III and aVF or notched morphology in lead II. We compared the maximum and minimum LA/RA volume indices (max and min LAV/RAVI), LA/RA expansion index (LAEI/RAEI), and total, passive, and active LA/RA emptying fraction (LAEF/RAEF) between patients with and without A-IAB. RESULTS Of the 74 patients (mean age, 64.3 ± 9.6 years), 35 (47%) showed A-IAB. Patients with A-IAB had a significantly higher likelihood of hypertension and left ventricular diastolic dysfunction than those without. Patients with A-IAB had significantly larger max (69.2 [60.7-79.7]mL/m2 vs. 60.9 [50.4-68.3]mL/m2, P < 0.01) and min (44.0 [37.2-52.1]mL/m2 vs. 34.1 [29.2-43.5]mL/m2, P < 0.01) LAVI than those without. The max and min RAVI were not significantly different between groups. LAEI (55.1 [48.2-78.5]% vs. 72.1 [57.8-84.8]%, P < 0.05), total LAEF (35.5 [32.5-44.0]% vs. 41.9 [36.6-45.9]%, P < 0.05), and passive LAEF (12.2 [10.0-14.4]% vs. 15.5 [11.2-19.6]%, P < 0.05) were significantly lower in patients with A-IAB than without. CONCLUSIONS A-IAB was associated with LA, but not RA enlargement, in patients with AF. A-IAB may indicate LA functional remodeling in the reservoir and conduit phases.
Collapse
Affiliation(s)
- Ryota Kaimori
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Hidehiro Iwakawa
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Nobuhiro Suzuki
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Mako Aokawa
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Haruwo Tashiro
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Ken Terata
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan.
| |
Collapse
|
4
|
Hsiao CS, Hsiao SH, Chiou FR, Chiou KR. Early predicting improvement of severe systolic heart failure by left atrial volume. Heart Vessels 2023; 38:523-534. [PMID: 36409354 DOI: 10.1007/s00380-022-02199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
Abstract
Left atrium (LA) modulates left ventricle (LV) filling and cardiac performance. We aimed to assess the effect of heart failure (HF) therapy on LA and LV function, and the relationship between LA/LV improvement and clinical outcome in acute HF with reduced LV ejection fraction (LVEF). Totally, 224 hospitalized patients with acute HF and LVEF < 35% were enrolled and underwent echocardiography. They all received maximal tolerable doses of evidence-based medications. Patients received echocardiographic measurements at each visit including stroke volume, LVEF, LA minimal/maximal volume (LAVmin/LAVmax), LA expansion index, and tissue Doppler parameters. The threshold of LV functional improvement was LVEF > 45% ever occurred before study end. During the mean follow-up of 6.3 years, 62 cases improved well, mean LVEF 49 ± 5% at study end. The reduction of LV filling pressure occurring as early as 2 weeks later, LV systolic function improvement took longer (> 1 month). The reductions in LAVmin and LAVmax between initial stabilization and 2 weeks after HF treatment (Initial-2 W) and the increase of LA expansion index (Initial-2 W) were associated independently with LVEF improvement (p 0.002, 0.006, and 0.007, respectively). The best predictor of LVEF improvement was LAVmin reduction (Initial-2 W) > 5 ml with 77% sensitivity, 76% specificity. Cox proportional hazard regression analyses for cardiovascular events revealed LVEF improvement reduced 74% of events (hazard ratio 0.264, 95% CI 0.192-0.607, p < 0.0001); and LA expansion index (per 1% increase) reduced 14% of events (hazard ratio 0.862, 95% CI 0.771-0.959, p < 0.0001). The early reduction of LAV (Initial-2 W), especially LAVmin, is a powerful early predictor of LVEF improvement. Its occurrence reduces cardiovascular events significantly. ClinicalTrials.gov number: NCT01307722.
Collapse
Affiliation(s)
- Chao-Sheng Hsiao
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,Department of Internal Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shih-Hung Hsiao
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Fei-Ran Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuan-Rau Chiou
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. .,School of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
5
|
Genovese D, Previtero M, Prete G, Carrer A, De Michieli L, Badano LP, Muraru D, Cernetti C, Mele D, Tarantini G, Iliceto S, Perazzolo Marra M. Non-invasive evaluation of pulmonary capillary wedge pressure using the left atrial expansion index in mitral valve stenosis, prosthesis and repair. Int J Cardiovasc Imaging 2023; 39:967-975. [PMID: 36763208 DOI: 10.1007/s10554-023-02807-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
Pulmonary capillary wedge pressure (PCWP) non-invasive evaluation is limited in patients with mitral valve (MV) stenosis, prosthesis, and surgical repair. This study aimed to assess the left atrial expansion index (LAEI) measured through transthoracic echocardiography (TTE) as a novel parameter for estimating PCWP in these challenging cardiac conditions. We performed a retrospective, cross-sectional study, including chronic cardiac patients receiving within 24 h a clinically indicated right heart catheterization (RHC) and transthoracic echocardiographic (TTE) exam. PCWP measured during RHC was used as the reference. TTE measurements were performed offline, blinded to RHC results. LAEI was calculated as LAEI = [(LAmaxVolume-LAminVolume)/LAminVolume] × 100. We included 167 patients (age = 73 ± 11.5 years; PCWP = 18 ± 7.7 mmHg) with rheumatic mitral valve (MV) stenosis (16.2%), degenerative MV stenosis (51.2%), MV prosthesis (18.0%), and MV surgical repair (13.8%). LAEI correlated logarithmically with PCWP, and the log-transformed LAEI (lnLAEI) showed a good linear association with PCWP (r = - 0.616; p < 0.001). lnLAEI was an independent PCWP determinant, providing added predictive value over conventional clinical (age, atrial fibrillation, heart rate, MV subgroups) and echocardiographic variables (LVEF, MV effective orifice area, MV mean gradient, net atrioventricular compliance, and pulmonary arterial systolic pressure). lnLAEI identified PCWP > 12 mmHg with AUC = 0.870, p < 0.001; and PCWP > 15 mmHg with AUC = 0.797, p < 0.001, with an optimal cut-off of lnLAEI < 3.69. The derived equation PCWP = 36.8-5.5xlnLAEI estimated the invasively measured PCWP ± 6.1 mmHg. In this cohort of patients with MV stenosis, prosthesis, and surgical repair, lnLAEI resulted in a helpful echocardiographic parameter for PCWP estimation.
Collapse
Affiliation(s)
- Davide Genovese
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy.
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy.
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera di Padova, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Marco Previtero
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Giacomo Prete
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Anna Carrer
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Laura De Michieli
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Luigi Paolo Badano
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Denisa Muraru
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Carlo Cernetti
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Donato Mele
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| |
Collapse
|
6
|
Gosling R, Swift AJ, Garg P. Cardiovascular magnetic resonance can improve the precision for left ventricular filling pressure assessment. Eur Heart J 2023; 44:427-428. [PMID: 36515072 DOI: 10.1093/eurheartj/ehac740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Rebecca Gosling
- The Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, 18 Claremont Crescent, C Floor, Polaris, Sheffield S10 2TA, UK
| | - Andrew J Swift
- The Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, 18 Claremont Crescent, C Floor, Polaris, Sheffield S10 2TA, UK
| | - Pankaj Garg
- The Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, 18 Claremont Crescent, C Floor, Polaris, Sheffield S10 2TA, UK
- Norwich Medical School, The University of East Anglia, Bob Champion Research Education Building, Rosalind Franklin Road, Norwich NR4 7UQ, UK
| |
Collapse
|
7
|
Pathan S, Negishi K, Pathan F. Elevated Filling Pressures: Identifying Patients With the Use of Atrial Expansion Index and Atrial Strain. JACC. CARDIOVASCULAR IMAGING 2022; 15:2014-2015. [PMID: 36357145 DOI: 10.1016/j.jcmg.2022.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/24/2022] [Accepted: 07/28/2022] [Indexed: 11/09/2022]
|
8
|
Kitai T, Pak M. Reply: Elevated Filling Pressures: Identifying Patients With the Use of Atrial Expansion Index and Atrial Strain. JACC Cardiovasc Imaging 2022; 15:2015-2016. [PMID: 36357146 DOI: 10.1016/j.jcmg.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/09/2022]
|
9
|
Bowcock EM, Mclean A. Bedside assessment of left atrial pressure in critical care: a multifaceted gem. Crit Care 2022; 26:247. [PMID: 35964098 PMCID: PMC9375940 DOI: 10.1186/s13054-022-04115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/31/2022] [Indexed: 11/23/2022] Open
Abstract
Evaluating left atrial pressure (LAP) solely from the left ventricular preload perspective is a restrained approach. Accurate assessment of LAP is particularly relevant when pulmonary congestion and/or right heart dysfunction are present since it is the pressure most closely related to pulmonary venous pressure and thus pulmonary haemodynamic load. Amalgamation of LAP measurement into assessment of the ‘transpulmonary circuit’ may have a particular role in differentiating cardiac failure phenotypes in critical care. Most of the literature in this area involves cardiology patients, and gaps of knowledge in application to the bedside of the critically ill patient remain significant. Explored in this review is an overview of left atrial physiology, invasive and non-invasive methods of LAP measurement and their potential clinical application.
Collapse
|
10
|
Wen S, Pislaru SV, Lin G, Scott CG, Lee AT, Asirvatham SJ, Pellikka PA, Kane GC, Pislaru C. Association of Post-procedural Left Atrial Volume and Reservoir Function with Outcomes in Patients with Atrial Fibrillation Undergoing Catheter Ablation. J Am Soc Echocardiogr 2022; 35:818-828.e3. [DOI: 10.1016/j.echo.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/04/2022] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
|
11
|
Bandera F, Mollo A, Frigelli M, Guglielmi G, Ventrella N, Pastore MC, Cameli M, Guazzi M. Cardiac Imaging for the Assessment of Left Atrial Mechanics Across Heart Failure Stages. Front Cardiovasc Med 2022; 8:750139. [PMID: 35096989 PMCID: PMC8792604 DOI: 10.3389/fcvm.2021.750139] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/14/2021] [Indexed: 12/26/2022] Open
Abstract
The left atrium (LA) is emerging as a key element in the pathophysiology of several cardiac diseases due to having an active role in contrasting heart failure (HF) progression. Its morphological and functional remodeling occurs progressively according to pressure or volume overload generated by the underlying disease, and its ability of adaptation contributes to avoid pulmonary circulation congestion and to postpone HF symptoms. Moreover, early signs of LA dysfunction can anticipate and predict the clinical course of HF diseases before the symptom onset which, particularly, also applies to patients with increased risk of HF with still normal cardiac structure (stage A HF). The study of LA mechanics (chamber morphology and function) is moving from a research interest to a clinical application thanks to a great clinical, prognostic, and pathophysiological significance. This process is promoted by the technological progress of cardiac imaging which increases the availability of easy-to-use tools for clinicians and HF specialists. Two-dimensional (2D) speckle tracking echocardiography and feature tracking cardiac magnetic resonance are becoming essential for daily practice. In this context, a deep understanding of LA mechanics, its prognostic significance, and the available approaches are essential to improve clinical practice. The present review will focus on LA mechanics, discussing atrial physiology and pathophysiology of main cardiac diseases across the HF stages with specific attention to the prognostic significance. Imaging techniques for LA mechanics assessment will be discussed with an overlook on the dynamic (under stress) evaluation of the chamber.
Collapse
Affiliation(s)
- Francesco Bandera
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Anita Mollo
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Matteo Frigelli
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Giulia Guglielmi
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Nicoletta Ventrella
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Marco Guazzi
- Department of Biological Sciences, University of Milano, Milan, Italy
- Cardiology Division, San Paolo Hospital, Milan, Italy
| |
Collapse
|