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Qi F, Yang L, Chang G, Wang X, Tao G, Xiao H. Comprehensive mendelian randomization reveals atrial fibrillation-breast cancer relationship and explores common druggable targets. Front Pharmacol 2024; 15:1435545. [PMID: 39170695 PMCID: PMC11335625 DOI: 10.3389/fphar.2024.1435545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/26/2024] [Indexed: 08/23/2024] Open
Abstract
Background Atrial fibrillation (AF) and breast cancer pose significant risks to human health. The reasons behind the concurrent occurrence of AF and breast cancer remain unclear, leading to complex treatment approaches. Mendelian Randomization (MR) analyses aim to offer genetic evidence supporting the causation of AF and breast cancer and to investigate common druggable genes associated with both conditions. Methods We used two-samples of MR to sequentially explore the causal relationship between atrial fibrillation and breast cancer, and between atrial fibrillation and breast cancer therapeutic drugs, and verified the stability of the results through colocalization analysis. We utilized the Connectivity map database to infer the direction of drug effects on disease. Finally, we explored druggable genes that play a role in AF and breast cancer and performed a Phenome-wide MR analysis to analyze the potential side effects of drug targets. Results We found 15 breast cancer therapeutic drugs that significantly support a causal association between AF and breast cancer through expression in blood and/or atrial appendage tissue. Among these, activation of ANXA5 by Docetaxel, inhibition of EIF5A by Fulvestrant, and inhibition of GNA12 by Tamoxifen increased the risk of AF, while inhibition of ANXA5 by Gemcitabine and Vinorebine and inhibition of PCGF6 by Paclitaxel reduced the risk of AF. Inhibition of MSH6 and SF3B1 by Cyclophosphamide, as well as inhibition of SMAD4 and PSMD2 and activation of ASAH1 and MLST8 by Doxorubicin can have bidirectional effects on AF occurrence. XBP1 can be used as a common druggable gene for AF and breast cancer, and there are no potential side effects of treatment against this target. Conclusion This study did not find a direct disease causality between AF and breast cancer but identified 40 target genes for 15 breast cancer therapeutic drugs associated with AF, clarified the direction of action of 8 breast cancer therapeutic drugs on AF, and finally identified one common druggable target for AF and breast cancer.
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Affiliation(s)
- Fenglin Qi
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lunzhe Yang
- Department of Neurosurgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guanglei Chang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangbin Wang
- School of Life Sciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou, China
| | - Guanghong Tao
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Xiao
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Lee JM, Cha MJ, Nam GB, Choi KJ, Sun BJ, Kim DH, Song JM, Kang DH, Song JK, Cho MS. Incidence and predictors of left atrial thrombus in patients with atrial fibrillation under anticoagulation therapy. Clin Res Cardiol 2024; 113:1242-1250. [PMID: 38446148 DOI: 10.1007/s00392-024-02422-5] [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: 12/22/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Left atrial thrombus (LAT) formation is associated with thromboembolic events. OBJECTIVE To investigate the incidence and associated factors of LAT in patients with atrial fibrillation (AF) who had been receiving anticoagulation therapy for more than 4 weeks, and to develop a prediction model using clinical and echocardiographic features. METHODS Medical records of 1,122 patients with AF (mean age, 59.4 ± 11.0 years, 58.3% male) who were on anticoagulation more than 4 weeks and underwent transesophageal echocardiography (TEE) were evaluated. The main outcome was the presence of LAT on TEE. RESULTS Warfarin and non-vitamin K oral anticoagulants were used in 74.4% and 25.6% of the patients at the time of examination, respectively. LAT was present in 60 patients (5.3%). Presence of LAT on TEE was associated with age ≥ 75 years (odds ratio [OR] 2.13 [95% confidence interval, 0.94-4.58]), persistent/permanent AF (OR 2.61 [1.42-4.93]), CHA2DS2-VASc score ≥ 3 points (OR 1.91 [1.05-3.48]), left ventricular ejection fraction < 40% (OR 2.35 [1.07-4.81]), and severe left atrial enlargement (OR 3.52 [1.89-6.79]). The presence of moderate-to-severe mitral regurgitation was associated with a lower risk of LAT (OR 0.13 [0.04-0.34]). A scoring system composed of the aforementioned predictors showed excellent discrimination performance (area under the curve 0.791 [95% CI, 0.727-0.854]). CONCLUSIONS LAT was present in a considerable number of patients who were already receiving anticoagulation therapy. A prediction model that combines clinical and echocardiographic predictors could be useful in distinguishing patients who require imaging evaluations before left atrial intervention.
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Affiliation(s)
- Joong Min Lee
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Myung-Jin Cha
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Gi-Byoung Nam
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Kee-Joon Choi
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Byung Joo Sun
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Dae-Hee Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Jong-Min Song
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Duk-Hyun Kang
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Jae-Kwan Song
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Min Soo Cho
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea.
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Wang W, Reyes JL, Oyenuga A, Eaton AA, Norby FL, Parikh R, Inciardi RM, Alonso A, Lutsey PL, Herzog CA, Ishigami J, Matsushita K, Coresh J, Shah AM, Solomon SD, Chen LY. Association of Left Atrial Function With Incident Chronic Kidney Disease in Older Adults. Mayo Clin Proc Innov Qual Outcomes 2024; 8:343-355. [PMID: 38974529 PMCID: PMC11225621 DOI: 10.1016/j.mayocpiqo.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Objective To examine the association of left atrial (LA) function with incident chronic kidney disease (CKD) and assess the clinical utility of adding LA function to a CKD risk prediction equation. Patients and Methods We included 4002 Atherosclerosis Risk in Communities study participants without prevalent CKD (mean ± SD age, 75±5 years; 58% female, 18% Black). Left atrial function (reservoir, conduit, and contractile strain) was evaluated by 2D-echocardiograms on 2011 to 2013. Chronic kidney disease was defined as greater than 25% decline in estimated glomerular filtration rate of less than 60 mL/min/1.73 m2, end-stage kidney disease, or hospital records. Cox proportional hazards models were used. Risk prediction and decision curve analyses evaluated 5-year CKD risk by diabetes status. Results Median follow-up was 7.2 years, and 598 participants developed incident CKD. Incidence rate for CKD was 2.29 per 100 person-years. After multivariable adjustments, the lowest quintile of LA reservoir, conduit, and contractile strain (vs highest quintile) had a higher risk of CKD (hazard ratios [95% CIs]: 1.94 [1.42-2.64], 1.62 [1.19-2.20], and 1.49 [1.12-1.99]). Adding LA reservoir strain to the CKD risk prediction equation variables increased the C-index by 0.026 (95% CI: 0.005-0.051) and 0.031 (95% CI: 0.006-0.058) in participants without and with diabetes, respectively. Decision curve analysis found the model with LA reservoir strain had a higher net benefit than the model with CKD risk prediction equation variables alone. Conclusion Lower LA function is independently associated with incident CKD. Adding LA function to the CKD risk prediction enhances prediction and yields a higher clinical net benefit. These findings suggest that impaired LA function may be a novel risk factor for CKD.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Jorge L. Reyes
- Lillehei Heart Institute and Department of Medicine (Cardiovascular Division), University of Minnesota Medical School, Minneapolis
| | - Abayomi Oyenuga
- Lillehei Heart Institute and Department of Medicine (Cardiovascular Division), University of Minnesota Medical School, Minneapolis
| | - Anne A. Eaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis
| | - Faye L. Norby
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Romil Parikh
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Riccardo M. Inciardi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Charles A. Herzog
- Department of Medicine and Chronic Disease Research Group, Hennepin Healthcare, University of Minnesota, Minneapolis
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amil M. Shah
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Scott D. Solomon
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Lin Yee Chen
- Lillehei Heart Institute and Department of Medicine (Cardiovascular Division), University of Minnesota Medical School, Minneapolis
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Naser JA, Harada T, Tada A, Doi S, Tsaban G, Pislaru SV, Nkomo VT, Scott CG, Kennedy AM, Eleid MF, Reddy YNV, Lin G, Pellikka PA, Borlaug BA. Prevalence, Incidence, and Outcomes of Diastolic Dysfunction in Isolated Tricuspid Regurgitation: Perhaps Not Really "Isolated"? JACC Cardiovasc Imaging 2024:S1936-878X(24)00231-6. [PMID: 39066743 DOI: 10.1016/j.jcmg.2024.05.019] [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: 10/19/2023] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND In the absence of left-sided cardiac/pulmonary disease, functional tricuspid regurgitation (FTR) is referred to as isolated or idiopathic. Relationships between left ventricular diastolic dysfunction (DD) and FTR remain unknown. OBJECTIVES The purpose of this study was to investigate the prevalence, incidence, and outcome of DD in patients with idiopathic FTR. METHODS Adults without structural heart disease were identified. Severe DD was defined by ≥3 of 4 abnormal DD parameters (medial e', medial E/e', TR velocity, left atrial volume index) and ≥ moderate DD by ≥2. Propensity-score matching was performed (3:1) between each less-than-severe TR group and severe TR based on age, sex, body mass index, and comorbidities. RESULTS Among 30,428 patients, FTR was absent in 73%, mild in 22%, moderate in 4%, and severe in 0.4%. In the propensity-matched sample, severe DD was present in 2%, 6%, 9%, and 13% patients, and ≥ moderate DD in 11%, 18%, 28%, and 48%, respectively (P < 0.001). The probability of heart failure with preserved ejection fraction using the H2FPEF score increased with increasing FTR (median 29.7%, 45.5%, 61.4%, and 88.7%, respectively), as did the prevalence of impaired left atrial strain <24% (35%, 48%, and 69% in mild, moderate, and severe TR). Incident severe and ≥ moderate DD developed more frequently with increasing FTR (HR: 8.45 [95% CI: 2.60-27.50] and HR: 2.82 [95% CI: 1.40-5.69], respectively for ≥ moderate vs no FTR) over a median of 3.0 years. Findings were confirmed in patients without lung disease or right ventricular enlargement. Over a median of 5.0 years, patients with ≥ moderate FTR and DD had the greatest risk of worse outcomes (multivariable P < 0.001). The association between TR and adverse outcomes was significantly diminished in the absence of DD. CONCLUSIONS Diastolic dysfunction, increased heart failure with preserved ejection fraction probability, and impaired left atrial strain are commonly present in patients with idiopathic FTR, suggesting that the latter may not be truly isolated. Patients with FTR without DD or heart failure are at increased risk of incident DD. Patients with FTR and DD display worse outcomes.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tomonari Harada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Atsushi Tada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shunichi Doi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gal Tsaban
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher G Scott
- Department of Quantitative Health Sciences and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Austin M Kennedy
- Department of Quantitative Health Sciences and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Ji L, Gao X, Xiao W, Yu S. Assessment of left atrial function provides incremental value: the left atrial volumetric/mechanical coupling index in patients with chronic kidney disease. Front Cardiovasc Med 2024; 11:1407531. [PMID: 39045007 PMCID: PMC11265283 DOI: 10.3389/fcvm.2024.1407531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/14/2024] [Indexed: 07/25/2024] Open
Abstract
Background Heart failure is a common cause of adverse cardiovascular outcomes in patients with chronic kidney disease (CKD). Left atrial (LA) characteristics are thought to be involved in the development of heart failure. However, LA assessment is complex. Though a variety of parameters have been defined, there is no single parameter that best defines LA function. Pilot data indicate that left atrial volumetric/mechanical coupling index (LACI) may be useful, but data with CKD are lacking. Aim The objective of this study was to define LACI in a cohort of patients with CKD and to assess its value in evaluating LA function and predicting heart failure. Methods A cohort of patients with CKD was enrolled at our hospital between 2021 and 2023. Follow-up was performed for heart failure. LACI is a volumetric to mechanical coupling index, calculated as the ratio of the LA volume index to the tissue-Doppler myocardial velocity at atrial contraction. Spearman's rank correlation or Pearson's correlation was used to calculate the correlation between LACI and echocardiographic/hemodynamic variables. Receiver operating characteristic curve (ROC) analysis was utilised to derive the area under the curve (AUC) for LACI, LVGLS, LASr, LASct and LASI for the detection of heart failure. Kaplan-Meier survival curves were employed to compare clinical outcomes based on LACI thresholds. A multivariable logistic regression analysis was employed to assess the relationship between risk factors and elevated LACI. Cox proportional hazards regression was used to identify risk factors for heart failure. Results LACI showed a positive correlation with NT-proBNP, CK-MB, LAVI, E/e' and LASI (r = 0.504, 0.536, 0.856, 0.541 and 0.509, p < 0.001); and a negative correlation with LASr (r = -0.509, p < 0.001). On the ROC analysis for the determination of heart failure, the AUC of LACI was comparable to those of LVGLS (0.588 vs. 509, p = 0.464), LASr (0.588 vs. 0.448, p = 0.132), LASct (0.588 vs. 0.566, p = 0.971) and LASI (0.588 vs. 0.570, p = 0.874). The cardiovascular risk factors increased by LACI were age, BMI, diabetes, triglycerides, LA size, LASr, LASI, E/A, E/e' and EF (p < 0.05). During a median follow-up of 16 months (range, 6-28 months), the event-free survival curves demonstrated a higher risk of heart failure in the group with LACI > 5.0 (log-rank test: P < 0.001). LACI > 5.0 was an independent predictor of heart failure [OR: 0.121, 95% CI (0.020-0.740), p = 0.022]. Conclusion LACI may prove to be a valuable tool for assessing LA function in patients with CKD, and could be integrated into the routine assessment of LA for the purpose of prognostic assessment and clinical decision-making in patients with CKD.
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Affiliation(s)
- Liqin Ji
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Xue Gao
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Weiwei Xiao
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Shaomei Yu
- Department of Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
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Sposato LA, Sur NB, Katan M, Johansen MC, De Marchis GM, Caso V, Fischer U, Chaturvedi S. Embolic Stroke of Undetermined Source: New Data and New Controversies on Cardiac Monitoring and Anticoagulation. Neurology 2024; 103:e209535. [PMID: 38861698 DOI: 10.1212/wnl.0000000000209535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Embolic strokes of undetermined source (ESUS) represent 9%-25% of all ischemic strokes. Based on the suspicion that a large proportion of cardioembolic sources remain undetected among embolic stroke of undetermined source patients, it has been hypothesized that a universal approach of anticoagulation would be better than aspirin for preventing recurrent strokes. However, 4 randomized controlled trials (RCTs), with different degrees of patient selection, failed to confirm this hypothesis. In parallel, several RCTs consistently demonstrated that prolonged cardiac monitoring increased atrial fibrillation detection and anticoagulation initiation compared with usual care in patients with ESUS, and later in individuals with ischemic stroke of known cause (e.g., large or small vessel disease). However, none of these trials or subsequent meta-analyses of all available RCTs have shown a reduction in stroke recurrence associated with the use of prolonged cardiac monitoring. In this article, we review the clinical and research implications of recent RCTs of antithrombotic therapy in patients with ESUS and in high-risk populations with and without stroke, with device-detected asymptomatic atrial fibrillation.
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Affiliation(s)
- Luciano A Sposato
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Nicole B Sur
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Mira Katan
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Michelle C Johansen
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Gian Marco De Marchis
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Valeria Caso
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Urs Fischer
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Seemant Chaturvedi
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
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Larsen BS, Biering-Sørensen T, Olsen FJ. Ischemic stroke and the emerging role of left atrial function. Expert Rev Cardiovasc Ther 2024; 22:289-300. [PMID: 38943632 DOI: 10.1080/14779072.2024.2370814] [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: 02/11/2024] [Accepted: 06/18/2024] [Indexed: 07/01/2024]
Abstract
INTRODUCTION Ischemic stroke is a leading cause of morbidity and mortality worldwide. Emerging evidence suggests that left atrial (LA) dysfunction could play a role in the pathophysiology of ischemic stroke, as a possible contributor and as a predictive biomarker. AREAS COVERED This narrative review details the intricate relationship between LA function, atrial fibrillation (AF), and ischemic stroke. We discuss imaging techniques used to assess LA function, the mechanisms by which impaired LA function may contribute to stroke, and its potential as a prognostic marker of stroke. EXPERT OPINION There is a lack of evidence-based treatments of LA dysfunction in both primary and secondary stroke prevention. This is partly due to the lack of a practical clinical definition and unanswered questions concerning the clinical implications of LA dysfunction in patients without AF. Until such questions are resolved, addressing well-known cardiovascular risk factors, like hypertension and obesity, should be prioritized for preventing AF and ischemic stroke. These risk factors are closely tied to atrial remodeling, emphasizing the importance of targeting primary modifiable factors for preventing future morbidity and mortality.
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Affiliation(s)
- Bjørn Strøier Larsen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
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8
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Lim DJ, Varadarajan V, Quinaglia T, Pezel T, Wu C, Noda C, Heckbert SR, Bluemke D, Ambale-Venkatesh B, Lima JAC. Change in left atrial function and volume predicts incident heart failure with preserved and reduced ejection fraction: Multi-Ethnic Study of Atherosclerosis. Eur Heart J Cardiovasc Imaging 2024:jeae138. [PMID: 38885142 DOI: 10.1093/ehjci/jeae138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/12/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024] Open
Abstract
AIMS The role of change in left atrial (LA) parameters prior to the onset of heart failure (HF) remains unclear. We used cardiac magnetic resonance (CMR) imaging to investigate the relationship between longitudinal change in LA function and incident HF in a multi-ethnic population with subclinical cardiovascular disease (CVD). METHODS AND RESULTS In this prospective multi-ethnic cohort study, 2470 participants (60 ± 9 years, 47% males), free at baseline of clinical CVD, had LA volume and function assessed via multimodality tissue tracking on CMR imaging at baseline (2000-02) and a second study 9.4 ± 0.6 years later. Free of HF, 73 participants developed incident HF [HF with preserved ejection fraction (HFpEF), n = 39; reduced ejection fraction (HFrEF), n = 34] 7.1 ± 2.1 years after the second study. An annual decrease of 1 SD unit in peak LA strain (ΔLASmax) was most strongly associated with the risk of HFpEF [subdistribution hazard ratios (HR) = 2.56, 95% confidence interval (CI) (1.34-4.90), P = 0.004] and improved model reclassification and discrimination in predicting HFpEF [C-statistic = 0.84, 95% CI (0.79-0.90); net reclassification index (NRI) = 0.34, P = 0.01; and integrated discrimination index (IDI) = 0.02, P = 0.02], whilst an annual decrease of 1 mL/m2 of pre-atrial indexed LA volumes (ΔLAVipreA) was most strongly associated with the risk of HFrEF [subdistribution HR = 1.88, 95% CI (1.44-2.45), P < 0.001] and improved model reclassification and discrimination in predicting HFrEF [C-statistic = 0.81, 95% CI (0.72-0.90); NRI = 0.31, P = 0.03; and IDI = 0.01, P = 0.50] after adjusting for event-specific risk factors and baseline LA measures. CONCLUSION ΔLASmax and ΔLAVipreA were associated with and incrementally predictive of HFpEF and HFrEF, after adjusting for risk factors and baseline LA measures in this population of subclinical CVD.
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Affiliation(s)
- Daniel J Lim
- School of Medicine, Johns Hopkins University, Baltimore MD, USA
| | | | | | - Theo Pezel
- School of Medicine, Johns Hopkins University, Baltimore MD, USA
| | - Colin Wu
- Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Chikara Noda
- School of Medicine, Johns Hopkins University, Baltimore MD, USA
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - David Bluemke
- Department of Radiology, University of Wisconsin-Madison, WI, USA
| | | | - Joao A C Lima
- School of Medicine, Johns Hopkins University, Baltimore MD, USA
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9
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Aronson D, Sliman H, Abadi S, Maiorov I, Perlow D, Mutlak D, Lessick J. Conduit Flow Compensates for Impaired Left Atrial Passive and Booster Functions in Advanced Diastolic Dysfunction. Circ Cardiovasc Imaging 2024; 17:e016276. [PMID: 38716653 PMCID: PMC11111319 DOI: 10.1161/circimaging.123.016276] [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: 10/24/2023] [Accepted: 03/14/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Quantification of left atrial (LA) conduit function and its contribution to left ventricular (LV) filling is challenging because it requires simultaneous measurements of both LA and LV volumes. The functional relationship between LA conduit function and the severity of diastolic dysfunction remains controversial. We studied the role of LA conduit function in maintaining LV filling in advanced diastolic dysfunction. METHODS We performed volumetric and flow analyses of LA function across the spectrum of LV diastolic dysfunction, derived from a set of consecutive patients undergoing multiphasic cardiac computed tomography scanning (n=489). From LA and LV time-volume curves, we calculated 3 volumetric components: (1) early passive emptying volume; (2) late active (booster) volume; and (3) conduit volume. Results were prospectively validated on a group of patients with severe aortic stenosis (n=110). RESULTS The early passive filling progressively decreased with worsening diastolic function (P<0.001). The atrial booster contribution to stroke volume modestly increases with impaired relaxation (P=0.021) and declines with more advanced diastolic function (P<0.001), thus failing to compensate for the reduction in early filling. The conduit volume increased progressively (P<0.001), accounting for 75% of stroke volume (interquartile range, 63-81%) with a restrictive filling pattern, compensating for the reduction in both early and booster functions. Similar results were obtained in patients with severe aortic stenosis. The pulmonary artery systolic pressure increased in a near-linear fashion when the conduit contribution to stroke volume increased above 60%. Maximal conduit flow rate strongly correlated with mitral E-wave velocity (r=0.71; P<0.0001), indicating that the increase in mitral E wave in diastolic dysfunction represents the increased conduit flow. CONCLUSIONS An increase in conduit volume contribution to stroke volume represents a compensatory mechanism to maintain LV filling in advanced diastolic dysfunction. The increase in conduit volume despite increasing LV diastolic pressures is accomplished by an increase in pulmonary venous pressure.
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Affiliation(s)
- Doron Aronson
- Departments of Cardiology (D.A., H.S., D.P., D.M., J.L.), Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine (D.A., S.A., D.M., J.L.), Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hend Sliman
- Departments of Cardiology (D.A., H.S., D.P., D.M., J.L.), Rambam Health Care Campus, Haifa, Israel
| | - Sobhi Abadi
- Medical Imaging (S.A.), Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine (D.A., S.A., D.M., J.L.), Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ida Maiorov
- BioMedical Engineering (I.M.), Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Daniel Perlow
- Departments of Cardiology (D.A., H.S., D.P., D.M., J.L.), Rambam Health Care Campus, Haifa, Israel
| | - Diab Mutlak
- Departments of Cardiology (D.A., H.S., D.P., D.M., J.L.), Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine (D.A., S.A., D.M., J.L.), Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Jonathan Lessick
- Departments of Cardiology (D.A., H.S., D.P., D.M., J.L.), Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine (D.A., S.A., D.M., J.L.), Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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10
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Wang Y, Zhang T, Zhang Y, Huang Z, Guo Q, Lan C, Deng L, Liu Y, Wu M, Yu P, Lin L, Liao Y. Interrelationships among abnormal P-wave axis, metabolic syndrome and its components, and mortality in US adults. J Electrocardiol 2024; 84:137-144. [PMID: 38696980 DOI: 10.1016/j.jelectrocard.2024.04.004] [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: 03/03/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Metabolic syndrome (MetS) is associated with increased rates of cardiovascular disease and mortality and is linked to abnormal electrocardiogram (ECG) parameters. We aimed to explore the relationships and interactions among MetS and its components, abnormal P-wave axis (aPWA), and mortality rates. METHODS We analyzed data from 7526 adult participants with sinus rhythm recruited from the National Health and Nutrition Examination Survey III. MetS was classified based on the NCEP ATP III-2005 definition. aPWA included all P-wave axis outside 0-75°. The National Death Index was utilized to identify survival status. Hazard ratios (HRs) and 95% confidence intervals (CIs) categorized by aPWA, MetS, and their components were analyzed using Cox proportional hazards models to investigate all-cause and cardiovascular mortalities. RESULTS Within a median follow-up period of 20.76 years, 4686 deaths were recorded, of which 1414 were attributable to cardiovascular disease. Participants with both MetS and aPWA had higher all-cause (HR: 1.45, 95% CI: 1.29-1.64, interaction P = 0.043) and cardiovascular (HR: 1.36, 95% CI: 1.02-1.79, interaction P-value = 0.058) mortality rates than participants without MetS and with a normal P-wave axis. Participants with the greatest number of MetS components and aPWA had a higher risk of all-cause mortality (HR: 1.70, 95% CI: 1.13-2.55, P = 0.011). CONCLUSIONS Individuals with both aPWA and MetS have a higher risk of mortality, and those with a greater number of MetS components and aPWA have a higher risk of all-cause mortality. These findings highlight the significance of integrating ECG characteristics with metabolic health status in clinical assessment.
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Affiliation(s)
- Yun Wang
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Ting Zhang
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Yanbin Zhang
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Zhibiao Huang
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Qian Guo
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Caifeng Lan
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Lin Deng
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Yuchen Liu
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Mingxin Wu
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Pei Yu
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Lijun Lin
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Ying Liao
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China.
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11
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Naser JA, Alexandrino FB, Harada T, Michelena HI, Borlaug BA, Eleid MF, Lin G, Scott C, Kennedy AM, Pellikka PA, Nkomo VT, Pislaru SV. The Natural History of Atrial Functional Mitral Regurgitation. J Am Coll Cardiol 2024; 83:1495-1507. [PMID: 38530687 DOI: 10.1016/j.jacc.2024.02.026] [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: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The natural history of moderate/severe atrial functional mitral regurgitation (AFMR) is unknown. OBJECTIVES The authors sought to study the incidence of left ventricular (LV) systolic dysfunction (LVSD), progression or regression of ≥mild-moderate AFMR, and impact on mortality. METHODS Adults with left atrial (LA) volume index ≥40 mL/m2, ≥mild-moderate AFMR, and follow-up echocardiogram were followed for incident LVSD (ejection fraction <50% and ≥10% lower than baseline), progression of mild-moderate/moderate AFMR to severe, and persistent regression of AFMR to no/trivial. Relation of AFMR progression or regression as time-dependent covariates with all-cause mortality was studied. Incidence of LVSD was compared with patients with no/mild AFMR matched on age, sex, comorbidities and ejection fraction. Patients were followed until mitral intervention, myocardial infarction, or last follow-up. RESULTS A total of 635 patients (median age 75 years, 51% female, 96% mild-moderate/moderate AFMR, 4% severe AFMR) were included. Over a median 2.2 years (Q1-Q3: 1.0-4.3 years), incidence rates per 100 person-years were 3.2 for LVSD (P = 0.52 vs patients with no/mild AFMR), 1.9 for progression of AFMR, and 3.9 for regression. Female sex and larger LA volume index were independently associated with progression, whereas younger age, male sex, absent atrial fibrillation, and higher LA emptying fraction were independently associated with regression. Neither AFMR progression nor regression was independently associated with mortality. Instead, independent risk factors for mortality included older age, concentric LV geometry, and higher estimated LV filling and pulmonary pressures. CONCLUSIONS In patients with predominantly mild-moderate/moderate AFMR, regression of MR was more common than progression, but neither was associated with mortality. Instead, diastolic function abnormalities were more important. Over a median 2-year follow-up, LVSD risk was not increased.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | | | - Tomonari Harada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher Scott
- Department of Biostatistics and Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Austin M Kennedy
- Department of Biostatistics and Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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12
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Zhao Y, Song Y, Mu X. Application of left atrial strain derived from cardiac magnetic resonance feature tracking to predict cardiovascular disease: A comprehensive review. Heliyon 2024; 10:e27911. [PMID: 38560271 PMCID: PMC10979159 DOI: 10.1016/j.heliyon.2024.e27911] [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: 08/18/2023] [Revised: 03/01/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
The structural and functional changes of the left atrium (LA)are important for maintaining the filling of the left ventricle (LV), whether the hemodynamics is stable or not, and are valuable for evaluating LV diastolic dysfunction and grading the severity. Studies over the past decade have shown that LA structural alterations are linked to several cardiovascular disorders, and LA enlargement has been identified as a strong predictor of several cardiovascular diseases. However, LA structural or volumetric abnormalities are commonly seen in the advanced stages of disease and do not adequately represent functional changes throughout the cardiac cycle. In recent years, LA strain obtained using cardiac magnetic resonance feature tracking (CMR-FT)technology has been shown to provide early monitoring of LA tension damage while also comprehensively reflecting LA functional changes in three phases, providing deeper insights into cardiovascular disease risk, prognosis of cardiovascular disease, and evaluation of therapeutic efficacy. When compared to the ultrasound speckle tracking approach, the CMR-FT technique provides improved spatial resolution, repeatability, and reproducibility. We report a comprehensive review of the most recent studies on CMR-LA strain in the past five years, including normal reference values, early detection of disease, incremental diagnosis, improvement of risk stratification, assessment of the value of atrial-ventricular hemodynamics and coupled injury, major adverse cardiovascular events and prognostic value, as well as future research perspectives and current limitations, aiming at providing an objective reference for the further exploration of the value of the application of CMR-LA strain in various cardiac disorders.
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Affiliation(s)
- Yetong Zhao
- Department of Radiology, Central Hospital of Dalian University of Technology, Dalian, 116033, PR China
- Department of Graduate School, Dalian Medical University, Dalian, 116000, PR China
| | - Yang Song
- Department of Radiology, Central Hospital of Dalian University of Technology, Dalian, 116033, PR China
| | - Xiaolin Mu
- Department of Radiology, Central Hospital of Dalian University of Technology, Dalian, 116033, PR China
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13
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Gioia G, Kresoja KP, Rosch S, Schöber A, Harnisch E, von Roeder M, Scholz M, Henger S, Isermann B, Thiele H, Lurz P, Rommel KP. Clinical Trajectory and Risk Stratification for Heart Failure with Preserved Ejection Fraction in a Real-World Cohort of Patients with Suspected Coronary Artery Disease. J Clin Med 2024; 13:2092. [PMID: 38610857 PMCID: PMC11012700 DOI: 10.3390/jcm13072092] [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: 02/26/2024] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) is a widespread condition with significant morbidity and mortality. Its clinical heterogeneity may delay the diagnosis. Aim: To identify predictors of HFpEF-related hospitalizations in ambulatory patients presenting with elevated cardiovascular risk, suspected coronary artery diseases (CADs), and positive HFpEF screenings. Methods: Consecutive patients presenting with suspected CAD, enrolled in the observational LIFE-Heart study (2006-2014, NCT00497887), and meeting HFpEF criteria per the 2016 European Society of Cardiology (ESC) guidelines were categorized according to the presence of "overlapping conditions" potentially masking or contributing to their symptoms. Additional stratification using the H2FPEF score (<2: low risk, 2-5: intermediate risk, and ≥6 high risk) was performed. Follow-up for hospitalizations, reasons of hospitalization, and death spanned a median of 6 years. Results: Of 1054 patients (66 ± 10 years, 60% male, NT-pro-BNP 286, IQR 183-574 pg/mL), 53% had overlapping conditions, while 47% had "isolated HFpEF". The H2FPEF scores classified 23%, 57%, and 20% as low-, intermediate-, and high-risk, respectively, with consistent proportions across patients with and without overlapping conditions (p = 0.91). During the follow-up observational phase, 54% were rehospitalized, 22% experienced heart failure (HF) rehospitalizations, and 11% of patients died. Multivariable logistic regression revealed a high-risk H2FPEF category as an independent predictor of HF rehospitalization in the overall cohort (odds ratio: 3.4, CI: 2.4-4.9, p < 0.01) as well as in patients with and without overlapping conditions. Furthermore, a H2FPEF score ≥ 6 was independently associated with higher mortality rates (hazard ratio: 1.8, CI: 1.2-2.6, p < 0.01) in the Cox regression analysis. Conclusions: Ambulatory patients presenting for suspected CAD and meeting HFpEF screening criteria face elevated risks for rehospitalizations over six years. Regardless of concomitant diagnoses, quantifying cardiac damage with the H2FPEF score helps in risk-stratifying patients for HF hospitalization and mortality.
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Affiliation(s)
- Guglielmo Gioia
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Karl-Patrik Kresoja
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Sebastian Rosch
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Anne Schöber
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Elias Harnisch
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Maximilian von Roeder
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Markus Scholz
- LIFE—Leipzig Research Center for Civilization Diseases, University of Leipzig, 04109 Leipzig, Germany;
- Institute of Medical Informatics, Statistic and Epidemiology, University of Leipzig, 04109 Leipzig, Germany;
| | - Sylvia Henger
- Institute of Medical Informatics, Statistic and Epidemiology, University of Leipzig, 04109 Leipzig, Germany;
| | - Berend Isermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Holger Thiele
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
| | - Philipp Lurz
- Department of Cardiology, University Hospital Mainz, 55131 Mainz, Germany;
| | - Karl-Philipp Rommel
- Department of Medicine/Cardiology, Heart Center at University Leipzig and Leipzig Heart Science, Strümpellstraße 39, 04289 Leipzig, Germany; (G.G.); (K.-P.K.); (S.R.); (E.H.); (M.v.R.)
- Cardiovascular Research Foundation, New York, NY 10019, USA
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14
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Dhont S, van den Acker G, van Loon T, Verbrugge FH, Verwerft J, Deferm S, Churchill TW, Mullens W, Lumens J, Bertrand PB. Mitral regurgitation in heart failure with preserved ejection fraction: The interplay of valve, ventricle, and atrium. Eur J Heart Fail 2024; 26:974-983. [PMID: 38629747 PMCID: PMC11184410 DOI: 10.1002/ejhf.3231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/22/2024] [Accepted: 03/26/2024] [Indexed: 05/31/2024] Open
Abstract
Mitral regurgitation (MR) is highly prevalent among patients with heart failure and preserved ejection fraction (HFpEF). Despite this combination being closely associated with unfavourable outcomes, it remains relatively understudied. This is partly due to the inherent heterogeneity of patients with HFpEF. To address this gap, dissecting HFpEF into mechanism-based phenotypes may offer a promising avenue for advancing our comprehension of these complex intertwined conditions. This review employs the validated CircAdapt model to explore the haemodynamic implications of moderate to severe MR across a well-defined spectrum of myocardial disease, characterized by impaired relaxation and reduced myocardial compliance. Both heart failure and mitral valve disease share overlapping symptomatology, primarily attributed to elevated pulmonary pressures. The intricate mechanisms contributing to these elevated pressures are multifaceted, potentially influenced by diastolic dysfunction, left atrial myopathy, and MR. Accurate evaluation of the haemodynamic and clinical impact of MR necessitates a comprehensive approach, taking into account the characteristics of both the left atrium and left ventricle, as well as their intricate interactions, which may currently be underemphasized in diagnostic practice. This holistic assessment is imperative for enhancing our understanding and refining therapeutic strategies within this patient cohort.
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Affiliation(s)
- Sebastiaan Dhont
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Gitte van den Acker
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Tim van Loon
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Frederik H. Verbrugge
- Center for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jan Verwerft
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Sébastien Deferm
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Cardiology, Inselspital Bern, Bern, Switzerland
| | | | - Wilfried Mullens
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Joost Lumens
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Philippe B. Bertrand
- Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
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15
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Krishnarao K, Yip DS, Goswami RM, Leoni JC, Patel PC. Stiff right atrial syndrome? A complex clinical case report utilizing multimodality imaging and invasive hemodynamics. Eur Heart J Case Rep 2024; 8:ytae163. [PMID: 38690555 PMCID: PMC11057788 DOI: 10.1093/ehjcr/ytae163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/12/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024]
Abstract
Background Stiff left atrial syndrome is a well-established cause of heart failure symptoms. A parallel entity involving the right atrium (RA) has not previously been described. We present a case of refractory right heart failure (RHF) 12 years following orthotopic heart transplantation. Case summary Patient underwent annuloplasty ring placement for severe tricuspid regurgitation in 2018 and kidney transplantation in 2020. The use of multimodality imaging and a multidisciplinary approach suggested a stiff RA as a potential etiology to refractory symptoms. Redo-heart and kidney transplantation in March 2021 led to the resolution of symptoms without recurrence. Discussion We propose stiff right atrial syndrome that may need to be considered in the setting of refractory RHF primarily suggested by significant right atrial enlargement and restrictive physiology.
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Affiliation(s)
- Krithika Krishnarao
- Department of Cardiovascular Disease, Orlando Health Heart & Vascular Institute, 1222 S Orange Ave 1st floor, Orlando, FL 32806, USA
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Daniel S Yip
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Rohan M Goswami
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Juan C Leoni
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Parag C Patel
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
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16
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Akashi J, Iwataki M, Nabeshima Y, Onoue T, Hayashi A, Tanaga T, Nishino S, Kimura T, Yano M, Watanabe N, Tsuda Y, Araki M, Shibata Y, Nishimura Y, Otsuji Y, Kataoka M. Potential Effects of Mild Atrial Secondary Mitral Regurgitation in Patients With Isolated Atrial Fibrillation. Circ Cardiovasc Imaging 2024; 17:e016239. [PMID: 38415386 DOI: 10.1161/circimaging.123.016239] [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: 10/18/2023] [Accepted: 01/17/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Patients with only moderate atrial secondary mitral regurgitation (asMR) frequently develop heart failure (HF). Mechanisms of HF with moderate asMR and the impact of mild asMR remain unclarified. Although mild/moderate primary mitral regurgitation is compensated by left ventricular (LV) dilatation, the LV is not dilated in asMR. We hypothesized that patients with mild asMR without LV dilatation may have impaired hemodynamics and higher risks of subsequent symptomatic HF deterioration. METHODS Stroke volume, cardiac output, and systolic pulmonary artery pressure were measured by echocardiography in 142 patients with isolated atrial fibrillation and 30 healthy controls. The prognosis of patients with isolated atrial fibrillation was followed up. RESULTS In the 142 patients with isolated atrial fibrillation, asMR was no/trivial in 55, mild in 83, moderate in 4, while none had severe asMR. Compared with controls and patients with no/trivial asMR, LV end-diastolic volume index was not increased and hemodynamic parameters were abnormal in patients with mild asMR (LV end-diastolic volume index, 65±6 versus 58±8 versus 60±8 mL/m²; stroke volume index, 42±4 versus 35±4 versus 29±6 mL/m²; P<0.001 versus other 2 groups; cardiac output index, 2.8±0.4 versus 2.8±0.5 versus 2.3±0.6 L/min per m²; P<0.001; systolic pulmonary artery pressure, 21±3 versus 26±5 versus 37±9 mm Hg; P<0.001). Although the event-free rate of HF symptomatic deterioration or hospitalization in patients with no/trivial asMR during a median 13.9 months follow-up was 86.9% and 100%, the rate in mild asMR was 59.4% and 85.0% (P<0.001 or P=0.032), respectively. CONCLUSIONS In the presence of isolated AF and no compensatory LV dilatation, impaired hemodynamics and higher risks of symptomatic HF deterioration were associated with mild asMR, requiring further studies of causalities.
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Affiliation(s)
- Jun Akashi
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Mai Iwataki
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Yosuke Nabeshima
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Takeshi Onoue
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Atsushi Hayashi
- Division of Cardiovascular Medicine, Shiga University of Medical Science, Japan (A.H.)
| | - Tetsuo Tanaga
- Departments of Clinical Laboratory (T.T.), Miyazaki Medical Association Hospital Cardiovascular Center, Japan
| | - Shun Nishino
- Cardiology (S.N., T.K., Y.S.), Miyazaki Medical Association Hospital Cardiovascular Center, Japan
| | - Toshiyuki Kimura
- Cardiology (S.N., T.K., Y.S.), Miyazaki Medical Association Hospital Cardiovascular Center, Japan
| | - Mitsuhiro Yano
- Cardiovascular Surgery (M.Y.), Miyazaki Medical Association Hospital Cardiovascular Center, Japan
| | - Nozomi Watanabe
- Cardiovascular Physiology, Faculty of Medicine, University of Miyazaki, Japan (N.W.)
| | - Yuki Tsuda
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Masaru Araki
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Yoshisato Shibata
- Cardiology (S.N., T.K., Y.S.), Miyazaki Medical Association Hospital Cardiovascular Center, Japan
| | - Yosuke Nishimura
- Department of Cardiovascular Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan (Y. Nishimura)
| | - Yutaka Otsuji
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
| | - Masaharu Kataoka
- Second Department of Internal Medicine (J.A., M.I., Y. Nabeshima, T.O., Y.T., M.A., Y.O., M.K.)
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Girard AA, Denney TS, Gupta H, Dell'Italia LJ, Calhoun DA, Oparil S, Sharifov OF, Lloyd SG. Spironolactone improves left atrial function and atrioventricular coupling in patients with resistant hypertension. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:487-497. [PMID: 38123867 DOI: 10.1007/s10554-023-03013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023]
Abstract
To determine the blood pressure independent effects of spironolactone on left atrial (LA) size and function in patients with resistant hypertension (RHTN). Patients with RHTN (n = 36, mean age 55 ± 7) were prospectively recruited. Spironolactone was initiated at 25 mg/day and increased to 50 mg/day after 4 weeks. Other antihypertensives were withdrawn to maintain constant blood pressure. Cardiac magnetic resonance imaging was performed at baseline and after 6 months of spironolactone treatment and changes in LA functional metrics were assessed. LA size and function parameters were improved (p < 0.05) from baseline to month-6: LA volumes indexed to body surface area (LAVI) were reduced (LAVImaximum 41.4 ± 12 vs. 33.2±9.7 mL/m2; LAVIpre-A 32.6 ± 9.8 vs. 25.6 ± 8.1 mL/m2; median LAVIminimum 18.5 [13.9-24.8] vs. 14.1 [10.9-19.2] mL/m2); left atrioventricular coupling index was reduced (28.2 ± 11.5 vs. 22.7 ± 9.2%); LA emptying fractions (LAEF) were increased (median total LAEF 52.4 [48.7-60.3] vs. 55.9 [50.3-61.1] %; active LAEF 40.2 ± 8.6 vs. 43.1 ± 7.8%). LA global longitudinal strain in the active phase was increased (16.3 ± 4.1 vs. 17.8 ± 4.2%). The effect of spironolactone was similar in patients with high (N = 18) and normal (N = 18) aldosterone status (defined by plasma renin activity and 24-h urine aldosterone). Treatment of RHTN with spironolactone is associated with improvements in LA size and function, and atrioventricular coupling, regardless of whether aldosterone levels were normal or high at baseline. This study suggests the need for larger prospective studies examining effects of mineralocorticoid receptor antagonists on atrial function and atrioventricular coupling.
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Affiliation(s)
- Andrew A Girard
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas S Denney
- Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA
| | | | - Louis J Dell'Italia
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- VA Medical Center, Birmingham, AL, USA
| | - David A Calhoun
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Vascular Biology and Hypertension Program, UAB, Birmingham, AL, USA
| | - Oleg F Sharifov
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 1808 7th Avenue South, BDB 143, Birmingham, AL, 35294, USA.
| | - Steven G Lloyd
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- VA Medical Center, Birmingham, AL, USA
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18
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Ni JC, Zhang F, Xu WQ, Hu XL, Zhao XY, Sun YW, Chen L, Wang YQ, Huang J, Xu QQ. Role of automated functional imaging and myocardial work in assessment of cardiac function in children with obstructive sleep apnea. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:601-611. [PMID: 38183509 DOI: 10.1007/s10554-023-03030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/30/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Early identification of abnormal left ventricular function in children with obstructive sleep apnea (OSA) is difficult using conventional echocardiographic indices and commonly used clinical markers of myocardial damage. We sought to investigate the value of automatic function imaging and myocardial work parameters in predicting early cardiac impairment in children having OSA with preserved left heart function and thereby identifying an optimal index for assessment. PATIENTS AND METHODS Fifty-two children who presented with symptoms of nocturnal sleep snoring and open-mouth breathing and 34 healthy controls were enrolled in this study. Clinical characteristics and conventional echocardiographic data were collected, and image analysis was performed using two-dimensional speckle-tracking echocardiography to obtain left ventricular global longitudinal strain (GLS), post-systolic index, peak strain dispersion, global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency. RESULTS Children with OSA had significantly lower GLS, GWI, and GCW than those without (P < 0.05). Additionally, GWI (β = -32.87, 95% CI: -53.47 to -12.27), and GCW (β = -35.09, 95% CI: -55.35 to -14.84) were found to correlate with the disease severity in the multiple linear regression mode, with worsening values observed as the severity of the disease increased. ROC curve analysis revealed that GCW was the best predictor of myocardial dysfunction, with an AUC of 0.809 (P < 0.001), and the best cutoff point for diagnosing myocardial damage in children with OSA was 1965.5 mmHg%, with a sensitivity of 92.5% and a specificity of 58.7%. CONCLUSIONS GLS, GWI, and GCW were identified as predictors of myocardial dysfunction in children with OSA, with GCW being the best predictor.
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Affiliation(s)
- Jun-Cheng Ni
- Department of Pediatric Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, SuzhouJiangsu, 215003, China
| | - Fan Zhang
- Department of Pediatric Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, SuzhouJiangsu, 215003, China
| | - Wen-Qing Xu
- Department of Pediatrics, The First People's Hospital of Kunshan, 566 East Qian-Jin Road, KunshanJiangsu, 215300, China
| | - Xin-Lu Hu
- Department of Pediatric Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, SuzhouJiangsu, 215003, China
| | - Xiao-Yan Zhao
- Department of Child and Adolescent Health Care, Children's Hospital of Soochow University, 92 Zhongnan Road, SuzhouJiangsu, 215003, China
| | - Yao-Wen Sun
- Department of Pediatric Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, SuzhouJiangsu, 215003, China
| | - Long Chen
- Department of Pediatric Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, SuzhouJiangsu, 215003, China
| | - Yu-Qing Wang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, 92 Zhongnan Road, SuzhouJiangsu, 215003, China
| | - Jie Huang
- Department of Pediatric Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, SuzhouJiangsu, 215003, China
| | - Qiu-Qin Xu
- Department of Pediatric Cardiology, Children's Hospital of Soochow University, 92 Zhongnan Road, SuzhouJiangsu, 215003, China.
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19
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Sakai A, Nagao M, Yamamoto A, Nakao R, Sakai S, Yamaguchi J. Prognostic value of right atrial strain in systemic sclerosis based on tissue tracking analysis using cine cardiac magnetic resonance imaging: a retrospective observational study. Heart Vessels 2024; 39:135-143. [PMID: 37777970 DOI: 10.1007/s00380-023-02320-2] [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: 12/09/2022] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
Interstitial lung disease and cardiac involvement are common manifestations and prognostic factors of systemic sclerosis. However, it is unclear whether impaired right atrial function associated with interstitial lung disease in systemic sclerosis can be used as a prognostic factor in this patient population. Therefore, this study aimed to investigate the relationship between right atrial function, interstitial lung disease, and prognosis in patients with systemic sclerosis using tissue tracking analysis with cine cardiac magnetic resonance imaging. In this retrospective observational study, a total of 40 patients with systemic sclerosis were enrolled. Tissue tracking analysis was used to obtain time curves of right atrial strain. Reservoir (total strain), conduit (passive strain), and booster (active strain) pump function were calculated, and right atrial strain, interstitial lung disease, and clinical outcomes were examined. An adverse clinical event was defined as all-cause death. Overall, 23 patients had interstitial lung disease (58%). Six patients died during the follow-up (median, 44 months). The total skin score and right ventricular systolic pressure on echocardiography were higher in patients with an event than in those without an event (28 ± 16% vs. 13 ± 13%, P = 0.02; 46.3 ± 10.7 mmHg vs. 36.0 ± 8.5 mmHg, P = 0.01, respectively). Further, right atrial total strain and active strain were significantly lower in patients with an event than in those without an event (14.3 ± 11.3% vs. 25.8 ± 11.4%, P = 0.03; 3.48 ± 2.37 vs. 11.7 ± 6.78, P = 0.007, respectively). Multivariate analysis revealed that active strain was an independent predictor of all-cause death (hazard ratio 0.76, P = 0.029). Kaplan-Meier analysis revealed that the survival rate was significantly higher in patients with right atrial active strain levels above the cutoff 7.4 (P < 0.05). In systemic sclerosis, right atrial booster function was predictive of mortality. Hence, right atrial functional assessment may have incremental prognostic value for patients with systemic sclerosis, leading to better risk stratification.
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Affiliation(s)
- Akiko Sakai
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjyuku-Ku, Tokyo, 162-8666, Japan.
| | - Michinobu Nagao
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjyuku-Ku, Tokyo, 162-8666, Japan
| | - Atsushi Yamamoto
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjyuku-Ku, Tokyo, 162-8666, Japan
| | - Risako Nakao
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjyuku-Ku, Tokyo, 162-8666, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjyuku-Ku, Tokyo, 162-8666, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjyuku-Ku, Tokyo, 162-8666, Japan
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20
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Ostrominski JW, Vaduganathan M. Chapter 2: Clinical and Mechanistic Potential of Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors in Heart Failure with Preserved Ejection Fraction. Am J Med 2024; 137:S9-S24. [PMID: 37160196 DOI: 10.1016/j.amjmed.2023.04.035] [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: 04/01/2022] [Accepted: 04/18/2023] [Indexed: 05/11/2023]
Abstract
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have emerged as an important approach for the treatment of heart failure in patients with or without diabetes. Although the precise mechanisms underpinning their clinical impact remain incompletely resolved, mechanistic studies and insights from major clinical trials have demonstrated the impact of SGLT2 inhibitors on numerous cardio-renal-metabolic pathways of relevance to heart failure with preserved ejection fraction (HFpEF), which, in the contemporary era, constitutes approximately half of all patients with heart failure. Despite rates of morbidity and mortality that are commensurate with those of heart failure with reduced ejection fraction, disease-modifying therapies have comparatively been severely lacking. As such, HFpEF remains among the greatest unmet needs in cardiovascular medicine. Within the past decade, HFpEF has been established as a highly integrated disorder, involving not only the cardiovascular system, but also the lungs, kidneys, skeletal muscle, and adipose tissue. Given their multisystem impact, SGLT2i offer unique promise in addressing the complex pathophysiology of HFpEF, and in recent randomized controlled trials, were shown to significantly reduce heart failure events and cardiovascular death in patients with HFpEF. Herein, we discuss several proposed mechanisms of clinical benefit of SGLT2i in HFpEF.
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Affiliation(s)
- John W Ostrominski
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass.
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21
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Omote K, Sorimachi H, Obokata M, Verbrugge FH, Omar M, Popovic D, Reddy YNV, Pislaru SV, Pellikka PA, Borlaug BA. Biatrial myopathy in heart failure with preserved ejection fraction. Eur J Heart Fail 2024; 26:288-298. [PMID: 38059338 DOI: 10.1002/ejhf.3104] [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: 08/31/2023] [Revised: 10/27/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
AIM Left atrial (LA) myopathy is increasingly recognized as an important phenotypic trait in heart failure (HF) with preserved ejection fraction (HFpEF). Right atrial (RA) remodelling and dysfunction also develop in HFpEF, but little data are available regarding the clinical characteristics and pathophysiology among patients with isolated LA, RA, or biatrial myopathy. METHODS AND RESULTS Patients with HFpEF underwent invasive haemodynamic exercise testing, comprehensive imaging including speckle tracking strain echocardiography, and clinical follow-up at Mayo Clinic between 2006 and 2018. LA myopathy was defined as LA volume index >34 ml/m2 and/or LA reservoir strain ≤24% and RA myopathy by RA volume index >39 ml/m2 in men and >33 ml/m2 in women and/or RA reservoir strain ≤19.8%. Of 476 consecutively evaluated patients with HFpEF defined by invasive exercise testing with evaluable atrial structure/function, 125 (26%) had no atrial myopathy, 147 (31%) had isolated LA myopathy, 184 (39%) had biatrial myopathy, and 20 (4%) had isolated RA myopathy. Patients with HFpEF and biatrial myopathy had more atrial fibrillation, poorer left ventricular systolic and diastolic function, more severe pulmonary vascular disease, tricuspid regurgitation, ventricular interdependence and right ventricular dysfunction, and poorer cardiac output reserve with exercise. There were 94 patients with events over a median follow-up of 2.9 (interquartile range 1.4-4.6) years. Individuals with biatrial myopathy had an 84% higher risk of HF hospitalization or death as compared to those with isolated LA myopathy (hazard ratio 1.84; 95% confidence interval 1.16-2.92, p = 0.01). CONCLUSIONS Biatrial myopathy identifies patients with more advanced HFpEF characterized by more severe pulmonary vascular disease, right HF, poorer cardiac reserve, and a greater risk for adverse outcomes. Further study is required to define optimal strategies to treat and prevent biatrial myopathy in HFpEF.
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Affiliation(s)
- Kazunori Omote
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hidemi Sorimachi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Frederik H Verbrugge
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
| | - Massar Omar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Dejana Popovic
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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22
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Vîjîiac A, Scărlătescu AI, Petre IG, Vîjîiac C, Vătășescu RG. Three-Dimensional Combined Atrioventricular Coupling Index-A Novel Prognostic Marker in Dilated Cardiomyopathy. Biomedicines 2024; 12:302. [PMID: 38397904 PMCID: PMC10886977 DOI: 10.3390/biomedicines12020302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Atrioventricular coupling has recently emerged as an outcome predictor. Our aim was to assess, through three-dimensional (3D) echocardiography, the role of the left atrioventricular coupling index (LACI), right atrioventricular coupling index (RACI) and a novel combined atrioventricular coupling index (CACI) in a cohort of patients with dilated cardiomyopathy (DCM). One hundred twenty-one consecutive patients with DCM underwent comprehensive 3D echocardiographic acquisitions. LACI was defined as the ratio between left atrial and left ventricular 3D end-diastolic volumes. RACI was defined as the ratio between right atrial and right ventricular 3D end-diastolic volumes. CACI was defined as the sum of LACI and RACI. Patients were prospectively followed for death, heart transplant, nonfatal cardiac arrest and hospitalization for heart failure. Fifty-five patients reached the endpoint. All three coupling indices were significantly more impaired in patients with events, with CACI showing the highest area under the curve (AUC = 0.66, p = 0.003). All three indices were independent outcome predictors when tested in multivariable Cox regression (HR = 2.62, p = 0.01 for LACI; HR = 2.58, p = 0.004 for RACI; HR = 2.37, p = 0.01 for CACI), but only CACI showed an incremental prognostic power over traditional risk factors such as age, left ventricular strain, right ventricular strain and mitral regurgitation severity (likelihood ratio χ2 test = 28.2, p = 0.03). CACI assessed through 3D echocardiography, reflecting both left and right atrioventricular coupling, is an independent predictor of adverse events in DCM, yielding an incremental prognostic power over traditional risk factors.
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Affiliation(s)
- Aura Vîjîiac
- Cardiology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.G.P.); (R.G.V.)
| | | | - Ioana Gabriela Petre
- Cardiology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.G.P.); (R.G.V.)
- Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania;
| | | | - Radu Gabriel Vătășescu
- Cardiology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.G.P.); (R.G.V.)
- Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania;
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23
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Cascos E, Loncaric F, Vidal B, Sanchis L, Sitges M. Agreement between 3D volumetric and strain parameters to assess left atrial function. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:103-105. [PMID: 37543189 DOI: 10.1016/j.rec.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Enric Cascos
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Filip Loncaric
- Hospital Clinical Center Zagreb, Department of Cardiovascular Disease, Zagreb, Croatia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Barbara Vidal
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Sanchis
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Sitges
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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24
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Koraćević G, Mićić S, Stojanović M, Zdravkovic M, Simić D, Kostić T, Atanasković V, Janković-Tomašević R. Beta-blockers in Hypertensive Left Ventricular Hypertrophy and Atrial Fibrillation Prevention. Curr Vasc Pharmacol 2024; 22:19-27. [PMID: 38031765 DOI: 10.2174/0115701611264647231110101700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/23/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Hypertensive left ventricular hypertrophy (HTN LVH) is a key risk factor for atrial fibrillation (AF). OBJECTIVE To evaluate the possible role of beta-blockers (BBs) in addition to a renin-angiotensinaldosterone system (RAAS) blocker in AF prevention in patients with HTN LVH. METHODS We performed a PubMed, Elsevier, SAGE, Oxford, and Google Scholar search with the search items 'beta blocker hypertension left ventricular hypertrophy patient' from 2013-2023. In the end, a 'snowball search', based on the references of relevant papers as well as from papers that cited them was performed. RESULTS HTN LVH is a risk factor for AF. In turn, AF substantially complicates HTN LVH and contributes to the genesis of heart failure (HF) with preserved ejection fraction (HFpEF). The prognosis of HFpEF is comparable with that of HF with reduced EF (HFrEF), and, regardless of the type, HF is associated with five-year mortality of 50-75%. The antiarrhythmic properties of BBs are wellrecognized, and BBs as a class of drugs are - in general - recommended to decrease the incidence of AF in HTN. CONCLUSION BBs are recommended (as a class) for AF prevention in several contemporary guidelines for HTN. LVH regression in HTN - used as a single criterion for the choice of antihypertensive medication - does not capture this protective effect. Consequently, it is worth studying how meaningful this antiarrhythmic action (to prevent AF) of BBs is in patients with HTN LVH in addition to a RAAS blocker.
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Affiliation(s)
- Goran Koraćević
- Department of Cardiovascular Diseases, University Clinical Center Niš, Serbia
- Faculty of Medicine, Niš University, Serbia
| | - Sladjana Mićić
- Department of Nephrology, University Clinical Center Niš, Serbia
| | | | - Marija Zdravkovic
- Department of Cardiology, University Hospital Medical Center Bežanijska kosa and Faculty of Medicine, University of Belgrade, Serbia
| | - Dragan Simić
- Department of Cardiovascular Diseases, University Clinical Center Belgrade, Serbia
| | - Tomislav Kostić
- Department of Cardiovascular Diseases, University Clinical Center Niš, Serbia
- Faculty of Medicine, Niš University, Serbia
| | - Vesna Atanasković
- Department of Cardiovascular Diseases, University Clinical Center Niš, Serbia
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25
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Henkens MTHM, Raafs AG, Vanloon T, Vos JL, Vandenwijngaard A, Brunner HG, Krapels IPC, Knackstedt C, Gerretsen S, Hazebroek MR, Vernooy K, Nijveldt R, Lumens J, Verdonschot JAJ. Left Atrial Function in Patients with Titin Cardiomyopathy. J Card Fail 2024; 30:51-60. [PMID: 37230314 DOI: 10.1016/j.cardfail.2023.05.013] [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: 11/18/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Truncating variants in titin (TTNtv) are the most prevalent genetic etiology of dilated cardiomyopathy (DCM). Although TTNtv has been associated with atrial fibrillation, it remains unknown whether and how left atrial (LA) function differs between patients with DCM with and without TTNtv. We aimed to determine and compare LA function in patients with DCM with and without TTNtv and to evaluate whether and how left ventricular (LV) function affects the LA using computational modeling. METHODS AND RESULTS Patients with DCM from the Maastricht DCM registry that underwent genetic testing and cardiovascular magnetic resonance (CMR) were included in the current study. Subsequent computational modeling (CircAdapt model) was performed to identify potential LV and LA myocardial hemodynamic substrates. In total, 377 patients with DCM (n = 42 with TTNtv, n = 335 without a genetic variant) were included (median age 55 years, interquartile range [IQR] 46-62 years, 62% men). Patients with TTNtv had a larger LA volume and decreased LA strain compared with patients without a genetic variant (LA volume index 60 mLm-2 [IQR 49-83] vs 51 mLm-2 [IQR 42-64]; LA reservoir strain 24% [IQR 10-29] vs 28% [IQR 20-34]; LA booster strain 9% [IQR 4-14] vs 14% [IQR 10-17], respectively; all P < .01). Computational modeling suggests that while the observed LV dysfunction partially explains the observed LA dysfunction in the patients with TTNtv, both intrinsic LV and LA dysfunction are present in patients with and without a TTNtv. CONCLUSIONS Patients with DCM with TTNtv have more severe LA dysfunction compared with patients without a genetic variant. Insights from computational modeling suggest that both intrinsic LV and LA dysfunction are present in patients with DCM with and without TTNtv.
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Affiliation(s)
- Michiel T H M Henkens
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands; Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands; Netherlands Heart Institute (NLHI), Utrecht, the Netherlands
| | - Anne G Raafs
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands; Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Tim Vanloon
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Jacqueline L Vos
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arthur Vandenwijngaard
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Han G Brunner
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands; GROW Institute for Developmental Biology and Cancer, Maastricht University, Maastricht, the Netherlands; Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ingrid P C Krapels
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Christian Knackstedt
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands; Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Suzanne Gerretsen
- Department of Radiology and Nuclear Medicine, Cardiovascular research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Mark R Hazebroek
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands; Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Job A J Verdonschot
- Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands; Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands.
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Russo G, Badano LP, Adamo M, Alessandrini H, Andreas M, Braun D, Connelly KA, Denti P, Estevez-Loureiro R, Fam N, Gavazzoni M, Hahn RT, Harr C, Hausleiter J, Himbert D, Kalbacher D, Ho E, Latib A, Lubos E, Ludwig S, Lurz P, Monivas V, Nickenig G, Pedicino D, Pedrazzini G, Pozzoli A, Pires Marafon D, Pastorino R, Praz F, Rodes-Cabau J, Besler C, Schofer J, Scotti A, Piayda K, Sievert H, Tang GHL, Thiele H, Schlotter F, von Bardeleben RS, Webb J, Windecker S, Leon M, Maisano F, Metra M, Taramasso M. Characteristics and outcomes of patients with atrial versus ventricular secondary tricuspid regurgitation undergoing tricuspid transcatheter edge-to-edge repair - Results from the TriValve registry. Eur J Heart Fail 2023; 25:2243-2251. [PMID: 37905381 DOI: 10.1002/ejhf.3075] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/19/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
AIM Functional or secondary tricuspid regurgitation (STR) is the most common phenotype of tricuspid regurgitation (TR) with atrial STR (ASTR) and ventricular STR (VSTR) being recently identified as two distinct entities. Data on tricuspid transcatheter edge-to-edge repair (T-TEER) in patients with STR according to phenotype (i.e. ASTR vs. VSTR) are lacking. The aim of this study was to assess characteristics and outcomes of patients with ASTR versus VSTR undergoing T-TEER. METHODS AND RESULTS Patients with STR undergoing T-TEER were selected from the Transcatheter Tricuspid Valve Therapies (TriValve) registry. ASTR was defined by (i) left ventricular ejection fraction ≥50%, (ii) atrial fibrillation, and (iii) systolic pulmonary artery pressure <50 mmHg. Patients not matching these criteria were classified as VSTR. Patients with primary TR and cardiac implantable electronic device were excluded. Key endpoints included procedural success and survival at follow-up. A total of 298 patients were enrolled in the study: 65 (22%) with ASTR and 233 (78%) with VSTR. Procedural success was similar in the two groups (80% vs. 83% for ASTR vs. VSTR, p = 0.56) and TEER was effective in reducing TR in both groups (from 97% of patients with baseline TR ≥3+ to 23% in ASTR and to 15% in VSTR, all p = 0.001). At 12-month follow-up, survival was significantly higher in the ASTR versus VSTR cohort (91% vs. 72%, log-rank p = 0.02), with VSTR being an independent predictor of mortality at multivariable analysis (hazard ratio 4.75). CONCLUSIONS In a real-world, multicentre registry, T-TEER was effective in reducing TR grade in both ASTR and VSTR. At 12-month follow-up, ASTR showed better survival than VSTR.
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Affiliation(s)
- Giulio Russo
- Department of Biomedicine and Prevention, Cardiology Unit, Policlinico Tor Vergata, University of Rome, Rome, Italy
| | - Luigi P Badano
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy
- Department of Cardiology, Auxologico IRCCS, Milan, Italy
| | - Marianna Adamo
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Braun
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Kim A Connelly
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Paolo Denti
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Neil Fam
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Mara Gavazzoni
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy
- Department of Cardiology, Auxologico IRCCS, Milan, Italy
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, NY, USA
| | - Claudia Harr
- Department of Cardiology, Asklepios clinic Sankt Georg, Hamburg, Germany
| | - Joerg Hausleiter
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | | | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Edwin Ho
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Edith Lubos
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Vanessa Monivas
- Division of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
| | | | - Daniela Pedicino
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
- Biomedical Faculty, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Alberto Pozzoli
- Division of Cardiac Surgery, Cardiocentro Ticino Institute EOC, Lugano, Switzerland
| | - Denise Pires Marafon
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Pastorino
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabien Praz
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Joseph Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Joachim Schofer
- Department of Cardiology, Asklepios clinic Sankt Georg, Hamburg, Germany
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | | | - Horst Sievert
- CardioVascular Center Frankfurt CVC, Frankfurt, Germany
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - John Webb
- St. Paul Hospital, Vancouver, BC, Canada
| | - Stephan Windecker
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Martin Leon
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, NY, USA
| | - Francesco Maisano
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Baratto C, Caravita S, Vachiéry JL. Pulmonary Hypertension Associated with Left Heart Disease. Semin Respir Crit Care Med 2023; 44:810-825. [PMID: 37709283 DOI: 10.1055/s-0043-1772754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Pulmonary hypertension (PH) is a common complication of diseases affecting the left heart, mostly found in patients suffering from heart failure, with or without preserved left ventricular ejection fraction. Initially driven by a passive increase in left atrial pressure (postcapillary PH), several mechanisms may lead in a subset of patient to significant structural changes of the pulmonary vessels or a precapillary component. In addition, the right ventricle may be independently affected, which results in right ventricular to pulmonary artery uncoupling and right ventricular failure, all being associated with a worse outcome. The differential diagnosis of PH associated with left heart disease versus pulmonary arterial hypertension (PAH) is especially challenging in patients with cardiovascular comorbidities and/or heart failure with preserved ejection fraction (HFpEF). A stepwise approach to diagnosis is proposed, starting with a proper clinical multidimensional phenotyping to identify patients in whom hemodynamic confirmation is deemed necessary. Provocative testing (exercise testing, fluid loading, or simple leg raising) is useful in the cath laboratory to identify patients with abnormal response who are more likely to suffer from HFpEF. In contrast with group 1 PH, management of PH associated with left heart disease must focus on the treatment of the underlying condition. Some PAH-approved targets have been unsuccessfully tried in clinical studies in a heterogeneous group of patients, some even leading to an increase in adverse events. There is currently no approved therapy for PH associated with left heart disease.
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Affiliation(s)
- Claudia Baratto
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, Milano, Italy
| | - Sergio Caravita
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, Milano, Italy
- Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Bergamo, Italy
| | - Jean-Luc Vachiéry
- Department of Cardiology, HUB Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
- European Reference Network on Rare Pulmonary Diseases (ERN-LUNG), Germany
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28
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Masood S, Ashraf SMK, Malik MA, Wahab S. P-wave indices and left atrial mechanics as predictors of atrial cardiopathy in embolic stroke of undetermined source. Sci Rep 2023; 13:19965. [PMID: 37968274 PMCID: PMC10651911 DOI: 10.1038/s41598-023-44285-2] [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: 04/27/2023] [Accepted: 10/05/2023] [Indexed: 11/17/2023] Open
Abstract
Recent research has shed light on the culpability of LA (left atrial) abnormality, in the form of atrial cardiopathy, as an independent risk factor for the development of atrial fibrillation, LA thrombus and subsequent stroke. The aim of this study was to measure LA electromechanical dissociation (EMD), LA volumes, P-wave dispersion (PWD) and P-wave terminal force in V1 (PTFV1) as markers of atrial cardiopathy in patients with ESUS (embolic stroke of undetermined source), to determine whether atrial cardiopathy is an integral part in the causal pathway of ESUS. 28 patients presenting with ischemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study along with a control group of 28 age- and gender-matched apparently healthy individuals. On ECG, PWD and PTFV1 were measured. On echocardiography, LA EMD and LA volumes were recorded. Increased PWD (34.14 ± 9.89 ms vs. 27.32 ± 8.95 ms; p = 0.01), atrial EMD (73.32 ± 16.31 ms vs. 63.63 ± 13.59 ms; p = 0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p < 0.01). According to the results of our study, PWD, atrial EMD and LA volumes may be novel predictors for ESUS. Our results support the notion that atrial cardiopathy is a distinct mechanism of thrombosis in ESUS patients. Further research is required to clarify its function in the causation of stroke, ESUS in particular.
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Affiliation(s)
- Samia Masood
- Department of Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, UP, 202002, India.
| | - Syed Mohammad Kamil Ashraf
- Department of Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, UP, 202002, India
| | - Mohammad Azharuddin Malik
- Department of Cardiology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, UP, 202002, India
| | - Shagufta Wahab
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, UP, 202002, India
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29
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Silva Garcia E, Lobo-Torres I, Fernández-Armenta J, Penela D, Fernandez-Garcia M, Gomez-Lopez A, Soto-Iglesias D, Fernández-Rivero R, Vazquez-Garcia R, Acosta J, Bisbal F, Cano-Calabria L, Berruezo A. Functional mapping to reveal slow conduction and substrate progression in atrial fibrillation. Europace 2023; 25:euad246. [PMID: 37961921 PMCID: PMC10644200 DOI: 10.1093/europace/euad246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/11/2023] [Indexed: 11/15/2023] Open
Abstract
AIMS The aim of our study was to analyse the response to short-coupled atrial extrastimuli to identify areas of hidden slow conduction (HSC) and their relationship with the atrial fibrillation (AF) phenotype. METHODS AND RESULTS Twenty consecutive patients with paroxysmal AF and persistent AF (10:10) underwent the first pulmonary vein isolation procedure. Triple short-coupled extrastimuli were delivered in sinus rhythm (SR), and the evoked response was analysed: sites exhibiting double or highly fragmented electrograms (EGM) were defined as positive for HSC (HSC+). The delta of the duration of the bipolar EGM was analysed, and bipolar EGM duration maps were built. High-density maps were acquired using a multipolar catheter during AF, SR, and paced rhythm. Spatial co-localization of HSC+ and complex fractionated atrial EGMs (CFAE) during AF was evaluated. Persistent AF showed a higher number and percentage of HSC+ than paroxysmal AF (13.9% vs. 3.3%, P < 0.001). The delta of EGM duration was 53 ± 22 ms for HSC+ compared with 13 ± 11 (10) ms in sites with negative HSC (HSC-) (P < 0.001). The number and density of HSC+ were lower than CFAE during AF (19 vs. 56 per map, P < 0.001). The reproducibility and distribution of HSC+ in repeated maps were superior to CFAE (P = 0.19 vs. P < 0.001). Sites with negative and positive responses showed a similar bipolar voltage in the preceding sinus beat (1.65 ± 1.34 and 1.48 ± 1.47 mV, P = 0.12). CONCLUSION Functional mapping identifies more discrete and reproducible abnormal substrates than mapping during AF. The HSC+ sites in response to triple extrastimuli are more frequent in persistent AF than in paroxysmal AF.
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Affiliation(s)
- Etel Silva Garcia
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Ivan Lobo-Torres
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - Diego Penela
- Teknon Medical Center, Heart Institute, Barcelona, Spain
| | | | - Andrea Gomez-Lopez
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | | | | | - Juan Acosta
- Department of Cardiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Felipe Bisbal
- Institut del Cor (iCor), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Lucas Cano-Calabria
- Department of Cardiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
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30
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Cronin EM, Vedage N, Israel CW. Alternative atrial pacing site to improve cardiac function: focus on Bachmann's bundle pacing. Eur Heart J Suppl 2023; 25:G44-G55. [PMID: 37970517 PMCID: PMC10637835 DOI: 10.1093/eurheartjsupp/suad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Pacing from the right atrial appendage (RAA) prolongs the P wave duration and can induce interatrial and especially left-sided atrio-ventricular dyssynchrony. Pacing from Bachmann's bundle closely reproduces normal physiology and has the potential to avoid the electromechanical dysfunction associated with conventional RAA pacing. Interatrial conduction delay is associated with an increased risk of stroke, heart failure, and death. In addition to a reduction in atrial fibrillation, Bachmann's bundle pacing has emerging applications as a hemodynamic pacing modality. This review outlines the pathophysiology of atrial conduction disturbances and their potential remedies and provides the reader with a practical guide to implementing Bachmann's bundle pacing with an emphasis on the recapitulation of normal electrical and mechanical function.
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Affiliation(s)
- Edmond M Cronin
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, USA
| | - Natasha Vedage
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, USA
| | - Carsten W Israel
- Department of Medicine—Cardiology, Diabetology, and Nephrology, Bethel-Clinic, Bielefeld, Germany
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31
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Marino PN. Sodium-dependent glucose transporter 2 inhibition and the atrial antiremodelling effects in HFrEF patients. J Cardiovasc Med (Hagerstown) 2023; 24:838-839. [PMID: 37773883 DOI: 10.2459/jcm.0000000000001547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Affiliation(s)
- Paolo N Marino
- School of Medicine, Università del Piemonte Orientale, Novara, Istituto Iperbarico, Villafranca, Verona, Italy
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32
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Garg PK, Wilson N, Yuan Y, Howard VJ, Judd S, Howard G, Soliman EZ. Association of hypertension severity and control with risk of incident atrial fibrillation: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Clin Cardiol 2023; 46:1418-1425. [PMID: 37605862 PMCID: PMC10642317 DOI: 10.1002/clc.24135] [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: 06/04/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The association of hypertension (HTN) severity and control with the risk of incident atrial fibrillation (AF) is unclear. HYPOTHESIS Increased HTN severity and poorer blood pressure control would be associated with an increased risk of incident AF. METHODS This analysis included 9485 participants (mean age 63 ± 8 years; 56% women; 35% Black). Participants were stratified into six mutually exclusive groups at baseline-normotension (n = 1629), prehypertension (n = 704), controlled HTN (n = 2224), uncontrolled HTN (n = 4123), controlled apparent treatment-resistant hypertension (aTRH) (n = 88), and uncontrolled aTRH (n = 717). Incident AF was ascertained at the follow-up visit, defined by either electrocardiogram or self-reported medical history of a physician diagnosis. Multivariable logistic regression analyses adjusted for demographic and clinical variables. RESULTS Over an average of 9.3 years later, 868 incident AF cases were detected. Compared to those with normotension, incident AF risk was highest for those with aTRH (controlled aTRH: odds ratio (OR) 2.95; 95% confidence interval (CI) 1.60, 5.43, & uncontrolled aTRH: OR 2.47; 95% CI 1.76, 3.48). The increase in AF risk was smaller for those on no more than three antihypertensive agents regardless of their blood pressure control (controlled OR 1.72; 95% CI 1.30, 2.29 and uncontrolled OR 1.56; 95% CI 1.14, 2.13). CONCLUSIONS The risk of developing AF is increased in all individuals with HTN. Risk is highest in those aTRH regardless of blood pressure control. A more aggressive approach that focuses on lifestyle and pharmacologic measures to either prevent HTN or better control HTN during earlier stages may be particularly beneficial in reducing related AF risk.
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Affiliation(s)
- Parveen K. Garg
- Division of CardiologyUSC Keck School of MedicineLos AngelesCaliforniaUSA
| | - Nicole Wilson
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Ya Yuan
- School of Public HealthUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Virginia J. Howard
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Suzanne Judd
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - George Howard
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Elsayed Z. Soliman
- Department of MedicineEpidemiological Cardiology Research Center (EPICARE), Section of Cardiovascular Medicine, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
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Mohammed NY, Ali Mohammed DA, Al-Qadhi RG, Al-Ganmi AHA. The net atrioventricular compliance in mild to moderate hypertensive patients during the early left ventricle filling: A case series. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:341. [PMID: 38144025 PMCID: PMC10743916 DOI: 10.4103/jehp.jehp_769_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/15/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The compliance is considered one of the most important parameters which is defined as the change in volume with given change in pressure (dv/dp). It is varying inversely with both diastolic filling and modulus of chamber stiffness. AIMS This study aimed to deduce the net atrioventricular compliance which is affected the trans mitral blood flow. MATERIALS AND METHODS This study focuses on study group of 25 patients (15 males and ten females) with mild to moderate hypertension and mean age (49 ± 5.9) who were investigated for atrioventricular compliance and compared with 18 normal individuals (ten males and eight females) with a mean age of (44.9 ± 14.9) years old. The measurement of mitral valve area and the deceleration flow rate during ventricular early filling were taken from peak E wave to the minimum of the descending E wave. The atrioventricular (net) compliance was calculated according to the theoretical calculation Formula. RESULTS When the atrioventricular compliance is measured during the early filling, a decrease in the net compliance of 50.27% in normal individuals was observed. The isovolumetric relaxation time was lower by 32.9% in normal individuals than in patients with mild to moderate hypertension. CONCLUSION The increase in the atrioventricular net compliance for hypertensive patients is thought to be attributed to the compensatory mechanism of cardiac muscle before fibrosis can take place leading to a consequent increase in compliance measured during the early diastolic filling stage of the cardiac cycle.
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Affiliation(s)
- Nadiya Y. Mohammed
- Department of Physiology, College of Medicine, University of Baghdad, Baghdad, Iraq
| | | | - Ramaq G. Al-Qadhi
- Department of Physiology, College of Medicine, University of Baghdad, Baghdad, Iraq
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Naser JA, Michelena HI, Lin G, Scott CG, Lee E, Kennedy AM, Noseworthy PA, Pellikka PA, Nkomo VT, Pislaru SV. Incidence, risk factors, and outcomes of atrial functional mitral regurgitation in patients with atrial fibrillation or sinus rhythm. Eur Heart J Cardiovasc Imaging 2023; 24:1450-1457. [PMID: 37556366 DOI: 10.1093/ehjci/jead199] [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: 04/14/2023] [Revised: 07/17/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023] Open
Abstract
AIMS Atrial functional mitral regurgitation (AFMR) has been associated with atrial fibrillation (AF) and heart failure with preserved ejection fraction. However, data on incident AFMR are scarce. We aimed to study the incidence, risk factors, and clinical significance of AFMR in AF or sinus rhythm (SR). METHODS AND RESULTS Adults with new diagnosis of AF and adults in SR were identified. Patients with >mild MR at baseline, primary mitral disease, cardiomyopathy, left-sided valve disease, previous cardiac surgery, or with no follow-up echocardiogram were excluded. Diastolic dysfunction (DD) was indicated by ≥2/4 abnormal diastolic function parameters [mitral medial e', mitral medial E/e', tricuspid regurgitation velocity, left atrial volume index (LAVI)]. Overall, 1747 patients with AF and 29 623 in SR were included. Incidence rate of >mild AFMR was 2.6 per 100 person-year in new-onset AF and 0.7 per 100 person-year in SR, P < 0.001. AF remained associated with AFMR in a propensity score-matched analysis based on age, sex, and comorbidities between AF and SR [hazard ratio: 3.80 (95% confidence interval 3.04-4.76)]. Independent risk factors associated with incident AFMR were age ≥65 years, female sex, LAVI, and DD in both AF and SR, in addition to rate (vs. rhythm) control in AF. Incident AFMR was independently associated with all-cause death in both groups (both P < 0.001). CONCLUSIONS AF conferred a three-fold increase in the risk of incident AFMR. DD, older age, left atrial size, and female sex were independent risk factors in both SR and AF, while rhythm control was protective. AFMR was universally associated with worse mortality.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Eunjung Lee
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Austin M Kennedy
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Bai L, Sun Y, Si J, Ding Z, Zhang X, Zhang Y, Xia Y, Liu Y. Effects of rhythm control on left atrial structure remodeling in atrial fibrillation and heart failure with preserved ejection fraction. Front Cardiovasc Med 2023; 10:1265269. [PMID: 37817865 PMCID: PMC10560714 DOI: 10.3389/fcvm.2023.1265269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Background The benefits of rhythm control for atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFpEF) have not been conclusively determined. We assessed the effects of rhythm control on left atrial (LA) structure remodeling and prognosis in patients with AF and HFpEF. Methods This was a retrospective, real-world, observational study involving patients diagnosed with AF and HFpEF. The cohort was divided into rhythm-control and rate-control groups depending on their treatment strategies. The primary outcomes were all-cause mortality, rehospitalization for any cause, HF-related rehospitalization, and stroke. Differences in follow-up LA structure parameters were also analyzed. Results Compared to the rate-control group, patients in the rhythm-control group had a lower risk of HF-related rehospitalization even after adjusting for potential confounders (adjusted HR 0.605, 95% CI 0.413-0.887, p = 0.010). Moreover, rhythm-control therapy led to marked reductions in LA echocardiographic indicators and a higher proportion of LA reverse remodeling (LARR). Conclusions Rhythm-control therapy reverses LA structure remodeling and is associated with improved clinical outcomes; therefore, it is an optimal treatment approach for AF in HFpEF patients.
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Affiliation(s)
- Lin Bai
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuxi Sun
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiping Si
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zijie Ding
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xinxin Zhang
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanli Zhang
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Liu
- Heart Failure and Structural Cardiology Ward, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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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.
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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.
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Perrone MA, Iellamo F, D’Antoni V, Gismondi A, Di Biasio D, Vadalà S, Marazzi G, Morsella V, Volterrani M, Caminiti G. Acute Changes on Left Atrial Function during Incremental Exercise in Patients with Heart Failure with Mildly Reduced Ejection Fraction: A Case-Control Study. J Pers Med 2023; 13:1272. [PMID: 37623522 PMCID: PMC10456046 DOI: 10.3390/jpm13081272] [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: 06/20/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND the aim of this study was to assess acute changes in left atrial (LA) function during incremental aerobic exercise in patients with heart failure with mildly reduced ejection fraction (HFmrEF) in comparison to healthy subjects (HS). METHODS twenty patients with established HFmrEF were compared with 10 HS, age-matched controls. All subjects performed a stepwise exercise test on a cycle ergometer. Echocardiography was performed at baseline, during submaximal effort, at peak of exercise, and after 5 min of recovery. RESULTS HS obtained a higher value of METs at peak exercise than HFmrEF (7.4 vs. 5.6; between group p = 0.002). Heart rate and systolic blood pressure presented a greater increase in the HS group than in HFmrEF (between groups p = 0.006 and 0.003, respectively). In the HFmrEF group, peak atrial longitudinal strain (PALS) and conduit strain were both increased at submaximal exercise (p < 0.05 for both versus baseline) and remained constant at peak exercise. Peak atrial contraction strain (PACS) did not show significant changes during the exercise. In the HS group, PALS and PACS increased significantly at submaximal level (p < 0.05 for both versus baseline), but PALS returned near baseline values at peak exercise; conduit strain decreased progressively during the exercise in HS. Stroke volume (SV) increased in both groups at submaximal exercise; at peak exercise, SV remained constant in the HFmrEF, while it decreased in controls (between groups p = 0.002). CONCLUSIONS patients with HFmrEF show a proper increase in LA reservoir function during incremental aerobic exercise that contributes to maintain SV throughout the physical effort.
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Affiliation(s)
- Marco Alfonso Perrone
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (M.A.P.); (F.I.)
| | - Ferdinando Iellamo
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (M.A.P.); (F.I.)
| | - Valentino D’Antoni
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, 00163 Rome, Italy; (V.D.); (A.G.); (D.D.B.); (S.V.); (G.M.); (V.M.); (M.V.)
| | - Alessandro Gismondi
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, 00163 Rome, Italy; (V.D.); (A.G.); (D.D.B.); (S.V.); (G.M.); (V.M.); (M.V.)
| | - Deborah Di Biasio
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, 00163 Rome, Italy; (V.D.); (A.G.); (D.D.B.); (S.V.); (G.M.); (V.M.); (M.V.)
| | - Sara Vadalà
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, 00163 Rome, Italy; (V.D.); (A.G.); (D.D.B.); (S.V.); (G.M.); (V.M.); (M.V.)
| | - Giuseppe Marazzi
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, 00163 Rome, Italy; (V.D.); (A.G.); (D.D.B.); (S.V.); (G.M.); (V.M.); (M.V.)
| | - Valentina Morsella
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, 00163 Rome, Italy; (V.D.); (A.G.); (D.D.B.); (S.V.); (G.M.); (V.M.); (M.V.)
| | - Maurizio Volterrani
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, 00163 Rome, Italy; (V.D.); (A.G.); (D.D.B.); (S.V.); (G.M.); (V.M.); (M.V.)
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, 00163 Rome, Italy
| | - Giuseppe Caminiti
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, 00163 Rome, Italy; (V.D.); (A.G.); (D.D.B.); (S.V.); (G.M.); (V.M.); (M.V.)
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, 00163 Rome, Italy
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Zhang Z, Li L, Hu Z, Zhou L, Zhang Z, Xiong Y, Yao Y. Causal effects between atrial fibrillation and heart failure: evidence from a bidirectional Mendelian randomization study. BMC Med Genomics 2023; 16:187. [PMID: 37580781 PMCID: PMC10424396 DOI: 10.1186/s12920-023-01606-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/12/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Observational studies have suggested a close association between atrial fibrillation (AF) and heart failure (HF), yet the causal effect remains uncertain. In this study, we employed a bidirectional Mendelian randomization analysis to investigate the causal effect of one disease on the other. METHODS Genetic instrumental variables were obtained from large-scale summary-level genome-wide association studies of AF (n = 1,030,836) and HF(n = 1,665,481), respectively. Two-sample Mendelian randomization was conducted to establish causal inferences. Inverse-variance weighted (IVW) was the primary estimate, while additional analyses including MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO), MR-Egger, and Weighted median were performed to validate robustness and identify pleiotropy. RESULTS After accounting for confounding variables, MR analysis suggested a potential causal relationship between AF and HF. An augmented genetic predisposition to atrial fibrillation was associated with an elevated risk of heart failure (odds ratio (OR) = 1.18, 95% confidence interval (CI):1.14-1.22). Likewise, genetically determined heart failure also increased the risk of heart failure (OR = 1.44, 95%CI:1.23-1.68). The robustness of the findings was corroborated through MR sensitivity analyses, and the causal estimates remained consistent when the instrument P-value threshold was tightened. CONCLUSIONS Our bidirectional Mendelian randomization study supports a reciprocal causal relationship between AF and HF. The shared genetic profile of these conditions may provide crucial insights into potential therapeutic targets for the prevention and progression of both disorders. These findings underscore the necessity for further investigation into the underlying molecular mechanisms linking AF and HF, as well as the potential for personalized treatment strategies grounded in genetic profiling.
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Affiliation(s)
- Zhuxin Zhang
- Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Le Li
- Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhao Hu
- Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Likun Zhou
- Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenhao Zhang
- Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yulong Xiong
- Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Yao
- Fuwai Hospital, National Center for Cardiovascular Diseases, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Cardiac Arrhythmia Center, Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, 100037, China.
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Ferró E, Pérez N, Althoff T, Guasch E, Prat S, Doltra A, Borrás R, Tolosana JM, Arbelo E, Sitges M, Porta-Sánchez A, Roca-Luque I, Mont L, Guichard JB. Magnetic resonance detection of advanced atrial cardiomyopathy increases the risk for atypical atrial flutter occurrence following atrial fibrillation ablation. Europace 2023; 25:euad276. [PMID: 37751383 PMCID: PMC10532122 DOI: 10.1093/europace/euad276] [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: 07/15/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
AIMS Recurrence of arrhythmia after catheter ablation of atrial fibrillation (AF) in the form of atypical atrial flutter (AFL) is common among a significant number of patients and often requires redo ablation with limited success rates. Identifying patients at high risk of AFL after AF ablation could aid in patient selection and personalized ablation approach. The study aims to assess the relationship between pre-existing atrial cardiomyopathy and the occurrence of AFL following AF ablation. METHODS AND RESULTS We analysed a cohort of 1007 consecutive AF patients who underwent catheter ablation and were included in a prospective registry. Patients who did not have baseline cardiac magnetic resonance imaging and late gadolinium enhancement (LGE-CMR) or did not experience any recurrences were excluded. A total of 166 patients were included gathering 56 patients who underwent re-ablation due to AFL recurrences and 110 patients who underwent re-ablation due to AF recurrences (P = 0.11). A multiparametric assessment of atrial cardiomyopathy was based on basal LGE-CMR, including left atrial (LA) volume, LA sphericity, and global and segmental LA fibrosis using semiautomated post-processing software. Out of the initial cohort of 1007 patients, AFL and AF occurred in 56 and 110 patients, respectively. An age higher than 65 [odds ratio (OR) = 5.6, 95% confidence interval (CI): 2.2-14.4], the number of previous ablations (OR = 3.0, 95% CI: 1.2-7.8), and the management of ablation lines in the index procedure (OR = 2.5, 95% CI: 1.0-6.3) were independently associated with AFL occurrence. Furthermore, several characteristics assessed by LGE-CMR were identified as independent predictors of AFL recurrence after the index ablation for AF, such as enhanced LA sphericity (OR = 1.3, 95% CI: 1.1-1.6), LA global fibrosis (OR = 1.03, 95% CI: 1.01-1.07), and increased fibrosis in the lateral wall (OR = 1.03, 95% CI: 1.01-1.04). CONCLUSION Advanced atrial cardiomyopathy assessed by LGE-CMR, such as increased LA sphericity, global LA fibrosis, and fibrosis in the lateral wall, is independently associated with arrhythmia recurrence in the form of AFL following AF ablation.
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Affiliation(s)
- Elisenda Ferró
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Carrer del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Núria Pérez
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Till Althoff
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Carrer del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Department of Cardiology and Angiology, Charité-University Medicine, Berlin, Germany
| | - Eduard Guasch
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Carrer del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Susana Prat
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Carrer del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Adelina Doltra
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Carrer del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Roger Borrás
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red e Salud Mental (CIBERSAM), Madrid, Spain
| | - José María Tolosana
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Carrer del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Elena Arbelo
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Carrer del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Avinguda Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Marta Sitges
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Carrer del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Avinguda Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Andreu Porta-Sánchez
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
| | - Ivo Roca-Luque
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Carrer del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Lluís Mont
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Carrer del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Avinguda Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Jean-Baptiste Guichard
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Carrer del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Avinguda Monforte de Lemos, 3-5, 28029 Madrid, Spain
- INSERM, SAINBIOSE U1059, University Hospital of Saint-Étienne, 10 rue de la Marandinière, 42270 Saint-Priest-enJarez, France
- Cardiology Department, University Hospital of Saint-Étienne, 42 Avenue Albert Raimond, 42270 Saint-Priest-en-Jarez, France
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Pascual-Figal DA, Zamorano JL, Domingo M, Morillas H, Nuñez J, Cobo Marcos M, Riquelme-Pérez A, Teis A, Santas E, Caro-Martinez C, Pinilla JM, Rodriguez-Palomares JF, Dobarro D, Restrepo-Córdoba MA, González-Juanatey JR, Bayés Genís A. Impact of dapagliflozin on cardiac remodelling in patients with chronic heart failure: The DAPA-MODA study. Eur J Heart Fail 2023; 25:1352-1360. [PMID: 37211950 DOI: 10.1002/ejhf.2884] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023] Open
Abstract
AIMS Dapagliflozin improves the prognosis of patients with heart failure (HF), regardless of left ventricular ejection fraction (LVEF). However, its effect on cardiac remodelling parameters, specifically left atrial (LA) remodelling, is not well established. METHODS AND RESULTS The DAPA-MODA trial (NCT04707352) is a multicentre, single-arm, open-label, prospective and interventional study that aimed to evaluate the effect of dapagliflozin on cardiac remodelling parameters over 6 months. Patients with stable chronic HF receiving optimized guideline-directed therapy, except for any sodium-glucose cotransporter 2 inhibitor, were included. Echocardiography was performed at baseline, 30 and 180 days, and analysed by a central core-lab in a blinded manner to both patient and time. The primary endpoint was the change in maximal LA volume index (LAVI). A total of 162 patients (64.2% men, 70.5 ± 10.6 years, 52% LVEF >40%) were included in the study. At baseline, LA dilatation was observed (LAVI 48.1 ± 22.6 ml/m2 ) and LA parameters were similar between LVEF-based phenotypes (≤40% vs. >40%). LAVI showed a significant reduction at 180 days (-6.6% [95% confidence interval -11.1, -1.8], p = 0.008), primarily due to a decrease in reservoir volume (-13.8% [95% confidence interval -22.5, -4], p = 0.007). Left ventricular geometry improved with significant reductions in left ventricular mass index (-13.9% [95% confidence interval -18.7, -8.7], p < 0.001), end-diastolic volume (-8.0% [95% confidence interval -11.6, -4.2], p < 0.001) and end-systolic volume (-11.9% [95% confidence interval -16.7, -6.8], p < 0.001) at 180 days. N-terminal pro-B-type natriuretic peptide (NT-proBNP) showed a significant reduction at 180 days (-18.2% [95% confidence interval -27.1, -8.2], p < 0.001), without changes in filling Doppler measures. CONCLUSION Dapagliflozin administration in stable out-setting patients with chronic HF and optimized therapy results in global reverse remodelling of cardiac structure, including reductions in LA volumes and improvement in left ventricular geometry and NT-proBNP concentrations.
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Affiliation(s)
- Domingo A Pascual-Figal
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto IMIB-Pascual Parrilla, Murcia, Spain
- Medicine Department, Universidad de Murcia, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
| | - J Luis Zamorano
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mar Domingo
- Cardiology Department, Hospital Universitari Germans Trias i Pujol. l'Institut del Cor, Badalona, Spain
| | | | - Julio Nuñez
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Marta Cobo Marcos
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Alejandro Riquelme-Pérez
- Medicine Department, Universidad de Murcia, Murcia, Spain
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
| | - Albert Teis
- Cardiology Department, Hospital Universitari Germans Trias i Pujol. l'Institut del Cor, Badalona, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Cesar Caro-Martinez
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto IMIB-Pascual Parrilla, Murcia, Spain
| | - Jose Manuel Pinilla
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Jose F Rodriguez-Palomares
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Dobarro
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Álvaro Cunqueiro, IIS Galicia Sur, Vigo, Spain
| | | | - J Ramón González-Juanatey
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antoni Bayés Genís
- Centro de Investigación Biomédica en Red, CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitari Germans Trias i Pujol. l'Institut del Cor, Badalona, Spain
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Lampert J, Power D, Havaldar S, Govindarajulu U, Kawamura I, Maan A, Miller MA, Menon K, Koruth J, Whang W, Bagiella E, Bayes-Genis A, Musikantow D, Turagam M, Bayes de Luna A, Halperin J, Dukkipati SR, Vaid A, Nadkarni G, Glicksberg B, Fuster V, Reddy VY. Interatrial Block Association With Adverse Cardiovascular Outcomes in Patients Without a History of Atrial Fibrillation. JACC Clin Electrophysiol 2023; 9:1804-1815. [PMID: 37354170 DOI: 10.1016/j.jacep.2023.04.006] [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: 12/19/2022] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Interatrial block (IAB) is associated with thromboembolism and atrial arrhythmias. However, prior studies included small patient cohorts so it remains unclear whether IAB predicts adverse outcomes particularly in context of atrial fibrillation (AF)/atrial flutter (AFL). OBJECTIVES This study sought to determine whether IAB portends increased stroke risk in a large cohort in the presence or absence of AFAF/AFL. METHODS We performed a 5-center retrospective analysis of 4,837,989 electrocardiograms (ECGs) from 1,228,291 patients. IAB was defined as P-wave duration ≥120 ms in leads II, III, or aVF. Measurements were extracted as .XML files. After excluding patients with prior AF/AFL, 1,825,958 ECGs from 458,994 patients remained. Outcomes were analyzed using restricted mean survival time analysis and restricted mean time lost. RESULTS There were 86,317 patients with IAB and 355,032 patients without IAB. IAB prevalence in the cohort was 19.6% and was most common in Black (26.1%), White (20.9%), and Hispanic (18.5%) patients and least prevalent in Native Americans (9.2%). IAB was independently associated with increased stroke probability (restricted mean time lost ratio coefficient [RMTLRC]: 1.43; 95% CI: 1.35-1.51; tau = 1,895), mortality (RMTLRC: 1.14; 95% CI: 1.07-1.21; tau = 1,924), heart failure (RMTLRC: 1.94; 95% CI: 1.83-2.04; tau = 1,921), systemic thromboembolism (RMTLRC: 1.62; 95% CI: 1.53-1.71; tau = 1,897), and incident AF/AFL (RMTLRC: 1.16; 95% CI: 1.10-1.22; tau = 1,888). IAB was not associated with stroke in patients with pre-existing AF/AFL. CONCLUSIONS IAB is independently associated with stroke in patients with no history of AF/AFL even after adjustment for incident AF/AFL and CHA2DS2-VASc score. Patients are at increased risk of stroke even when AF/AFL is not identified.
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Affiliation(s)
- Joshua Lampert
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA. https://twitter.com/joshuamlampertmd
| | - David Power
- Mount Sinai Heart, Mount Sinai Hospital, New York, New York, USA
| | - Shreyas Havaldar
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usha Govindarajulu
- Center for Biostatistics, Department of Population Health, Mount Sinai Hospital, New York, New York, USA
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Abhishek Maan
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Marc A Miller
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Kartikeya Menon
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob Koruth
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - William Whang
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Emilia Bagiella
- Center for Biostatistics, Department of Population Health, Mount Sinai Hospital, New York, New York, USA
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitario Germans trias I Pujol, Badalona, Spain
| | - Daniel Musikantow
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Mohit Turagam
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Antoni Bayes de Luna
- Cardiovascular Research Foundation, Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | | | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Akhil Vaid
- Division of Data-Driven and Digital Medicine (D3M), Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Girish Nadkarni
- Division of Data-Driven and Digital Medicine (D3M), Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin Glicksberg
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Valentin Fuster
- Mount Sinai Heart, Mount Sinai Hospital, New York, New York, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA.
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Molnár AÁ, Sánta A, Pásztor DT, Merkely B. Atrial Cardiomyopathy in Valvular Heart Disease: From Molecular Biology to Clinical Perspectives. Cells 2023; 12:1796. [PMID: 37443830 PMCID: PMC10340254 DOI: 10.3390/cells12131796] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
This review discusses the evolving topic of atrial cardiomyopathy concerning valvular heart disease. The pathogenesis of atrial cardiomyopathy involves multiple factors, such as valvular disease leading to atrial structural and functional remodeling due to pressure and volume overload. Atrial enlargement and dysfunction can trigger atrial tachyarrhythmia. The complex interaction between valvular disease and atrial cardiomyopathy creates a vicious cycle of aggravating atrial enlargement, dysfunction, and valvular disease severity. Furthermore, atrial remodeling and arrhythmia can predispose to atrial thrombus formation and stroke. The underlying pathomechanism of atrial myopathy involves molecular, cellular, and subcellular alterations resulting in chronic inflammation, atrial fibrosis, and electrophysiological changes. Atrial dysfunction has emerged as an essential determinant of outcomes in valvular disease and heart failure. Despite its predictive value, the detection of atrial fibrosis and dysfunction is challenging and is not included in the clinical routine. Transthoracic echocardiography and cardiac magnetic resonance imaging are the main diagnostic tools for atrial cardiomyopathy. Recently published data have revealed that both left atrial volumes and functional parameters are independent predictors of cardiovascular events in valvular disease. The integration of atrial function assessment in clinical practice might help in early cardiovascular risk estimation, promoting early therapeutic intervention in valvular disease.
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43
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Shi Y, Qiu Z, Yu J, Li Z, Hua S, Chen Y, Chen X, Shen K, Jin W. Association between insulin resistance and cardiac remodeling in HER2-positive breast cancer patients: a real-world study. BMC Cancer 2023; 23:615. [PMID: 37400804 DOI: 10.1186/s12885-023-11102-y] [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: 12/16/2022] [Accepted: 06/22/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Insulin resistance is an overlapping risk factor for both heart and breast cancer, while its interaction with cardiotoxicity in breast cancer (BC) patients is not clear. This study investigated the impact of insulin resistance on cardiac remodeling in patients with human epidermal growth factor receptor 2 (HER2)-positive BC during and after trastuzumab therapy in real-world clinical practice. METHODS HER2-positive BC patients who received trastuzumab treatment between December 2012 and December 2017 were reviewed and 441 patients with baseline metabolic indices and serial echocardiographic measurements (baseline, 6, 12, and 18 months) after trastuzumab therapy initiation were included. Repeated measurement analysis of variance was used to evaluate temporal trends in multiparameter echocardiography. Linear mixed model was applied to further evaluate the role of insulin resistance in forementioned changes. Correlation of homeostasis model assessment-estimated insulin resistance (HOMA-IR) and triglyceride-glucose index (TyG) levels to changes in echocardiography parameters was explored. RESULTS Of 441 patients (mean age 54 ± 10 [SD] years), 61.8% received anthracycline-based chemotherapy, 33.5% received left-sided radiotherapy, 46% received endocrine therapy. No symptomatic cardiac dysfunction was observed over the therapy course. A total of 19 (4.3%) participants experienced asymptomatic cancer therapy-related cardiac dysfunction (CTRCD), and the peak onset time was 12 months after the initiation of trastuzumab. Albeit relatively low CTRCD incidence, cardiac geometry remodeling, especially left atrial (LA) dilation over therapy was notable and was more severe in high HOMA-IR and TyG level groups (P < 0.01). Noteworthy, a partial reversibility of cardiac remodeling was observed with treatment cessation. Additionally, HOMA-IR level positively correlated to changes in LA diameter from baseline to 12 months (r = 0.178, P = 0.003). No significant association (all P > 0.10) was detected between HOMA-IR or TyG level and dynamic left ventricular parameter evaluation. Multivariate linear regression analysis demonstrated that higher HOMA-IR level was an independent determinant for LA enlargement in BC patients during anti-HER2 targeted therapy course after adjusting for confounding risk factors (P = 0.006). CONCLUSION Insulin resistance was associated with left atrial adverse remodeling (LAAR) in HER2-positive BC patients that received standard trastuzumab therapy, indicating that insulin resistance could be a supplementation to baseline cardiovascular risk stratification proforma for HER2-targeted antitumor therapies.
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Affiliation(s)
- Yunjing Shi
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Zeping Qiu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Jing Yu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R. China
| | - Zhuojin Li
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Sha Hua
- Heart Failure Center, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, 149 S. Chongqing Road, Shanghai, 200020, P. R. China
| | - Yanjia Chen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R. China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R. China
| | - Wei Jin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China.
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China.
- Heart Failure Center, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, 149 S. Chongqing Road, Shanghai, 200020, P. R. China.
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Sharma S, Patel NR, Hanudel MR, Ix JH, Salusky IB, Nguyen KL. Plasma FGF23 is associated with left atrial remodeling in children on hemodialysis. Pediatr Nephrol 2023; 38:2179-2187. [PMID: 36508050 PMCID: PMC10247494 DOI: 10.1007/s00467-022-05812-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/15/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND FGF23 mediates cardiac fibrosis through the activation of pro-fibrotic factors in in vitro models and is markedly elevated in kidney disease. Left atrial global longitudinal strain (LA GLS) derived by echocardiographic speckle-tracking measures longitudinal shortening of the LA walls, quantifies atrial performance and may enable detection of early LA remodeling in the setting of normal ventricular function. We hypothesized that LA GLS is abnormal in children on hemodialysis (HD) compared to healthy controls of comparable age/sex distribution and that, among HD patients, greater FGF23 levels are associated with abnormal LA GLS. METHODS Clinical and echocardiographic data from 29 children receiving HD and 13 healthy controls were collected in a cross-sectional single-center study. Plasma FGF23 concentrations were measured using ELISA. The primary outcome was LA GLS measured using 2D speckle-tracking strain analysis. Linear regression analysis was used to investigate predictors of LA GLS in HD. RESULTS Median dialysis vintage was 1.5 (IQR 0.5-4.3) years. Median intact FGF23 levels were substantially higher in the HD vs. control group (1206 [215, 4707] vs. 51 [43, 66.5] pg/ml; P = 0.0001), and LA GLS was 39.9% SD 11.6 vs. 32.8% SD 5.7 (P = 0.04). Among HD patients, higher FGF23 was associated with lower LA GLS (β per unit Ln-FGF23: - 2.7; 95% CI slope - 5.4, - 0.1; P = 0.04 after adjustment for age, body size, and HD vintage. FGF23 was not associated with LA phasic reservoir, conduit, or contractile strain. CONCLUSIONS In children on HD and preserved left ventricular ejection fraction, greater FGF23 is associated with lower LA GLS (indicative of impaired atrial performance). A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Shilpa Sharma
- Division of Nephrology, David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Room 6030, Los Angeles, CA, 90073, USA.
| | - Nisha R Patel
- Stritch School of Medicine, Loyola University Chicago, IL, Maywood, USA
| | - Mark R Hanudel
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Isidro B Salusky
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kim-Lien Nguyen
- Division of Cardiology, David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Deferm S, Bertrand PB, Dhont S, von Bardeleben RS, Vandervoort PM. Arrythmia-Mediated Valvular Heart Disease. Heart Fail Clin 2023; 19:357-377. [PMID: 37230650 DOI: 10.1016/j.hfc.2023.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aging population is rising at record pace worldwide. Along with it, a steep increase in the prevalence of atrial fibrillation and heart failure with preserved ejection fraction is to be expected. Similarly, both atrial functional mitral and tricuspid regurgitation (AFMR and AFTR) are increasingly observed in daily clinical practice. This article summarizes all current evidence regarding the epidemiology, prognosis, pathophysiology, and therapeutic options. Specific attention is addressed to discern AFMR and AFTR from their ventricular counterparts, given their different pathophysiology and therapeutic needs.
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Affiliation(s)
- Sébastien Deferm
- Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; Department of Cardiology, Mainz University Hospital, Langenbeckstraße 1, Mainz, Germany. https://twitter.com/S_Deferm
| | - Philippe B Bertrand
- Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; Department of Cardiology, Hospital Oost-Limburg Genk, Schiepse Bos 6, 3600 Genk, Belgium. https://twitter.com/Ph_Bertrand
| | - Sebastiaan Dhont
- Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; Department of Cardiology, Hospital Oost-Limburg Genk, Schiepse Bos 6, 3600 Genk, Belgium. https://twitter.com/S_Dhont
| | - Ralph S von Bardeleben
- Department of Cardiology, Mainz University Hospital, Langenbeckstraße 1, Mainz, Germany. https://twitter.com/vonbardelebenRS
| | - Pieter M Vandervoort
- Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; Department of Cardiology, Hospital Oost-Limburg Genk, Schiepse Bos 6, 3600 Genk, Belgium.
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Monte IP, Faro DC, Trimarchi G, de Gaetano F, Campisi M, Losi V, Teresi L, Di Bella G, Tamburino C, de Gregorio C. Left Atrial Strain Imaging by Speckle Tracking Echocardiography: The Supportive Diagnostic Value in Cardiac Amyloidosis and Hypertrophic Cardiomyopathy. J Cardiovasc Dev Dis 2023; 10:261. [PMID: 37367426 DOI: 10.3390/jcdd10060261] [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: 04/21/2023] [Revised: 05/29/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Background: Left atrial (LA) function is crucial for assessing left ventricular filling in various cardiovascular conditions. Cardiac Amyloidosis (CA) is characterized by atrial myopathy and LA function impairment, with diastolic dysfunction up to restrictive filling pattern, leading to progressive heart failure and arrhythmias. This study evaluates LA function and deformation using speckle tracking echocardiography (STE) in patients with CA compared to a cohort of patients with sarcomeric Hypertrophic Cardiomyopathy (HCM) and a control group. Methods: We conducted a retrospective, observational study (from January 2019 to December 2022) including a total of 100 patients: 33 with ATTR-CA, 34 with HCMs, and 33 controls. Clinical evaluation, electrocardiograms, and transthoracic echocardiography were performed. Echocardiogram images were analyzed in post-processing using EchoPac software for LA strain quantification, including LA-reservoir, LA-conduit, and LA-contraction strain. Results: The CA group exhibited significantly impaired LA function compared to HCMs and control groups, with LA-reservoir median values of -9%, LA-conduit -6.7%, and LA-contraction -3%; this impairment was consistent even in the CA subgroup with preserved ejection fraction. LA strain parameters correlated with LV mass index, LA volume index, E/e', and LV-global longitudinal strain and were found to be associated with atrial fibrillation and exertional dyspnea. Conclusions: LA function assessed by STE is significantly impaired in CA patients compared to HCMs patients and healthy controls. These findings highlight the potential supportive role of STE in the early detection and management of the disease.
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Affiliation(s)
- Ines Paola Monte
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Denise Cristiana Faro
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Giancarlo Trimarchi
- Department of Clinical and Experimental Medicine, University Hospital of Messina, 98121 Messina, Italy
| | - Fabrizio de Gaetano
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Mariapaola Campisi
- Azienda Ospedaliera Provinciale di Catania, Santa Maria e Santa Venera Hospital, 95024 Acireale, Italy
| | - Valentina Losi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Lucio Teresi
- Department of Clinical and Experimental Medicine, University Hospital of Messina, 98121 Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University Hospital of Messina, 98121 Messina, Italy
| | - Corrado Tamburino
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University Hospital of Messina, 98121 Messina, Italy
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Rabinovitch A, Rabinovitch R, Biton Y, Braunstein D, Thieberger R. A possible new cardiac heterogeneity as an arrhythmogenic driver. Sci Rep 2023; 13:7571. [PMID: 37165085 PMCID: PMC10172337 DOI: 10.1038/s41598-023-33438-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/12/2023] [Indexed: 05/12/2023] Open
Abstract
Atrial fibrillation (AF) is the commonest cardiac arrhythmia, affecting 3 million people in the USA and 8 million in the EU (according to the European Society of Cardiology). So, why is it that even with the best medical care, around a third of the patients are treatment resistant. Extensive research of its etiology showed that AF and its mechanisms are still debatable. Some of the AF origins are ascribed to functional and ionic heterogeneities of the heart tissue and possibly to additional triggering agents. But, have all AF origins been detected? Are all accepted origins, in fact, arrhythmogenic? In order to study these questions and specifically to check our new idea of intermittency as an arrhythmogenesis agent, we chose to employ a mathematical model which was as simple as possible, but which could still be used to observe the basic network processes of AF development. At this point we were not interested in the detailed ionic propagations nor in the actual shapes of the induced action potentials (APs) during the AF outbreaks. The model was checked by its ability to exactly recapture the basic AF developmental stages known from experimental cardiac observations and from more elaborate mathematical models. We use a simple cellular automata 2D mathematical model of N × N matrices to elucidate the field processes leading to AF in a tissue riddled with randomly distributed heterogeneities of different types, under sinus node operation, simulated by an initial line of briefly stimulated cells inducing a propagating wave, and with or without an additional active ectopic action potential pulse, in turn simulated by a transitory operation of a specific cell. Arrhythmogenic contributions, of three different types of local heterogeneities in myocytes and their collaborations, in inducing AF are examined. These are: a heterogeneity created by diffuse fibrosis, a heterogeneity created by myocytes having different refractory periods, and a new heterogeneity type, created by intermittent operation of some myocytes. The developmental stages (target waves and spirals) and the different probabilities of AF occurring under each condition, are shown. This model was established as being capable of reproducing the known AF origins and their basic development stages, and in addition has shown: (1) That diffuse fibrosis on its own is not arrhythmogenic but in combination with other arrhythmogenic agents it can either enhance or limit AF. (2) In general, combinations of heterogeneities can act synergistically, and, most importantly, (3) The new type of intermittency heterogeneity proves to be extremely arrhythmogenic. Both the intermittency risk and the fibrosis role in AF generation were established. Knowledge of the character of these arrhythmogenesis agents can be of real importance in AF treatment.
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Affiliation(s)
- A Rabinovitch
- Physics Department, Ben-Gurion University, Beer-Sheva, Israel.
| | | | - Y Biton
- Physics Department, Ben-Gurion University, Beer-Sheva, Israel
| | - D Braunstein
- Physics Department, Sami Shamoon College of Engineering, Beer-Sheva, Israel
| | - R Thieberger
- Physics Department, Ben-Gurion University, Beer-Sheva, Israel
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Ahmad MI, Mujtaba M, Floyd JS, Chen LY, Soliman EZ. Electrocardiographic markers of atrial cardiomyopathy and risk of heart failure in the multi-ethnic study of atherosclerosis (MESA) cohort. Front Cardiovasc Med 2023; 10:1143338. [PMID: 37180781 PMCID: PMC10169752 DOI: 10.3389/fcvm.2023.1143338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Background The association of electrocardiographic (ECG) markers of atrial cardiomyopathy with heart failure (HF) and its subtypes is unclear. Methods This analysis included 6,754 participants free of clinical cardiovascular disease (CVD), including atrial fibrillation (AF), from the Multi-Ethnic Study of Atherosclerosis. Five ECG markers of atrial cardiomyopathy (P-wave terminal force in V1 [PTFV1], deep-terminal negativity in V1 [DTNV1], P-wave duration [PWD], P-wave axis [PWA], advanced intra-atrial block [aIAB]) were derived from digitally recorded electrocardiograms. Incident HF events through 2018 were centrally adjudicated. An ejection fraction (EF) of 50% at the time of HF was used to classify HF as HF with reduced EF (HFrEF), HF with preserved EF (HFpEF), or unclassified HF. Cox proportional hazard models were used to examine the associations of markers of atrial cardiomyopathy with HF. The Lunn-McNeil method was used to compare the associations in HFrEF vs. HFpEF. Results 413 HF events occurred over a median follow-up of 16 years. In adjusted models, abnormal PTFV1 (HR (95%CI): 1.56(1.15-2.13), abnormal PWA (HR (95%CI):1.60(1.16-2.22), aIAB (HR (95%CI):2.62(1.47-4.69), DTNPV1 (HR (95%CI): 2.99(1.63-7.33), and abnormal PWD (HR (95%CI): 1.33(1.02-1.73), were associated with increased HF risk. These associations persisted after further adjustments for intercurrent AF events. No significant differences in the strength of association of each ECG predictor with HFrEF and HFpEF were noted. Conclusions Atrial cardiomyopathy defined by ECG markers is associated with HF, with no differences in the strength of association between HFrEF and HFpEF. Markers of atrial Cardiomyopathy may help identify individuals at risk of developing HF.
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Affiliation(s)
- Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Wauwatosa, WI, United States
| | - Mohammadtokir Mujtaba
- Department of Internal Medicine, Section on Hospital Medicine, Geisel School of Medicine, Dartmouth, NH, United States
| | - James S. Floyd
- Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Lin Y. Chen
- Lillehei Heart Institute and Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Hobson S, Arefin S, Witasp A, Hernandez L, Kublickiene K, Shiels PG, Stenvinkel P. Accelerated Vascular Aging in Chronic Kidney Disease: The Potential for Novel Therapies. Circ Res 2023; 132:950-969. [PMID: 37053277 DOI: 10.1161/circresaha.122.321751] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
The pathophysiology of vascular disease is linked to accelerated biological aging and a combination of genetic, lifestyle, biological, and environmental risk factors. Within the scenario of uncontrolled artery wall aging processes, CKD (chronic kidney disease) stands out as a valid model for detailed structural, functional, and molecular studies of this process. The cardiorenal syndrome relates to the detrimental bidirectional interplay between the kidney and the cardiovascular system. In addition to established risk factors, this group of patients is subjected to a plethora of other emerging vascular risk factors, such as inflammation, oxidative stress, mitochondrial dysfunction, vitamin K deficiency, cellular senescence, somatic mutations, epigenetic modifications, and increased apoptosis. A better understanding of the molecular mechanisms through which the uremic milieu triggers and maintains early vascular aging processes, has provided important new clues on inflammatory pathways and emerging risk factors alike, and to the altered behavior of cells in the arterial wall. Advances in the understanding of the biology of uremic early vascular aging opens avenues to novel pharmacological and nutritional therapeutic interventions. Such strategies hold promise to improve future prevention and treatment of early vascular aging not only in CKD but also in the elderly general population.
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Affiliation(s)
- S Hobson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (S.H., S.A., A.W., L.H., K.K., P.S.)
| | - S Arefin
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (S.H., S.A., A.W., L.H., K.K., P.S.)
| | - A Witasp
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (S.H., S.A., A.W., L.H., K.K., P.S.)
| | - L Hernandez
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (S.H., S.A., A.W., L.H., K.K., P.S.)
| | - K Kublickiene
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (S.H., S.A., A.W., L.H., K.K., P.S.)
| | - P G Shiels
- School of Molecular Biosciences, MVLS, University of Glasgow, United Kingdom (P.G.S.)
| | - P Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (S.H., S.A., A.W., L.H., K.K., P.S.)
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Sacharczuk W, Dankowski R, Ożegowski S, Rojna M, Szyszka A. Evaluation of early left-sided cardiac reverse remodeling under combined therapy of sacubitril-valsartan and spironolactone compared with angiotensin-converting enzyme inhibitors and spironolactone. Front Cardiovasc Med 2023; 10:1103688. [PMID: 37077749 PMCID: PMC10106719 DOI: 10.3389/fcvm.2023.1103688] [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: 11/20/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
We aimed to compare therapies of sacubitril/valsartan + spironolactone (S/V + S) with angiotensin-converting enzyme inhibitors + spironolactone (ACEI + S) on the left-sided cardiac reverse remodeling (L-CRR). The second objective was to analyze the usefulness of GLS and LVEF in response to therapy. Methods 78 patients (mean age 63.4 years, 20 females) with symptomatic heart failure with reduced ejection fraction were randomized to groups of equal numbers, i.e., 39 patients, and started on therapy of S/V + S or ACEI + S. Second evaluations were made after 6-8 weeks of therapy. Results GLS changed from -7.4% to -9.4% (18% improvement) in both arms equally. More than 50% of patients, initially with very severe systolic dysfunction (GLS > -8%), were reclassified to severe (GLS -8% to -12%). LVEF did not improve in any of the groups. The quality of life measured by MLHFQ and walking distance by 6-MWT increased. Positive correlations between GLS and 6MWT (r = 0.41, p = 0.02) and GLS and MHFLQ (r = 0.42, p = 0.03) were found. The S/V + S subgroup demonstrated improvements in LVEDV (Δ16.7 vs. 4.5 ml), E/e ratio (Δ 2.8 vs. 1.4), and LAVI (Δ 9.4 vs. 8.4 ml/m2) as compared to ACEI + S. Conclusion GLS, unlike LVEF, detects early changes in LV systolic function after 6-8 weeks of combined therapy, i.e., SV + S and ACE + S. GLS is more useful than LVEF in assessing early response to treatment. The effect of S/V + S and ACEI + S on LV systolic function was comparable, but the improvement in diastolic function as expressed by E/e', LAVI, and LVEDV was more pronounced with S/V + S.
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Affiliation(s)
- Wioletta Sacharczuk
- Second Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
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