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Brás PG, Cunha PS, Timóteo AT, Portugal G, Galrinho A, Laranjo S, Cruz MC, Valente B, Rio P, Delgado AS, Paulo M, Brás M, Ferreira RC, Oliveira MM, Branco LM. Evaluation of left atrial strain imaging and integrated backscatter as predictors of recurrence in patients with paroxysmal, persistent, and long-standing persistent atrial fibrillation undergoing catheter ablation. J Interv Card Electrophysiol 2024; 67:479-492. [PMID: 37414922 DOI: 10.1007/s10840-023-01602-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Impaired left atrial (LA) strain predicts atrial fibrillation (AF) recurrence after catheter ablation (CA), but currently there is no cut-off to guide patient selection for CA. Integrated backscatter (IBS) is a promising tool for noninvasive quantification of myocardial fibrosis. The aim of this study was to compare LA strain and IBS between paroxysmal, persistent, and long-standing persistent AF and evaluate their association with AF recurrence after CA. METHODS Analysis of consecutive patients with symptomatic paroxysmal and persistent AF who underwent CA. LA phasic strain, strain rate and IBS were assessed by two-dimensional speckle-tracking at baseline. RESULTS We analyzed 78 patients, 31% with persistent AF (46% long-standing AF), 65% male, mean age 59 ± 14 years, who underwent CA and were followed-up for 12 months. AF recurrence occurred in 22 (28%) patients. LA phasic strain parameters were significantly impaired in patients with AF recurrence and were independent predictors of AF recurrence in a multivariable analysis. LA reservoir strain (LASr) < 18% predicted AF recurrence with 86% sensitivity and 71% specificity, with a higher predictive power compared to LA volume index (LAVI). LASr < 22% in paroxysmal AF and LASr < 12% in persistent AF correlated with AF recurrence. Increased IBS was a predictor of AF recurrence in patients with paroxysmal AF. CONCLUSION LA phasic strain parameters were predictors of AF recurrence after CA, independently of LAVI and AF subtype. LASr < 18% showed a higher predictive power compared to LAVI. Further studies are needed to investigate the role of IBS as a predictor of AF recurrence.
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Affiliation(s)
- Pedro Garcia Brás
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal.
| | - Pedro Silva Cunha
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Ana Teresa Timóteo
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), Lisbon, Portugal
| | - Guilherme Portugal
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Ana Galrinho
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Sérgio Laranjo
- Department of Physiology, NOVA Medical School|Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Madalena Coutinho Cruz
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Bruno Valente
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Pedro Rio
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Ana Sofia Delgado
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Margarida Paulo
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Manuel Brás
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Mário Martins Oliveira
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
- Department of Physiology, NOVA Medical School|Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
| | - Luísa Moura Branco
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
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Tubeeckx MRL, De Keulenaer GW, Heidbuchel H, Segers VFM. Pathophysiology and clinical relevance of atrial myopathy. Basic Res Cardiol 2024; 119:215-242. [PMID: 38472506 DOI: 10.1007/s00395-024-01038-0] [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: 09/30/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/14/2024]
Abstract
Atrial myopathy is a condition that consists of electrical, structural, contractile, and autonomic remodeling of the atria and is the substrate for development of atrial fibrillation, the most common arrhythmia. Pathophysiologic mechanisms driving atrial myopathy are inflammation, oxidative stress, atrial stretch, and neurohormonal signals, e.g., angiotensin-II and aldosterone. These mechanisms initiate the structural and functional remodeling of the atrial myocardium. Novel therapeutic strategies are being developed that target the pathophysiologic mechanisms of atrial myopathy. In this review, we will discuss the pathophysiology of atrial myopathy, as well as diagnostic and therapeutic strategies.
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Affiliation(s)
- Michiel R L Tubeeckx
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium.
| | - Gilles W De Keulenaer
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium
- Department of Cardiology, ZNA Middelheim Hospital Antwerp, Antwerp, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Vincent F M Segers
- Laboratory of Physiopharmacology, Universiteitsplein 1, Building T (2nd Floor), 2610, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
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Moharram MA, Lamberts RR, Whalley G, Williams MJA, Coffey S. Myocardial tissue characterisation using echocardiographic deformation imaging. Cardiovasc Ultrasound 2019; 17:27. [PMID: 31730467 PMCID: PMC6858720 DOI: 10.1186/s12947-019-0176-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/06/2019] [Indexed: 12/13/2022] Open
Abstract
Myocardial pathology results in significant morbidity and mortality, whether due to primary cardiomyopathic processes or secondary to other conditions such as ischemic heart disease. Cardiac imaging techniques characterise the underlying tissue directly, by assessing a signal from the tissue itself, or indirectly, by inferring tissue characteristics from global or regional function. Cardiac magnetic resonance imaging is currently the most investigated imaging modality for tissue characterisation, but, due to its accessibility, advanced echocardiography represents an attractive alternative. Speckle tracking echocardiography (STE) is a reproducible technique used to assess myocardial deformation at both segmental and global levels. Since distinct myocardial pathologies affect deformation differently, information about the underlying tissue can be inferred by STE. In this review, the current available studies correlating STE deformation parameters with underlying tissue characteristics in humans are examined, with separate emphasis on global and segmental analysis. The current knowledge is placed in the context of integrated backscatter and the future of echocardiographic based tissue characterisation is discussed. The use of these imaging techniques to more precisely phenotype myocardial pathology more precisely will allow the design of translational cardiac research studies and, potentially, tailored management strategies.
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Affiliation(s)
- Mohammed A. Moharram
- Department of Medicine – HeartOtago, Dunedin School of Medicine, University of Otago, Box 56, Dunedin, PO 9054 New Zealand
| | - Regis R. Lamberts
- Department of Physiology – HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Gillian Whalley
- Department of Medicine – HeartOtago, Dunedin School of Medicine, University of Otago, Box 56, Dunedin, PO 9054 New Zealand
| | - Michael J. A. Williams
- Department of Medicine – HeartOtago, Dunedin School of Medicine, University of Otago, Box 56, Dunedin, PO 9054 New Zealand
| | - Sean Coffey
- Department of Medicine – HeartOtago, Dunedin School of Medicine, University of Otago, Box 56, Dunedin, PO 9054 New Zealand
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Tanaka S, Noda T, Kawasaki M, Segawa T, Tsugita N, Fuseya T, Kubota T, Iwama M, Nishigaki K, Watanabe S, Minagawa T, Ohashi H, Minatoguchi S. Relationship between electrical conduction and phasic left atrial function: P-wave signal-averaged electrocardiography and time-left atrial volume curve assessments using two-dimensional speckle-tracking echocardiography. Heart Vessels 2019; 34:1212-1220. [DOI: 10.1007/s00380-019-01351-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/18/2019] [Indexed: 11/29/2022]
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Kawasaki M, Tanaka R, Yoshida A, Nagaya M, Minatoguchi S, Yoshizane T, Watanabe T, Kanamori H, Ono K, Hirose T, Noda T, Watanabe S. Non-Invasive Pulmonary Capillary Wedge Pressure Assessment on Speckle Tracking Echocardiography as a Predictor of New-Onset Non-Valvular Atrial Fibrillation - Four-Year Prospective Study (NIPAF Study). Circ J 2018; 82:3029-3036. [PMID: 30333437 DOI: 10.1253/circj.cj-18-0799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although new-onset atrial fibrillation (AF) increases with ageing, the prediction of new-onset AF is complicated. We previously reported that pulmonary capillary wedge pressure (ePCWP) estimated by the combination of left atrial volume index (LAVI) and active left atrial emptying function (aLAEF) had a strong relationship with PCWP on catheterization (r=0.92): ePCWP=10.8-12.4×log (aLAEF/minimum LAVI). We sought to determine the usefulness of ePCWP to predict new-onset AF. Methods and Results: We measured LAVI, aLAEF and ePCWP on speckle tracking echocardiography (STE) in 566 consecutive elderly patients (72±6 years) without a history of AF. A total of 63 patients (73±6 years) developed electrocardiographically confirmed AF during a mean follow-up period of 50 months. Baseline aLAEF was significantly lower in patients with than without new-onset AF (17.9±6.5 vs. 28.2±7.5%), whereas ePCWP was significantly higher (14.8±3.7 vs. 10.3±3.1 mmHg). In multivariate logistic regression analysis, ePCWP and aLAEF were strong independent predictors of AF. Using ePCWP >13 mmHg or aLAEF ≤22% on univariate Cox regression analysis, the HR for new-onset AF were 3.53 (95% CI: 1.68-7.44, P<0.001) and 4.06 (95% CI: 1.90-8.65, P<0.001), respectively. By combining these 2 criteria (>13 mmHg and ≤22%), the HR increased to 11.84 (95% CI: 6.85-20.5, P<0.001). CONCLUSIONS ePCWP and aLAEF measured on STE are useful predictors of new-onset AF. ePCWP provides added value for risk stratification of new-onset AF.
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Affiliation(s)
- Masanori Kawasaki
- Department of Cardiology, Gifu University Graduate School of Medicine
| | | | - Akihiro Yoshida
- Department of Cardiology, Gifu University Graduate School of Medicine
| | - Maki Nagaya
- Department of Cardiology, Gifu Prefectural General Medical Center
| | | | | | - Takatomo Watanabe
- Department of Cardiology, Gifu University Graduate School of Medicine
| | | | - Koji Ono
- Department of Cardiology, Gifu Prefectural General Medical Center
| | - Takeshi Hirose
- Department of Cardiology, Gifu Prefectural General Medical Center
| | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center
| | - Sachiro Watanabe
- Department of Cardiology, Gifu Prefectural General Medical Center
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Shang Z, Su D, Cong T, Sun Y, Liu Y, Chen N, Yang J. Assessment of left atrial mechanical function and synchrony in paroxysmal atrial fibrillation with two-dimensional speckle tracking echocardiography. Echocardiography 2017; 34:176-183. [PMID: 28240425 DOI: 10.1111/echo.13434] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate left atrial (LA) function and synchrony in paroxysmal atrial fibrillation (PAF) patients using two-dimensional speckle tracking echocardiography (STE). METHODS Forty-five PAF patients and 30 healthy controls were enrolled. LA peak ventricular systolic longitudinal strain (LAS-S ) and strain rate (LASR-S ) and left atrial longitudinal strain (LAS-A ) and strain rate (LASR-A ) during late diastole were determined using STE, and the standard deviation of the time to peak (TPSD) of the regional strains was calculated to quantify LA dyssynchrony. TPSD during ventricular systole and late diastole were named SDs and SDa, respectively. RESULTS Left atrial peak longitudinal strain during ventricular systole (LAS-S ) (29.34±8.57 vs 36.73±6.13), LASR-S (1.27±0.311 vs 1.57±0.25), LAS-A (13.11±4.91 vs 17.86±3.57), and LASR-A (-1.51±0.58 vs -1.90±0.30) were reduced in the PAF group compared with the controls (P<.05 for all). SDs (8.11±3.00% vs 4.67±1.48%) and SDa (5.57±2.26% vs 3.11±1.13%) were greater in PAF patients than in the controls (P<.05 for both). Furthermore, PAF patients with normal LA sizes exhibited lower LAS-S (P<.05), LASR-S (P<.05), LAS-A (P<.05), and LASR-A (P<.05) values and increased SDs (P<.05) and SDa (P<.05) values compared with the controls. Multivariate regression confirmed that SDs and SDa were powerful parameters for differentiating PAF patients from controls (SDs: sensitivity, 83%; specificity, 72%; SDa: sensitivity, 81%; specificity, 76%). CONCLUSIONS Left atrial (LA) dysfunction and dyssynchrony in PAF patients can be detected with STE even in the absence of LA enlargement. STE-derived SDs and SDa were powerful parameters for identifying PAF patients.
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Affiliation(s)
- Zhijuan Shang
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Dechun Su
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tao Cong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yinghui Sun
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yan Liu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Na Chen
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
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Sasaki N, Okumura Y, Watanabe I, Nagashima K, Sonoda K, Kogawa R, Takahashi K, Iso K, Ohkubo K, Nakai T, Hiro T, Hirayama A. Transthoracic echocardiographic backscatter-based assessment of left atrial remodeling involving left atrial and ventricular fibrosis in patients with atrial fibrillation. Int J Cardiol 2014; 176:1064-6. [DOI: 10.1016/j.ijcard.2014.07.138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022]
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Tenekecioglu E, Agca FV, Karaagac K, Ozluk OA, Peker T, Kuzeytemiz M, Senturk M, Yılmaz M. Left atrial appendage function in prediction of paroxysmal atrial fibrilation in patients with untreated hypertension. Clin Exp Hypertens 2013; 36:348-53. [PMID: 24047156 DOI: 10.3109/10641963.2013.827700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract The onset of AF results in a significant increase in mortality rates and morbidity in hypertensive patients and this rhythm disorder exposes patients to a significantly increased risk of cerebral or peripheral embolisms. Tissue Doppler imaging was found to be useful in early detection of myocardial dysfunction in several diseases. It was shown that tissue Doppler analysis of the walls of the left atrial appendage (LAA) can give accurate information about the function of the LAA in hypertensive patients. In this study, we aimed to investigate and identify the specific predictive parameters for the onset of AF in patients with hypertension with tissue Doppler imaging of LAA. We studied age and sex matched 57 untreated hypertensive patients with paroxysmal atrial fibrillation (PAF) and 27 untreated hypertensive subjects without PAF. With transthoracic echocardiography, diastolic mitral A-velocity and LA maximal volume index which reflects reservoir function of left atrium was measured, with transesophageal echocardiography, LAA emptying velocity (LAA-PW D2) and tissue Doppler contracting velocity of LAA (LAA-TDI-D2) were measured. LA maximal volume index of the groups (22.28 ± 3.59 mL/m(2) in Group 1 versus 20.37 ± 3.97 mL/m(2) in Group 2, p = 0.07) and diastolic mitral A-velocity [0.93 (0.59-1.84) m/s in patients with PAF versus 0.90 (0.62-1.76) m/s in patients without PAF, p = 0.26] was not significantly different between study groups, during TEE, LAA-PW D2 (0.31 ± 0.04 m/s in Group 1 versus 0.33 ± 0.03 m/s in Group 2, p = 0.034) and LAA-TDI-D2 (0.18 ± 0.04 m/s in Group 1 versus 0.21 ± 0.05 m/s in Group 2, p = 0.014) were significantly decreased in Group 1. In this study, we found that in hypertensive PAF patients despite normal global LA functions, LAA contracting function was deteriorated. Tissue Doppler analysis of LAA is clinically usefull approach to detect the risk of developing PAF in hypertensives.
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Affiliation(s)
- Erhan Tenekecioglu
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Resarch Hospital , Bursa , Turkey
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Kubota T, Kawasaki M, Takasugi N, Imai H, Ishihara Y, Okubo M, Takahashi S, Sato H, Nishigaki K, Takemura G, Minatoguchi S. Left atrial pathological degeneration assessed by integrated backscatter transesophageal echocardiography as a predictor of progression to persistent atrial fibrillation: results from a prospective study of three-years follow-up. Cardiovasc Ultrasound 2012; 10:28. [PMID: 22747941 PMCID: PMC3416739 DOI: 10.1186/1476-7120-10-28] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 06/29/2012] [Indexed: 11/10/2022] Open
Abstract
Background It is recognized that one of the causes of atrial fibrillation (AF) is pathological degeneration of the left atrium (LA). However, prospective study that elucidated the relationship between the incidence of persistent AF and pathological degeneration has not been performed. The purpose of this study was to elucidate the usefulness of integrated backscatter (IBS) values for the prediction of progression from paroxysmal AF (PAF) to persistent AF. Methods We measured IBS values of the entire LA wall at 5 mm intervals (except the posterior wall) in 27 patients with paroxysmal AF and evaluated progression to persistent AF for three years. IBS values were acquired with transesophageal echocardiography (TEE) using a 4–7 MHz transducer. IBS values were calculated as the average power of the backscattered signal from regions of interest (ROI). Each IBS value was color-coded to construct three dimensional maps. Results Average IBS values of total voxels in color-coded maps in the persistent AF group were significantly greater than those in the non-persistent AF group (25.8 ± 5.0 dB vs. 17.4 ± 10.2 dB, p = 0.047), whereas there was no significant difference in LA diameter between the persistent AF and the non-persistent AF group. There was significant difference in persistent AF-free survival after the baseline measurements in the subjects stratified by IBS value (<20 dB versus ≥20 dB) (univariate Cox regression analysis: hazard ratio: 8.74, p =0.046). Conclusion Using IBS values measured by TEE, we can identify an increase in atrial degeneration that may predict the occurrence of persistent AF before LA dilation.
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Affiliation(s)
- Tomoki Kubota
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
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Kojima T, Kawasaki M, Tanaka R, Ono K, Hirose T, Iwama M, Watanabe T, Noda T, Watanabe S, Takemura G, Minatoguchi S. Left atrial global and regional function in patients with paroxysmal atrial fibrillation has already been impaired before enlargement of left atrium: velocity vector imaging echocardiography study. Eur Heart J Cardiovasc Imaging 2011; 13:227-34. [PMID: 22166594 DOI: 10.1093/ejechocard/jer281] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS Left atrial volume (LAV) has been proposed as a predictor of atrial fibrillation (AF) and LA function has been investigated by velocity vector imaging (VVI) echocardiography. The aim of this study was to determine whether LA function was associated with the existence of AF. METHODS AND RESULTS We examined emptying function (EF) as a global function and strain rate (SR) as a regional function of LA function during three phases of the cardiac cycle (reservoir, conduit, and booster pump phase). The parameters were measured (apical four-chamber view) by VVI in 302 subjects [126 sinus rhythm, 91 paroxysmal AF (PAF), and 85 chronic AF]. Global and regional LA function were significantly lower in PAF patients during sinus rhythm (LA total EF: 35 ± 8%; SR at atrial contraction: -0.8 ± 0.3s(-1)) and much lower in chronic AF patients (LA total EF 22 ± 8%) than in subjects with sinus rhythm (LA total EF: 47 ± 7%; SR at atrial contraction: -1.4 ± 0.4s(-1)). In multivariate logistic regression analysis, LA active EF and SR at atrial contraction were independent features of PAF. CONCLUSION LA function, particularly LA active relaxation and contraction, was lower in PAF patients than in subjects with sinus rhythm, regardless of LA size and age. LA functional impairment was observed regardless of hypertension before LA enlargement in patients with PAF. Reduced LA function, as assessed by VVI, is an important feature of AF as well as LA structure.
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Affiliation(s)
- Tai Kojima
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
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Hirose T, Kawasaki M, Tanaka R, Ono K, Watanabe T, Iwama M, Noda T, Watanabe S, Takemura G, Minatoguchi S. Left atrial function assessed by speckle tracking echocardiography as a predictor of new-onset non-valvular atrial fibrillation: results from a prospective study in 580 adults. Eur Heart J Cardiovasc Imaging 2011; 13:243-50. [PMID: 22120846 DOI: 10.1093/ejechocard/jer251] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
AIMS The aim of this prospective study was to evaluate left atrial (LA) function for the prediction of increased risk of new-onset non-valvular atrial fibrillation (AF). Risk stratification for new-onset AF based on LA remodelling may have a major public health impact. Although left atrial volume (LAV) or LA dimension have been proposed as predictors of AF, other predictive parameters of LA function have not yet been fully examined. METHODS AND RESULTS LA emptying function (EF), strain rate (SR), and LAV were evaluated in the apical four-chamber view by speckle tracking echocardiography in 580 consecutive adults (age 64 ± 17, 303 men) without a history of atrial arrhythmias. During a follow-up period of 28 months, 32 subjects (age 73 ± 9, 18 men) developed electrocardiographically confirmed AF. Subjects with new-onset AF had lower LA active EF (16 ± 5 vs. 28 ± 8%, P< 0.001) and lower LA SR at atrial contraction (-0.9 ± 0.2 vs. -1.4 ± 0.5 S(-1), P< 0.001), but larger maximum LAV index (59 ± 12 vs. 46 ± 16 mL/m(2), P< 0.001) compared with non-AF subjects at baseline. In multivariate logistic regression analysis, LA active EF was the only independent predictor of new-onset AF. Using an LA active EF cut-off of ≤20%, the sensitivity and specificity for new-onset AF based on receiver operator characteristic curve analysis were 88 and 81%, respectively (area under the curve: 0.92). CONCLUSION Reduced LA active EF (booster pump function) assessed by speckle tracking echocardiography independently predicts the risk of new-onset AF, suggesting a stronger association between LA functional remodelling and AF than between LA size and AF.
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Affiliation(s)
- Takeshi Hirose
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
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Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, Galderisi M, Marwick T, Nagueh SF, Sengupta PP, Sicari R, Smiseth OA, Smulevitz B, Takeuchi M, Thomas JD, Vannan M, Voigt JU, Zamorano JL. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:167-205. [PMID: 21385887 DOI: 10.1093/ejechocard/jer021] [Citation(s) in RCA: 676] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Echocardiographic imaging is ideally suited for the evaluation of cardiac mechanics because of its intrinsically dynamic nature. Because for decades, echocardiography has been the only imaging modality that allows dynamic imaging of the heart, it is only natural that new, increasingly automated techniques for sophisticated analysis of cardiac mechanics have been driven by researchers and manufacturers of ultrasound imaging equipment. Several such techniques have emerged over the past decades to address the issue of reader's experience and inter-measurement variability in interpretation. Some were widely embraced by echocardiographers around the world and became part of the clinical routine, whereas others remained limited to research and exploration of new clinical applications. Two such techniques have dominated the research arena of echocardiography: (1) Doppler-based tissue velocity measurements, frequently referred to as tissue Doppler or myocardial Doppler, and (2) speckle tracking on the basis of displacement measurements. Both types of measurements lend themselves to the derivation of multiple parameters of myocardial function. The goal of this document is to focus on the currently available techniques that allow quantitative assessment of myocardial function via image-based analysis of local myocardial dynamics, including Doppler tissue imaging and speckle-tracking echocardiography, as well as integrated back- scatter analysis. This document describes the current and potential clinical applications of these techniques and their strengths and weaknesses, briefly surveys a selection of the relevant published literature while highlighting normal and abnormal findings in the context of different cardiovascular pathologies, and summarizes the unresolved issues, future research priorities, and recommended indications for clinical use.
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Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, Galderisi M, Marwick T, Nagueh SF, Sengupta PP, Sicari R, Smiseth OA, Smulevitz B, Takeuchi M, Thomas JD, Vannan M, Voigt JU, Zamorano JL. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr 2011; 24:277-313. [PMID: 21338865 DOI: 10.1016/j.echo.2011.01.015] [Citation(s) in RCA: 864] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Echocardiographic imaging is ideally suited for the evaluation of cardiac mechanics because of its intrinsically dynamic nature. Because for decades, echocardiography has been the only imaging modality that allows dynamic imaging of the heart, it is only natural that new, increasingly automated techniques for sophisticated analysis of cardiac mechanics have been driven by researchers and manufacturers of ultrasound imaging equipment.Several such technique shave emerged over the past decades to address the issue of reader's experience and inter measurement variability in interpretation.Some were widely embraced by echocardiographers around the world and became part of the clinical routine,whereas others remained limited to research and exploration of new clinical applications.Two such techniques have dominated the research arena of echocardiography: (1) Doppler based tissue velocity measurements,frequently referred to as tissue Doppler or myocardial Doppler, and (2) speckle tracking on the basis of displacement measurements.Both types of measurements lend themselves to the derivation of multiple parameters of myocardial function. The goal of this document is to focus on the currently available techniques that allow quantitative assessment of myocardial function via image-based analysis of local myocardial dynamics, including Doppler tissue imaging and speckle-tracking echocardiography, as well as integrated backscatter analysis. This document describes the current and potential clinical applications of these techniques and their strengths and weaknesses,briefly surveys a selection of the relevant published literature while highlighting normal and abnormal findings in the context of different cardiovascular pathologies, and summarizes the unresolved issues, future research priorities, and recommended indications for clinical use.
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