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Liu T, Yang X, Jia R, Han J, Gu X, Liu P, Zhang Y, Jiang W, Hao X, He Y. Left atrial mechanical dispersion and left atrial stiffness predicts recurrence of atrial fibrillation: In patients with moderate-severe rheumatic mitral stenosis. Int J Cardiol 2024:132480. [PMID: 39197727 DOI: 10.1016/j.ijcard.2024.132480] [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: 06/27/2024] [Revised: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 09/01/2024]
Abstract
AIMS The aim of this study was to evaluate the relationship between preoperative left atrial function and recurrence of atrial fibrillation (AF) after mitral valve surgery and Cox Maze procedure in patients with moderate-to-severe rheumatic mitral stenosis (MS) combined with AF, in order to facilitate clinical risk stratification and to guide treatment strategies. METHODS AND RESULTS Patients with moderate-to-severe rheumatic MS attending Beijing Anzhen Hospital of Capital Medical University from April 2022 to September 2023 were prospectively collected, and all of them underwent transthoracic two-dimensional speckle-tracking echocardiography to assess left atrial structure and function before undergoing mitral valve surgery and Cox Maze procedure and postoperative follow-up. 121 patients were enrolled, of whom 77.69 % (94/121) were female, with a median follow-up time of 9.56 ± 1.83 months, and 48 patients (39.7 %, 48/121) had postoperative recurrence of AF. Preoperative left atrial stiffness index (LASI) [3.76(3.10-5.44) vs. 2.41(1.75-3.33), P < 0.001] and left atrial mechanical dispersion (SD-TPS) (15.84 ± 5.92vs. 11.58 ± 5.96, P = 0.001) were significantly higher in the postoperative AF recurrence group than in the without recurrence group; Multivariable cox regression analysis showed that LASI>3.15 and SD -TPS > 13.2 were associated with independent risk factors for AF recurrence (hazard ratio = 2.957, 95 %CI,1.366-6.399, P = 0.006 and hazard ratio = 2.892, 95 %CI,1.381-6.057, P = 0.005). CONCLUSION LASI and SD-TPS were effective predictors of postoperative recurrence of AF in patients with moderate-to-severe rheumatic MS, and LASI >3.15 and SD-TPS% >13.2 were independent influences on the recurrence of AF after Cox Maze in this group of patients.
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Affiliation(s)
- Tingting Liu
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, China
| | - Xian Yang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, China
| | - Ruihan Jia
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, China
| | - Jiancheng Han
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, China
| | - Xiaoyan Gu
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, China
| | - Peiyi Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, China
| | - Yazhe Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, China
| | - Wenjian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, China.
| | - Xiaoyan Hao
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, China.
| | - Yihua He
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, China.
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Ferkh A, Geenty P, Stefani L, Emerson P, Pham J, Byth K, Boyd AC, Richards D, Taylor MS, Kwok F, Kizana E, Thomas L. Diagnostic and prognostic value of the left atrial myopathy evaluation in cardiac amyloidosis using echocardiography. ESC Heart Fail 2024. [PMID: 39129371 DOI: 10.1002/ehf2.15013] [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: 01/04/2024] [Revised: 06/11/2024] [Accepted: 07/16/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Cardiac amyloidosis (CA) is an under-recognized cause of heart failure. Left atrial (LA) myopathy contributes to a worse prognosis in heart failure and is a feature of transthyretin (ATTR) and light-chain (AL) CA. LA mechanical dispersion (LA-MD) is a novel marker of intra-atrial dyssynchrony implicated in LA myopathy and the future development of atrial fibrillation (AF). AIMS This study aimed to determine the characteristics and prognostic value of LA myopathy in ATTR and AL cardiomyopathy through a comprehensive LA echocardiographic evaluation. METHODS ATTR (n = 86) and AL (n = 86) CA patients were compared with hypertensive heart disease (HHT) patients (n = 58). Transthoracic echocardiographic measurements including LA strain and LA-MD were obtained with patient follow-up for mortality. RESULTS ATTR and AL patients had a median follow-up of 66 months, with 26 mortality events. Left ventricular (LV) mass, diastolic function (average-e' and E/e'), LV global longitudinal strain, and LA volume and function (LA function index and strain) were more impaired in ATTR versus AL; these echocardiographic parameters were more impaired in both amyloid groups compared to HHT patients (P < 0.05). LA-MD was increased in ATTR versus AL [median 72.2 (inter-quartile range 55-88.9) vs. 54 (43.5-64.2), respectively, P < 0.001]. Multivariable logistic regression adjusted for age, presence of AF, LV mass, global and basal strain, and E/e' demonstrated that LA-MD was an independent determinant of ATTR CA (P = 0.014). On multivariable analysis, LA reservoir strain was independently associated with the presence of heart failure in the CA group (P < 0.001). LA minimum volume (cut-off ≥18 mL/m2) was a determinant of mortality in AL CA [Cox proportional hazard ratio (HR) 1.042 (1.003-1.082), P = 0.034 and Kaplan-Meier analysis, P = 0.016]. CONCLUSION Characterizing LA myopathy has significant diagnostic and prognostic utility in CA. ATTR patients have increased atrial dyssynchrony, which may have implications for AF development. LA reservoir strain was associated with heart failure in CA, whilst LA minimum volume was a predictor of mortality in AL CA.
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Affiliation(s)
- Aaisha Ferkh
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Paul Geenty
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Luke Stefani
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Peter Emerson
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Jennifer Pham
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Karen Byth
- WSLHD Research and Education Network, Westmead Hospital, Westmead, New South Wales, Australia
| | - Anita C Boyd
- Westmead Private Cardiology, Westmead, New South Wales, Australia
| | - David Richards
- Westmead Private Cardiology, Westmead, New South Wales, Australia
| | - Mark S Taylor
- Department of Clinical Immunology and Allergy, Westmead Hospital, Westmead, New South Wales, Australia
| | - Fiona Kwok
- Department of Haematology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Eddy Kizana
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Centre for Heart Research, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Liza Thomas
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- South-West Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
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Knappe D, Vogler J, Weimann J, Banas V, Yildirim S, Memenga F, Senftinger J, Keil L, Ismaili D, Nies M, Rillig A, Willems S, Blankenberg S, Kirchhof P, Metzner A, Sinning C. Association of atrial mechanical dispersion with atrial fibrillation recurrence following catheter ablation: results of the ASTRA-AF pilot study. Clin Res Cardiol 2024:10.1007/s00392-024-02435-0. [PMID: 38771346 DOI: 10.1007/s00392-024-02435-0] [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: 12/07/2023] [Accepted: 03/11/2024] [Indexed: 05/22/2024]
Abstract
AIMS For patients with symptomatic drug-refractory atrial fibrillation (AF), catheter ablation to achieve rhythm control is an important therapeutic option. The atrial mechanical dispersion measured as standard deviation of the time to peak strain (SD-TPS) is associated with the risk of AF recurrence following catheter ablation. METHODS The study cohort prospectively enrolled n = 132 consecutive patients with paroxysmal (n = 88) or persistent AF (n = 44) presenting for de novo pulmonary vein isolation (PVI) and followed for 1 year. We related left atrial (LA) volume, LA ejection fraction, SD-TPS, and global longitudinal strain of the left ventricle and clinical variables (sex, age, and type of AF) to AF recurrence. RESULTS Kaplan-Meier curves showed higher AF recurrence rate with an increase of SD-TPS with the calculated cut-off of 38.6 ms. Uni- and multivariable Cox regression analysis could show that SD-TPS had the highest relevance regarding AF recurrence with a HR of 1.05 (95% CI, 1.01; 1.09, p = 0.01) and HR of 1.05 (95% CI, 1.01; 1.09, p = 0.02) per 10 ms increase. In the additional analyses for the model including the clinical variables age, sex, and type of AF with paroxysmal or persisting AF, SD-TPS did only show a trend and after adjusting for covariates, SD-TPS showed a HR of 1.04 (95% CI, 0.99; 1.09, p = 0.09) per 10 ms increase. CONCLUSION Atrial mechanical dispersion was associated with recurrent AF.
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Affiliation(s)
- Dorit Knappe
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany.
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany
| | - Victor Banas
- Department of Medicine III (Cardiology, Angiology, Intensive Care Medicine), University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sevenai Yildirim
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany
| | - Felix Memenga
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany
| | - Juliana Senftinger
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany
| | - Laura Keil
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany
| | - Djemail Ismaili
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany
| | - Moritz Nies
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Institute of Cardiovascular Sciences and SWBH and UHB NHS Trusts, Birmingham, UK
| | - Andreas Metzner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany
| | - Christoph Sinning
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
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Zhao Y, Zhao L, Huang Q, Liao C, Yuan Y, Cao H, Li A, Zeng W, Li S, Zhang B. Nomogram to predict recurrence risk factors in patients with non-valvular paroxysmal atrial fibrillation after catheter radiofrequency ablation. Echocardiography 2024; 41:e15779. [PMID: 38477165 DOI: 10.1111/echo.15779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/03/2024] [Accepted: 01/25/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) is an effective method for controlling the heart rate of paroxysmal atrial fibrillation (PAF). However, recurrence is trouble under the RFCA. To gain a deeper understanding of the risk factors for recurrence in patients, we created a nomogram model to provide clinicians with treatment recommendations. METHODS A total of two hundred thirty-three patients with PAF treated with RFCA at Guizhou Medical University Hospital between January 2021 and December 2022 were consecutively included in this study, and after 1 year of follow-up coverage, 166 patients met the nadir inclusion criteria. Patients with AF were divided into an AF recurrence group and a non-recurrence group. The nomogram was constructed using univariate and multivariate logistic regression analyses. By calculating the area under the curve, we analyzed the predictive ability of the risk scores (AUC). In addition, the performance of the nomogram in terms of calibration, discrimination, and clinical utility was evaluated. RESULTS At the 12-month follow-up, 48 patients (28.92%) experienced a recurrence of AF after RFCA, while 118 patients (71.08%) maintained a sinus rhythm. In addition to age, sex, and TRV, LAD, and TTPG were independent predictors of recurrence of RFCA. The c-index of the nomogram predicted AF recurrence with an accuracy of .723, showing good decision curves and a calibrated nomogram, as determined by internal validation using a bootstrap sample size of 1000. CONCLUSION We created a nomogram based on multifactorial logistic regression analysis to estimate the probability of recurrence in patients with atrial fibrillation 1 year after catheter ablation. This plot can be utilized by clinicians to predict the likelihood of recurrence.
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Affiliation(s)
- Yueyao Zhao
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Lina Zhao
- Guizhou Medical University, Guiyang, Guizhou, China
- Department of Ultrasound Center, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | | | - Chunyan Liao
- Guizhou Medical University, Guiyang, Guizhou, China
- Department of Ultrasound Center, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yao Yuan
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Hongjuan Cao
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Aiyue Li
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Weidan Zeng
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Sha Li
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Bei Zhang
- Guizhou Medical University, Guiyang, Guizhou, China
- Department of Ultrasound Center, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
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Jing M, Li D, Xi H, Zhang Y, Zhou J. Value of Imaging in the Non-Invasive Prediction of Recurrence after Catheter Ablation in Patients with Atrial Fibrillation: An Up-to-Date Review. Rev Cardiovasc Med 2023; 24:241. [PMID: 39076720 PMCID: PMC11266785 DOI: 10.31083/j.rcm2408241] [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: 01/26/2023] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 07/31/2024] Open
Abstract
Catheter ablation (CA) is the first-line treatment for atrial fibrillation (AF) patients. However, the risk of recurrence associated with CA treatment should not be ignored. Therefore, the preoperative identification of patients at risk of recurrence is essential for identifying patients who will benefit from non-invasive surgery. Echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI) are essential for the preoperative non-invasive prediction of AF recurrence after CA. Compared to laboratory examinations and other examination methods, these modalities can identify structural changes in the heart and assess functional variations. Accordingly, in past studies, morphological features, quantitative parameters, and imaging information of the heart, as assessed by echocardiography, CT, and MRI, have been used to predict AF recurrence after CA noninvasively. This review summarizes and discusses the current research on echocardiography, CT, MRI, and machine learning for predicting AF recurrence following CA. Recommendations for future research are also presented.
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Affiliation(s)
- Mengyuan Jing
- Department of Radiology, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
- Second Clinical School, Lanzhou University, 730030 Lanzhou, Gansu, China
- Key Laboratory of Medical Imaging of Gansu Province, 730030 Lanzhou, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, Gansu, China
| | - Dong Li
- Department of Cardiovascular Medicine, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
| | - Huaze Xi
- Department of Radiology, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
- Second Clinical School, Lanzhou University, 730030 Lanzhou, Gansu, China
- Key Laboratory of Medical Imaging of Gansu Province, 730030 Lanzhou, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, Gansu, China
| | - Yuting Zhang
- Department of Radiology, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
- Second Clinical School, Lanzhou University, 730030 Lanzhou, Gansu, China
- Key Laboratory of Medical Imaging of Gansu Province, 730030 Lanzhou, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, Gansu, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
- Second Clinical School, Lanzhou University, 730030 Lanzhou, Gansu, China
- Key Laboratory of Medical Imaging of Gansu Province, 730030 Lanzhou, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, Gansu, China
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Fujisawa T, Kawakami H, Nagai T, Miyazaki S, Akazawa Y, Miyoshi T, Higaki A, Seike F, Higashi H, Nishimura K, Inoue K, Ikeda S, Yamaguchi O. Premature atrial contraction immediately after catheter ablation was associated with late recurrence of atrial fibrillation. Pacing Clin Electrophysiol 2023; 46:152-160. [PMID: 36524673 DOI: 10.1111/pace.14648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although premature atrial contractions (PACs) just after catheter ablation (CA) for atrial fibrillation (AF) are common, their clinical significance is uncertain. This study aimed to evaluate whether the PAC burden after an initial CA for AF was associated with late recurrence. METHODS We enrolled 346 patients with AF (median age, 65 years; 30% female; 57% with paroxysmal AF) who underwent an initial radiofrequency CA and a 24-h Holter monitoring the day after the procedure. PAC was defined as supraventricular complexes occurring ≥30% earlier than expected compared with a previous RR interval, and the number of PAC/24 h during post-procedural Holter monitoring was analyzed. RESULTS AF recurred in 106 patients (31%) during a median follow-up of 19 months. These patients had significantly more PAC/24 h than those without (median [interquartile range], 891 [316-4351] beats vs. 409 [162-1,303] beats; p < 0.01). The number of PACs was independently associated with AF recurrence after adjustment for clinical parameters and left atrial (LA) enlargement. Receiver operating characteristic (ROC) curve analysis revealed that 1431 PAC/24 h was the optimal cut-off value for predicting AF recurrence. Adding the PAC/24 h to the prediction model with LA diameter appeared to correctly reclassify patients who were thought to be at high risk for AF recurrence into the low-risk group and vice versa. CONCLUSIONS The number of PACs was an independent risk factor for AF recurrence. A 24-h Holter recording the day after an initial CA is a simple and beneficial tool for the risk stratification of AF recurrence.
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Affiliation(s)
- Tomoki Fujisawa
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hiroshi Kawakami
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Takayuki Nagai
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Shigehiro Miyazaki
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yusuke Akazawa
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Toru Miyoshi
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Akinori Higaki
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Fumiyasu Seike
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Haruhiko Higashi
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kazuhisa Nishimura
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Katsuji Inoue
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Shuntaro Ikeda
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Osamu Yamaguchi
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
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Baalman SWE, van den Berg NWE, Neefs J, Berger WR, Meulendijks ER, de Bruin-Bon RHACM, Bouma BJ, van Boven WJP, Driessen AHG, de Groot JR. Left atrial strain and recurrence of atrial fibrillation after thoracoscopic surgical ablation: a subanalysis of the AFACT study. Int J Cardiovasc Imaging 2022; 38:2615-2624. [DOI: 10.1007/s10554-022-02645-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/06/2022] [Indexed: 11/05/2022]
Abstract
AbstractTo assess transthoracic echocardiographic (TTE) left atrial (LA) strain parameters and their association with atrial fibrillation (AF) recurrence after thoracoscopic surgical ablation (SA) in patients in sinus rhythm (SR) or in AF at baseline. Patients participating in the Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery trial were included. All patients underwent thoracoscopic pulmonary vein isolation with LA appendage exclusion and were randomized to ganglion plexus (GP) or no GP ablation. In TTEs performed before surgery, LA strain and mechanical dispersion (MD) of the LA reservoir and conduit phase in all patients, and of the contraction phase in patients in SR were obtained. Recurrence of AF was defined as any documented atrial tachyarrhythmia lasting > 30 s during one year of follow-up. Two hundred and four patients (58.6 ± 7.8 years, 73% male, 57% persistent AF) were included. At baseline TTE 121 (59%) were in SR and 83 (41%) had AF. Patients with AF recurrence had lower LA strain of the reservoir phase (13.0% vs. 16.6%; p = < 0.001) and a less decrease in strain of the conduit phase (−9.0% vs. −11.8%; p = 0.006), regardless of rhythm. MD of the conduit phase was larger in patients with AF recurrence (79.4 vs. 43.5 ms; p = 0.012). Multivariate cox regression analysis demonstrated solely an association between LA strain of the reservoir phase and AF recurrence in patients in SR (HR 0.95, p = 0.046) or with AF (HR 0.90, p = 0.038). A reduction in LA strain of the reservoir phase prior to SA predicts recurrence of AF in both patients with SR or AF. Left atrial strain assessment may therefore add to a better patient selection for SA.
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8
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Huang S, Liao C, Chen Z, Chao T, Chen S, Tsao H. Distinct atrial remodeling in patients with subclinical atrial fibrillation: Lessons from computed tomographic images. Pharmacol Res Perspect 2022; 10:e00927. [PMID: 35194973 PMCID: PMC8863578 DOI: 10.1002/prp2.927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Cardiac implanted electronic devices (CIEDs) can detect atrial high-rate episodes (AHREs) and challenge current management of subclinical atrial fibrillation (AF). METHODS To characterize the anatomic and functional remodeling of cardiac structures between patients with subclinical AF (SCAF) and clinical AF. The predictors for AHREs ≥6 min were also investigated. RESULTS We compared the atrial volume, dynamic function, and peri-atrial fat between 104 CIEDs (AHREs = 0, n = 12; SCAF, n = 66; CIEDs with AF, n = 26) and 40 paroxysmal AF patients who were planning for catheter ablation (AF for ablation) using 256-slice multidetector computed tomography for the duration of the AHREs. The maximal volume of the left atrium (LA) and LA appendage (LAA) were significantly smaller; the total emptying fraction (EF) and active EF of the LA and LAA were significantly better in the patients with SCAF than in those with clinical AF. Less peri-atrial fat (p < 0.001) and a greater LAA/ascending aorta (AA) Hounsfield unit (HU) ratio (p < 0.05) were noted in the patients with SCAF. Significantly increased volume reduced the total EF of LA and LAA and a reduced LAA/AA HU ratio (0.91 ± 0.18 vs 0.98 ± 0.03 vs 0.97 ± 0.05, p < 0.05) were demonstrated in patients with AHREs ≥6 min compared to those with AHREs <6 min and without AHRE. Multivariate analysis showed the reduced LAA/AA HU ratio is an independent predictor for the development of AHREs ≥6 min. CONCLUSION As compared to clinical AF, patients with SCAF show a more favorable LA remodeling process. Among the patients with device-detected AHREs, worse LA remodeling and a reduced LAA/AA HU ratio were associated with the occurrence of AHREs ≥6 min. These findings may provide an incremental value for understanding SCAF.
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Affiliation(s)
- Sung‐Hao Huang
- Division of CardiologyDepartment of MedicineNational Yang‐Ming Chiao‐Tung University HospitalYilanTaiwan
| | - Chao‐Feng Liao
- Division of CardiologyDepartment of MedicineNational Yang‐Ming Chiao‐Tung University HospitalYilanTaiwan
| | - Zu‐Yin Chen
- Division of CardiologyDepartment of MedicineNational Yang‐Ming Chiao‐Tung University HospitalYilanTaiwan
| | - Tze‐Fan Chao
- Heart Rhythm CenterDivision of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- School of MedicineNational Yang‐Ming Chiao‐Tung UniversityTaipeiTaiwan
| | - Shih‐Ann Chen
- Heart Rhythm CenterDivision of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- School of MedicineNational Yang‐Ming Chiao‐Tung UniversityTaipeiTaiwan
- Cardiovascular CenterTaichung Veterans General HospitalTaichungTaiwan
| | - Hsuan‐Ming Tsao
- Division of CardiologyDepartment of MedicineNational Yang‐Ming Chiao‐Tung University HospitalYilanTaiwan
- School of MedicineNational Yang‐Ming Chiao‐Tung UniversityTaipeiTaiwan
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9
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Inoue K, Kawakami H, Akazawa Y, Higashi H, Higaki T, Yamaguchi O. Echocardiographic Assessment of Atrial Function: From Basic Mechanics to Specific Cardiac Diseases. J Cardiovasc Dev Dis 2022; 9:jcdd9030068. [PMID: 35323616 PMCID: PMC8955277 DOI: 10.3390/jcdd9030068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 02/06/2023] Open
Abstract
The left and right atria serve as buffer chambers to control the flow of venous blood for ventricular filling. If an atrium is absent, blood does not flow effectively into the ventricle, leading to venous blood retention and low cardiac output. The importance of atrial function has become increasingly recognized, because left atrial (LA) function contributes to cardiac performance, and loss of LA function is associated with heart failure. LA volume change has been used for LA function assessment in experimental and clinical studies. In conjunction with LA pressure, the LA pressure–volume relationship provides a better understanding of LA mechanics. LA strain measurement by speckle tracking echocardiography was introduced to evaluate three components of LA function as a (booster) pump, reservoir and conduit. Furthermore, increasing evidence supports the theory that LA reservoir strain has prognostic utility in various cardiac diseases. In this review, we summarize LA contribution to maintain cardiac performance by evaluating LA function with echocardiography according to our experiences and previous reports. Furthermore, we discuss LA dysfunction in challenging cardiac diseases of cardiac amyloidosis and adult congenital heart disease.
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Affiliation(s)
- Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
- Correspondence: ; Tel.: +81-89-960-5303
| | - Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
| | - Yusuke Akazawa
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
| | - Takashi Higaki
- Department of Regional Pediatrics and Perinatology, Ehime University Graduate School of Medicine, Toon 791-029, Ehime, Japan;
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
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10
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Sánchez FJ, Pueyo E, Diez ER. Strain Echocardiography to Predict Postoperative Atrial Fibrillation. Int J Mol Sci 2022; 23:1355. [PMID: 35163278 PMCID: PMC8836170 DOI: 10.3390/ijms23031355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/23/2022] [Accepted: 01/23/2022] [Indexed: 11/16/2022] Open
Abstract
Postoperative atrial fibrillation (POAF) complicates 15% to 40% of cardiovascular surgeries. Its incidence progressively increases with aging, reaching 50% in octogenarians. This arrhythmia is usually transient but it increases the risk of embolic stroke, prolonged hospital stay, and cardiovascular mortality. Though many pathophysiological mechanisms are known, POAF prediction is still a hot topic of discussion. Doppler echocardiogram and, lately, strain echocardiography have shown significant capacity to predict POAF. Alterations in oxidative stress, calcium handling, mitochondrial dysfunction, inflammation, fibrosis, and tissue aging are among the mechanisms that predispose patients to the perfect "atrial storm". Manifestations of these mechanisms have been related to enlarged atria and impaired function, which can be detected prior to surgery. Specific alterations in the atrial reservoir and pump function, as well as atrial dyssynchrony determined by echocardiographic atrial strain, can predict POAF and help to shed light on which patients could benefit from preventive therapy.
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Affiliation(s)
| | - Esther Pueyo
- BSICOS Group, I3A, IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain;
- CIBER-BBN, 28029 Madrid, Spain
| | - Emiliano Raúl Diez
- Faculty of Medical Sciences, National University of Cuyo, Mendoza 5500, Argentina;
- Institute of Medical and Experimental Biology of Cuyo, IMBECU-UNCuyo-CONICET, Mendoza 5500, Argentina
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11
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Gong S, Zhou J, Li B, Kang S, Ma X, Cai Y, Guo Y, Hu R, Zhang X. The Association of Left Atrial Appendage Morphology to Atrial Fibrillation Recurrence After Radiofrequency Ablation. Front Cardiovasc Med 2021; 8:677885. [PMID: 34458330 PMCID: PMC8387723 DOI: 10.3389/fcvm.2021.677885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: The probability of late recurrent atrial fibrillation (AF) after radiofrequency ablation (RFA) has not yet been fully clarified. This study aims to study the association of left atrial appendage (LAA) morphology with AF recurrence after RFA. Methods: We retrospectively enrolled 84 patients (24 patients had persistent AF, 60 patients had paroxysmal AF) who underwent RFA in Shanghai East Hospital from June 2014 to May 2018. The mean follow-up of these patients was 618.6 days. According to preoperative transesophageal echocardiography (TEE), the morphology feature of LAA was classified and evaluated by two classification methods. The first method was divided into chicken-wing, windsock, cactus, and cauliflower, and the second method was divided into one lobe, two lobes, and multiple lobes. The correlation between morphological feature of LAA and the recurrence rate of AF after RFA was analyzed. Results: During follow-up, 12 patients (50%) and 10 patients (16.7%) had AF recurrence in persistent and paroxysmal AF, respectively. The LAA morphology was associated with the recurrence of AF after RFA with the chicken-wing highest recurrence risk (68.2%). The structure type of LAA was also related to the AF recurrence rate (p < 0.01). Compared with one lobe and multiple lobes, two lobes (recurrence, 47.6%) were more likely associated with the recurrence of AF (p < 0.02). Logistic regression analysis showed that the chicken-wing group had a higher risk of recurrence after RFA (OR = 8.13, p = 0.004), and the windsock group had a lower risk of recurrence (OR = 0.17, p = 0.002). Conclusion: The morphological feature of LAA is related to the recurrence risk of AF after RFA. LAA morphology assessment can predict the risk of AF recurrence.
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Affiliation(s)
- Shiyu Gong
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jian Zhou
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bingyu Li
- Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Sheng Kang
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaoye Ma
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ying Cai
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yang Guo
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rui Hu
- Department of Laboratory, Taiyuan Hospital Health Center for Woman and Children, Taiyuan, China
| | - Xumin Zhang
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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12
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Stefani LD, Trivedi SJ, Ferkh A, Altman M, Thomas L. Changes in left atrial phasic strain and mechanical dispersion: Effects of age and gender. Echocardiography 2021; 38:417-426. [PMID: 33594734 DOI: 10.1111/echo.14997] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Left atrial (LA) function by two-dimensional (2D) strain is an emerging tool with increasing clinical utility. Age and gender are key modulators of strain parameters; however, the specific time course for LA structural and functional changes is not clearly defined. METHODS A total of 147 healthy individuals (20-69 years) underwent transthoracic echocardiography; subjects were evaluated by age (decade) and gender. LA and left ventricular (LV) volumetric and strain measurements were performed. RESULTS Left atrial reservoir (ƐR) and conduit strain (ƐCD) with negatively correlated with age (r =-.36; r = -.56; P < .001, respectively) being significantly lower by the 6th and 5th decades, respectively. Contractile strain (ƐCT) positively correlated with age (r = .36; P < .001), being significantly higher by the 6th decade. ƐR and ƐCD were higher in young females (20-34 years) compared to young males (P = .033 and P < .001, respectively). ƐCT was significantly higher in middle-aged adult males (35-50yrs; P = .010), though seen later in females (≥51 years; P = .005). Standard deviation of time to positive strain (SD-TPS) significantly higher by the 5th decade and correlated with age in both males (r = .44; P <.001) and females (r = .40; P = .001). CONCLUSION We demonstrate that ƐR and ƐCD are lower with age, with differing rates between males and females. As a compensatory mechanism for decline in ƐCD, ƐCT is higher, more notably in males; comparatively, females display a more prominent decline in ƐR and ƐCD with age. Alteration in electromechanical properties occurred in both genders with SD-TPS becoming higher with age.
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Affiliation(s)
- Luke D Stefani
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - Siddharth J Trivedi
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, NSW, Australia
| | - Aaisha Ferkh
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, NSW, Australia
| | - Mikhail Altman
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, NSW, Australia
| | - Liza Thomas
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, NSW, Australia.,South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
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13
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Mao Y, Yu C, Yang Y, Ma M, Wang Y, Jiang R, Chen R, Zhao B, Jiang C. Comparison of left atrial and left atrial appendage mechanics in the risk stratification of stroke in patients with atrial fibrillation. Cardiovasc Ultrasound 2021; 19:7. [PMID: 33422087 PMCID: PMC7797160 DOI: 10.1186/s12947-020-00232-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/10/2020] [Indexed: 02/07/2023] Open
Abstract
Background Left atrial (LA) and left atrial appendage (LAA) dysfunction has been demonstrated to contribute to atrial fibrillation (AF)-related stroke. However, usefulness of LA and LAA mechanics has not been fully compared. We sought to investigate the association of LA and LAA mechanics with stroke and to compare their diagnostic values in the risk stratification of stroke in patients with nonvalvular AF. Methods A total of 208 consecutive patients with AF (63.58 ± 10.37 years, 63.9% male,57.7% persistent AF) who underwent echocardiography before catheter ablation were prospectively enrolled. Speckle-tracking was used to measure LA and LAA global longitudinal strain (GLS). LA and LAA mechanical dispersions (MD) were defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval. Results Patients with prior stroke/ transient ischemic attack (TIA) (n = 31) had significantly higher LA and LAA MD than those without (n = 177) (11.56 ± 4.38% vs. 8.43 ± 3.44%, 15.15 ± 5.46% vs. 10.94 ± 4.40%, both P < 0.01). In multivariable analysis, LA and LAA MD were independently associated with stroke/TIA (odds ratio, 1.18–1.29, 1.19–1.22, respectively, both P < 0.01), providing incremental values over clinical and standard echocardiographic parameters. In a subgroup analysis, LA MD was more useful than LAA MD in patients with normal LA volumes, while LAA MD was superior to LA MD in patients with LA enlargement. Conclusions Higher LA and LAA mechanical dispersion are independently associated with stroke/TIA in AF patients and had incremental values over clinical and conventional echocardiographic parameters. What’s more, priorities of dispersion assessment are different depending on patients’ LA size. Supplementary Information The online version contains supplementary material available at 10.1186/s12947-020-00232-z.
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Affiliation(s)
- Yankai Mao
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, #3 East Qingchun Road, Hangzhou, China
| | - Chan Yu
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, #3 East Qingchun Road, Hangzhou, China
| | - Yuan Yang
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, #3 East Qingchun Road, Hangzhou, China
| | - Mingming Ma
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, #3 East Qingchun Road, Hangzhou, China
| | - Yunhe Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, People's Republic of China
| | - Ruhong Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, People's Republic of China
| | - Ran Chen
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, #3 East Qingchun Road, Hangzhou, China
| | - Bowen Zhao
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, #3 East Qingchun Road, Hangzhou, China.
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, People's Republic of China.
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14
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Sánchez FJ, Gonzalez VA, Farrando M, Baigorria Jayat AO, Segovia-Roldan M, García-Mendívil L, Ordovás L, Prado NJ, Pueyo E, Diez ER. Atrial Dyssynchrony Measured by Strain Echocardiography as a Marker of Proarrhythmic Remodeling and Oxidative Stress in Cardiac Surgery Patients. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8895078. [PMID: 33456678 PMCID: PMC7787772 DOI: 10.1155/2020/8895078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 12/14/2022]
Abstract
Aging leads to structural and electrophysiological changes that increase the risk of postoperative atrial arrhythmias; however, noninvasive preoperative markers of atrial proarrhythmic conditions are still needed. This study is aimed at assessing whether interatrial dyssynchrony determined using two-dimensional speckle tracking echocardiography relates to proarrhythmic structural and functional remodeling. A cohort of 45 patients in sinus rhythm referred for cardiac surgery was evaluated by echocardiography and surface electrocardiogram the day before the intervention. Transmembrane potential, connexin, and potassium channel distribution, inflammatory, and nitrooxidative markers were measured from right atrial tissue obtained from patients. A difference greater than 40 milliseconds between right and left atrial free wall contraction confirmed the presence of interatrial dyssynchrony in 21 patients. No difference in relation with age, previous diseases, and 2-dimensional echocardiographic findings as well as average values of global longitudinal right and left atrial strain were found between synchronic and dyssynchronic patients. Postoperative atrial fibrillation incidence increased from 8.3% in the synchronic group to 33.3% in the dyssynchronic ones. P wave duration showed no difference between groups. Action potentials from dyssynchronous patients decreased in amplitude, maximal rate of depolarization, and hyperpolarized. Duration at 30% of repolarization increased, being markedly shorter at 90% of repolarization. Only the dyssynchronous group showed early and delayed afterdepolarizations. Atrial tissue of dyssynchronous patients displayed lateralization of connexin 40 and increased connexin 43 expression and accumulation of tumor necrosis factor-α in the intercalated disc. Tumor necrosis factor-α did not colocalize, however, with lateralized connexin 40. Nitroxidative marks and KATP channels increased perivascularly and in myocytes. Our results demonstrate that, as compared to a traditional surface electrocardiogram, the novel noninvasive echocardiographic evaluation of interatrial dyssynchrony provides a better identification of nonaged-related proarrhythmic atrial remodeling with increased susceptibility to postoperative atrial fibrillation.
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Affiliation(s)
- Francisco J. Sánchez
- Department of Morphophysiology, School of Medicine, National University of Cuyo, Centro Universitario, Mendoza 5500, Argentina
- Department of Cardiovascular Surgery, Clinic of Cuyo, Mendoza 5500, Argentina
| | | | - Martin Farrando
- Department of Cardiovascular Surgery, Clinic of Cuyo, Mendoza 5500, Argentina
| | | | - Margarita Segovia-Roldan
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Aragon Institute of Engineering Research (I3A), University of Zaragoza Instituto de Investigación Sanitaria (IIS), Zaragoza 50018, Spain
| | - Laura García-Mendívil
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Aragon Institute of Engineering Research (I3A), University of Zaragoza Instituto de Investigación Sanitaria (IIS), Zaragoza 50018, Spain
| | - Laura Ordovás
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Aragon Institute of Engineering Research (I3A), University of Zaragoza Instituto de Investigación Sanitaria (IIS), Zaragoza 50018, Spain
- Aragon Agency for Research and Development (ARAID), Zaragoza 50018, Spain
| | - Natalia J. Prado
- Institute of Experimental Medicine and Biology of Cuyo (IMBECU)-CONICET, Mendoza 5500, Argentina
| | - Esther Pueyo
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Aragon Institute of Engineering Research (I3A), University of Zaragoza Instituto de Investigación Sanitaria (IIS), Zaragoza 50018, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza 50018, Spain
| | - Emiliano R. Diez
- Department of Morphophysiology, School of Medicine, National University of Cuyo, Centro Universitario, Mendoza 5500, Argentina
- Institute of Experimental Medicine and Biology of Cuyo (IMBECU)-CONICET, Mendoza 5500, Argentina
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15
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Jin Y, Wang HS, Han JS, Zhang J, Zhang YJ, Xin FR, Yu Y, Zhao Y. Recovery of atrial contractile function after cut-and-sew maze for long-standing persistent valvular atrial fibrillation. Int J Cardiol 2020; 324:84-89. [PMID: 32920067 DOI: 10.1016/j.ijcard.2020.09.010] [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: 05/13/2020] [Revised: 08/20/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The recovery of atrial contractile (AC) after maze has been concerned and even questioned. Now, studied the AC recovery degree and its influencing factors. METHOD 237 patients with valvular long-standing persistent atrial fibrillation (AF) were retrospectively grouped according to whether sinus rhythm(SR) maintained and AC restored: SR-AC (163 cases), SR-no-AC (41 cases) and AF-no-AC (33 cases). SR-AC were grouped according to Em/Am ratio. Em/Am≤2 showed that the AC recovered well. RESULTS The SR maintained rate (161/177, 90.96%) in patients underwent the cut-and-sew maze III (CSM) was significantly higher than that in cryoablation (43/60, 71.7%). Preoperative AF duration had no significant difference among three groups (P = 0.679). Maze methods had significant relationship with whether SR recovered, P < 0.05, but no significant relationship with whether AC recovered in SR maintained patients (P = 0.280). Nearly 80% (163/204) patients can recover AC, among 156 patients (156/204, 76.5%) recovered contractile of left and right atrium, and 63 (63/204, 30.1%) recovered significant left atrial contractile, that is, Em/Am≤2. Whether AC was significantly restored was not related to maze methods, P = 0.370. AC recovered degree in rheumatic heart disease (RHD) patients was worse than that in mitral valve prolapse (MVP) patients, P = 0.004. CONCLUSION To sum up, the CSM is safe and effective, and the atrial contractile function recovery was found in 80%. The key to the success of maze is to form a complete and lasting electrical isolation, and there was no difference in the rate of atrial contractile recovery when postoperative SR was maintained, no matter what maze method is used. MVP patients should be treated with maze more actively than RHD patients.
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Affiliation(s)
- Yan Jin
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 110840, China
| | - Hui-Shan Wang
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 110840, China.
| | - Jin-Song Han
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 110840, China
| | - Jian Zhang
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 110840, China
| | - Yu-Ji Zhang
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 110840, China
| | - Fang-Ran Xin
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 110840, China
| | - Yan Yu
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 110840, China
| | - Yang Zhao
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 110840, China
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16
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Ciuffo L, Bruña V, Martínez-Sellés M, de Vasconcellos HD, Tao S, Zghaib T, Nazarian S, Spragg DD, Marine J, Berger RD, Lima JAC, Calkins H, Bayés-de-Luna A, Ashikaga H. Association between interatrial block, left atrial fibrosis, and mechanical dyssynchrony: Electrocardiography-magnetic resonance imaging correlation. J Cardiovasc Electrophysiol 2020; 31:1719-1725. [PMID: 32510679 DOI: 10.1111/jce.14608] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Advanced interatrial block (IAB) on a 12-lead electrocardiogram (ECG) is a predictor of stroke, incident atrial fibrillation (AF), and AF recurrence after catheter ablation. The objective of this study was to determine which features of IAB structural remodeling is associated with left atrium (LA) magnetic resonance imaging structure and function. METHODS/RESULTS We included 152 consecutive patients (23% nonparoxysmal AF) who underwent preprocedural ECG and cardiac magnetic resonance (CMR) in sinus rhythm before catheter ablation of AF. IAB was defined as P-wave duration ≥120 ms, and was considered partial if P-wave was positive and advanced if P-wave had a biphasic morphology in inferior leads. From cine CMR and late gadolinium enhancement, we derived LA maximum and minimum volume indices, strain, LA fibrosis, and LA dyssynchrony. A total of 77 patients (50.7% paroxysmal) had normal P-wave, 52 (34.2%) partial IAB, and 23 (15.1%) advanced IAB. Patients with advanced IAB had significantly higher LA minimum volume index (25.7 vs 19.9 mL/m2 , P = .010), more LA fibrosis (21.9% vs 13.1%, P = .020), and lower LA maximum strain rate (0.99 vs 1.18, P = .007) than those without. Advanced IAB was independently associated with LA (minimum [P = .032] and fibrosis [P = .009]). P-wave duration was also independently associated with LA fibrosis (β = .33; P = .049) and LA mechanical dyssynchrony (β = 2.01; P = .007). CONCLUSION Advanced IAB is associated with larger LA volumes, lower emptying fraction, and more fibrosis. Longer P-wave duration is also associated with more LA fibrosis and higher LA mechanical dyssynchrony.
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Affiliation(s)
- Luisa Ciuffo
- Division of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Vanesa Bruña
- Servicio de Cardiología, CIBERCV, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, CIBERCV, Hospital Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Ciencias Biomédicas, Universidad Europea, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | | | - Susumu Tao
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tarek Zghaib
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saman Nazarian
- Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David D Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ronald D Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Antonio Bayés-de-Luna
- Cardiovascular Research Foundation, Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Hiroshi Ashikaga
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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17
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Bayés-de-Luna A, Martínez-Sellés M, Elosua R, Bayés-Genís A, Mendieta G, Baranchuk A, Breithardt G. Relation of Advanced Interatrial Block to Risk of Atrial Fibrillation and Stroke. Am J Cardiol 2020; 125:1745-1748. [PMID: 32284175 DOI: 10.1016/j.amjcard.2020.02.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/18/2022]
Abstract
Advanced interatrial block (A-IAB) has been associated to atrial fibrillation (AF) and ischemic stroke, raising the question as to whether such patients, even when still in sinus rhythm without documented AF, could benefit from oral anticoagulation. AF and A-IAB are both markers of stroke. The anatomical substrate in both is fibrotic atrial cardiomyopathy, resulting in atrial electromechanical dyssynchrony, dysfunction, and left atrial remodelling, that favour blood stasis and hypercoagulation. Under these conditions thrombogenic cascade may be triggered, resulting in systemic embolization. Before proposing oral anticoagulation in the management of selected patients with A-IAB, as is currently recommended in patients with AF and high CHA2DS2-Vasc score, a randomized clinical trial will have to demonstrate efficacy and safety of anticoagulation in this setting. In the meantime, an individualized approach may be considered based on the recognition of those patients at a higher risk of stroke. These may be elderly patients with A-IAB and several risk factors and, thus, with a high CHA2DS2-Vasc score and the presence of environmental arrhythmias.
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18
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Habibi M, Chrispin J, Spragg DD, Zimmerman SL, Tandri H, Nazarian S, Halperin H, Trayanova N, Calkins H. Utility of Cardiac MRI in Atrial Fibrillation Management. Card Electrophysiol Clin 2020; 12:131-139. [PMID: 32451098 DOI: 10.1016/j.ccep.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Advances in cardiac magnetic resonance (CMR) techniques and image acquisition have made it an excellent tool in the assessment of atrial myopathy. Remolding of the left atrium is the mainstay of atrial fibrillation (AF) development and its progression. CMR can detect phasic atrial volumes, atrial function, and atrial fibrosis using cine, and contrast-enhanced or non-contrast-enhanced images. These abilities make CMR a versatile and extraordinary tool in management of patients with AF including for risk stratification, ablation prognostication and planning, and assessment of stroke risk. We review the latest advancements in utility of CMR in management of patients with AF.
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Affiliation(s)
- Mohammadali Habibi
- Division of Cardiology, Section for Cardiac Electrophysiology, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan Chrispin
- Division of Cardiology, Section for Cardiac Electrophysiology, Johns Hopkins University, Baltimore, MD, USA
| | - David D Spragg
- Division of Cardiology, Section for Cardiac Electrophysiology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Harikrishna Tandri
- Division of Cardiology, Section for Cardiac Electrophysiology, Johns Hopkins University, Baltimore, MD, USA
| | - Saman Nazarian
- Division of Cardiology, Section for Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Henry Halperin
- Division of Cardiology, Section for Cardiac Electrophysiology, Johns Hopkins University, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Natalia Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Section for Cardiac Electrophysiology, Johns Hopkins University, Baltimore, MD, USA.
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19
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20
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Ta HT, Alsaied T, Steele JM, Truong VT, Mazur W, Nagueh SF, Kutty S, Tretter JT. Atrial Function and Its Role in the Non-invasive Evaluation of Diastolic Function in Congenital Heart Disease. Pediatr Cardiol 2020; 41:654-668. [PMID: 32342149 DOI: 10.1007/s00246-020-02351-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/17/2020] [Indexed: 01/19/2023]
Abstract
Diastolic dysfunction has correlated with adverse outcomes in various forms of unrepaired and repaired or palliated congenital heart disease (CHD). The non-invasive assessment of diastolic function in pediatric and adult patients with CHD remains challenging. Atrial size has a pivotal role in the evaluation of diastolic function; however, a growing body of evidence supports the additional role of atrial function as a more sensitive parameter of ventricular diastolic dysfunction. While the importance of atrial function is becoming clearer in adult acquired heart disease, it remains ambiguous in those with CHD. In this review we set the stage with the current understanding of diastolic function assessment in CHD, followed by insight into atrial form and function including its non-invasive assessment, and conclude with the current knowledge of atrial function in CHD. A general pattern of decrease in reservoir and conduit function with compensatory increase followed by decompensatory decrease in contractile function seems to be the common pathway of atrial dysfunction in most forms of CHD.
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Affiliation(s)
- Hieu T Ta
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Tarek Alsaied
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeremy M Steele
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Vien T Truong
- Department of Cardiology, The Christ Hospital, Cincinnati, OH, USA
| | - Wojciech Mazur
- Department of Cardiology, The Christ Hospital, Cincinnati, OH, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Shelby Kutty
- The Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Justin T Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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21
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Koike H, Kishi S, Hosoda N, Takemoto S, Tomii D, Ninomiya K, Tanaka T, Asami M, Yahagi K, Komiyama K, Tanaka J, Yuzawa H, Nakanishi R, Fujino T, Aoki J, Venkatesh BA, Lima JAC, Tanabe K, Ikeda T. The impact of tissue-tracking strain on the left atrial dysfunction in the patients with left ventricular dysfunction. IJC HEART & VASCULATURE 2020; 26:100453. [PMID: 31921972 PMCID: PMC6948228 DOI: 10.1016/j.ijcha.2019.100453] [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: 09/19/2019] [Revised: 11/05/2019] [Accepted: 12/09/2019] [Indexed: 11/29/2022]
Abstract
Background The extracellular volume (ECV) calculated by T1 mapping, and tissue-tracking strain using cardiac magnetic resonance (CMR) are useful for assessing the left ventricular (LV) function. However, those parameters are controversial for assessing left atrial (LA) function. This study aimed to investigate the usefulness of CMR to evaluate the LA function using those parameters. Furthermore, those LA function parameters were compared in each LV function. Methods A total of 65 consecutive patients who underwent contrast CMR were prospectively enrolled (age 55.7 ± 14. 6 years, males 67.7%). Among the 65 patients, there were 15 without hypertension, diabetes, or atrial fibrillation (Healthy group). The remaining 50 patients were divided into two groups according to a left ventricular ejection fraction (LVEF) of 50%. We assessed the correlations between the LV- and LA-CMR parameters among the three groups (LVEF < 50%; n = 20, LVEF ≥ 50%; n = 30, and Healthy; n = 15). Results The LA-longitudinal strain for an LVEF < 50% was lower than that for the others (LVEF < 50%; 13.6 ± 7.9%, LVEF ≥ 50%; 24. 5 ± 13.5%, Healthy; 24.5 ± 9.8%, p = 0.003). However, the LA-ECV did not significantly differ among the three groups (LVEF < 50%; 50.3 ± 3.6%, LVEF ≥ 50%; 53.1 ± 4.9%, Healthy; 53.2 ± 6.5%, p = 0.12). A multiple regression model after adjusting for the patient background revealed that a worse LA-longitudinal strain was correlated with a low LVEF and large LA-volume, but the LA-ECV was not associated with those. Conclusions The LA-strain in LV dysfunction patients was significantly lower. However, the LA-ECV did not significantly differ from that in those without LV dysfunction. Tissue-tracking strain is more useful for evaluating the LA dysfunction than T1 mapping.
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Affiliation(s)
- Hideki Koike
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Satoru Kishi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Naoki Hosoda
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | | | - Daijiro Tomii
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kai Ninomiya
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Tetsu Tanaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kazuyuki Yahagi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kota Komiyama
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Jun Tanaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hitomi Yuzawa
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | | | | | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
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Left Atrial Mechanical Dispersion Assessed by Strain Echocardiography as an Independent Predictor of New-Onset Atrial Fibrillation: A Case-Control Study. J Am Soc Echocardiogr 2019; 32:1268-1276.e3. [DOI: 10.1016/j.echo.2019.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 01/08/2023]
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23
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Xu C, Chen K, Yu F, Wang Q, Su H, Yang D, Xu J, Yan J. Atrial Dyssynchrony: A New Predictor for Atrial High-Rate Episodes in Patients with Cardiac Resynchronization Therapy. Cardiology 2019; 144:18-26. [DOI: 10.1159/000502541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/06/2019] [Indexed: 11/19/2022]
Abstract
Background: Heart failure may induce atrial dyssynchrony. We aim to investigate whether preimplantation left atrial (LA) dyssynchrony could predict newly detected atrial high-rate episodes (AHRE) after receiving cardiac resynchronization therapy defibrillator (CRT-D). Methods: We conducted a retrospective analysis of consecutive patients who received CRT-D for standard indications and without a history of atrial fibrillation. The standard deviation of the time-to-peak strain in each LA segment during ventricular systole (SDs) and late diastole (SDa) were calculated to quantify LA dyssynchrony using two-dimensional speckle tracking echocardiography before device implantation. Patients were divided into the AHRE group and the AHRE-free group, depending on the presence of AHRE during device interrogation. Results: Thirty-one patients (28%) had newly detected AHRE during a mean follow-up of 21 ± 9 months. Patients in the AHRE group had higher SDs (8.2 ± 2.6% vs. 6.3 ± 2.3%, p < 0.001) and SDa (5.4 ± 1.8% vs. 4.1 ± 1.4%, p < 0.001) values before implantation than patients in the AHRE-free group. In the multivariate logistic analysis, both SDs (OR 1.325, 95% CI: 1.074–1.636, p =0.009) and SDa (OR: 1.499, 95% CI: 1.071–2.098, p= 0.018) were independent predictors of newly detected AHRE. At a cutoff value of 7.4% for SDs and 5.3% for SDa, the Kaplan-Meier survival analysis showed that patients with higher SDs and SDa had significantly increased risks of newly detected AHRE after receiving CRT-D. Conclusions: Dyssynchronous LA lengthening and contraction could assist in the prediction of newly detected AHRE in patients with CRT-D.
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Ciuffo LA, Lima J, Vasconcellos HDD, Balouch M, Tao S, Nazarian S, Spragg DD, Marine JE, Berger RD, Calkins H, Ashikaga H. Intra-Atrial Dyssynchrony Using Cardiac Magnetic Resonance to Quantify Tissue Remodeling in Patients with Atrial Fibrillation. Arq Bras Cardiol 2019; 112:441-450. [PMID: 30994724 PMCID: PMC6459423 DOI: 10.5935/abc.20190064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/21/2019] [Indexed: 01/31/2023] Open
Abstract
Background Recent studies suggest that left atrial (LA) late gadolinium enhancement
(LGE) can quantify the underlying tissue remodeling that harbors atrial
fibrillation (AF). However, quantification of LA-LGE requires
labor-intensive magnetic resonance imaging acquisition and postprocessing at
experienced centers. LA intra-atrial dyssynchrony assessment is an emerging
imaging technique that predicts AF recurrence after catheter ablation. We
hypothesized that 1) LA intra-atrial dyssynchrony is associated with LA-LGE
in patients with AF and 2) LA intra-atrial dyssynchrony is greater in
patients with persistent AF than in those with paroxysmal AF. Method We conducted a cross-sectional study comparing LA intra-atrial dyssynchrony
and LA-LGE in 146 patients with a history of AF (60.0 ± 10.0 years,
30.1% nonparoxysmal AF) who underwent pre-AF ablation cardiac magnetic
resonance (CMR) in sinus rhythm. Using tissue-tracking CMR, we measured the
LA longitudinal strain in two- and four-chamber views. We defined
intra-atrial dyssynchrony as the standard deviation (SD) of the time to peak
longitudinal strain (SD-TPS, in %) and the SD of the time to the peak
pre-atrial contraction strain corrected by the cycle length
(SD-TPSpreA, in %). We used the image intensity ratio (IIR)
to quantify LA-LGE. Results Intra-atrial dyssynchrony analysis took 5 ± 9 minutes per case.
Multivariable analysis showed that LA intra-atrial dyssynchrony was
independently associated with LA-LGE. In addition, LA intra-atrial
dyssynchrony was significantly greater in patients with persistent AF than
those with paroxysmal AF. In contrast, there was no significant difference
in LA-LGE between patients with persistent and paroxysmal AF. LA
intra-atrial dyssynchrony showed excellent reproducibility and its analysis
was less time-consuming (5 ± 9 minutes) than the LA-LGE (60 ±
20 minutes). Conclusion LA Intra-atrial dyssynchrony is a quick and reproducible index that is
independently associated with LA-LGE to reflect the underlying tissue
remodeling.
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Affiliation(s)
- Luisa Allen Ciuffo
- University of New Mexico, New Mexico - USA.,The Johns Hopkins University, Baltimore - USA
| | - João Lima
- Johns Hopkins Hospital and Health System, Baltimore - USA
| | | | | | - Susumu Tao
- The Johns Hopkins University, Baltimore - USA
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25
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Bering PT, Cavalcante JL. Quantification of Left Atrial Tissue Remodeling Using Intra-Atrial Dyssynchrony by Cardiac Magnetic Resonance Imaging. Arq Bras Cardiol 2019; 112:451-452. [PMID: 30994725 PMCID: PMC6459435 DOI: 10.5935/abc.20190073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Patrick T. Bering
- Medstar Washington Hospital Center, Washington - District of
Columbia
| | - João L. Cavalcante
- Minneapolis Heart Institute - Abbott Northwestern Hospital,
Minneapolis - Minnesota
- Valve Science Center - Minneapolis Heart Institute Foundation,
Minneapolis - Minnesota
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26
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Donal E, Galli E, Lederlin M, Martins R, Schnell F. Multimodality Imaging for Best Dealing With Patients in Atrial Arrhythmias. JACC Cardiovasc Imaging 2019; 12:2245-2261. [PMID: 30878420 DOI: 10.1016/j.jcmg.2018.06.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/21/2018] [Accepted: 06/22/2018] [Indexed: 12/28/2022]
Abstract
The management of atrial fibrillation (AF) is not only a clinical challenge but also an imaging challenge. The role of different imaging modalities to estimate the thromboembolic risk in AF is a key clinical question. The present review summarizes the advances of myocardial imaging in the stratification of thromboembolic risk, diagnosis, and management of left atrial thrombosis in patients with AF. These imaging techniques are also important for understanding arrhythmias and their consequences. It is becoming fundamental for guiding therapy. Still, large studies are required, but be sure that left atrial imaging will become more and more clinically fundamental.
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Affiliation(s)
- Erwan Donal
- Service de Cardiologie, CIC-IT INSERM 1414, CHU Pontchaillou, Rennes, France; Laboratoire Traitement du Signal et de l'Image, Université de Rennes 1, INSERM, UMR 1099, Rennes, France.
| | - Elena Galli
- Service de Cardiologie, CIC-IT INSERM 1414, CHU Pontchaillou, Rennes, France; Laboratoire Traitement du Signal et de l'Image, Université de Rennes 1, INSERM, UMR 1099, Rennes, France
| | - Matthieu Lederlin
- Laboratoire Traitement du Signal et de l'Image, Université de Rennes 1, INSERM, UMR 1099, Rennes, France; Service de Radiologie, CHU Pontchaillou, Rennes, France
| | - Raphael Martins
- Service de Cardiologie, CIC-IT INSERM 1414, CHU Pontchaillou, Rennes, France; Laboratoire Traitement du Signal et de l'Image, Université de Rennes 1, INSERM, UMR 1099, Rennes, France
| | - Frederic Schnell
- Service de Cardiologie, CIC-IT INSERM 1414, CHU Pontchaillou, Rennes, France; Service de médecine du sport et laboratoire de physiologie, Université Rennes 1, CHU Pontchaillou, Rennes, France
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Early Detection of Increased Risk for Atrial Fibrillation Recurrence Based on Intra-Atrial Dyssynchrony. JACC Cardiovasc Imaging 2019; 12:320-322. [DOI: 10.1016/j.jcmg.2018.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/02/2018] [Accepted: 04/12/2018] [Indexed: 01/30/2023]
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Left Atrial Dyssynchrony in Dilated Cardiomyopathy: Diastolic Dysfunction Matters but Left Bundle Branch Block Does Not. INTERNATIONAL JOURNAL OF HEART FAILURE 2019; 1:53-56. [PMID: 36262738 PMCID: PMC9536675 DOI: 10.36628/ijhf.2019.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/18/2022]
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