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Băghină RM, Crișan S, Luca S, Pătru O, Lazăr MA, Văcărescu C, Negru AG, Luca CT, Gaiță D. Association between Inflammation and New-Onset Atrial Fibrillation in Acute Coronary Syndromes. J Clin Med 2024; 13:5088. [PMID: 39274304 DOI: 10.3390/jcm13175088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/16/2024] Open
Abstract
Acute coronary syndrome (ACS) is a complex clinical syndrome that encompasses acute myocardial infarction (AMI) and unstable angina (UA). Its underlying mechanism refers to coronary plaque disruption, with consequent platelet aggregation and thrombosis. Inflammation plays an important role in the progression of atherosclerosis by mediating the removal of necrotic tissue following myocardial infarction and shaping the repair processes that are essential for the recovery process after ACS. As a chronic inflammatory disorder, atherosclerosis is characterized by dysfunctional immune inflammation involving interactions between immune (macrophages, T lymphocytes, and monocytes) and vascular cells (endothelial cells and smooth muscle cells). New-onset atrial fibrillation (NOAF) is one of the most common arrhythmic complications in the setting of acute coronary syndromes, especially in the early stages, when the myocardial inflammatory reaction is at its maximum. The main changes in the atrial substrate are due to atrial ischemia and acute infarcts that can be attributed to neurohormonal factors. The high incidence of atrial fibrillation (AF) post-myocardial infarction may be secondary to inflammation. Inflammatory response and immune system cells have been involved in the initiation and development of atrial fibrillation. Several inflammatory indexes, such as C-reactive protein and interleukins, have been demonstrated to be predictive of prognosis in patients with ACS. The cell signaling activation patterns associated with fibrosis, apoptosis, and hypertrophy are forms of cardiac remodeling that occur at the atrial level, predisposing to AF. According to a recent study, the presence of fibrosis and lymphomononuclear infiltration in the atrial tissue was associated with a prior history of AF. However, inflammation may contribute to both the occurrence/maintenance of AF and its thromboembolic complications.
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Affiliation(s)
- Ruxandra-Maria Băghină
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Simina Crișan
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Silvia Luca
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Oana Pătru
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Mihai-Andrei Lazăr
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Cristina Văcărescu
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Alina Gabriela Negru
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Constantin-Tudor Luca
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Dan Gaiță
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
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2
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Rösner A, Kornev M, Caglayan HA, Queiros S, Malyutina S, Ryabikov A, Kudryavtsev AV, Schirmer H. Atrial Strain and Strain Rate in a General Population: Do These Measures Improve the Assessment of Elevated NT-proBNP Levels? Cardiol Res Pract 2024; 2024:1546629. [PMID: 39224177 PMCID: PMC11368553 DOI: 10.1155/2024/1546629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 06/05/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
Background Noninvasive assessment of elevated filling pressure in the left ventricle (LV) remains an unresolved problem. Of the many echocardiographic parameters used to evaluate diastolic pressure, the left atrial strain and strain rate (LA S/SR) have shown promise in clinical settings. However, only a few previous studies have evaluated LA S/SR in larger populations. Methods A total of 2033 participants from Norwegian (Tromsø 7) and Russian (Know Your Heart) population studies, equally distributed by age and sex, underwent echocardiography, including atrial and ventricular S/SR and NT-proBNP measurements. Of these, 1069 were identified as healthy (without hypertension (HT), atrial fibrillation (AF), or structural cardiac disease) and were used to define the age- and sex-adjusted normal ranges of LA S/SR. Furthermore, the total study population was divided into groups according to ejection fraction (EF) ≥50%, EF <50%, and AF. In each group, uni- and multiple regression and receiver operating characteristic curve analyses were performed to test LA and LV functional parameters as potential indicators of NT-proBNP levels above 250 ng/ml. Results The mean LA S/SR values in this study were higher than those in previous large studies, whereas the lower references were comparable. In normal hearts, atrial total strain (ATS) and mitral valve E deceleration time (MV DT) were independent factors indicating elevated NT-proBNP levels, whereas in hearts with reduced EFs, the independent indicators were peak atrial contraction strain (PACS) and LV stroke volume. The areas under the curve for these significant indicators to discriminate elevated NT-proBNP levels were 0.639 (95% confidence interval (CI): 0.577-0.701) for normal EF and 0.805 (CI: 0.675-0.935) for reduced EF. Conclusion The results confirm good intrastudy reproducibility, with mean values in the upper range of previous meta-analyses. In the future, automated border-detection algorithms may be able to generate highly reproducible normal values. Furthermore, the study showed atrial S/SR as an additional indicator of elevated NT-proBNP levels in the general population, demonstrating the incremental value of both ATS and PACS in addition to conventional and ventricular strain echocardiography. Thus, the LA S/SR may be regarded as an important addition to the multiparametric approach used for evaluating LV filling.
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Affiliation(s)
- Assami Rösner
- Department of CardiologyUniversity Hospital of North Norway, Tromsø, Norway
- Department of Clinical MedicineUiT Arctic University of Norway, Tromsø, Norway
| | - Mikhail Kornev
- Department of CardiologyUniversity Hospital of North Norway, Tromsø, Norway
- Department of Clinical MedicineUiT Arctic University of Norway, Tromsø, Norway
| | - Hatice Akay Caglayan
- Department of CardiologyUniversity Hospital of North Norway, Tromsø, Norway
- Department of Clinical MedicineUiT Arctic University of Norway, Tromsø, Norway
| | - Sandro Queiros
- Life and Health Sciences Research Institute (ICVS)Escola de MedicinaUniversity of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimaraes, Braga, Portugal
| | - Sofia Malyutina
- Research Institute of Internal and Preventive MedicineBranch of the Institute of Cytology and GeneticsSiberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
- Novosibirsk Medical Institute, Novosibirsk, Russia
| | - Andrew Ryabikov
- Research Institute of Internal and Preventive MedicineBranch of the Institute of Cytology and GeneticsSiberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
- Novosibirsk Medical Institute, Novosibirsk, Russia
| | - Alexander V. Kudryavtsev
- Department of Community MedicineUiT Arctic University of Norway, Tromsø, Norway
- International Research Competence CentreNorthern State Medical University, Arkhangelsk, Russia
| | - Henrik Schirmer
- Department of CardiologyAkershus University Hospital, Lillestrøm, Norway
- Institute of Clinical MedicineCardiovascular Research GroupCampus AhusUniversity of Oslo, Oslo, Norway
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Nussbaumer C, Schwerzmann M, Elchinova E, Goulouti E, Tobler D, Greutmann M, Wustmann K, Papa A, Schwitz F. Association of reduced peak left atrial strain with supraventricular arrhythmia in adults with congenital heart disease. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03205-9. [PMID: 39147918 DOI: 10.1007/s10554-024-03205-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 07/23/2024] [Indexed: 08/17/2024]
Abstract
Atrial arrhythmias are an important cause of morbidity and mortality in adults with congenital heart disease (ACHD). In acquired heart disease, the left atrial (LA) strain has been shown to predict supraventricular tachyarrhythmias (SVT). This study aimed to investigate whether reduced LA strain is associated with SVT in ACHD patients. This retrospective, single-center cohort study collected baseline clinical and echocardiographic data of 206 ACHD patients (157 left heart defect, 49 right heart defect). Patients with sinus rhythm at baseline and a 5-year follow-up (median age 29, IQR 22-41 years) were included. Diagnosis of sustained SVT was determined from clinical reports during the follow-up period. New or recurrent sustained SVT occurred in 16 patients (7.8%, median follow-up of 6.2 years). Patients who developed SVT were older, more likely to have diastolic dysfunction, and had larger LA dimensions, left ventricular mass, and a lower peak LA longitudinal strain (PALS). Lower PALS was associated with higher risk of SVT in patients with left and right heart defects. Patients in the lowest quartile for PALS had a 15.9-fold higher hazard ratio of SVT (95% confidence interval, 4.5 to 56.0, p < 0.001) in comparison with the top three quartiles. PALS provides information about the occurrence of SVT in the ACHD population. Including measurement of LA strain in the follow-up of these patients may allow to better identify patients at risk of future atrial arrhythmias.
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Affiliation(s)
- Clément Nussbaumer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Schwerzmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Elena Elchinova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eleni Goulouti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Tobler
- Department of Cardiology, Basel University Hospital, Basel, Switzerland
| | - Matthias Greutmann
- Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
| | - Kerstin Wustmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Munich, Germany
| | - Andrea Papa
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabienne Schwitz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Cardiology, Inselspital, Center for Congenital Heart Disease, Bern University Hospital, Freiburgstrasse 18, Bern, 3010, Switzerland.
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4
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Mangia M, D'Andrea E, Cecchetto A, Beccari R, Mele D, Nistri S. Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function. J Cardiovasc Dev Dis 2024; 11:241. [PMID: 39195149 DOI: 10.3390/jcdd11080241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/28/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular (CV) diseases. The assessment of LA function by echocardiography primarily includes volumetric measurements (LA ejection fraction [LAEF]), tissue Doppler imaging (TDI) (mitral annular late diastolic velocity [a']), and speckle-tracking methods, such as LA longitudinal reservoir strain (LA strain). This review analyzes and discusses the current medical evidence and potential clinical usefulness of these different methods to analyze LA function.
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Affiliation(s)
- Mario Mangia
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Emilio D'Andrea
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Antonella Cecchetto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Riccardo Beccari
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Donato Mele
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Stefano Nistri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
- Cardiology Service, CMSR Veneto Medica, 36077 Altavilla Vicentina, Italy
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5
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Troisi F, Guida P, Di Monaco A, Romanazzi I, Vitulano N, Quadrini F, Valenti N, Davì V, Bonaparte I, Surgo A, Carbonara R, Guglielmo FCD, Calbi R, Ciliberti MP, Fiorentino A, Grimaldi M. Left atrial strain after paroxysmal atrial fibrillation linac-based cardiac radioablation in elderly population. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03187-8. [PMID: 38985214 DOI: 10.1007/s10554-024-03187-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024]
Abstract
Catheter ablation of atrial fibrillation (AF) may increase the risk of complication in aged patients. Stereotactic arrhythmia radioablation (STAR) is a non-invasive therapeutic alternative for cardiac arrhythmia. This sub-study evaluated left atrial strain (LAS) in elderly AF patients underwent STAR. Symptomatic paroxysmal AF patients aged > 70 years, with antiarrhythmic drugs failure or intolerance, enrolled in a phase II trial that have demonstrated the feasibility of LINAC-based STAR (total dose of 25 Gy single fraction delivered in 3 min), performed a 15-day electrocardiogram Holter monitoring to detect AF episodes (≥ 30 s) and an echocardiographic LAS evaluation before and after STAR (at 1-, 3-, 6- and 12-month). Out 18 patients underwent STAR in the trial, 16 (7 males, 78 ± 5 years) completed the follow-up for LAS study. No baseline difference in echocardiographic and LAS parameters was observed between the 9 patients with AF recurrence during follow-up and those who maintained sinus rhythm. At 6- and 12-month after STAR, LAS reservoir was lower in patients with AF episodes than those without (respectively, p = 0.039 and p = 0.001). Values of left atrial area and volume as well as LAS conduit and contractile phase were not statistically significant different by patient's outcome across evaluations. Although no baseline LAS parameter before STAR seems predict AF recurrence after treatment in elderly patients, lower values of reservoir phase were observed during follow-up in those experiencing AF episodes. More research is needed to better assess the value of LAS monitoring in paroxysmal AF patients underwent Stereotactic cardiac radioablation.
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Affiliation(s)
- Federica Troisi
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, 70021, Italy.
| | - Pietro Guida
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, 70021, Italy
| | - Antonio Di Monaco
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, 70021, Italy
| | - Imma Romanazzi
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, 70021, Italy
| | - Nicola Vitulano
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, 70021, Italy
| | - Federico Quadrini
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, 70021, Italy
| | - Noemi Valenti
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, 70021, Italy
| | - Valerio Davì
- Radiation Oncology, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Ilaria Bonaparte
- Radiation Oncology, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Alessia Surgo
- Radiation Oncology, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Roberta Carbonara
- Radiation Oncology, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | | | - Roberto Calbi
- Department of Radiology, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Maria Paola Ciliberti
- Radiation Oncology, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Alba Fiorentino
- Radiation Oncology, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
- Department of Medicine, LUM University, Casamassima, Bari, Italy
| | - Massimo Grimaldi
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, 70021, Italy
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6
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Campora A, Lisi M, Pastore MC, Mandoli GE, Ferrari Chen YF, Pasquini A, Rubboli A, Henein MY, Cameli M. Atrial Fibrillation, Atrial Myopathy, and Thromboembolism: The Additive Value of Echocardiography and Possible New Horizons for Risk Stratification. J Clin Med 2024; 13:3921. [PMID: 38999487 PMCID: PMC11242512 DOI: 10.3390/jcm13133921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/22/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac sustained arrhythmia, and it is associated with increased stroke and dementia risk. While the established paradigm attributes these complications to blood stasis within the atria and subsequent thrombus formation with cerebral embolization, recent evidence suggests that atrial myopathy (AM) may play a key role. AM is characterized by structural and functional abnormalities of the atria, and can occur with or without AF. Moving beyond classifications based solely on episode duration, the 4S-AF characterization has offered a more comprehensive approach, incorporating patient's stroke risk, symptom severity, AF burden, and substrate assessment (including AM) for tailored treatment decisions. The "ABC" pathway emphasizes anticoagulation, symptom control, and cardiovascular risk modification and emerging evidence suggests broader benefits of early rhythm control strategies, potentially reducing stroke and dementia risk and improving clinical outcomes. However, a better integration of AM assessment into the current framework holds promise for further personalizing AF management and optimizing patient outcomes. This review explores the emerging concept of AM and its potential role as a risk factor for stroke and dementia and in AF patients' management strategies, highlighting the limitations of current risk stratification methods, like the CHA2DS2-VASc score. Echocardiography, particularly left atrial (LA) strain analysis, has shown to be a promising non-invasive tool for AM evaluation and recent studies suggest that LA strain analysis may be a more sensitive risk stratifier for thromboembolic events than AF itself, with some studies showing a stronger association between LA strain and thromboembolic events compared to traditional risk factors. Integrating it into routine clinical practice could improve patient management and targeted therapies for AF and potentially other thromboembolic events. Future studies are needed to explore the efficacy and safety of anticoagulation in AM patients with and without AF and to refine the diagnostic criteria for AM.
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Affiliation(s)
- Alessandro Campora
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Matteo Lisi
- Department of Emergency, Internal Medicine and Cardiology-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121 Ravenna, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Yu Fu Ferrari Chen
- Cardiovascular Division, Pisa University Hospital and University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Rubboli
- Department of Emergency, Internal Medicine and Cardiology-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121 Ravenna, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 1, 53100 Siena, Italy
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7
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Yu LZ, Lin YW, Shi RY, Fan ZY, Xu JR, Yao QY, Tang H, Chen S, Wu LM. Quantification of left atrial strain in patients with idiopathic inflammatory myopathy using cardiovascular magnetic resonance feature tracking. Clin Radiol 2024; 79:544-552. [PMID: 38599951 DOI: 10.1016/j.crad.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Left atrial (LA) dysfunction is involved in idiopathic inflammatory myopathy (IIM). Multiparametric cardiovascular magnetic resonance (CMR) strain imaging is a feasible and reproducible tool for examining global and regional LA functions, as well as left ventricular (LV) function in IIM patients. AIM The aim of this study was to evaluate the feasibility and reproducibility of LA strain occurrence and strain rate for LA function assessment using CMR in IIM cases. MATERIALS AND METHODS A total of 36 IIM and 42 healthy control cases were included. Baseline ventricular function was comparatively assessed in both groups. LA strain occurrence and strain rate were examined by cine cardiac magnetic resonance imaging [MRI] utilizing an in-house semiautomated technique. LA global function indexes were quantitated, including reservoir, conduit, and booster-pump functions. RESULTS A total of 78 participants were enrolled in this study. There was no significant difference in left/right ventricular routine functions between IIM patients and control individuals (p>0.05); the same results (p>0.05) was also observed between patients with high hs-cTnI and normal. However, LV mass index had significant difference (p1=0.003, p2<0.01). Compared with IIM patients and control individuals, only total strain (εs) (p4=0.046) and passive strain (εe) (p4=0.002) showed significant difference, and in cases with high hs-cTnI and normal hs-cTnI, there are differences for εs (p3=0.012) and εe (p4=0.047). The strongest association was found between εe and LV ejection fraction (LVEF) (r=0.581, p<0.01). CONCLUSION IIM cases have altered LA reservoir and conduit functions, and LA strain could reflect LA function.
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Affiliation(s)
- L-Z Yu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Y-W Lin
- Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - R-Y Shi
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Z-Y Fan
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - J-R Xu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Q-Y Yao
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - H Tang
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
| | - S Chen
- Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
| | - L-M Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
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8
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Pirruccello JP, Di Achille P, Choi SH, Rämö JT, Khurshid S, Nekoui M, Jurgens SJ, Nauffal V, Kany S, Ng K, Friedman SF, Batra P, Lunetta KL, Palotie A, Philippakis AA, Ho JE, Lubitz SA, Ellinor PT. Deep learning of left atrial structure and function provides link to atrial fibrillation risk. Nat Commun 2024; 15:4304. [PMID: 38773065 PMCID: PMC11109224 DOI: 10.1038/s41467-024-48229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 04/24/2024] [Indexed: 05/23/2024] Open
Abstract
Increased left atrial volume and decreased left atrial function have long been associated with atrial fibrillation. The availability of large-scale cardiac magnetic resonance imaging data paired with genetic data provides a unique opportunity to assess the genetic contributions to left atrial structure and function, and understand their relationship with risk for atrial fibrillation. Here, we use deep learning and surface reconstruction models to measure left atrial minimum volume, maximum volume, stroke volume, and emptying fraction in 40,558 UK Biobank participants. In a genome-wide association study of 35,049 participants without pre-existing cardiovascular disease, we identify 20 common genetic loci associated with left atrial structure and function. We find that polygenic contributions to increased left atrial volume are associated with atrial fibrillation and its downstream consequences, including stroke. Through Mendelian randomization, we find evidence supporting a causal role for left atrial enlargement and dysfunction on atrial fibrillation risk.
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Affiliation(s)
- James P Pirruccello
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA.
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA.
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA.
- Cardiovascular Genetics Center, University of California San Francisco, San Francisco, CA, USA.
| | - Paolo Di Achille
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Seung Hoan Choi
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
| | - Joel T Rämö
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Shaan Khurshid
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mahan Nekoui
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sean J Jurgens
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, NL, Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, University of Amsterdam, Amsterdam, NL, Netherlands
| | - Victor Nauffal
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Shinwan Kany
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Samuel F Friedman
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Puneet Batra
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kathryn L Lunetta
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
- Analytic and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Boston, MA, USA
| | | | - Jennifer E Ho
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- CardioVascular Institute, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Steven A Lubitz
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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9
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Anwar AM. Incremental diagnostic and prognostic utility of left atrial deformation in heart failure using speckle tracking echocardiography. Heart Fail Rev 2024; 29:713-727. [PMID: 38466374 DOI: 10.1007/s10741-024-10392-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] [Accepted: 01/31/2024] [Indexed: 03/13/2024]
Abstract
Left atrium (LA) is a very important component of cardiovascular performance. The assessment of LA function has gathered the interest with expanding research supporting the utility as a biomarker for outcomes in heart failure (HF). Echocardiography is the main imaging modality which helps in a qualitative and quantitative assessment of the LA size and function. Recent advances in probe technology and software analysis have provided a better understanding of LA anatomy, physiology, pathology, and function. A variety of parameters have been defined as markers of LA function but there is no single parameter that best defines LA function. Speckle tracking echocardiography-derived analysis of LA deformation provides a window on all phases of LA function (reservoir, conduit, and booster pump). There is accumulative published data that supported the diagnostic and prognostic values of LA deformation integration during echo assessment of LA in HF. This review article summarized the clinical utility of LA deformation that may help in prediction, diagnosis, categorization, risk stratification, and guiding the proper selection of therapy in HF patients in daily practice.
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Affiliation(s)
- Ashraf M Anwar
- Department of Cardiology, King Fahad Armed Forces Hospital, P.O. Box: 9862, Jeddah, 21159, Saudi Arabia.
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
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10
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Figueiredo FDA, Esteves WAM, Hung J, Gomes NFA, Taconeli CA, Pantaleão AN, de Oliveira MAR, de Magalhães SM, Chavez LMT, Tan TC, Bhat A, Levine RA, Nunes MCP. Left atrial function in patients with rheumatic mitral stenosis: addressing prognostic insights beyond atrial fibrillation prediction. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae067. [PMID: 39224865 PMCID: PMC11367946 DOI: 10.1093/ehjimp/qyae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024]
Abstract
Aims Rheumatic mitral stenosis (MS) frequently leads to impaired left atrial (LA) function because of pressure overload, highlighting the underlying atrial pathology. Two-dimensional speckle tracking echocardiography (2D-STE) offers early detection of LA dysfunction, potentially improving risk assessment in patients with MS. This study aims to evaluate the predictive value of LA function assessed by 2D-STE for clinical outcomes in patients with MS. Methods and results Between 2011 and 2021, patients with MS underwent LA function assessment using 2D-STE, with focus on the reservoir phase (LASr). Atrial fibrillation (AF) development constituted the primary outcome, with death or valve replacement as the secondary outcome. Conditional inference trees were employed for analysis, validated through sample splitting. The study included 493 patients with MS (mean valve area 1.1 ± 0.4 cm2, 84% female). At baseline, 166 patients (34%) had AF, with 62 patients (19%) developing AF during follow-up. LASr emerged as the primary predictor for new-onset AF, with a threshold of 17.9%. Over a mean 3.8-year follow-up, 125 patients (25%) underwent mitral valve replacement, and 32 patients (6.5%) died. A decision tree analysis identified key predictors such as age, LASr, severity of tricuspid regurgitation (TR), net atrioventricular compliance (C n), and early percutaneous mitral valvuloplasty, especially in patients aged ≤49 years, where LASr, with a threshold of 12.8%, significantly predicted adverse outcomes. Conclusion LASr emerged as a significant predictor of cardiovascular events in this MS cohort, validated through a decision tree analysis. Patients were stratified into low- or high-risk categories for adverse outcomes, taking into account LASr, age, TR severity, and C n.
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Affiliation(s)
- Fernanda de Azevedo Figueiredo
- Postgraduate Program of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG 30130 100, Brazil
| | - William Antonio M Esteves
- Postgraduate Program of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG 30130 100, Brazil
- Hospital das Clínicas, School of Medicine,Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG 30130 100, Brazil
| | - Judy Hung
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, MA 02114, USA
| | - Nayana Flamini Arantes Gomes
- Postgraduate Program of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG 30130 100, Brazil
- Hospital das Clínicas, School of Medicine,Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG 30130 100, Brazil
| | - Cesar Augusto Taconeli
- Department of Statistics, Universidade Federal do Paraná, Curitiba Rua Cel. Francisco Heráclito dos Santos, 100 Centro Politécnico - Jardim das América sEdifício do Setor de Ciências Exatas, 81531-980, Curitiba, PR, Brazil
| | - Alexandre Negrão Pantaleão
- Hospital das Clínicas, School of Medicine,Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG 30130 100, Brazil
| | - Matheus Assunção Rabello de Oliveira
- Hospital das Clínicas, School of Medicine,Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG 30130 100, Brazil
| | - Silvio Mendes de Magalhães
- Hospital das Clínicas, School of Medicine,Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG 30130 100, Brazil
| | - Luz Marina Tacuri Chavez
- Postgraduate Program of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG 30130 100, Brazil
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Blacktown Road, Blacktown, Sydney, NSW 2148, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Blacktown Road, Blacktown, Sydney, NSW 2148, Australia
| | - Robert A Levine
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, MA 02114, USA
| | - Maria Carmo Pereira Nunes
- Postgraduate Program of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG 30130 100, Brazil
- Hospital das Clínicas, School of Medicine,Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG 30130 100, Brazil
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11
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Wedin JO, Rodin S, Flachskampf FA, Simonson OE, Pallin J, Hörsne Malmborg J, James SK, Ståhle E, Grinnemo KH. Left atrial dysfunction in bicuspid aortic valve patients with severe aortic stenosis is associated with post-operative atrial fibrillation following aortic valve replacement. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae020. [PMID: 38590529 PMCID: PMC11000824 DOI: 10.1093/ehjopen/oeae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/10/2024] [Accepted: 03/11/2024] [Indexed: 04/10/2024]
Abstract
Aims To investigate (i) the association between pre-operative left atrial (LA) reservoir strain and post-operative atrial fibrillation (AF) and (ii) the incidence of post-operative ischaemic stroke events separately in bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients after surgical aortic valve replacement for isolated severe aortic stenosis (AS). Methods and results We prospectively enrolled 227 patients (n = 133 BAV and n = 94 TAV) with isolated severe AS scheduled for aortic valve replacement. A comprehensive intra- and inter-observer validated pre-operative echocardiogram with an analysis of LA reservoir strain was performed. Post-operative AF was defined as a sustained (>30 s) episode of AF or atrial flutter. The timing of neurological events was defined in accordance with the Valve Academic Research Consortium-3 criteria for stroke. Post-operative AF occurred in 114 of 227 patients (50.2%), with no difference between BAV and TAV patients (48.1 vs. 53.1%, P = 0.452). Persisting post-operative AF at discharge was more frequent in BAV patients (29.7 vs. 8.0%, P = 0.005). Pre-operative LA reservoir strain was independently associated with post-operative AF (odds ratio = 1.064, 95% confidence interval 1.032-1.095, P < 0.001), with a significant interaction between LA reservoir strain and aortic valve morphology (Pinteraction = 0.002). The cumulative transient ischemic attack (TIA)/stroke incidence during follow-up was significantly higher in BAV patients (19.1 vs. 5.8% at 5 years). Conclusion Pre-operative LA function was associated with post-operative AF after aortic valve replacement in BAV AS patients, while post-operative AF in TAV AS patients likely depends on transient post-operative alterations and traditional cardiovascular risk factors. TIA/stroke during follow-up was more common in BAV AS patients.
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Affiliation(s)
- Johan O Wedin
- Department of Surgical Sciences, Uppsala University Hospital, entrance 70, 1st floor, SE-751 85 Uppsala, Sweden
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
| | - Sergey Rodin
- Department of Surgical Sciences, Uppsala University Hospital, entrance 70, 1st floor, SE-751 85 Uppsala, Sweden
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
| | - Frank A Flachskampf
- Department of Medical Sciences, Uppsala University Hospital, entrance 40, 5th floor, SE-751 85 Uppsala, Sweden
- Department of Clinical Physiology, Uppsala University Hospital, entrance 40, 5th floor, SE-751 85 Uppsala, Sweden
| | - Oscar E Simonson
- Department of Surgical Sciences, Uppsala University Hospital, entrance 70, 1st floor, SE-751 85 Uppsala, Sweden
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
| | - Johan Pallin
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
| | - Jonathan Hörsne Malmborg
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
| | - Stefan K James
- Department of Medical Sciences, Uppsala University Hospital, entrance 40, 5th floor, SE-751 85 Uppsala, Sweden
- Department of Cardiology, Uppsala University Hospital, entrance 40, 5th floor, SE-751 85 Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala Science Park, Hubben, Dag Hammarskjölds väg 38, SE-751 85 Uppsala, Sweden
| | - Elisabeth Ståhle
- Department of Surgical Sciences, Uppsala University Hospital, entrance 70, 1st floor, SE-751 85 Uppsala, Sweden
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
| | - Karl-Henrik Grinnemo
- Department of Surgical Sciences, Uppsala University Hospital, entrance 70, 1st floor, SE-751 85 Uppsala, Sweden
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
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12
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Kataoka N, Imamura T. How to risk stratify new-onset atrial fibrillation in patients with hypertension and diabetes mellitus. J Arrhythm 2024; 40:195. [PMID: 38333374 PMCID: PMC10848574 DOI: 10.1002/joa3.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 02/10/2024] Open
Affiliation(s)
- Naoya Kataoka
- Second Department of Internal MedicineUniversity of ToyamaToyamaJapan
| | - Teruhiko Imamura
- Second Department of Internal MedicineUniversity of ToyamaToyamaJapan
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13
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Egbe AC, Younis A, Miranda WR, Jain CC, Connolly HM, Borlaug BA. Determinants and prognostic implications of left atrial reverse remodelling after coarctation of aorta repair in adults. Eur Heart J Cardiovasc Imaging 2024; 25:249-256. [PMID: 37585542 PMCID: PMC10824485 DOI: 10.1093/ehjci/jead203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/19/2023] [Accepted: 07/12/2023] [Indexed: 08/18/2023] Open
Abstract
AIMS Left atrial (LA) dysfunction and atrial fibrillation are also relatively common in adults with coarctation of aorta (COA), and the severity of LA dysfunction is associated with a higher risk of atrial fibrillation in this population. The purpose of this study was to determine whether LA function improved after COA repair (LA reverse remodelling), and the relationship between LA reverse remodelling and atrial fibrillation. METHODS AND RESULTS Retrospective cohort study of adults undergoing COA repair (2003-20). LA reservoir strain was assessed pre intervention and 12-24 months post intervention, using speckle tracking echocardiography. Incident atrial fibrillation was assessed from COA repair to last follow-up. Of 261 adults who underwent COA repair [age 37 ± 13 years; males 148 (57%)], 124 (47%) and 137 (53%) presented with native vs. recurrent COA, respectively. Of 261 patients, 231 (82%) and 48 (18%) underwent surgical and transcatheter COA repair, respectively. The LA reservoir strain increased from 32 ± 8% (pre intervention) to 39 ± 7% (post intervention), yielding a relative increase of 21 ± 5%. Older age [β ± standard error (SE) -0.16 ± 0.09 per 5 years, P = 0.02], higher systolic blood pressure (β ± SE -0.12 ± 0.04 per 5 mmHg, P = 0.005), and higher residual COA mean gradient (β ± SE -0.17 ± 0.06 per 5 mmHg, P = 0.002) post intervention were associated with less LA reverse remodelling, after adjustment for sex, hypertension diagnosis, and left ventricular indices. LA reverse remodelling (hazard ratio 0.97, 95% confidence interval 0.96-0.98 per 1% increase from pre-intervention LA function, P = 0.006) was associated with a lower risk of atrial fibrillation after adjustment for age, sex, pre-intervention LA reservoir strain, and history of atrial fibrillation. CONCLUSION COA repair resulted in improved LA function and decreased risk for atrial fibrillation, especially in patients without residual hypertension or significant residual COA gradient.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Ahmed Younis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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14
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Gherbesi E, Gianstefani S, Angeli F, Ryabenko K, Bergamaschi L, Armillotta M, Guerra E, Tuttolomondo D, Gaibazzi N, Squeri A, Spaziani C, Pizzi C, Carugo S. Myocardial strain of the left ventricle by speckle tracking echocardiography: From physics to clinical practice. Echocardiography 2024; 41:e15753. [PMID: 38284665 DOI: 10.1111/echo.15753] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Speckle tracking echocardiography (STE) is a reliable imaging technique of recognized clinical value in several settings. This method uses the motion of ultrasound backscatter speckles within echocardiographic images to derive myocardial velocities and deformation parameters, providing crucial insights on several cardiac pathological and physiological processes. Its feasibility, reproducibility, and accuracy have been widely demonstrated, being myocardial strain of the various chambers inserted in diagnostic algorithms and guidelines for various pathologies. The most important parameters are Global longitudinal strain (GLS), Left atrium (LA) reservoir strain, and Global Work Index (GWI): based on large studies the average of the lower limit of normality are -16%, 23%, and 1442 mmHg%, respectively. For GWI, it should be pointed out that myocardial work relies primarily on non-invasive measurements of blood pressure and segmental strain, both of which exhibit high variability, and thus, this variability constitutes a significant limitation of this parameter. In this review, we describe the principal aspects of the theory behind the use of myocardial strain, from cardiac mechanics to image acquisition techniques, outlining its limitation, and its principal clinical applications: in particular, GLS have a role in determine subclinical myocardial dysfunction (in cardiomyopathies, cardiotoxicity, target organ damage in ambulatory patients with arterial hypertension) and LA strain in determine the risk of AF, specifically in ambulatory patients with arterial hypertension.
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Affiliation(s)
- Elisa Gherbesi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Silvia Gianstefani
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Khrystyna Ryabenko
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Luca Bergamaschi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Emiliano Guerra
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Domenico Tuttolomondo
- Cardiology Division, Parma University Hospital, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Nicola Gaibazzi
- Cardiology Division, Parma University Hospital, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Angelo Squeri
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Cristina Spaziani
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
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15
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Almeida ALC, Melo MDTD, Bihan DCDSL, Vieira MLC, Pena JLB, Del Castillo JM, Abensur H, Hortegal RDA, Otto MEB, Piveta RB, Dantas MR, Assef JE, Beck ALDS, Santo THCE, Silva TDO, Salemi VMC, Rocon C, Lima MSM, Barberato SH, Rodrigues AC, Rabschkowisky A, Frota DDCR, Gripp EDA, Barretto RBDM, Silva SME, Cauduro SA, Pinheiro AC, Araujo SPD, Tressino CG, Silva CES, Monaco CG, Paiva MG, Fisher CH, Alves MSL, Grau CRPDC, Santos MVCD, Guimarães ICB, Morhy SS, Leal GN, Soares AM, Cruz CBBV, Guimarães Filho FV, Assunção BMBL, Fernandes RM, Saraiva RM, Tsutsui JM, Soares FLDJ, Falcão SNDRS, Hotta VT, Armstrong ADC, Hygidio DDA, Miglioranza MH, Camarozano AC, Lopes MMU, Cerci RJ, Siqueira MEMD, Torreão JA, Rochitte CE, Felix A. Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023. Arq Bras Cardiol 2023; 120:e20230646. [PMID: 38232246 DOI: 10.36660/abc.20230646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Central Illustration : Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023 Proposal for including strain in the integrated diastolic function assessment algorithm, adapted from Nagueh et al.67 Am: mitral A-wave duration; Ap: reverse pulmonary A-wave duration; DD: diastolic dysfunction; LA: left atrium; LASr: LA strain reserve; LVGLS: left ventricular global longitudinal strain; TI: tricuspid insufficiency. Confirm concentric remodeling with LVGLS. In LVEF, mitral E wave deceleration time < 160 ms and pulmonary S-wave < D-wave are also parameters of increased filling pressure. This algorithm does not apply to patients with atrial fibrillation (AF), mitral annulus calcification, > mild mitral valve disease, left bundle branch block, paced rhythm, prosthetic valves, or severe primary pulmonary hypertension.
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Affiliation(s)
| | | | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felicio Rocho, Belo Horizonte, MG - Brasil
| | | | - Henry Abensur
- Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | - Vera Maria Cury Salemi
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - Camila Rocon
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Márcio Silva Miguel Lima
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardiaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Veronica Camara Dos Santos
- Departamento de Cardiologia Pediátrica (DCC/CP) da Sociedade Brasileira de Cardiologia (SBC), São Paulo, SP - Brasil
- Sociedade Brasileira de Oncologia Pediátrica, São Paulo, SP - Brasil
| | | | | | - Gabriela Nunes Leal
- Instituto da Criança e do Adolescente do Hospital das Clinicas Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | | | - Viviane Tiemi Hotta
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Grupo Fleury, São Paulo, SP - Brasil
| | | | - Daniel de Andrade Hygidio
- Hospital Nossa Senhora da Conceição, Tubarão, SC - Brasil
- Universidade do Sul de Santa Catarina (UNISUL), Tubarão, SC - Brasil
| | - Marcelo Haertel Miglioranza
- EcoHaertel - Hospital Mae de Deus, Porto Alegre, RS - Brasil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS - Brasil
| | | | | | | | | | - Jorge Andion Torreão
- Hospital Santa Izabel, Salvador, BA - Brasil
- Santa Casa da Bahia, Salvador, BA - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Alex Felix
- Diagnósticos da América SA (DASA), São Paulo, SP - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
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16
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Takagi T, Hosomi T. Peak atrial longitudinal strain represents atrial fibrillation burden in daily practice: clinical implication of routine left atrial strain measurements. J Echocardiogr 2023; 21:113-121. [PMID: 36564608 DOI: 10.1007/s12574-022-00595-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Usefulness of left atrial (LA) strain measurements using speckle tracking echocardiography has been reported in various clinical settings. However, clinical implication of routine LA strain measurements in daily practice remains unclear. The purpose of this study was to evaluate clinical utility of routine LA strain measurements in daily practice. METHODS From January 6, 2020 to December 28, 2021, 338 consecutive patients underwent echocardiography in Takagi Cardiology Clinic, and all comers were enrolled to the study. Echocardiographic measurements including peak atrial longitudinal strain (PALS) measurement using speckle tracking echocardiography were attempted in all patients. RESULTS PALS was obtained in 335 patients (age 71 ± 16 years, male 43%, hypertensive 74%), and mean value was 22.3 ± 11.5%. PALS was progressively impaired with worsening atrial fibrillation (AF) burden. PALS in patients without AF, in patients with history of AF (paroxysmal AF &/or ablation therapy), and in patients with AF onsite were 26.8 ± 9.8%, 20.3 ± 7.9%, and 8.1 ± 3.3%, respectively (anova p < 0.0001). In patients without history of AF at the time of echocardiography, using cut-off value of 15.0% (i.e., mean + 2SD of PALS in AF patients), Kaplan-Meier analysis revealed that impaired PALS was associated with increased new-onset AF during follow-up period (log-rank p < 0.0001). CONCLUSION In daily practice, PALS represents AF burden. Furthermore, impaired PALS is associated with increased new-onset AF. Therefore, routine LA strain measurements using speckle tracking echocardiography will be useful in risk stratification of AF in daily practice.
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Affiliation(s)
- Tsutomu Takagi
- Takagi Cardiology Clinic, Mibu Kayogosho-cho 3-3, Nakagyo-ku, Kyoto, 604-8811, Japan.
| | - Takeshi Hosomi
- Takagi Cardiology Clinic, Mibu Kayogosho-cho 3-3, Nakagyo-ku, Kyoto, 604-8811, Japan
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17
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Raafs AG, Vos JL, Henkens MTHM, Verdonschot JAJ, Sikking M, Stroeks S, Gerretsen S, Hazebroek MR, Knackstedt C, Nijveldt R, Heymans SRB. Left Atrial Strain Is an Independent Predictor of New-Onset Atrial Fibrillation in Dilated Cardiomyopathy. JACC Cardiovasc Imaging 2023:S1936-878X(23)00040-2. [PMID: 37038873 DOI: 10.1016/j.jcmg.2023.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 04/12/2023]
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18
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Han PL, Shen MT, Jiang Y, Jiang ZK, Li K, Yang ZG. Prognostic Value of Left Atrial Reservoir Strain in Left Ventricular Myocardial Noncompaction: A 3.0 T Cardiac Magnetic Resonance Feature Tracking Study. J Magn Reson Imaging 2023; 57:559-575. [PMID: 35703421 DOI: 10.1002/jmri.28292] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The relationship of left atrial (LA) strain to high-risk heart failure (HF) events in patients with left ventricular myocardial noncompaction (LVNC) remains to be thoroughly investigated. PURPOSE To evaluate the LA performance in patients with LVNC, and to investigate the prognostic value of LA phasic strain on high-risk HF events, and its influencing factors. STUDY TYPE Retrospective. POPULATION A total of 95 LVNC patients (74 with LA enlargement [LAE] and 21 without LAE) and 50 healthy controls. FIELD STRENGTH/SEQUENCE A 3.0 T, balanced steady-state free-precession cine imaging. ASSESSMENT LA longitudinal strains were measured by cardiac MRI feature tracking technique. LA volume index (LAVI) and LA ejection fraction (LAEF) were calculated. Their intraobserver and interobserver reproducibility were evaluated. The primary outcome was high-risk HF events, a composite of first HF hospitalization, hospitalization for worsening HF and death from HF. STATISTICAL TESTS Student's t/Mann-Whitney U, one-way analysis of variance/Kruskal-Wallis, Chi-squared, receiver operating characteristic, Kaplan-Meier, log-rank, Cox regression, Pearson and Spearman correlation and linear regression analyses were performed. The significance threshold was set at P < 0 .05. RESULTS LAEF and LA longitudinal strains decreased in LVNC patients irrespective of the presence of LAE. During a median follow-up of 32.17 months, high-risk HF occurred in 13 (13.68%) patients. Patients with increased LAVI, decreased LAEF and decreased LA longitudinal strain had significantly higher risks of high-risk HF events. In patients with LVNC, LA reservoir strain (εs) was independently associated with high-risk HF (hazard ratio = 23.208 [95% CI: 2.993-179.967]). LV global longitudinal strain (LV GLS) (β = -1.783 [95% CI: -2.493 to -1.073]) was significantly and independently associated with εs. Intraobserver and interobserver reproducibility was excellent for LAVI, LAEF, and LA strain. CONCLUSION In patients with LVNC, εs was an independent predictor for high-risk HF events. LV GLS was an independent determinant of εs in LVNC. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Pei-Lun Han
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ze-Kun Jiang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Kang Li
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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19
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Choi YJ, Kim D, Rhee TM, Lee HJ, Park JB, Lee SP, Chang SA, Kim YJ, Jeon ES, Oh JK, Choi JO, Kim HK. Left atrial reservoir strain as a novel predictor of new-onset atrial fibrillation in light-chain-type cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2023; 24:751-758. [PMID: 36637873 DOI: 10.1093/ehjci/jeac269] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS To investigate whether left arterial reservoir strain (LASr) could predict new-onset atrial fibrillation (NOAF) in patients with light-chain-type cardiac amyloidosis (ALCA). METHODS AND RESULTS This study enrolled 427 patients with CA from two tertiary centres between 2005 and 2019. LASr was measured using a vendor-independent analysis programme. The primary outcome was NOAF. A total of 287 patients with ALCA were included [median age 63.0 (56.0-70.0) years, 53.3% male]. The median LASr was 13.9% (10.5-20.8%). During the median follow-up of 0.85 years, AF occurred in 34 patients (11.8%). In the receiver operating characteristics curve analysis, the optimal cut-off of LASr for predicting NOAF was 14.4%. Patients with LASr ≤14.4% had a higher risk of NOAF than those with LASr >14.4% (18.1% vs. 5.1%, P < 0.010). In the multivariate analysis adjusting for confounding factors, including left arterial volume index and left ventricular global longitudinal strain (LV-GLS), higher LASr (%) was independently associated with lower risk for NOAF [adjusted hazard ratio (aHR): 0.936, 95% confidence interval (95% CI): 0.879-0.997, P = 0.039]. Furthermore, LASr ≤14.4% was an independent predictor for NOAF (aHR: 3.370, 95% CI: 1.337-8.492, P = 0.010). This remained true after accounting for all-cause death as a competing risk. Compared with Model 1 (LV-GLS) and Model 2 (LV-GLS plus LAVI), Model 3, including LASr showed a better reclassification ability for predicting NOAF (net reclassification index = 0.735, P < 0.001 compared with Model 1; net reclassification index = 0.514, P = 0.003 compared with Model 2). CONCLUSION LASr was an independent predictor of NOAF in patients with ALCA.
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Affiliation(s)
- You-Jung Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-dong, Guro-gu Seoul 08308, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea
| | - Darae Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Tea-Min Rhee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Eun-Seok Jeon
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Jae K Oh
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea.,Department of Cardiovascular Medicine, Mayo Clinic, 201 W. Center St., Rochester, MN 55902, USA
| | - Jin-Oh Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
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20
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Brand A, Romero Dorta E, Wolf A, Blaschke-Waluga D, Seeland U, Crayen C, Bischoff S, Mattig I, Dreger H, Stangl K, Regitz-Zagrosek V, Landmesser U, Knebel F, Stangl V. Phasic left atrial strain to predict worsening of diastolic function: Results from the prospective Berlin Female Risk Evaluation follow-up trial. Front Cardiovasc Med 2023; 10:1070450. [PMID: 36891246 PMCID: PMC9986257 DOI: 10.3389/fcvm.2023.1070450] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
Purpose The predictive value of maximum left atrial volume index (LAVI), phasic left atrial strain (LAS) and other standard echocardiographic parameters assessing left ventricular (LV) diastolic function to discriminate a future worsening of diastolic function (DD) in patients at risk is unclear. We aimed to prospectively assess and compare the clinical impact of these parameters in a randomly selected study sample of the general urban female population. Methods and results A comprehensive clinical and echocardiographic evaluation was performed in 256 participants of the Berlin Female Risk Evaluation (BEFRI) trial after a mean follow up time of 6.8 years. After an assessment of participants' current DD status, the predictive impact of an impaired LAS on the course of DD was assessed and compared with LAVI and other DD parameters using receiver operating characteristic (ROC) curve and multivariate logistic regression analyses. Subjects with no DD (DD0) who showed a decline of diastolic function by the time of follow-up showed a reduced LA reservoir (LASr) and conduit strain (LAScd) compared to subjects who remained in the healthy range (LASr 28.0% ± 7.0 vs. 41.9% ± 8.5; LAScd -13.2% ± 5.1 vs. -25.4% ± 9.1; p < 0.001). With an area under the curve (AUC) of 0.88 (95%CI 0.82-0.94) and 0.84 (95%CI 0.79-0.89), LASr and LAScd exhibited the highest discriminative value in predicting worsening of diastolic function, whereas LAVI was only of limited prognostic value [AUC 0.63 (95%CI 0.54-0.73)]. In logistic regression analyses, LAS remained a significant predictor for a decline of diastolic function after controlling for clinical and standard echocardiographic DD parameters, indicating its incremental predictive value. Conclusion The analysis of phasic LAS may be useful to predict worsening of LV diastolic function in DD0 patients at risk for a future DD development.GRAPHICAL ABSTRACT.
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Affiliation(s)
- Anna Brand
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Elena Romero Dorta
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Adrian Wolf
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Daniela Blaschke-Waluga
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Ute Seeland
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany.,Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Crayen
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Sven Bischoff
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Isabel Mattig
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Henryk Dreger
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Karl Stangl
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Vera Regitz-Zagrosek
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany.,Institute of Gender in Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Ulf Landmesser
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Fabian Knebel
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany.,Clinical Department of Cardiology, Internal Medicine II, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Verena Stangl
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
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21
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Thomas L, Negishi K, Pathan FK. Editorial: Evaluation of the left atrium: Its role in atrial fibrillation and diastolic function. Front Cardiovasc Med 2023; 10:1130531. [PMID: 36895834 PMCID: PMC9989286 DOI: 10.3389/fcvm.2023.1130531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Affiliation(s)
- Liza Thomas
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia.,Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.,South West Clinical School, University of New South Wales, Kensington, NSW, Australia
| | - Kazuaki Negishi
- Department of Cardiology, Nepean Hospital, Nepean, NSW, Australia.,Nepean Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Faraz Khalid Pathan
- Department of Cardiology, Nepean Hospital, Nepean, NSW, Australia.,Nepean Clinical School, University of Sydney, Sydney, NSW, Australia
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22
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Left Atrial Remodeling in Response to Aortic Valve Replacement: Pathophysiology and Myocardial Strain Analysis. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122074. [PMID: 36556439 PMCID: PMC9788515 DOI: 10.3390/life12122074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Severe aortic stenosis (AS) is the most common valve disease in the elderly and is associated with poor prognosis if treated only medically. AS causes chronic pressure overload, concentric left ventricular (LV) hypertrophy, myocardial stiffness, and diastolic dysfunction. This adverse remodeling also affects the left atrium (LA), which dilates and develops myocardial fibrosis, with a reduction in intrinsic function and a consequent high risk of the development of atrial fibrillation. Speckle-tracking echocardiography is able to detect myocardial dysfunction before other conventional parameters, such as LV ejection fraction, and also predict clinical outcomes. This review aims at describing LV and LA remodeling in AS and before and after aortic valve replacement and the usefulness of myocardial strain analysis in this clinical setting.
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23
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Park J, Choi H, Hwang I, Yoon YE, Park J, Park J, Cho G. Prognostic Implications of Mechanical Phenotypes in Heart Failure Characterized by 3-Chamber Strain Echocardiography. J Am Heart Assoc 2022; 11:e028040. [PMID: 36416151 PMCID: PMC9851439 DOI: 10.1161/jaha.122.028040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Heart failure (HF) involves dysfunction of the left ventricle (LV) as well as left atrium and right ventricle. We characterized mechanical phenotypes of HF using 3-chamber strain echocardiography and compared their clinical outcomes. Methods and Results We retrospectively analyzed 3574 patients (median age, 74 years; male 52.8%) with acute HF who underwent 3-chamber strain echocardiography. Patients were classified as with LV, left atrium, or right ventricle myopathy if their corresponding strain values (LV global longitudinal strain, left atrium reservoir strain, and right ventricle global longitudinal strain) were lower than median cutoffs, respectively. The mechanical phenotypes of individual patients were characterized according to the combined myopathy. The primary outcome was a composite end point of 5-year all-cause mortality and HF hospitalization. During follow-up (median, 25.8 months), the primary outcome occurred in 1877 (52.5%) patients. Three-chamber strain values were independent predictors for the primary outcome. An incremental trend was observed for the primary outcome, along with the increasing numbers of combined myopathy. Each mechanical phenotype exhibited an increased risk of the primary outcome, with the highest risk observed in patients with 3-chamber myopathy (hazard ratio, 1.67 [95% CI, 1.42-1.96]). The prognostic significance of the mechanical phenotypes was feasible across the conventional HF subtypes stratified by LV ejection fraction. In HF with preserved ejection fraction, the presence of left atrium and right ventricle myopathy significantly increased the primary outcome, regardless of combined left ventricle myopathy. Conclusions Assessment of 3-chamber strain in HF enables characterization of distinctive mechanical phenotypes, which provides an independent prognostic value that may support long-term risk stratification.
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Affiliation(s)
- Jiesuck Park
- Department of Cardiology, Cardiovascular CenterSeoul National University Bundang HospitalSeongnamGyeonggi‐doRepublic of Korea,Department of Internal MedicineSeoul National University College of MedicineSeoulRepublic of Korea
| | - Hong‐Mi Choi
- Department of Cardiology, Cardiovascular CenterSeoul National University Bundang HospitalSeongnamGyeonggi‐doRepublic of Korea,Department of Internal MedicineSeoul National University College of MedicineSeoulRepublic of Korea
| | - In‐Chang Hwang
- Department of Cardiology, Cardiovascular CenterSeoul National University Bundang HospitalSeongnamGyeonggi‐doRepublic of Korea,Department of Internal MedicineSeoul National University College of MedicineSeoulRepublic of Korea
| | - Yeonyee E. Yoon
- Department of Cardiology, Cardiovascular CenterSeoul National University Bundang HospitalSeongnamGyeonggi‐doRepublic of Korea,Department of Internal MedicineSeoul National University College of MedicineSeoulRepublic of Korea
| | - Jun‐Bean Park
- Department of Internal MedicineSeoul National University College of MedicineSeoulRepublic of Korea,Cardiovascular Center and Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Jae‐Hyeong Park
- Department of Cardiology, Internal MedicineChungnam National University HospitalDaejeonRepublic of Korea
| | - Goo‐Yeong Cho
- Department of Cardiology, Cardiovascular CenterSeoul National University Bundang HospitalSeongnamGyeonggi‐doRepublic of Korea,Department of Internal MedicineSeoul National University College of MedicineSeoulRepublic of Korea
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24
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Tore D, Faletti R, Biondo A, Carisio A, Giorgino F, Landolfi I, Rocco K, Salto S, Santonocito A, Ullo F, Anselmino M, Fonio P, Gatti M. Role of Cardiovascular Magnetic Resonance in the Management of Atrial Fibrillation: A Review. J Imaging 2022; 8:300. [PMID: 36354873 PMCID: PMC9696856 DOI: 10.3390/jimaging8110300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 08/30/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia, and its prevalence is growing with time. Since the introduction of catheter ablation procedures for the treatment of AF, cardiovascular magnetic resonance (CMR) has had an increasingly important role for the treatment of this pathology both in clinical practice and as a research tool to provide insight into the arrhythmic substrate. The most common applications of CMR for AF catheter ablation are the angiographic study of the pulmonary veins, the sizing of the left atrium (LA), and the evaluation of the left atrial appendage (LAA) for stroke risk assessment. Moreover, CMR may provide useful information about esophageal anatomical relationship to LA to prevent thermal injuries during ablation procedures. The use of late gadolinium enhancement (LGE) imaging allows to evaluate the burden of atrial fibrosis before the ablation procedure and to assess procedural induced scarring. Recently, the possibility to assess atrial function, strain, and the burden of cardiac adipose tissue with CMR has provided more elements for risk stratification and clinical decision making in the setting of catheter ablation planning of AF. The purpose of this review is to provide a comprehensive overview of the potential applications of CMR in the workup of ablation procedures for atrial fibrillation.
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Affiliation(s)
- Davide Tore
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Andrea Biondo
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Andrea Carisio
- Department of Radiology, Humanitas Gradenigo Hospital, 10126 Turin, Italy
| | - Fabio Giorgino
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Ilenia Landolfi
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Katia Rocco
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Sara Salto
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Ambra Santonocito
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Federica Ullo
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
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25
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Hu HH. Editorial for "Cardiac MRI Left Atrial Strain Associated With New-Onset Atrial Fibrillation in Patients With ST-Segment Elevation Myocardial Infarction". J Magn Reson Imaging 2022. [PMID: 36250625 DOI: 10.1002/jmri.28493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Houchun Harry Hu
- Department of Radiology, Section of Radiological Science, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, 80045, USA
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26
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Bruns F, Dobrev D. Assessment of atrial function by echocardiography: Can this be used to assess the arrhythmogenic atrial substrate? Int J Cardiol 2022; 362:190-191. [PMID: 35659557 DOI: 10.1016/j.ijcard.2022.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Florian Bruns
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, 45147 Essen, Germany; Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Duisburg-Essen, 45147 Essen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, 45147 Essen, Germany; Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, USA; Montréal Heart Institute, University de Montréal, Montréal, Canada.
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Ji M, He L, Gao L, Lin Y, Xie M, Li Y. Assessment of Left Atrial Structure and Function by Echocardiography in Atrial Fibrillation. Diagnostics (Basel) 2022; 12:1898. [PMID: 36010248 PMCID: PMC9406407 DOI: 10.3390/diagnostics12081898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia with significant morbidity and mortality. Exacerbated by the aging population, the prevalence of AF is gradually increasing. Accurate evaluation of structure and function of left atrium (LA) has important prognostic significance in patients with AF. Echocardiography is the imaging technique of first choice to assess LA structure and function due to its better availability, accessibility and safety over cardiac computed tomography and cardiac magnetic resonance. Therefore, the aim of this review is to summarize the recent research progress of evaluating LA size by three-dimensional echocardiography and LA function by speckle tracking echocardiography (STE) in predicting the occurrence and recurrence of AF and determining the risk of stroke in AF. In addition, we summarized the role of traditional echocardiography in detecting AF patients that are at high risk of heart failure or cardiovascular death.
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Affiliation(s)
- Mengmeng Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lin He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lang Gao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
- Tongji Medical College and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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Perutsky DN, Obrezan AG, Osipova OA, Zarudsky AA. Left atrial function in patients with heart failure. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Improvement of the treatment and diagnosis of hypertension and heart failure (HF) contributes to an increase in life expectancy of the population and, accordingly, its aging. The problem of diagnosing and predicting HF with preserved ejection fraction (HFpEF) is currently one of the urgent problems. The role of left atrial function in the development and course prediction of HF are the subject of scientific study. This review provides an analysis of recent studies on left atrial function in HF patients.
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Echocardiography Assessment of Cardiac Function in Adults Living with HIV: A Speckle Tracking Study in the Era of Antiretroviral Therapy. J Clin Med 2022; 11:jcm11133792. [PMID: 35807077 PMCID: PMC9267567 DOI: 10.3390/jcm11133792] [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: 05/16/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 12/04/2022] Open
Abstract
Adults living with HIV (human immunodeficiency virus) infection (ALHIV) have high rates of cardiovascular events. New approaches are needed to detect subclinical cardiac dysfunction. We used conventional and speckle tracking echocardiography to investigate whether ALHIV display latent cardiac dysfunction. We analyzed 85 young subjects with HIV infection and free from cardiovascular risk factors (31 ± 4 years) and 80 matched healthy volunteers. We measured left ventricular (LV) layered global longitudinal strain, circumferential strain, peak longitudinal strain in the reservoir and contraction phases of the left atrium (LASr respectively LASct). In the HIV group, LV ejection fraction and s’ TDI (tissue doppler imaging) were slightly lower but still in the normal ranges. Layered longitudinal strain showed no significant difference, whereas circumferential global strain was significantly lower in the HIV group (−20.3 ± 3.9 vs. −22.3 ± 3.0, p < 0.001). LASr (34.3% ± 7.3% vs. 38.0% ± 6.9%, p < 0.001) was also lower in ALHIV and multivariate analysis showed that age (β = −0.737, p = 0.01) and infection duration (β = −0.221, p = 0.02) were independently associated with LASr. In the absence of cardiovascular risk factors, adults living with HIV display normal LV systolic function. Left atrial reservoir strain, is, however, decreased and suggests early diastolic dysfunction.
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Lee JH, Park JH, Hwang IC, Park JJ, Park JB. Decreased Peak Left Atrial Longitudinal Strain Is Associated with Persistent Pulmonary Hypertension Associated with Left Heart Disease. J Clin Med 2022; 11:3510. [PMID: 35743580 PMCID: PMC9225174 DOI: 10.3390/jcm11123510] [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: 03/28/2022] [Revised: 06/07/2022] [Accepted: 06/16/2022] [Indexed: 02/05/2023] Open
Abstract
Pulmonary hypertension (PH) associated with left heart disease (PH-LHD) is the most common form of PH and has significantly higher morbidity and mortality. We estimated the prevalence of PH-LHD on the follow-up echocardiography and the role of left atrial (LA) function in PH-LHD. From the STRATS-AHF registry composed of 4312 acute heart failure (HF) patients, we analyzed peak atrial longitudinal strain (PALS) in 1729 patients with follow-up echocardiographic examinations during mean 18.1 ± 13.5 months. PH was determined by the maximal velocity of tricuspid regurgitation (TR Vmax ≥ 3.4 m/s). Persistent PH was found in 373 patients (21.6%). The PH-LHD group was significantly older, and the prevalence of atrial fibrillation (AF), hypertension, diabetes, and heart failure with preserved ejection fraction were higher compared with the no PH-LHD group. Baseline left ventricular end-systolic volume and PALS were lower, and LA diameter, mitral E/E’ ratio, and TR Vmax were higher in the PH-LHD group. In the multivariate analysis, PALS (HR = 1.024, p = 0.040) was a significant variable after adjustment of LA diameter and mitral E/E’. A decreased PALS of <12.5% was the best cutoff value in the prediction of persistent PH-LHD (AUC = 0.594, sensitivity = 65.3%, specificity = 46.1%). PH-LHD was associated with increased HF hospitalization (HR = 2.344, p < 0.001) and mortality (HR = 2.015, p < 0.001) after adjusting for age and sex. In conclusion, persistent PH-LHD was found in 21.6% in the follow-up echocardiography and was associated with decreased PALS (<12.5%). PH-LHD persistence was associated with poor clinical outcomes. Thus, AHF patients with decreased PALS, especially <12.5%, should be followed with caution.
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Affiliation(s)
- Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Korea;
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, Korea
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (I.-C.H.); (J.J.P.)
| | - Jin Joo Park
- Department of Cardiology, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (I.-C.H.); (J.J.P.)
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea;
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Olsen FJ, Bertelsen L, Vejlstrup N, Bjerregaard CL, Diederichsen SZ, Jørgensen PG, Jensen MT, Dahl A, Landler NE, Graff C, Brandes A, Krieger D, Haugan K, Køber L, Højberg S, Svendsen JH, Biering-Sørensen T. Accuracy, analysis time, and reproducibility of dedicated 4D echocardiographic left atrial volume quantification software. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1277-1288. [PMID: 34981209 DOI: 10.1007/s10554-021-02512-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/29/2021] [Indexed: 11/05/2022]
Abstract
Four-dimensional (4D) echocardiography may provide more accurate estimations of left atrial (LA) volumes than 2-dimensional (2D) measures. We sought to compare the concordance of a novel 4D LA quantification software versus 2D echocardiography against cardiac magnetic resonance (CMR). This was a multimodality imaging substudy of a randomized clinical trial (the LOOP study). Elderly participants with stroke risk factors were included. A subgroup of this study population underwent transthoracic echocardiography (n = 1441) and a subset underwent CMR within two weeks (n = 73). The mean age of the echocardiographic study population was 74 years and 54% were men. The maximal LA volume (LAVmax) was 47 mL by 2D, 52 mL by 4D, and 104 mL by CMR. While 2D echocardiography showed a moderate correlation with 4D (R2 = 0.51) it yielded significantly lower values for LAVmax with a mean difference of 4.5 ± 11.9 mL, p < 0.001. 4D echocardiography correlated strongly with CMR measurements (R2 = 0.70), whereas 2D echocardiography showed a moderate correlation (R2 = 0.53). However, both modalities systematically underestimated LAVmax largely compared to CMR (2D vs. CMR: - 54.9 ± 21.3 mL; 4D vs. CMR: - 49.7 ± 18.6 mL). Similar observations were made for minimal LA volume and LA volume before atrial contraction. Analyses time by 4D was shorter than for 2D (90 ± 11 vs. 118 ± 16 s, p < 0.001). Intra- and interobserver variability was lower for 4D than 2D. Four-dimensional echocardiography is faster, more reproducible, and correlates more closely to CMR than 2D echocardiography. Both 4D and 2D echocardiography systematically underestimates LA volumes compared to CMR, emphasizing that values of LA volumes are not interchangeable between echocardiography and CMR.
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Affiliation(s)
- Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, University of Copenhagen, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark.
| | - Litten Bertelsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Søren Zöga Diederichsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Godsk Jørgensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Magnus T Jensen
- Department of Cardiology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Anders Dahl
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Nino Emmanuel Landler
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Derk Krieger
- University Hospital Zurich, University of Zurich, Zürich, Switzerland
- Stroke Unit, Mediclinic City Hospital, Dubai, UAE
| | - Ketil Haugan
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Søren Højberg
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Chen C, Yang Y, Ma W, Qi L, Zhang B, Zhang Y. Left atrial phasic function remodeling during its enlargement: a two-dimensional speckle-tracking echocardiography study. BMC Cardiovasc Disord 2022; 22:231. [PMID: 35590247 PMCID: PMC9118856 DOI: 10.1186/s12872-022-02672-z] [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: 10/24/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left atrial (LA) size is often used as a surrogate marker of LA function in clinical practice, with larger atrial thought to represent a "dysfunctioning" atrium, since there is no accepted 'gold' standard to evaluate LA function. The exact relationship between LA size and phasic function, and whether LA dysfunction occur before LA enlargement (LAE) may be of clinical interest while have not been fully studied. Two-dimensional speckle-tracking echocardiography (2D STE) was showed a promising method in measuring LA physical deformation. MATERIALS AND METHODS A community cohort of 715 subjects at cardiovascular disease high risk accepted comprehensive echocardiography. LA longitudinal phasic strain Sa (absolute peak strain during atrial contraction), Se (peak strain at early diastole) and Stot (total atrial strain = Sa + Se), representing contractile, conduit, and reservoir function respectively, were measured using off-line 2D STE software in apical 4 chamber view, and data were compared among groups at different LA size and between subgroups in normal LA size with and without hypertension (HT). RESULTS With LAE (from normal size, mild, moderate to severe LAE), the Stot (21.74 ± 5.97, 20.75 ± 4.99, 20.49 ± 5.27, 17.75 ± 4.71, respectively, ANOVA P = 0.003) and Sa (11.84 ± 3.92, 11.00 ± 3.29, 10.11 ± 2.57, 8.55 ± 2.88, respectively, ANOVA P < 0.001) reduced while Se had no change. Stot of Severe LAE group was significantly lower than that of Normal LA size group (P = 0.002). Sa of the three LAE groups were all significantly lower than that of Normal LA size group (P = 0.024, P = 0.002, P < 0.001, respectively). In normal sized LA subgroups, Stot (21.35 ± 5.91 vs. 23.01 ± 6.02, P = 0.008) and Se (9.51 ± 4.41 vs. 11.17 ± 4.89, P < 0.001) reduced in subjects with HT comparing with those without. CONCLUSION LA phasic function remodeling occurs before LAE and continues with LAE, with reservoir, conduit and contractile function being affected unparalleled.
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Affiliation(s)
- Chuyun Chen
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Ying Yang
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,Echocardiography Core Lab, Institute of Cardiovascular Disease, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Wei Ma
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Echocardiography Core Lab, Institute of Cardiovascular Disease, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Litong Qi
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Baowei Zhang
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China
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Mojica-Pisciotti ML, Panovský R, Masárová L, Pešl M, Stárek Z, Holeček T, Feitová V, Opatřil L, Doležalová K, Kincl V. Left atrium phasic impairments in paroxysmal atrial fibrillation patients assessed by cardiovascular magnetic resonance feature tracking. Sci Rep 2022; 12:7539. [PMID: 35534637 PMCID: PMC9085809 DOI: 10.1038/s41598-022-11233-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/06/2022] [Indexed: 11/12/2022] Open
Abstract
Atrial fibrillation (AF) is an abnormal and irregular heartbeat caused by uncoordinated electrical impulses in the left atrium (LA), which could induce lasting changes in the heart tissue or could be a consequence of underlying cardiac disease. This study aimed to assess the left atrial phasic function and deformation in paroxysmal AF (PAF) patients—who had not received radiofrequency ablation and had no signs of permanent AF—using the cardiovascular magnetic resonance (CMR) feature-tracking (FT) technique. Fifty subjects (27 PAF patients and 23 controls) were included and examined with CMR. Their LA volume, LA function, LA longitudinal strain (LS) and LA strain rate were assessed in the LA reservoir, conduit, and contractile phases. PAF patients exhibited higher LA volumes than controls, while their LA emptying fraction and LA LS was significantly lower in all three phases. In contrast, the corresponding emptying volumes (total, passive and active) were similar in both groups. The LA volumetric rates from CMR-derived volume curves differed significantly in PAF patients vs controls in the reservoir and contractile phases. In contrast, the equivalent LV volumetric rates were similar. This study suggests that assessing the LA phasic function could offer insight into early LA impairments for PAF patients.
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Layoun H, Mentias A, Akintoye E, Matta M, Kanaan C, Daou R, Ramchand J, Burns D, Gillinov AM, Bhattacharya S, Puri R, Collier P, Griffin B, Kapadia S, Harb SC. Clinical, functional and prognostic implications of severe atrial dilation in secondary mitral regurgitation. Open Heart 2022; 9:openhrt-2022-001996. [PMID: 35383126 PMCID: PMC8984044 DOI: 10.1136/openhrt-2022-001996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/11/2022] [Indexed: 11/20/2022] Open
Abstract
Objective Atrial dilation is known to be a poor prognostic indicator. However, its clinical, functional and prognostic implications have not been thoroughly explored in secondary mitral regurgitation (SMR). We sought to describe the implications of severe atrial dilation (SAD) in SMR. Methods We included all adult patients with severe SMR due to left ventricle dysfunction (with no organic mitral valve disease) who underwent transthoracic echocardiography between January 2012 and March 2021 at our institution. The concomitant presence of severe left atrial (LA) dilation (>48 mL/m2) defined SADMR (SAD in SMR), and these patients were compared with those without SAD. Results A total of 2011 patients were included (mean age 70% and 41% females), with 71% having SADMR. MR severity and ejection fraction were similar between both groups. Patients with SADMR were older, less females and had more diabetes, but similar rates of atrial fibrillation. Mechanistically, they had lower A wave velocity (0.61 vs 0.72 cm/sec, p<0.001) and more impaired LA reservoir strain (9.7% vs 15.5%, p<0.001). Geometrically, SADMR had shallower leaflets’ angulations, lower tenting height, larger annuli and smaller leaflet length/annular diameter ratios (all p<0.001). They underwent fewer MV interventions, although these were associated with better outcomes (log-rank p<0.001). Over the study period, SAD was an independent predictor of mortality (HR 1.26, p=0.04). Conclusion SADMR is associated with specific mechanistic and functional alterations and confers a worse prognosis.
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Affiliation(s)
- Habib Layoun
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amgad Mentias
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Emmanuel Akintoye
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Milad Matta
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chris Kanaan
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Remy Daou
- Family Medicine, Hotel-Dieu De France, Achrafieh, Lebanon
| | - Jay Ramchand
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Burns
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - A Marc Gillinov
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Rishi Puri
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick Collier
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Griffin
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serge C Harb
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Left Atrial Appendage Depth and Tachycardia Bradycardia Syndrome as Important Predictors of Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4632823. [PMID: 35401785 PMCID: PMC8986422 DOI: 10.1155/2022/4632823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/24/2022] [Accepted: 03/05/2022] [Indexed: 11/17/2022]
Abstract
Background Atrial fibrillation (AF) is the most common heart rhythm disorder that has been shown to be associated with a significant increase in stroke and systemic embolism risk. The left atrial appendage (LAA) is a finger-like extension originating from the left atrium; the formation of thrombus in LAA is the main reason of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). This study is aimed at finding out the risk of left atrial appendage thrombus (LAAT) in patients with nonvalvular atrial fibrillation (NVAF). Method We retrospectively examined the clinic and left atrial computer tomography angiography (CTA) features of patients assessed in Zhengzhou No. 7 People's Hospital between January 2020 and January 2021 derivation. Student's t-test, chi-square test, receiver operating characteristics (ROC) curves, and logistic regression analysis were used to identify predictors of LAAT. Result Of 480 patients included in the analysis, LAAT was found in approximately 9.2% of all patients. Univariate demographic predictors of LAAT included left atrium top and bottom diameter (LTD), left atrial appendage depth (LAAD), CHA2DS2-VASc, tachycardia bradycardia syndrome (TBS), and nonparoxysmal atrial fibrillation (PAF). In a multiple logistic regression analysis, the independent predictors of thrombus were LAAD > 23.45 mm (odds ratio: 4.216, 95% CI: 1.869-9.510, P = 0.001), TBS (odds ratio: 4.076, 95% CI: 1.655-10.038, P = 0.002), and non-PAF (odds ratio: 2.896, 95% CI: 1.183-7.094, P = 0.02). Conclusion In NVAF patients with LAAT, evidence suggested that larger LAAD, non-PAF, and TBS present a high risk of LAAT. This is the first report demonstrating that the LAAD and TBS are associated with LAAT in patients with NVAF.
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Stassen J, Butcher SC, Namazi F, Marsan NA, Bax JJ, Delgado V. Left atrial deformation imaging and atrial fibrillation in patients with rheumatic mitral stenosis. J Am Soc Echocardiogr 2021; 35:486-494.e2. [PMID: 34954048 DOI: 10.1016/j.echo.2021.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/20/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a frequent complication of rheumatic mitral stenosis (MS) and is associated with worse outcomes. Prediction of new-onset AF by assessing left atrial (LA) mechanics with speckle tracking echocardiography might be useful for risk stratification and guiding therapeutic strategies. Therefore, the aim of this study was to assess the association of left atrial reservoir strain (LASr) and strain rate (LASRr) with AF at follow-up in patients with rheumatic MS. METHODS LASr and LASRr, measured by speckle-tracking echocardiography, were assessed in 125 patients (mean age 50 ±15 years, 80.8% female) with rheumatic MS and without a history of prior AF. Patients were followed-up for the occurrence of a first episode of AF after the index echocardiogram. RESULTS During a median follow-up of 32 (9.5 - 70) months, 41 patients (32.8%) developed new-onset AF. Patients who developed AF had significantly more impaired LASr (13.4±5.2% vs 18.9±8.2%, p<0.001) and LASRr (0.72±0.26 s-1 vs 0.98±0.36 s-1, p<0.001) compared to patients who remained in sinus rhythm. On multivariable Cox regression analysis, LASr <21% and LASRr <0.8 s-1 were independently associated with the development of AF at follow-up (hazard ratio [HR] 7.03, 95% confidence interval [CI] 2.08-23.77, p=0.002 and HR 3.42, 95% CI 1.59-7.34, p=0.002, respectively). CONCLUSIONS LASr and LASRr are impaired in patients with rheumatic MS and the degree of impairment is associated with new-onset AF at follow-up.
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Affiliation(s)
- Jan Stassen
- Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Farnaz Namazi
- Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, The Netherlands.
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Beyls C, Hermida A, Bohbot Y, Martin N, Viart C, Boisgard S, Daumin C, Huette P, Dupont H, Abou-Arab O, Mahjoub Y. Automated left atrial strain analysis for predicting atrial fibrillation in severe COVID-19 pneumonia: a prospective study. Ann Intensive Care 2021; 11:168. [PMID: 34874509 PMCID: PMC8649321 DOI: 10.1186/s13613-021-00955-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most documented arrhythmia in COVID-19 pneumonia. Left atrial (LA) strain (LAS) analysis, a marker of LA contractility, have been associated with the development of AF in several clinical situations. We aimed to assess the diagnostic ability of LA strain parameters to predict AF in patients with severe hypoxemic COVID-19 pneumonia. We conducted a prospective single center study in Amiens University Hospital intensive care unit (ICU) (France). Adult patients with severe or critical COVID-19 pneumonia according to the World Health Organization definition and in sinus rhythm were included. Transthoracic echocardiography was performed within 48 h of ICU admission. LA strain analysis was performed by an automated software. The following LA strain parameters were recorded: LA strain during reservoir phase (LASr), LA strain during conduit phase (LAScd) and LA strain during contraction phase (LASct). The primary endpoint was the occurrence of AF during ICU stay. Results From March 2020 to February of 2021, 79 patients were included. Sixteen patients (20%) developed AF in ICU. Patients of the AF group were significantly older with a higher SAPS II score than those without AF. LAScd and LASr were significantly more impaired in the AF group compared to the other group (− 8.1 [− 6.3; − 10.9] vs. − 17.2 [− 5.0; − 10.2] %; P < 0.001 and 20.2 [12.3;27.3] % vs. 30.5 [23.8;36.2] %; P = 0.002, respectively), while LASct did not significantly differ between groups (p = 0.31). In a multivariate model, LAScd and SOFA cv were significantly associated with the occurrence of AF. A LAScd cutoff value of − 11% had a sensitivity of 76% and a specificity of 75% to identify patients with AF. The 30-day cumulative risk of AF was 42 ± 9% with LAScd > − 11% and 8 ± 4% with LAScd ≤ − 11% (log rank test P value < 0.0001). Conclusion For patients with severe COVID-19 pneumonia, development of AF during ICU stay is common (20%). LAS parameters seem useful in predicting AF within the first 48 h of ICU admission. Trial registration: NCT04354558.
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Affiliation(s)
- Christophe Beyls
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond-point du Pr Cabrol, 80054, Amiens, Cedex 1, France. .,UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, Amiens, France.
| | - Alexis Hermida
- Department of Rythmology, Amiens University Hospital, 80054, Amiens, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, 80054, Amiens, France
| | - Nicolas Martin
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond-point du Pr Cabrol, 80054, Amiens, Cedex 1, France
| | - Christophe Viart
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond-point du Pr Cabrol, 80054, Amiens, Cedex 1, France
| | - Solenne Boisgard
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond-point du Pr Cabrol, 80054, Amiens, Cedex 1, France
| | - Camille Daumin
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond-point du Pr Cabrol, 80054, Amiens, Cedex 1, France
| | - Pierre Huette
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond-point du Pr Cabrol, 80054, Amiens, Cedex 1, France
| | - Hervé Dupont
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond-point du Pr Cabrol, 80054, Amiens, Cedex 1, France
| | - Osama Abou-Arab
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond-point du Pr Cabrol, 80054, Amiens, Cedex 1, France
| | - Yazine Mahjoub
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, 1, Rond-point du Pr Cabrol, 80054, Amiens, Cedex 1, France
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Strzelczyk J, Kalinowski P, Zieniewicz K, Szmigielski C, Byra M, Styczyński G. The Influence of Surgical Weight Reduction on Left Atrial Strain. Obes Surg 2021; 31:5243-5250. [PMID: 34550536 PMCID: PMC8595175 DOI: 10.1007/s11695-021-05710-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity increases and surgical weight reduction decreases the risk of atrial fibrillation (AF) and heart failure (HF). We hypothesized that surgically induced weight loss may favorably affect left atrial (LA) mechanical function measured by longitudinal strain, which has recently emerged as an independent imaging biomarker of increased AF and HF risk. METHODS We retrospectively evaluated echocardiograms performed before and 12.2 ± 2.2 months after bariatric surgery in 65 patients with severe obesity (mean age 39 [36; 47] years, 72% of females) with no known cardiac disease or arrhythmia. The LA mechanical function was measured by the longitudinal strain using the semi-automatic speckle tracking method. RESULTS After surgery, body mass index decreased from 43.72 ± 4.34 to 30.04 ± 4.33 kg/m2. We observed a significant improvement in all components of the LA strain. LA reservoir strain (LASR) and LA conduit strain (LASCD) significantly increased (35.7% vs 38.95%, p = 0.0005 and - 19.6% vs - 24.4%, p < 0.0001) and LA contraction strain (LASCT) significantly decreased (- 16% vs - 14%, p = 0.0075). There was a significant correlation between an increase in LASR and LASCD and the improvement in parameters of left ventricular diastolic and longitudinal systolic function (increase in E' and MAPSE). Another significant correlation was identified between the decrease in LASCT and an improvement in LA function (decrease in A'). CONCLUSIONS The left atrial mechanical function improves after bariatric surgery. It is partially explained by the beneficial effect of weight reduction on the left ventricular diastolic and longitudinal systolic function. This effect may contribute to decreased risk of AF and HF after bariatric surgery.
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Affiliation(s)
- Jakub Strzelczyk
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Stefana Banacha Street 1A, 02-097, Warsaw, Poland.
| | - Piotr Kalinowski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Stefana Banacha Street 1A, 02-097, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Stefana Banacha Street 1A, 02-097, Warsaw, Poland
| | - Cezary Szmigielski
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Stefana Banacha Street 1A, 02-097, Warsaw, Poland
| | - Michał Byra
- Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences, Adolfa Pawińskiego Street 5B, 02-106, Warsaw, Poland
| | - Grzegorz Styczyński
- Department of Internal Medicine, Hypertension and Angiology, Medical University of Warsaw, Stefana Banacha Street 1A, 02-097, Warsaw, Poland
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Eichenlaub M, Mueller-Edenborn B, Minners J, Allgeier M, Lehrmann H, Allgeier J, Trenk D, Neumann FJ, Jander N, Arentz T, Jadidi A. Echocardiographic diagnosis of atrial cardiomyopathy allows outcome prediction following pulmonary vein isolation. Clin Res Cardiol 2021; 110:1770-1780. [PMID: 33914144 PMCID: PMC8563528 DOI: 10.1007/s00392-021-01850-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/25/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Relevant atrial cardiomyopathy (ACM), defined as a left atrial (LA) low-voltage area ≥ 2 cm2 at 0.5 mV threshold on endocardial contact mapping, is associated with new-onset atrial fibrillation (AF), higher arrhythmia recurrence rates after pulmonary vein isolation (PVI), and an increased risk of stroke. The current study aimed to assess two non-invasive echocardiographic parameters, LA emptying fraction (EF) and LA longitudinal strain (LAS, during reservoir (LASr), conduit (LAScd) and contraction phase (LASct)) for the diagnosis of ACM and prediction of arrhythmia outcome after PVI. METHODS We prospectively enrolled 60 consecutive, ablation-naive patients (age 66 ± 9 years, 80% males) with persistent AF. In 30 patients (derivation cohort), LA-EF and LAS cut-off values for the presence of relevant ACM (high-density endocardial contact mapping in sinus rhythm prior to PVI at 3000 ± 1249 sites) were established in sinus rhythm and tested in a validation cohort (n = 30). Arrhythmia recurrence within 12 months was documented using 72-h Holter electrocardiograms. RESULTS An LA-EF of < 34% predicted ACM with an area under the curve (AUC) of 0.846 (sensitivity 69.2%, specificity 76.5%) similar to a LASr < 23.5% (AUC 0.878, sensitivity 92.3%, specificity 82.4%). In the validation cohort, these cut-offs established the correct diagnosis of ACM in 76% of patients (positive predictive values 87%/93% and negative predictive values 73%/75%, respectively). Arrhythmia recurrence in the entire cohort was significantly more frequent in patients with LA-EF < 34% and LASr < 23.5% (56% vs. 29% and 55% vs. 26%, both p < 0.05). CONCLUSION The echocardiographic parameters LA-EF and LAS allow accurate, non-invasive diagnosis of ACM and prediction of arrhythmia recurrence after PVI.
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Affiliation(s)
- Martin Eichenlaub
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
| | - Bjoern Mueller-Edenborn
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Jan Minners
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Martin Allgeier
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Heiko Lehrmann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Juergen Allgeier
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Dietmar Trenk
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Nikolaus Jander
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Thomas Arentz
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Amir Jadidi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
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Eichenlaub M, Mueller-Edenborn B, Minners J, Jander N, Allgeier M, Lehrmann H, Schoechlin S, Allgeier J, Trenk D, Neumann FJ, Arentz T, Jadidi A. Left Atrial Hypertension, Electrical Conduction Slowing, and Mechanical Dysfunction - The Pathophysiological Triad in Atrial Fibrillation-Associated Atrial Cardiomyopathy. Front Physiol 2021; 12:670527. [PMID: 34421634 PMCID: PMC8375593 DOI: 10.3389/fphys.2021.670527] [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: 02/21/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common arrhythmia and a significant burden for healthcare systems worldwide. Presence of relevant atrial cardiomyopathy (ACM) is related to persistent AF and increased arrhythmia recurrence rates after pulmonary vein isolation (PVI). Objective To investigate the association of left atrial pressure (LAP), left atrial electrical [invasive atrial activation time (IAAT) and amplified p-wave duration (aPWD)] and mechanical [left atrial emptying fraction (LA-EF) and left atrial strain (LAS)] functional parameters with the extent of ACM and their impact on arrhythmia recurrence following PVI. Materials and Methods Fifty patients [age 67 (IQR: 61-75) years, 78% male] undergoing their first PVI for persistent AF were prospectively included. LAP (maximum amplitude of the v-wave), digital 12-lead electrocardiogram, echocardiography and high-density endocardial contact mapping were acquired in sinus rhythm prior to PVI. Arrhythmia recurrence was assessed using 72-hour Holter electrocardiogram at 6 and 12 months post PVI. Results Relevant ACM (defined as left atrial low-voltage extent ≥2 cm2 at <0.5 mV threshold) was diagnosed in 25/50 (50%) patients. Compared to patients without ACM, patients with ACM had higher LAP [17.6 (10.6-19.5) mmHg with ACM versus 11.3 (7.9-14.0) mmHg without ACM (p = 0.009)]. The corresponding values for the electrical parameters were 166 (149-181) ms versus 139 (131-143) ms for IAAT (p < 0.0001), 163 (154-176) ms versus 148 (136-152) ms for aPWD on surface-ECG (p < 0.0001) and for the mechanical parameters 27.0 (17.5-37.0) % versus 41.0 (35.0-45.0) % for LA-EF in standard 2D-echocardiography (p < 0.0001) and 15.2 (11.0-21.2) % versus 29.4 (24.9-36.6) % for LAS during reservoir phase (p < 0.0001). Furthermore, all parameters showed a linear correlation with ACM extent (p < 0.05 for all). Receiver-operator-curve-analysis demonstrated a LAP ≥12.4 mmHg [area under the curve (AUC): 0.717, sensitivity: 72%, and specificity: 60%], a prolonged IAAT ≥143 ms (AUC: 0.899, sensitivity: 84%, and specificity: 80%), a prolonged aPWD ≥153 ms (AUC: 0.860, sensitivity: 80%, and specificity: 79%), an impaired LA-EF ≤33% (AUC: 0.869, sensitivity: 84%, and specificity: 72%), and an impaired LAS during reservoir phase ≤23% (AUC: 0.884, sensitivity: 84%, and specificity: 84%) as predictors for relevant ACM. Arrhythmia recurrence within 12 months post PVI was significantly increased in patients with relevant ACM ≥2 cm2, electrical dysfunction with prolonged IAAT ≥143 ms and mechanical dysfunction with impaired LA-EF ≤33% (66 versus 20, 50 versus 23 and 55 versus 25%, all p < 0.05). Conclusion Left atrial hypertension, electrical conduction slowing and mechanical dysfunction are associated with ACM. These findings improve the understanding of ACM pathophysiology and may be suitable for risk stratification for new-onset AF, arrhythmia recurrence following PVI, and development of novel therapeutic strategies to prevent AF and its associated complications.
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Affiliation(s)
- Martin Eichenlaub
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Bjoern Mueller-Edenborn
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Jan Minners
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Nikolaus Jander
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Martin Allgeier
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Heiko Lehrmann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Simon Schoechlin
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Juergen Allgeier
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Dietmar Trenk
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Thomas Arentz
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Amir Jadidi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Bartko PE, Heitzinger G, Spinka G, Pavo N, Prausmüller S, Kastl S, Winter MP, Arfsten H, Tan TC, Gebhard C, Mascherbauer J, Hengstenberg C, Strunk G, Hülsmann M, Goliasch G. Principal Morphomic and Functional Components of Secondary Mitral Regurgitation. JACC Cardiovasc Imaging 2021; 14:2288-2300. [PMID: 34274262 DOI: 10.1016/j.jcmg.2021.05.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/14/2021] [Accepted: 05/21/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this work was to identify the key morphological and functional features in secondary mitral regurgitation (sMR) and their prognostic impact on outcome. BACKGROUND Secondary sMR in patients with heart failure and reduced ejection fraction typically results from distortion of the underlying cardiac architecture. The morphological components which may account for the clinical impact of sMR have not been systematically assessed or correlated with clinical outcomes. METHODS Morphomic and functional network profiling were performed on a cohort of patients with stable heart failure optimized on guideline-based medical therapy. Principal component (PC) analysis and subsequent cluster analysis were used to condense the morphomic and functional data first into PCs with varimax rotation (PCVmax) and second into homogeneous clusters. Clusters and PCs were tested for their correlations with clinical outcomes. RESULTS Morphomic and functional data from 383 patients were profiled and subsequently condensed into PCs. PCVmax 1 describes high loadings of left atrial morphological information, and PCVmax 2 describes high loadings of left ventricular (LV) topology. Based on these components, 4 homogeneous clusters were derived. sMR was most prominent in clusters 3 and 4, with the morphological difference being left ventricular size (median end-diastolic volume 188 mL [interquartile range: 160 mL-224 mL] vs 315 mL [264 mL-408 mL]; P < 0.001). Clusters were associated with mortality (P < 0.001), but sMR remained independently associated with mortality after adjusting for the clusters (adjusted HR: 1.42; 95% CI: 1.14-1.77; P < 0.01). The detrimental association of sMR with mortality was mainly driven by cluster 3 (HR: 2.18; 95% CI: 1.32-3.60; P = 0.002), the "small LV cavity" phenotype. CONCLUSIONS These results challenge the current perceptions that sMR in heart failure with reduced ejection fraction results exclusively from global or local LV remodeling and are suggestive of a potential role of the left atrial component. The association of sMR with mortality cannot be purely attributed to cardiac morphology alone, supporting other complementary key aspects of mitral valve closure consistent with the force balance theory. Unsupervised clustering supports the association of sMR with mortality predominantly driven by the small LV cavity phenotype, as previously suggested by a conceptional framework and termed disproportionate sMR.
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Affiliation(s)
- Philipp E Bartko
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Gregor Heitzinger
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georg Spinka
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Noemi Pavo
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Suriya Prausmüller
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Stefan Kastl
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Max-Paul Winter
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Henrike Arfsten
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Timothy C Tan
- Faculty of Medicine, Westmead Hospital, University of Sydney, Sydney, Australia; Department of Cardiology, Blacktown Hospital, Blacktown, Australia
| | - Catherine Gebhard
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Guido Strunk
- Department of Cardiology, Blacktown Hospital, Blacktown, Australia
| | - Martin Hülsmann
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
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Park JH, Hwang IC, Park JJ, Park JB, Cho GY. Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm. J Am Heart Assoc 2021; 10:e020414. [PMID: 34187174 PMCID: PMC8403314 DOI: 10.1161/jaha.120.020414] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Stroke is a major comorbidity in patients with heart failure (HF), especially in those with decreased left atrial (LA) function, and thus, identifying patients highly at risk of stroke can prevent its occurrence. We evaluated the predictive value of global longitudinal strain of LA (LAGLS) in patients with acute HF and sinus rhythm. Methods and Results In this retrospective study, 2461 patients (53.3% men, 69.7±14.4 years old) with sinus rhythm and LAGLS among 4312 consecutive patients with acute HF from 3 tertiary hospitals were included. HF phenotypes were defined as HF with reduced ejection fraction (EF) (left ventricular EF ≤40%), HF with midrange EF (40% <left ventricular EF <50%), and HF with preserved ejection fraction (left ventricular EF ≥50%). Primary outcome was new‐onset stroke. The mean left ventricular EF was 39.4%±15.6%. Moreover, 1388 (57.5%), 342 (14.2%), and 682 (28.3%) were classified with HF with reduced EF, HF with midrange EF, and HF with preserved EF, retrospectively. LAGLS was 17.2%±10.4%. During the follow‐up duration (mean: 30.3±25.4 months), 100 patients experienced stroke. Patients with stroke had higher LA diameter (P=0.031) and lower LAGLS (P=0.010) than those without stroke. In the univariate analysis, age, diabetes mellitus, LA diameter, LA volume index, and LAGLS were significant risk factors for stroke. In the multivariate analysis, each 1% decrease in LAGLS was associated with a 3.8% increased risk for stroke (hazard ratio [HR], 1.038; 95% CI, 1.013–1.065; P=0.003). When applying a LAGLS cutoff point of 14.5%, patients with LAGLS <14.5% had approximately twice the risk for stroke after adjusting other significant variables (HR, 1.940; 95% CI, 1.269–2.965; P=0.002). Conclusions In patients with acute HF and sinus rhythm, decreased LAGLS (<14.5%) was associated with an increased risk for stroke, with an annual incidence of 2.38%.
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Affiliation(s)
- Jae-Hyeong Park
- Department of Cardiology in Internal Medicine Chungnam National University HospitalChungnam National University College of Medicine Daejeon Korea
| | - In-Chang Hwang
- Cardiovascular Center & Department of Internal Medicine Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam Korea
| | - Jin Joo Park
- Cardiovascular Center & Department of Internal Medicine Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam Korea
| | - Jun-Bean Park
- Department of Internal Medicine Seoul National University College of MedicineSeoul National University Hospital Seoul Korea
| | - Goo-Yeong Cho
- Cardiovascular Center & Department of Internal Medicine Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam Korea
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Gonzales RA, Seemann F, Lamy J, Arvidsson PM, Heiberg E, Murray V, Peters DC. Automated left atrial time-resolved segmentation in MRI long-axis cine images using active contours. BMC Med Imaging 2021; 21:101. [PMID: 34147081 PMCID: PMC8214286 DOI: 10.1186/s12880-021-00630-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/10/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Segmentation of the left atrium (LA) is required to evaluate atrial size and function, which are important imaging biomarkers for a wide range of cardiovascular conditions, such as atrial fibrillation, stroke, and diastolic dysfunction. LA segmentations are currently being performed manually, which is time-consuming and observer-dependent. METHODS This study presents an automated image processing algorithm for time-resolved LA segmentation in cardiac magnetic resonance imaging (MRI) long-axis cine images of the 2-chamber (2ch) and 4-chamber (4ch) views using active contours. The proposed algorithm combines mitral valve tracking, automated threshold calculation, edge detection on a radially resampled image, edge tracking based on Dijkstra's algorithm, and post-processing involving smoothing and interpolation. The algorithm was evaluated in 37 patients diagnosed mainly with paroxysmal atrial fibrillation. Segmentation accuracy was assessed using the Dice similarity coefficient (DSC) and Hausdorff distance (HD), with manual segmentations in all time frames as the reference standard. For inter-observer variability analysis, a second observer performed manual segmentations at end-diastole and end-systole on all subjects. RESULTS The proposed automated method achieved high performance in segmenting the LA in long-axis cine sequences, with a DSC of 0.96 for 2ch and 0.95 for 4ch, and an HD of 5.5 mm for 2ch and 6.4 mm for 4ch. The manual inter-observer variability analysis had an average DSC of 0.95 and an average HD of 4.9 mm. CONCLUSION The proposed automated method achieved performance on par with human experts analyzing MRI images for evaluation of atrial size and function. Video Abstract.
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Affiliation(s)
- Ricardo A Gonzales
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
- Department of Electrical Engineering, Universidad de Ingeniería y Tecnología, Lima, Peru
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Felicia Seemann
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Per M Arvidsson
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Victor Murray
- Department of Electrical Engineering, Universidad de Ingeniería y Tecnología, Lima, Peru
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, United States of America
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America.
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Lisi M, Mandoli GE, Cameli M, Pastore MC, Righini FM, Benfari G, Rubboli A, D'Ascenzi F, Focardi M, Tsioulpas C, Bernazzali S, Maccherini M, Lisi E, Lindqvist P, Valente S, Mondillo S, Henein MY. Left atrial strain by speckle tracking predicts atrial fibrosis in patients undergoing heart transplantation. Eur Heart J Cardiovasc Imaging 2021; 23:829-835. [PMID: 34118154 DOI: 10.1093/ehjci/jeab106] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS In patients with heart failure (HF), chronically raised left ventricular (LV) filling pressures lead to progressive left atrial (LA) dysfunction and fibrosis. We aimed to assess the correlation of LA reservoir strain (peak atrial longitudinal strain, PALS) by speckle tracking echocardiography (STE) and LA fibrosis assessed by myocardial biopsy in patients undergoing heart transplantation (HTx). METHODS AND RESULTS Forty-eight patients with advanced HF [mean age 51.2 ± 8.1 years, 29% females; LV ejection fraction ≤25% and New York Heart Association (NYHA) class III-IV] referred for HTx were enrolled and underwent pre-operative echocardiographic evaluation, right heart catheterization, and cardiopulmonary exercise testing. Exclusion criteria were non-sinus rhythm, mechanical ventilation, severe mitral/tricuspid regurgitation, or other valvular disease and poor acoustic window. After HTx, LA bioptic samples were collected and analysed to determine the extent of myocardial fibrosis (%). LA fibrosis showed correlation with PALS (R = -0.88, P < 0.0001), VO2max (R = -0.68, P < 0.0001), NYHA class (R = 0.66, P < 0.0001), LA stiffness (R = 0.58, P = 0.0002), and E/e' (R = 0.44, P = 0.005), while poorly correlated with E/A ratio (R = 0.23, P = 0.21). PALS had a good correlation with NYHA class (R = -0.64, P < 0.0001), PAoP (R = -0.61, P = 0.03) and VO2max (R = 0.57, P = 0.0001). Multivariate regression analysis identified PALS (beta = -0.91, P < 0.001) and LA Volume (beta = -0.19, P = 0.03) as predictors of LA Fibrosis, while E/e' was not a significant predictor (beta = 0.15, P = 0.08). CONCLUSION Emerging as a possible index of myocardial fibrosis in patients with advanced HF, PALS could help to optimize the management and the selection of those patients with irreversible LA structural damage for advanced therapeutic strategies.
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Affiliation(s)
- Matteo Lisi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
- Division of Cardiology, Department of Cardiovascular Disease-AUSL Romagna, Ospedale S. Maria delle Croci, Ravenna, Italy
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Francesca Maria Righini
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | | | - Andrea Rubboli
- Division of Cardiology, Department of Cardiovascular Disease-AUSL Romagna, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Marta Focardi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | | | - Sonia Bernazzali
- Department of Cardiac Surgery, University of Siena, Siena, Italy
| | | | - Edoardo Lisi
- Department of Mathematics, Imperial College London, London, UK
| | - Per Lindqvist
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Serafina Valente
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Sergio Mondillo
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
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Abstract
Unlike the left ventricle (LV), the left atrium (LA) has a thin-walled structure and has been regarded as a simple conduit chamber. However, the unique function of the LA to modulate LV filling has recently drawn much attention. Because LA structure and function are directly influenced by the LV filling pressure, LA assessment is an essential step in the diagnosis of diastolic dysfunction that can help predict new-onset atrial fibrillation, assess the risk of further embolic events, and identify high-risk patients for adverse cardiovascular events. Even in the recent era of multimodality imaging, 2-dimensional (2D) echocardiography is the most common imaging method and the central modality for evaluation of LA function. LA strain derived from 2D echocardiography can help assess LA function objectively and demonstrates the 3 distinct phasic motions of the LA cycle. Further, LA strain provides invaluable pathophysiologic information and helps to predict clinical prognosis in various cardiovascular diseases. In this review article, we focus on LA strain: basic concepts, advantages over conventional parameters, and some unresolved issues. Additionally, we present a brief history of the clinical evidence for LA strain. Through this review, we suggest echocardiography for LA strain assessment in clinical practice.
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Affiliation(s)
- Byung Joo Sun
- Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital
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Baman JR, Cox JL, McCarthy PM, Kim D, Patel RB, Passman RS, Wilcox JE. Atrial fibrillation and atrial cardiomyopathies. J Cardiovasc Electrophysiol 2021; 32:2845-2853. [PMID: 33993617 DOI: 10.1111/jce.15083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/13/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia among adults. While there have been incredible advances in the management of AF and its clinical sequelae, investigation of atrial cardiomyopathies (ACMs) is becoming increasingly more prominent. ACM refers to the electromechanical changes-appreciated subclinically and/or clinically-that underlie atrial dysfunction and create an environment ripe for the development of clinically apparent AF. There are several subtypes of ACM, distinguished by histologic features. Recent progress in cardiovascular imaging, including echocardiography with speckle-tracking (e.g., strain analysis), cardiovascular magnetic resonance imaging (CMR), and atrial 4-D flow CMR, has enabled increased recognition of ACM. Identification of ACM and its features carry clinical implications, including elevating a patient's risk for development of AF, as well as associations with outcomes related to catheter-based and surgical AF ablation. In this review, we explore the definition and classifications of ACM, its complex relationship with clinical AF, imaging modalities, and clinical implications. We propose next steps for a more unified approach to ACM recognition that can direct further research into this complex field.
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Affiliation(s)
- Jayson R Baman
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James L Cox
- Department of Cardiac Surgery, Bluhm Cardiovascular Institute of Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Patrick M McCarthy
- Department of Cardiac Surgery, Bluhm Cardiovascular Institute of Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ravi B Patel
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rod S Passman
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane E Wilcox
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Covas P, Ismail H, Krepp J, Choi BG, Lewis JF, Katz RJ, Choi AD. Contemporary Cardiovascular Imaging Advancements and Social Media. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23:25. [PMID: 33746507 PMCID: PMC7958098 DOI: 10.1007/s11936-021-00902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Social media (SoMe) as a means of knowledge dissemination has grown significantly in cardiovascular imaging in recent years. This media platform allows for a free exchange of ideas, the development of new communities, and the ability to disseminate advancements rapidly. While the social media platforms offer limitless potential, their public domain necessitates several important suggestions around best practices. RECENT FINDINGS In cardiovascular imaging, specific hashtags have emerged to encompass the major modalities to include #EchoFirst, #YesCCT, #WhyCMR, and #CVNuc. Cardiovascular imaging journals have established major presences in the social media space as an avenue to present novel, high-quality, peer-reviewed content to new audiences. SUMMARY This review paper aims to introduce basic concepts in social media and cardiovascular imaging while highlighting recent topics of high importance, influence, and attention in cardiovascular imaging to include the ISCHEMIA trial, COVID-19, structural imaging, and multimodality advances from throughout 2020.
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Affiliation(s)
- Pedro Covas
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Haneen Ismail
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Joseph Krepp
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Brian G. Choi
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Jannet F. Lewis
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Richard J. Katz
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Andrew D. Choi
- Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
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Park JJ, Cho GY, Choi W, Hwang IC, Kim JY, Yoon Y, Yoon CH, Kim BJ, Han MK, Bae HJ. Heart failure and atrial fibrillation in patients with an interatrial shunt. Clin Res Cardiol 2021; 110:1270-1279. [PMID: 33649885 DOI: 10.1007/s00392-021-01811-4] [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: 11/09/2020] [Accepted: 01/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Congenital interatrial shunt can unload the left atrium (LA) and may lower the risk of new-onset heart failure (HF) or atrial fibrillation (AF). We evaluated the risk of new-onset HF or AF in patients with and without interatrial shunt. METHODS We enrolled 2660 consecutive patients with acute stroke or transient ischemic attack (TIA) who underwent transesophageal echocardiography at Seoul National University Bundang Hospital from January 1, 2006 to December 31, 2018. The primary outcomes were 10-year new-onset HF, new-onset AF, and new-onset HF or AF composite. RESULTS Overall, 466 (17.5%) patients with an interatrial shunt had smaller E velocity (0.66 ± 0.21 vs. 0.69 ± 0.22 m/s, P = 0.037) and smaller E/e' (9.1 ± 4.0 vs. 10.0 ± 5.0, P = 0.001) than 2194 (82.5%) patients without an interatrial shunt. The 10-year incidence of AF, HF, and AF or HF composite was lower in patients with an interatrial shunt (10-year AF, 11.2 vs. 17.8%, P < 0.001; 10-year HF, 6.2 vs. 10.4%, P = 0.005; 10-year AF or HF composite, 16.5 vs. 23.4%, P = 0.001). In multivariable analysis, the presence of an interatrial shunt was associated with a 38% (HR 0.62, 95% CI 0.40-0.96), 40% (HR 0.60; 95% CI 0.39-0.93), and 26% (HR 0.74; 95% CI 0.57-0.96) reduced risk for new-onset HF, AF, and new-onset HF or AF composite, respectively. CONCLUSION In patients with interatrial shunt, the risk of AF and HF was lower. Interatrial shunt may be beneficial, and the closure of an interatrial shunt should be performed only in carefully selected patients. An interatrial shunt can unload the left atrium. In patients with stroke or TIA, the presence of an interatrial shunt was associated with a reduced risk for new-onset HF and AF. AF atrial fibrillation, HF heart failure, HR hazard ratio, LA left atrium.
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Affiliation(s)
- Jin Joo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-do, Republic of Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-do, Republic of Korea.
| | - Wonsuk Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-do, Republic of Korea
| | - In-Chang Hwang
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-do, Republic of Korea
| | - Jun Yup Kim
- Department of Neurology, Cerebrovascular Disease Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Yeonyee Yoon
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-do, Republic of Korea
| | - Chang-Hwan Yoon
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-do, Republic of Korea
| | - Beom-Joon Kim
- Department of Neurology, Cerebrovascular Disease Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Moon-Ku Han
- Department of Neurology, Cerebrovascular Disease Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Disease Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173, Bundang-Gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea.
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49
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Hwang IC, Cho GY, Choi HM, Yoon YE, Park JJ, Park JB, Park JH, Lee SP, Kim HK, Kim YJ. H2FPEF Score Reflects the Left Atrial Strain and Predicts Prognosis in Patients With Heart Failure With Preserved Ejection Fraction. J Card Fail 2020; 27:198-207. [PMID: 33035685 DOI: 10.1016/j.cardfail.2020.09.474] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/06/2020] [Accepted: 09/29/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The H2FPEF score is a validated algorithm for the diagnosis of heart failure with preserved ejection fraction (HFpEF). We investigated the associations of the H2FPEF score with echocardiographic parameters and prognosis in patients with HFpEF admitted for acute heart failure. METHODS AND RESULTS In total, 4312 patients at 3 tertiary centers were identified. Among 1335 patients with HFpEF, the H2FPEF score was available in 1105 patients (39% male) with a median age of 77 years (interquartile range 69-82). The median H2FPEF score was 4 (interquartile range 3-6). Patients with higher H2FPEF scores had worse left atrial (LA) size, peak atrial longitudinal strain of the left atrium, mitral E/e' ratio, and peak tricuspid regurgitation velocity. Peak atrial longitudinal strain of the left atrium demonstrated a significant association with the H2FPEF score, in patients without atrial fibrillation and those without atrial fibrillation. After adjustment for clinical factors and echocardiographic parameters, patients with higher H2FPEF scores had a higher risk of mortality and hospitalization for heart failure, regardless of the presence of atrial fibrillation. CONCLUSIONS The H2FPEF score reflects left atrial function in patients with HFpEF admitted for acute heart failure. This association supports the clinical usefulness of the H2FPEF score as an indicator of diastolic dysfunction, a diagnostic algorithm for HFpEF, and a prognostic factor in patients with HFpEF.
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Affiliation(s)
- In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Hong-Mi Choi
- Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi, South Korea
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Joo Park
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jae-Hyeong Park
- Department of Cardiology, Internal Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
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50
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Marwick TH, Chandrashekhar Y. Left Atrial Strain. JACC Cardiovasc Imaging 2020; 13:2278-2279. [DOI: 10.1016/j.jcmg.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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