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Chen YF, Liu NN, Wang JY, Sun JS, Wang YX, Jiang HY, Zhou WW, Wang ZL, Liang M. Use of 3D Echocardiography Facilitates Analysis of Thrombolytic Efficacy in Patients With Persistent Atrial Fibrillation. J Cardiovasc Pharmacol 2024; 84:118-123. [PMID: 38547516 DOI: 10.1097/fjc.0000000000001567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/12/2024] [Indexed: 07/07/2024]
Abstract
ABSTRACT This study seeks to identify the anticoagulant efficacy of rivaroxaban treatment on thrombi detected using echocardiography of the left atrial appendage in 275 patients with persistent atrial fibrillation. During follow-up after 9-24 weeks of rivaroxaban treatment, patients were divided into "effective group" (n = 143) and "ineffective group" (n = 132) according to the thrombolytic effect of the drug. Left atrial diameter (LAD), left atrial ejection fraction (LAEF), left ventricular ejection fraction (LVEF), mean diameter of left atrial appendage (LAAD mean ), angle between left atrial appendage and left atrium (LAA-A), velocity of blood flow in left atrial appendage (LAA-v), and thrombus size were compared before and after drug administration. Following treatment, LAEF, LVEF, and LAA-v values were greater and LAD and LAAD mean values were lower in the effective ( P < 0.05). Logistic regression analysis showed significant correlations of LAD, LAEF, LVEF, LAA-A, and LAA-v with anticoagulant efficacy ( P < 0.05). The efficacy of rivaroxaban in treatment of left atrial auricular thrombosis in patients with persistent AF was correlated with LAD, LAEF, LVEF, LAA-A, and LAA-v. Multivariate logistic regression analysis further revealed LAEF [odds ratio (OR) 1.7, 95% confidence interval (CI), 0.45-16.9, P = 0.008], 3D-EF (OR 6.4, 95% CI, 1.06-16.9, P = 0.039) and left ventricular global longitudinal strain (OR 18.0, 95% CI, 1.38-35.68, P = 0.028) as factors related to left atrial appendage thrombus. Echocardiography with global longitudinal strain assessment could be effectively utilized to evaluate the functional parameters of LAA and thus aid in predicting the safety of rivaroxaban as an anticoagulation agent.
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Affiliation(s)
- Yin Feng Chen
- Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China ; and
| | - Nan Nan Liu
- Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China ; and
| | - Jing Yun Wang
- Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China ; and
| | - Jing Shu Sun
- Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China ; and
| | - Yi Xiao Wang
- Ultrasound Department, Anshan City Central Hospital, Anshan, Liaoning Province, China
| | - Hai Ying Jiang
- Ultrasound Department, Anshan City Central Hospital, Anshan, Liaoning Province, China
| | - Wei Wei Zhou
- Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China ; and
| | - Zu Lu Wang
- Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China ; and
| | - Ming Liang
- Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China ; and
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Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography 2023; 40:1048-1057. [PMID: 37548034 DOI: 10.1111/echo.15670] [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: 04/05/2023] [Revised: 07/15/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVES Although radiofrequency catheter ablation (RFCA) has become an important treatment strategy for paroxysmal or persistent atrial fibrillation (AF), AF recurrence after RFCA remains an important issue that plagues clinicians and patients. This study aimed to investigate the association of left atrial (LA) and left atrial appendage (LAA) mechanics with AF recurrence after RFCA and to compare their prognostic values in patients with AF undergoing RFCA. METHODS A total of 160 patients with non-valvular AF who underwent RFCA for the first time were included in this study. All patients underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) before the procedure. All patients were followed up for one year after RFCA, and AF recurrence was recorded. Speckle-tracking echocardiography was used to measure LA and LAA global longitudinal strain (GLS). LA and LAA mechanical dispersion (MD) were defined as the standard deviation of time to peak strain at each segment standardized by the R-R interval. Logistic regression analysis was used to analyze independent contributors for AF recurrence after RFCA. The prediction efficiency of factors associated with the presence of AF recurrence was evaluated by the receiver operating characteristic (ROC) curve with area under curve (AUC). RESULTS During 1-year follow-up, 45 (28%) patients had recurrence, and 115 (72%) patients had no recurrence. The age, CHA2 DS2 -VASc score, NT-proBNP, LA volume index (LAVI), LA MD, and LAA MD of patients in recurrence group were significantly higher than those in no recurrent group (p < .05). The LAA emptying fraction (LAAEF), LA GLS, and LAA GLS in recurrence group were significantly lower than those in no recurrent group (p < .05). Logistic regression analysis showed that LA and LAA GLS were independent contributors for AF recurrence (p < .05), providing incremental values. The AUCs of LA and LAA GLS in predicting AF recurrence were higher than that of other factors, and the LA GLS+LAA GLS joint model had higher prediction efficiency. CONCLUSION This study demonstrated the LA and LAA GLS were independent contributors for AF recurrence after RFCA and provided incremental values. LA and LAA GLS can be used as the predictor of AF recurrence after RFCA, and they may be beneficial for the risk stratification of AF recurrence.
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Affiliation(s)
- You Yang
- Department of Ultrasonic Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Biaohu Liu
- Department of Ultrasonic Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Wenyan Ji
- Department of Ultrasonic Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Jing Ding
- Department of Ultrasonic Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Shanqiang Tao
- Department of Ultrasonic Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Feifei Lian
- Department of Ultrasonic Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
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Wang H, Ruan L, Shang J, Song Y, Tong M, Wu T. Left atrial subclinical dysfunction in children with Kawasaki disease: a two-dimensional speckle-tracking echocardiography study. Minerva Pediatr (Torino) 2023; 75:567-575. [PMID: 31144493 DOI: 10.23736/s2724-5276.19.05459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Left atrial (LA) function is a very important prognostic indicator for many cardiovascular diseases. In this study, we aimed to determine whether LA function is impaired in children with Kawasaki disease (KD) and to analyze the relationships between LA deformation and conventional echocardiographic parameters and laboratory markers. METHODS A total of 50 KD patients during different disease phases and 50 age- and sex-matched controls were retrospectively analyzed. Patients in the acute phase based on coronary artery dilation (CAD) were subdivided into Group I (with CAD) and Group II (without CAD) and compared. RESULTS During the acute phase, KD patients had a lower peak LA longitudinal strain (PLALS), a lower LA strain peak during LA contraction (LASct), and a lower LA strain rate peak during LA contraction (LASRct) than the controls. The PLALS, LASct and LASRct began to increase during the subacute phase, and during the convalescent phase, all LA strains in patients had recovered to normal compared with the control subjects. Subgroup analysis revealed that, compared with Group II, Group I had higher C-reactive protein (CRP) and serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels; however, there were no significant differences in LA strains. Only the PLALS during the acute phase was negatively correlated with left ventricular mass index, CRP and NT-proBNP. CONCLUSIONS In patients with KD, LA function is impaired during the acute phase, and this impairment is transient. Two-dimensional speckled tracking echocardiography is a useful tool for detecting subclinical LA dysfunction.
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Affiliation(s)
- Haiyong Wang
- Department of Ultrasound Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Litao Ruan
- Department of Ultrasound Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China -
| | - Jing Shang
- Department of Ultrasound Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yan Song
- Department of Ultrasound Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Minghui Tong
- Third Department of Ultrasound Medicine, Second Affiliated Hospital, Lanzhou University, Lanzhou, China
| | - Tingting Wu
- Third Department of Ultrasound Medicine, Second Affiliated Hospital, Lanzhou University, Lanzhou, China
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Bao L, Cheng L, Gao X, Yan F, Fan H, Shan Y, Li Y, Shi H, Huang G, Bao L. Left atrial morpho-functional remodeling in atrial fibrillation assessed by three dimensional speckle tracking echocardiography and its value in atrial fibrillation screening. Cardiovasc Ultrasound 2022; 20:13. [PMID: 35501859 PMCID: PMC9061228 DOI: 10.1186/s12947-022-00282-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/06/2022] [Indexed: 12/16/2022] Open
Abstract
Background Three dimensional speckle tracking echocardiography (3D STE) is a novel technique combining 3D echocardiography and speckle tracking analysis. 3D STE software dedicated to the left atrium (LA) was recently available. Our study aimed to assess (1) atrial fibrillation (AF) related LA morpho-functional remodeling using 3D STE and (2) value of LA function parameters in identifying paroxysmal AF (PAF). Methods One hundred thirty-nine PAF, 109 persistent AF (Per-AF) and 59 non-AF subjects underwent 3D STE. LA phasic volumes and total LA emptying fraction (LAEF) were obtained and used to calculate passive (pLAEF) and active LA emptying fraction (aLAEF) based on atrial contraction. LA longitudinal and circumferential strain representing reservoir (LASr/LASrc), conduit (LAScd/LAScdc) and pump (LASct/LASctc) function were also assessed. Results 3D STE was found to have good reproducibility. Increase of LA volumes and decrease of parameters representing LA reservoir and pump function were independently associated with AF as well as AF burden. The correlations between LA emptying fraction and LA circumferential strain representing the same function were always stronger than those with LA longitudinal strain (p < 0.001). Minimal LA volume, LAEF, aLAEF, LASrc and LASctc can be used to accurately differentiate PAF from non-AF subjects (AUC > 0.8) with great sensitivity and specificity. Conclusions Assessing LA remodeling in AF using 3D STE was feasible. AF and AF burden were independently associated with LA enlargement and impairment of reservoir and pump function but not conduit function. LA function parameters can indicate underlying PAF and thus can guide AF screening strategy.
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Affiliation(s)
- Lilian Bao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lei Cheng
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiufang Gao
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Fangying Yan
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Huihua Fan
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Shan
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yong Li
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Haiming Shi
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Guoqian Huang
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Liwen Bao
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China.
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Yang CH, Liu HT, Lee HL, Lin FC, Chou CC. Left atrial booster-pump function as a predictive parameter for atrial fibrillation in patients with severely dilated left atrium. Quant Imaging Med Surg 2022; 12:2523-2534. [PMID: 35371928 PMCID: PMC8923837 DOI: 10.21037/qims-21-954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/12/2022] [Indexed: 03/22/2024]
Abstract
BACKGROUND Left atrial (LA) dimension ≥50 mm had approximately four times the risk of developing atrial fibrillation (AF). The aim of this study was to investigate whether the application of clinical and echocardiographic parameters could differentiate between the patients having severely dilated left atrium with and without AF. METHODS This retrospective cross-sectional study enrolled consecutive patients with LA dimension ≥50 mm and divided them into three groups: no AF (no-AF), paroxysmal AF (PAF) and non-paroxysmal AF (non-PAF) groups. For PAF and non-PAF groups, all patients underwent radiofrequency ablation, and the echocardiographic parameters were obtained on the next day after ablation. RESULTS Our study population comprised 160 patients, including 80, 53, and 27 patients in the non-AF, PAF and non-PAF groups, respectively. The no-AF group had a significantly higher body mass index (kg/m2) (29.31±6.27, 27.58±4.12 and 26.57±2.81, P=0.01), and a higher prevalence of diabetes mellitus (DM) [31 (38.80%), 13 (25.00%) and 4 (14.80%), P=0.01] and hypertension [67 (83.80%), 34 (65.40%), and 19 (70.40%), P=0.04], but a lower prevalence of rheumatic heart disease (RHD) [3 (3.80%), 6 (11.50%) and 5 (18.50%), P=0.02] and sick sinus syndrome [0 (0.00%), 6 (11.50%) and 4 (14.80%), P=0.045]. Echocardiographic studies showed that the non-AF group had significantly smaller LA minimal volume index (24.89±9.74, 34.06±19.38 and 42.83±17.44 mL/m2, P<0.01), higher LA emptying fraction (51.99%±13.97%, 38.40%±15.96% and 33.89%±10.73%, P<0.01), longitudinal strain (23.87%±7.72%, 17.11%±8.52% and 12.38%±4.28%, P<0.01) and strain rate than the AF groups. The multivariate analysis showed that the late diastolic component of LA strain rate was the only independent factor associated with the presence of AF (odds ratio, 21.69; 95% CI, 9.77-48.13, P<0.01). CONCLUSIONS LA function plays an important role in the absence of AF in patients with LA dimension ≥50 mm; the late diastolic component of LA strain rate was the only independent variable on multivariate analysis.
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Affiliation(s)
- Chia-Hung Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan
- Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei
| | - Hao-Tien Liu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan
| | - Hui-Ling Lee
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei Branch, Taipei
| | - Fen-Chiung Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan
| | - Chung-Chuan Chou
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan
- Chang Gung University College of Medicine, Taoyuan
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Chen N, Liu A, Sun S, Wei H, Sun Q, Shang Z, Sun Y, Fu T, Wang H, Xia Y, Hua L, His DH, Cong T. Evaluation of left atrial function and mechanical dispersion in breast cancer patients after chemotherapy. Clin Cardiol 2022; 45:540-548. [PMID: 35294063 PMCID: PMC9045082 DOI: 10.1002/clc.23813] [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: 09/17/2021] [Revised: 01/27/2022] [Accepted: 03/03/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Left atrial (LA) function and mechanical dispersion changes in breast cancer patients treated with chemotherapy remain unclear. HYPOTHESIS LA function and LA mechanical dispersion in breast cancer patients would be impaired after chemotherapy. METHODS This single-center retrospective study included 91 consecutive breast cancer patients treated with chemotherapy and 30 controls. Patients were examined by echocardiography three times at intervals. Conventional parameters, left ventricular strain, LA strain, and LA mechanical dispersion were evaluated and compared. RESULTS LA strain during reservoir phase (LASr), conduit phase (LAScd), and contraction phase (LASct) all decreased markedly after chemotherapy and were lower than those of the controls (all p < .01). The standard deviation of time to peak positive strain during LA reservoir phase corrected by R-R interval (LA SD-TPSr) was significantly increased after chemotherapy and was higher than that of the controls (p < .001). The change of LA function was expressed as Δ. Multivariate linear regression analyses showed that LAVIp (0.399, 95% confidence interval [CI]: 0.610, 1.756, p = .000) was independently associated with ΔLASr, LAPEF (-0.325, 95% CI: -45.123, -10.676, p = .002) and age (0.227, 95% CI: 0.021, 0.350, p = .027) were independently associated with ΔLAScd, and LAVImax (0.341, 95% CI: 0.192, 0.723, p = .001) was independently associated with ΔLASct. LAVImax (0.505, 95% CI: 0.000, 0.001, p = .039) and mitral E (-0.256, 95% CI: 0.000, 0.000, p = .024)were independently associated with ΔLA SD-TPSr. CONCLUSIONS Mechanical function of LA declined after chemotherapy in breast cancer patients. With the decrease of LA mechanical function, LA mechanical dispersion assessed by two-dimensional speckle-tracking echocardiography increased significantly, and its clinical value needs to be further studied.
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Affiliation(s)
- Na Chen
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Ansheng Liu
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Siyao Sun
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Hong Wei
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Qiaobing Sun
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Zhijuan Shang
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Yinghui Sun
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Tingting Fu
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Hongjiang Wang
- Department of Breast Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Yunlong Xia
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Lanqi Hua
- Department of Cardiovascular Ultrasound, Massachusetts General Hospital Cardiac Ultrasound Lab, Boston, Massachusetts, USA
| | - David H His
- Department of Cardiology, Stamford Hospital, Stamford, Connecticut, USA
| | - Tao Cong
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
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Inoue K, Kawakami H, Akazawa Y, Higashi H, Higaki T, Yamaguchi O. Echocardiographic Assessment of Atrial Function: From Basic Mechanics to Specific Cardiac Diseases. J Cardiovasc Dev Dis 2022; 9:jcdd9030068. [PMID: 35323616 PMCID: PMC8955277 DOI: 10.3390/jcdd9030068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 02/06/2023] Open
Abstract
The left and right atria serve as buffer chambers to control the flow of venous blood for ventricular filling. If an atrium is absent, blood does not flow effectively into the ventricle, leading to venous blood retention and low cardiac output. The importance of atrial function has become increasingly recognized, because left atrial (LA) function contributes to cardiac performance, and loss of LA function is associated with heart failure. LA volume change has been used for LA function assessment in experimental and clinical studies. In conjunction with LA pressure, the LA pressure–volume relationship provides a better understanding of LA mechanics. LA strain measurement by speckle tracking echocardiography was introduced to evaluate three components of LA function as a (booster) pump, reservoir and conduit. Furthermore, increasing evidence supports the theory that LA reservoir strain has prognostic utility in various cardiac diseases. In this review, we summarize LA contribution to maintain cardiac performance by evaluating LA function with echocardiography according to our experiences and previous reports. Furthermore, we discuss LA dysfunction in challenging cardiac diseases of cardiac amyloidosis and adult congenital heart disease.
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Affiliation(s)
- Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
- Correspondence: ; Tel.: +81-89-960-5303
| | - Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
| | - Yusuke Akazawa
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
| | - Takashi Higaki
- Department of Regional Pediatrics and Perinatology, Ehime University Graduate School of Medicine, Toon 791-029, Ehime, Japan;
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan; (H.K.); (Y.A.); (H.H.); (O.Y.)
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The prognostic value of left atrial dyssynchrony measured by speckle tracking echocardiography in the general population. Int J Cardiovasc Imaging 2021; 37:1679-1688. [PMID: 33506346 DOI: 10.1007/s10554-020-02154-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
LA dyssynchrony is a predictor of cardiovascular morbidity in various patient populations. However, the prognostic value of LA dyssynchrony as evaluated by two-dimensional speckle tracking (2D-STE) in the general population is unknown. A cohort of 375 participants without atrial fibrillation (AF), ischemic heart disease (IHD), heart failure (HF) or previous ischemic stroke (IS) had an echocardiogram, including LA 2D-STE, performed. LA dyssynchrony was defined as the standard deviation of the time to peak regional LA reservoir strain values. The endpoints were all-cause mortality, a combined endpoint of AF and IS, and a combined endpoint of major adverse cardiovascular events (MACE) comprised of acute myocardial infarction (AMI), HF or cardiovascular death (CVD). During a median follow up of 16.1 years (IQR 15.0-16.3 years), 83 (22%) participants died, 60 (15%) reached the composite endpoint of AF and IS, and 38 (10%) reached the composite MACE endpoint. LA dyssynchrony was a univariable predictor of all-cause mortality (HR 1.07, 95% CI 1.02-1.11, p = 0.001) but was not significantly associated with the combined endpoint of AF and IS (HR 1.05, p = 0.064) nor MACE (HR 1.04, p = 0.22). However, when adjusted for age, LA dyssynchrony did not predict all-cause mortality (HR 1.03, p = 0.28). Similarly, after further adjustments for clinical and echocardiographic parameters LA dyssynchrony did not predict any of the study outcomes. In this general population study, LA dyssynchrony was not an independent predictor of all-cause mortality and did not predict MACE nor a composite outcome consisting of AF and IS.
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Mujović NM, Marinković MM, Nedeljković I, Marković N, Banović M, Vučićević V, Stanković G, Potpara TS. Improvement of Maximal Exercise Performance After Catheter-Ablation of Atrial Fibrillation and Its Prognostic Significance for Long-Term Rhythm Outcome. J Am Heart Assoc 2021; 10:e017445. [PMID: 33506694 PMCID: PMC7955411 DOI: 10.1161/jaha.120.017445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Rhythm control may improve functional capacity in patients with atrial fibrillation (AF). Long‐term exercise tolerance improvement and its prognostic implications following catheter‐ablation (CA) of paroxysmal and nonparoxysmal AF are underreported. Methods and Results Consecutive patients underwent cardiopulmonary exercise testing just before and 12 months after their index CA of AF. Follow‐up 24‐hour Holter recordings were obtained at 6‐month intervals post‐CA, and any atrial arrhythmia >30 seconds detected after 3 months postprocedure was considered AF recurrence. Of 110 patients (mean age 57.5±10.6 years, 77.2% males) with paroxysmal AF (n=66) or nonparoxysmal AF (n=44), the 12‐month exercise tolerance improved significantly in those who maintained sinus rhythm during the first 12 months post‐CA (n=96), but not in patients with AF recurrence (n=14). After CA, the 12‐month respiratory exchange ratio at maximal workload significantly increased in patients with paroxysmal AF, whereas those with nonparoxysmal AF significantly reduced their heart rate during the 12‐month cardiopulmonary exercise testing (all P≤0.001). During the follow‐up of 42.8±7.8 months, a total of 29 patients (26.3%) experienced recurrent AF. On multivariate analysis including patients without recurrent AF at 12 months after CA, the extent of work time improvement at follow‐up cardiopulmonary exercise testing was independently associated with the rhythm outcome beyond 12 months postprocedure (hazard ratio of 0.936 [95% CI, 0.894–0.979] for each 10 seconds increase in the work time following ablation, P=0.004). Conclusions CA of AF was associated with recovery of exercise intolerance in patients with paroxysmal AF or nonparoxysmal AF. Inability to improve exercise capacity at 12 months post‐CA was an independent risk factor for later AF recurrence.
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Affiliation(s)
- Nebojša M Mujović
- Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | | | - Ivana Nedeljković
- Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Nebojša Marković
- Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Department of Medicine Rutgers New Jersey Medical School Newark NJ
| | - Marko Banović
- Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Vera Vučićević
- Center for Anesthesiology Clinical Center of Serbia Belgrade Serbia
| | - Goran Stanković
- Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
| | - Tatjana S Potpara
- Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Faculty of Medicine University of Belgrade Serbia
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Mao Y, Yu C, Yang Y, Ma M, Wang Y, Jiang R, Chen R, Zhao B, Jiang C. Comparison of left atrial and left atrial appendage mechanics in the risk stratification of stroke in patients with atrial fibrillation. Cardiovasc Ultrasound 2021; 19:7. [PMID: 33422087 PMCID: PMC7797160 DOI: 10.1186/s12947-020-00232-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/10/2020] [Indexed: 02/07/2023] Open
Abstract
Background Left atrial (LA) and left atrial appendage (LAA) dysfunction has been demonstrated to contribute to atrial fibrillation (AF)-related stroke. However, usefulness of LA and LAA mechanics has not been fully compared. We sought to investigate the association of LA and LAA mechanics with stroke and to compare their diagnostic values in the risk stratification of stroke in patients with nonvalvular AF. Methods A total of 208 consecutive patients with AF (63.58 ± 10.37 years, 63.9% male,57.7% persistent AF) who underwent echocardiography before catheter ablation were prospectively enrolled. Speckle-tracking was used to measure LA and LAA global longitudinal strain (GLS). LA and LAA mechanical dispersions (MD) were defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval. Results Patients with prior stroke/ transient ischemic attack (TIA) (n = 31) had significantly higher LA and LAA MD than those without (n = 177) (11.56 ± 4.38% vs. 8.43 ± 3.44%, 15.15 ± 5.46% vs. 10.94 ± 4.40%, both P < 0.01). In multivariable analysis, LA and LAA MD were independently associated with stroke/TIA (odds ratio, 1.18–1.29, 1.19–1.22, respectively, both P < 0.01), providing incremental values over clinical and standard echocardiographic parameters. In a subgroup analysis, LA MD was more useful than LAA MD in patients with normal LA volumes, while LAA MD was superior to LA MD in patients with LA enlargement. Conclusions Higher LA and LAA mechanical dispersion are independently associated with stroke/TIA in AF patients and had incremental values over clinical and conventional echocardiographic parameters. What’s more, priorities of dispersion assessment are different depending on patients’ LA size. Supplementary Information The online version contains supplementary material available at 10.1186/s12947-020-00232-z.
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Affiliation(s)
- Yankai Mao
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, #3 East Qingchun Road, Hangzhou, China
| | - Chan Yu
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, #3 East Qingchun Road, Hangzhou, China
| | - Yuan Yang
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, #3 East Qingchun Road, Hangzhou, China
| | - Mingming Ma
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, #3 East Qingchun Road, Hangzhou, China
| | - Yunhe Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, People's Republic of China
| | - Ruhong Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, People's Republic of China
| | - Ran Chen
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, #3 East Qingchun Road, Hangzhou, China
| | - Bowen Zhao
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, #3 East Qingchun Road, Hangzhou, China.
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, People's Republic of China.
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11
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Lohrmann G, Patel MA, Brauneis D, Sanchorawala V, Sarosiek S, Vellanki N, Siddiqi OK, Ruberg FL, Gopal DM. Left Atrial Mechanics Associates With Paroxysmal Atrial Fibrillation in Light-Chain Amyloidosis Following Stem Cell Transplantation. JACC: CARDIOONCOLOGY 2020; 2:721-731. [PMID: 33511355 PMCID: PMC7839967 DOI: 10.1016/j.jaccao.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Atrial fibrillation (AF) during high-dose melphalan and autologous stem-cell transplantation (HDM/SCT) for light-chain (AL) amyloidosis confers significant morbidity. Traditional risk factors provide limited prediction for development of paroxysmal AF during this vulnerable period. Objectives We sought to assess the association of clinical and echocardiographic parameters, including left atrial (LA) mechanics and development of AF in patients undergoing HDM/SCT therapy. Methods Baseline echocardiograms, electrocardiograms, and electronic medical records were retrospectively assessed among patients with AL amyloidosis before HDM/SCT (n = 91). LA function analysis was performed using speckle-tracking echocardiography. Results In this study, 42 patients (46%) had cardiac involvement; in the peri-transplant period, 12 (13%) developed AF (7 with cardiac involvement). No significant differences in age, sex, cardiac biomarkers, or cardiac risk factors were seen between patients with and without development of AF; one-third of patients with AF peri-transplant had previous AF. Although LA reservoir strain was reduced in patients with development of AF, time to peak strain rate indexed to R-R interval (TPSRI) (p = 0.001) was prolonged in patients with development of AF compared with sinus rhythm patients in the total cohort but also in subgroups with and without cardiac involvement. Conclusions TPSRI, a parameter of mechanical dispersion in the early reservoir phase of LA function, is associated with development of AF among patients undergoing HDM/SCT for AL amyloidosis. These findings require validation in larger prospective cohorts.
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Affiliation(s)
- Graham Lohrmann
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Monica Arun Patel
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Dina Brauneis
- Amyloidosis Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Vaishali Sanchorawala
- Amyloidosis Center, Boston University School of Medicine, Boston, Massachusetts, USA.,Section of Hematology and Oncology, Department of Medicine, Boston, Massachusetts, USA
| | - Shayna Sarosiek
- Amyloidosis Center, Boston University School of Medicine, Boston, Massachusetts, USA.,Section of Hematology and Oncology, Department of Medicine, Boston, Massachusetts, USA
| | - Nirupama Vellanki
- Boston University School of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Omar K Siddiqi
- Amyloidosis Center, Boston University School of Medicine, Boston, Massachusetts, USA.,Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Frederick L Ruberg
- Amyloidosis Center, Boston University School of Medicine, Boston, Massachusetts, USA.,Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Deepa M Gopal
- Amyloidosis Center, Boston University School of Medicine, Boston, Massachusetts, USA.,Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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12
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Hosseini K, Vasheghani-Farahani A, Hosseinsabet A. Decreased longitudinal systolic strain rate of the left atrial myocardium as one of the earliest markers of atrial cardiomyopathy in subjects with brief paroxysmal atrial fibrillation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:476-485. [PMID: 32478900 DOI: 10.1002/jcu.22874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Brief paroxysmal atrial fibrillation (BPAF) is defined as episodes of atrial fibrillation (AF) lasting less than 30 seconds and can be a sign of atrial cardiomyopathy. We aimed to evaluate left atrial (LA) function in patients with BPAF. METHODS This cross-sectional prospective study consecutively recruited 42 patients with BPAF on 24 to 48 hour electrocardiography Holter monitoring. We selected 50 volunteers as the control group after 24 hours electrocardiography Holter monitoring. Two-dimensional speckle-tracking echocardiography was performed to evaluate the longitudinal deformation variables of LA function. RESULTS Strain rate during LA reservoir phase was lower (P = .018) in patients with BPAF (2.0 ± 0.4 second-1 ) than in controls (2.2 ± 0.5 second-1 ). This difference remained significant after adjustments for left ventricular ejection fraction, LA maximal volume, and diabetes (β = 0.222, P = .036). Strain during LA reservoir, conduit, and contraction phases and strain rate during the conduit and contraction phases were not significantly different between the two groups. CONCLUSIONS The reservoir function of the LA evaluated by two-dimensional speckle-tracking echocardiography was lower in subjects than that without BPAF.
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Affiliation(s)
- Kaveh Hosseini
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R., Iran
| | - Ali Vasheghani-Farahani
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R., Iran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R., Iran
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13
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Nielsen AB, Skaarup KG, Lassen MCH, Djernæs K, Hansen ML, Svendsen JH, Johannessen A, Hansen J, Sørensen SK, Gislason G, Biering-Sørensen T. Usefulness of left atrial speckle tracking echocardiography in predicting recurrence of atrial fibrillation after radiofrequency ablation: a systematic review and meta-analysis. Int J Cardiovasc Imaging 2020; 36:1293-1309. [PMID: 32248332 DOI: 10.1007/s10554-020-01828-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/26/2020] [Indexed: 12/12/2022]
Abstract
The usefulness of peak atrial longitudinal strain (PALS) in identifying patients at high risk of atrial fibrillation (AF) recurrence after radiofrequency ablation (RFA) has been investigated in several small AF populations. The aim of this systematic review and meta-analysis was to investigate whether PALS predicts recurrence of AF after RFA treatment. MEDLINE, EMBASE and the Cochrane Library were searched. Studies investigating the value of PALS in predicting successful RFA in AF patients were selected. Patients underwent echocardiography prior to RFA. Risk of bias was evaluated using the Quality in Prognosis Studies (QUIPS) Tool. Twelve studies and a total of 1025 patients suffering from paroxysmal or persistent AF were included. Odds ratios (OR) were assessed in a random and fixed effects model for univariable and multivariable pooled analyses respectively. PALS was found to be a significant predictor of AF recurrence after RFA across study populations (Univariable: OR: 1.17, CI95% [1.03-1.34], p = 0.018, per 1% decrease) (Multivariable: OR: 1.16, CI95% [1.09-1.24], p < 0.001, per 1% decrease). Patients with recurrence had significantly lower PALS prior to RFA than patients who maintained sinus rhythm (15.7 ± 5.7% vs. 23.0 ± 7.0%, p = 0.016). A pooled analysis of weighted mean differences (WMD) also showed a significant difference in PALS between the two groups (WMD: - 6.57, CI95% [- 8.49: - 4.65], p < 0.001). Lower values of PALS are associated with an increased risk of AF recurrence after RFA. PALS provides prognostic value in clinical practice.
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Affiliation(s)
- Anne Bjerg Nielsen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | | | | | - Kasper Djernæs
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Lock Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Arne Johannessen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jim Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Samuel Kiil Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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14
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Zhu M, Chen H, Liu Y, Shu X. Clinical implication of disturbed left atrial phasic functions in the heterogeneous population associated with hypertension or atrial fibrillation. Cardiovasc Ultrasound 2019; 17:25. [PMID: 31718668 PMCID: PMC6852725 DOI: 10.1186/s12947-019-0175-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 10/31/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To evaluate left atrial (LA) phasic functions in patients with hypertension and/or paroxysmal atrial fibrillation (PAF) and its clinical significance. METHODS LA strain was studied in 77 patients (25 hypertension, 24 lone AF, and 28 with both hypertension and PAF) and 28 controls using two-dimensional speckle-tracking echocardiography (2D STE). The following indexes during atrial reservoir, conduit and pump phase were analyzed respectively: (1) peak atrial longitudinal strain (PALS) and strain rate (PALSR), (2) the standard deviation of time to PALS and PALSR of all LA segments (TpS-SD% and TpSR-SD%). RESULTS Compared with controls, PALSres, PALScond and PALSRcond were significantly reduced in patients with isolated hypertension (all P < 0.01) but no significant differences were observed in PALSpump, PALSRpump and TpSpump-SD% between them (all P > 0.05). PALSpump, PALSRpump and PALSRres were significantly lower in patients with both hypertension and PAF than in those with isolated hypertension (all P < 0.05). PALS and PALSR were significantly decreased, and TpS-SD% was significantly increased during each phase in lone AF patients than in controls (all P < 0.05), and PALSRpump was further depressed in patients with both hypertension and PAF (P = 0.029). PALSRcond ≤ 1.475 s- 1 combined with TpSpump-SD% ≥ 3.25% (sensitivity, 85%; specificity, 71%; AUC = 0.845, P < 0.001) could distinguish lone AF from healthy subjects effectively, while in hypertensive patients, PALSpump ≤ 14.2% was found to be an independent differentiator for occurrence of AF or not with sensitivity of 81% and specificity of 84% (AUC = 0.838, P < 0.001). LAVI≥29.3 mL/m2 was an independent characteristic for reflecting different LA remodeling in lone AF or hypertension with AF. CONCLUSIONS The impairment of LA phasic functions was varied in patients with hypertension and/or AF. The disturbed LA phasic functions were proved to have independent abilities of differential diagnosis in this heterogeneous population associated with hypertension or AF.
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Affiliation(s)
- Mengruo Zhu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China. .,Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
| | - Haiyan Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Yang Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China. .,Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
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15
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Left Atrial Mechanical Dispersion Assessed by Strain Echocardiography as an Independent Predictor of New-Onset Atrial Fibrillation: A Case-Control Study. J Am Soc Echocardiogr 2019; 32:1268-1276.e3. [DOI: 10.1016/j.echo.2019.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 01/08/2023]
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16
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Akilli H, Aribas A, İcli A, Tatar S, Gurbuz AS. Predictive value of transmitral A‐wave acceleration time for paroxysmal atrial fibrillation. Echocardiography 2019; 36:1633-1638. [DOI: 10.1111/echo.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/03/2019] [Accepted: 08/15/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Hakan Akilli
- Department of Cardiology Necmettin Erbakan University Meram Faculty of Medicine Konya Turkey
| | - Alpay Aribas
- Department of Cardiology Necmettin Erbakan University Meram Faculty of Medicine Konya Turkey
| | - Abdullah İcli
- Department of Cardiology Necmettin Erbakan University Meram Faculty of Medicine Konya Turkey
| | - Sefa Tatar
- Department of Cardiology Necmettin Erbakan University Meram Faculty of Medicine Konya Turkey
| | - Ahmet Seyfeddin Gurbuz
- Department of Cardiology Necmettin Erbakan University Meram Faculty of Medicine Konya Turkey
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17
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Septal total atrial conduction time for prediction of atrial fibrillation in embolic stroke of unknown source: a pilot study. Clin Res Cardiol 2019; 109:205-214. [PMID: 31236691 PMCID: PMC6989646 DOI: 10.1007/s00392-019-01501-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/03/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Subclinical atrial fibrillation (AF) is the underlying cause in a relevant part of patients with embolic stroke of unknown source (ESUS). This pilot study aims to identify novel echocardiographic parameters predicting AF subsequently detected in patients originally hospitalized with ESUS. METHODS AND RESULTS Patients with acute ischemic stroke [baseline diagnosis of ESUS (n = 69), stroke of macro- or microvascular cause (n = 16/25), stroke caused by AF (n = 5)] and controls with paroxysmal AF without acute ischemic stroke (n = 22) as well as healthy controls of young and old age (n = 21/17) in sinus rhythm were included (overall n = 175). Echocardiography was performed in all participants. Prolonged Holter-ECG-monitoring was performed in all stroke patients. In the overall cohort, septal total atrial conduction time (sPA-TDI), left atrial (LA) volume index to tissue Doppler velocity (LAVI/a`) and second negative peak strain rate during LA contraction (SRa), representing echocardiographic parameters of LA remodelling and function, were statistically significant different in patients with and without AF and predictive for subclinical AF (multivariate regression analysis: sPA-TDI: HR 1.06 [1.04-1.08], p < 0.001; LAVI/a`: HR 0.85, [0.74-0.97], p = 0.02; SRa: HR 2.35 [0.9-5.5], p = 0.05). Multivariate Cox regression analysis revealed sPA-TDI as an independent predictor of AF in ESUS patients (sPA-TDI: HR 1.10 [1.04-1.17], p = 0.001). A sPA-TDI of 126 ms strictly discriminated between presence and absence of subclinical AF within 48 h after initiation of Holter-ECG-monitoring in ESUS patients. CONCLUSIONS sPA-TDI seems to be a strong independent predictor of subclinical AF in patients hospitalized for ESUS and might support risk-stratified clinical decision making in these patients. Septal Total Atrial Conduction Time (sPA-TDI) determined by echocardiography for prediction of Atrial Fibrillation in Embolic Stroke of Unknown Source (ESUS).
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18
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Utility of left atrial strain for predicting atrial fibrillation following ischemic stroke. Int J Cardiovasc Imaging 2019; 35:1605-1613. [PMID: 31028567 DOI: 10.1007/s10554-019-01601-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/08/2019] [Indexed: 10/26/2022]
Abstract
Twenty-five percent of ischemic strokes (IS) are cryptogenic, but it is estimated that paroxysmal atrial fibrillation (PAF) is the underlying cause in up to a third of cases. We aimed to investigate the predictive value of speckle tracking of the left atrium (LA) in diagnosing PAF in IS patients. We retrospectively studied 186 IS patients with a clinical echocardiographic examination during sinus rhythm. Outcome was PAF defined by at least one reported episode of AF following their IS. Conventional echocardiographic measures were performed. Global longitudinal strain (GLS), LA reservoir-(εs), conduit-(εe), contraction-strain (εa) and LA dyssynchrony (standard deviation of time-to-peak εs; LA SD-T2P) were obtained by left ventricular and LA speckle tracking. Of 186 patients, 28 (15%) were diagnosed with PAF. PAF-patients did not differ from non-PAF patients with regards to GLS nor SD-TPS, but atrial strain measures were significantly impaired at baseline (εs 27 vs. 35%, εe 12 vs. 16%, εa 15 vs. 18%, p < 0.02 for all, for PAF and non-PAF, respectively). However, only εs remained independently associated with PAF after adjustment for clinical and echocardiographic parameters (OR 1.13 [1.04; 1.22], p = 0.003, per 1% decrease). εs also provided the highest area under the receiver operating characteristic curve among all variables (AUC = 0.74). With a cutoff of 29%, εs had a specificity of 76% and a negative predictive value of 93%. Atrial reservoir strain is independently associated with PAF and may be used to improve the diagnosis of PAF following IS.
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19
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Low Left Atrial Strain Is Associated With Adverse Outcomes in Hypertrophic Cardiomyopathy Patients. J Am Soc Echocardiogr 2019; 32:593-603.e1. [PMID: 30904367 DOI: 10.1016/j.echo.2019.01.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Paroxysmal atrial fibrillation (PAF) and left atrial (LA) structural remodeling are common in hypertrophic cardiomyopathy (HCM) patients, who are also at risk for adverse cardiovascular outcomes. OBJECTIVE We assessed whether PAF and/or LA remodeling was associated with adverse outcomes in HCM. METHODS We retrospectively studied 45 HCM patients with PAF (PAF group) and 59 HCM patients without atrial fibrillation (AF; no-AF group). LA/left ventricular (LV) function and mechanics were assessed by echocardiography. Patients were followed for development of the composite endpoint comprising heart failure, stroke, and death. RESULTS Clinical/demographic characteristics, degree of LV hypertrophy, and E/e' were similar in the two groups The PAF group had significantly higher LA volume, but lower LA ejection fraction (LAEF), LA contractile, and reservoir strain/strain rate than the no-AF group. During follow-up, 27 patients developed the composite endpoint. Incidence of the composite endpoint was similar in the two groups. Absolute values of 23.8% for reservoir strain and 10.2% for conduit strain were the best cutoffs for the composite endpoint, using receiver operating characteristic analysis. Kaplan-Meier survival analysis showed lower event-free survival in patients with reservoir strain ≤23.8% or conduit strain ≤10.2%. Univariate Cox analysis revealed an association between female sex, LAEF, LA reservoir/conduit strain, and LV global longitudinal strain with the composite endpoint. The association between LA reservoir/conduit strain and the composite endpoint persisted after controlling for age, sex, LAEF, and LV global longitudinal strain. CONCLUSIONS In this pilot HCM patient study, PAF was associated with a greater degree of LA myopathy, and low LA reservoir and conduit strain were associated with higher risk for adverse cardiovascular outcomes.
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20
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Olsen FJ. Assessment of left atrial mechanical function and synchrony in paroxysmal atrial fibrillation with two-dimensional speckle tracking echocardiography-utility of left atrial speckle tracking without left ventricular speckle tracking? Echocardiography 2017; 34:1112. [DOI: 10.1111/echo.13603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Flemming J. Olsen
- Department of Cardiology; Herlev & Gentofte Hospital; University of Copenhagen; Hellerup Denmark
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21
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Saha SK, Kiotsekoglou A. Speckle tracking-derived mechanical dispersion of left atrial myocardial deformation: An essential parameter in atrial fibrillation management? Echocardiography 2017; 34:159-161. [PMID: 28240426 DOI: 10.1111/echo.13449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Samir Kanti Saha
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anatoli Kiotsekoglou
- Department of Clinical Physiology, University Hospital of Örebro, Örebro, Sweden
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