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Chuang HJ, Lin LC, Yu AL, Liu YB, Lin LY, Huang HC, Ho LT, Lai LP, Chen WJ, Ho YL, Chen SY, Yu CC. Predicting impaired cardiopulmonary exercise capacity in patients with atrial fibrillation using a simple echocardiographic marker. Heart Rhythm 2024; 21:1493-1499. [PMID: 38614190 DOI: 10.1016/j.hrthm.2024.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/23/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Exercise intolerance is a common symptom associated with atrial fibrillation (AF). However, echocardiographic markers that can predict impaired exercise capacity are lacking. OBJECTIVE This study aimed to investigate the association between echocardiographic parameters and exercise capacity assessed by cardiopulmonary exercise testing in patients with AF. METHODS This single-center prospective study enrolled patients with AF who underwent echocardiography and cardiopulmonary exercise testing to evaluate exercise capacity at a tertiary center for AF management from 2020 to 2022. Patients with valvular heart disease, reduced left ventricular ejection fraction, or documented cardiomyopathy were excluded. RESULTS Of the 188 patients, 134 (71.2%) exhibited impaired exercise capacity (peak oxygen consumption ≤85%), including 4 (2.1%) having poor exercise capacity (peak oxygen consumption <50%). Echocardiographic findings revealed that these patients had an enlarged left atrial end-systolic diameter (LA); smaller left ventricular end-diastolic diameter (LVEDD); and increased relative wall thickness, tricuspid regurgitation velocity, and LA/LVEDD and E/e' ratios. In addition, they exhibited lower peak systolic velocity of the mitral annulus and LA reservoir strain. In the multivariate regression model, LA/LVEDD remained the only significant echocardiographic parameter after adjustment for age, sex, and body mass index (P = .020). This significance persisted even after incorporation of heart rate reserve, N-terminal pro-B-type natriuretic peptide level, and beta-blocker use into the model. CONCLUSION In patients with AF, LA/LVEDD is strongly associated with exercise capacity. Further follow-up and validation are necessary to clarify its clinical implications in patient care.
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Affiliation(s)
- Hung-Jui Chuang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Lung-Chun Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - An-Li Yu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-chu Branch, Hsinchu, Taiwan
| | - Yen-Bin Liu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hui-Chun Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Ting Ho
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ling-Ping Lai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Yi-Lwung Ho
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ssu-Yuan Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; Division of Physical Medicine and Rehabilitation, Fu Jen Catholic University Hospital and Fu Jen Catholic University School of Medicine, New Taipei City, Taiwan
| | - Chih-Chieh Yu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Abdollahi A, Kato Y, Bakhshi H, Varadarajan V, Chehab O, Zeitoun R, Ostovaneh MR, Wu CO, Bertoni AG, Shah SJ, Ambale-Venkatesh B, Bluemke DA, Lima JAC, Panzer A. Differential Stroke Volume between Left and Right Ventricles as a Predictor of Clinical Outcomes: The MESA Study. Radiology 2024; 312:e232973. [PMID: 39041933 PMCID: PMC11294760 DOI: 10.1148/radiol.232973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/09/2023] [Accepted: 04/15/2023] [Indexed: 07/24/2024]
Abstract
Background Valvular heart disease and intracardiac shunts can disrupt the balance between left ventricular (LV) and right ventricular (RV) stroke volumes. However, the prognostic value of such imbalances has not been established among asymptomatic individuals. Purpose To assess the association between differential ventricular stroke volumes quantified using cardiac MRI and clinical outcomes in individuals without cardiovascular disease. Materials and Methods This secondary analysis of a prospective study included participants without cardiovascular disease at enrollment (July 2000 to July 2002) who underwent cardiac MRI. Differences in stroke volume were calculated as LV stroke volume minus RV stroke volume, and participants were categorized as having balanced (greater than or equal to -30 mL to ≤30 mL), negative (less than -30 mL), or positive (>30 mL) differential stroke volumes. Multivariable Cox proportional hazard regression models were used to test the association between differences in stroke volume and adverse outcomes. Results A cohort of 4058 participants (mean age, 61.4 years ± 10 [SD]; 2120 female) were included and followed up for a median of 18.4 years (IQR, 18.3-18.5 years). During follow-up, 1006 participants died, 235 participants developed heart failure, and 764 participants developed atrial fibrillation. Compared with participants who had a balanced differential stroke volume, those with an increased differential stroke volume showed a higher risk of mortality (hazard ratio [HR], 1.73 [95% CI: 1.12, 2.67]; P = .01), heart failure (HR, 2.40 [95% CI: 1.11, 5.20]; P = .03), and atrial fibrillation (HR, 1.89 [95% CI: 1.16, 3.08]; P = .01) in adjusted models. Participants in the negative group, with a decreased differential stroke volume, showed an increased risk of heart failure compared with those in the balanced group (HR, 2.09 [95% CI: 1.09, 3.99]; P = .03); however, this was no longer observed after adjusting for baseline LV function (P = .34). Conclusion Participants without cardiovascular disease at the time of study enrollment who had an LV stroke volume exceeding the RV stroke volume by greater than 30 mL had an increased risk of mortality, heart failure, and atrial fibrillation compared with those with balanced stroke volumes. ClinicalTrials.gov Identifier: NCT00005487 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Almeida in this issue.
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Affiliation(s)
- Ashkan Abdollahi
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Yoko Kato
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Hooman Bakhshi
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Vinithra Varadarajan
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Omar Chehab
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Ralph Zeitoun
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Mohammad R. Ostovaneh
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Colin O. Wu
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Alain G. Bertoni
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Sanjiv J. Shah
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Bharath Ambale-Venkatesh
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - David A. Bluemke
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - João A. C. Lima
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
| | - Ariane Panzer
- From the Division of Cardiology, Department of Medicine (A.A., Y.K.,
H.B., V.V., O.C., R.Z., M.R.O., J.A.C.L.), and Department of Radiology (B.A.V.),
Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-0409; Office of
Biostatistics Research, National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (C.O.W.); Department of Epidemiology and
Prevention, Wake Forest School of Medicine, Winston-Salem, NC (A.G.B.); Division
of Cardiology, Department of Medicine, Northwestern University Feinberg School
of Medicine, Chicago, Ill (S.J.S.); and Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.)
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Güder G, Reiter T, Drayss M, Bauer W, Lengenfelder B, Nordbeck P, Fette G, Frantz S, Morbach C, Störk S. Improved Interpretation of Pulmonary Artery Wedge Pressures through Left Atrial Volumetry-A Cardiac Magnetic Resonance Imaging Study. J Cardiovasc Dev Dis 2024; 11:178. [PMID: 38921678 PMCID: PMC11204227 DOI: 10.3390/jcdd11060178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/29/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The pulmonary artery wedge pressure (PAWP) is regarded as a reliable indicator of left ventricular end-diastolic pressure (LVEDP), but this association is weaker in patients with left-sided heart disease (LHD). We compared morphological differences in cardiac magnetic resonance imaging (CMR) in patients with heart failure (HF) and a reduced left ventricular ejection fraction (LVEF), with or without elevation of PAWP or LVEDP. METHODS We retrospectively identified 121 patients with LVEF < 50% who had undergone right heart catheterization (RHC) and CMR. LVEDP data were available for 75 patients. RESULTS The mean age of the study sample was 63 ± 14 years, the mean LVEF was 32 ± 10%, and 72% were men. About 53% of the patients had an elevated PAWP (>15 mmHg). In multivariable logistic regression analysis, NT-proBNP, left atrial ejection fraction (LAEF), and LV end-systolic volume index independently predicted an elevated PAWP. Of the 75 patients with available LVEDP data, 79% had an elevated LVEDP, and 70% had concomitant PAWP elevation. By contrast, all but one patient with elevated PAWP and half of the patients with normal PAWP had concomitant LVEDP elevation. The Bland-Altman plot revealed a systematic bias of +5.0 mmHg between LVEDP and PAWP. Notably, LAEF was the only CMR variable that differed significantly between patients with elevated LVEDP and a PAWP ≤ or >15 mmHg. CONCLUSIONS In patients with LVEF < 50%, a normal PAWP did not reliably exclude LHD, and an elevated LVEDP was more frequent than an elevated PAWP. LAEF was the most relevant determinant of an increased PAWP, suggesting that a preserved LAEF in LHD may protect against backward failure into the lungs and the subsequent increase in pulmonary pressure.
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Affiliation(s)
- Gülmisal Güder
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, 97078 Würzburg, Germany;
| | - Theresa Reiter
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
- Department of Cardiac Rhythm Disorders, German Heart Center Munich, 80636 Munich, Germany
| | - Maria Drayss
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
| | - Wolfgang Bauer
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
| | - Björn Lengenfelder
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
| | - Peter Nordbeck
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
| | - Georg Fette
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, 97078 Würzburg, Germany;
- Service Center Medical Informatics (SMI), University of Würzburg, 97080 Würzburg, Germany
| | - Stefan Frantz
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, 97078 Würzburg, Germany;
| | - Caroline Morbach
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, 97078 Würzburg, Germany;
| | - Stefan Störk
- Division of Cardiology, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany; (T.R.); (M.D.); (W.B.); (B.L.); (P.N.); (S.F.); (C.M.); (S.S.)
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, 97078 Würzburg, Germany;
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Wang L, Yi J, Zhou Z, Liu J, Li Y, Tian A, Ren X, Zheng X. Left ventricular hypertrophy phenotype to predict incident atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis. Nutr Metab Cardiovasc Dis 2024; 34:1399-1406. [PMID: 38402001 DOI: 10.1016/j.numecd.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/21/2023] [Accepted: 01/09/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND AND AIM Left ventricular hypertrophy (LVH) has been shown to be associated with the occurrence of atrial fibrillation (AF). However, the predictive value of the LVH phenotype for incident AF remains uncertain. This study aimed to investigate the predictive value of LVH phenotype for incident AF. METHODS AND RESULTS This study utilized the Multi-Ethnic Study of Atherosclerosis (MESA) data. LVH was defined by cardiac magnetic resonance measured LV mass index. Isolated LVH was determined as LVH without elevated cardiac biomarker and malignant LVH was determined as LVH with at least 1 elevated biomarker. Receiver-operating characteristic (ROC) analysis was performed to calculate areas under the curves (AUC) for predicting AF. A total of 4983 community-dwelling participants were included, with a mean age of 61.5 years. 279 (5.6 %) had isolated LVH, and 222 (4.5 %) had malignant LVH. During a median follow-up of 8.5 years, 272 incident AF was observed. Compared to participants without LVH and elevated cardiac biomarkers, those with isolated LVH (HR, 1.82; 95 % CI, 1.03-3.20) and malignant LVH (HR, 4.13; 95 % CI, 2.77-6.16) had a higher risk of incident AF. Malignant LVH carried a 1.5-fold increased risk of AF compared to isolated LVH (HR: 2.48, 95 % CI: 1.30-4.73). Including the LVH phenotype in the CHARGE-AF model improved model discrimination (AUC increase: 0.03, p < 0.001). CONCLUSIONS The risks of AF incidence varied across LVH phenotypes. Malignant LVH carried the highest risk among LVH phenotypes. LVH phenotype provides incremental predictive value over the variables included in the CHARGE-AF model.
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Affiliation(s)
- Lili Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiayi Yi
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Zeming Zhou
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiamin Liu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yan Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xiangpeng Ren
- Department of Biochemistry, Medical College, Jiaxing University, Jiaxing, China
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Shenzhen, Coronary Artery Diasease Center, Fuwai hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China.
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5
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Lee J. [Using CT to Evaluate Cardiac Function]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:308-326. [PMID: 38617866 PMCID: PMC11009136 DOI: 10.3348/jksr.2023.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/16/2024]
Abstract
A comprehensive evaluation of cardiac function includes information in relation to cardiac output and systemic venous return. The heart is composed of four chambers: two atria and two ventricles, each with its own unique mechanical function. These four cardiac chambers, their valves, and the pulmonary circulation system are inter-related as they preload or afterload on each other. Cardiac dysfunction is a failure of global cardiac function, resulting in typical clinical manifestations. To investigate the underlying cause of cardiac dysfunction, a step-by-step evaluation of cardiac blood flow tracks is necessary. In this context, imaging markers showing details of the cardiac structures have an important role in assessing cardiac function. An image-based evaluation allows for investigation of function in terms of individual cardiac components. Evaluation of cardiac function using cardiac CT has recently been validated. This review aimed to discuss cardiac CT-based imaging markers for comprehensive and detailed cardiac function assessment.
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Kerkhof PLM. On atrial cardiopathy associated biomarkers and embolic stroke of undetermined source (ESUS). Echocardiography 2024; 41:e15772. [PMID: 38400560 DOI: 10.1111/echo.15772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024] Open
Affiliation(s)
- Peter L M Kerkhof
- Department Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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7
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Tran TV, Djaileb L, Riou L, Lantuejoul LR, Giai J, Barone-Rochette G. Coronary microvascular dysfunction as assessed by multimodal diagnostic imaging in patients with hypertrophic cardiomyopathy is related to the severity of cardiac dysfunction. Microcirculation 2024; 31:e12843. [PMID: 38174616 DOI: 10.1111/micc.12843] [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: 08/16/2023] [Revised: 12/05/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Coronary microvascular dysfunction (CMD) plays a major role in hypertrophic cardiomyopathy (HCM) physiopathology but its assessment in clinical practice remains a challenge. Nowadays, innovations in invasive and noninvasive coronary evaluation using multimodal imaging provide options for the diagnosis of CMD. The objective of the present study was to investigate if new multimodal imaging diagnosis of CMD could detect HCM patients with more impaired cardiac function by left atrioventricular coupling index (LACI). METHODS AND RESULTS A total of 32 consecutive patients with a confirmed diagnosis of HCM (62 ± 13 years, 62% men) were prospectively screened for CMD using a multimodal imaging method. LACI was assessed by cardiovascular magnetic resonance imaging. Fifteen (47%) patients had CMD by multimodal imaging method. Patients with CMD presented a significantly higher LACI (48.5 ± 25.4 vs. 32.5 ± 10.6, p = .03). A multivariate logistic regression analysis demonstrated that CMD was independently associated with LACI (OR = 1.069, 95% CI 1.00-1.135, p = .03). CONCLUSION Multimodal imaging diagnosis of CMD is applicable to HCM patients and is associated with more impaired cardiac function.
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Affiliation(s)
- Tien Vuong Tran
- Department of Cardiology, University Hospital, Grenoble, France
| | - Loic Djaileb
- Department of Nuclear Medicine, University Hospital, Grenoble, France
- Université Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, Grenoble, France
| | - Laurent Riou
- Université Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, Grenoble, France
| | | | - Joris Giai
- Université Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, TIMC UMR 5525, Grenoble, France
| | - Gilles Barone-Rochette
- Department of Cardiology, University Hospital, Grenoble, France
- Université Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, Grenoble, France
- FACT (French Alliance for Cardiovascular Clinical Trials), an F-CRIN network, Paris, France
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8
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Chehab O, Abdollahi A, Whelton SP, Wu CO, Ambale-Venkatesh B, Post WS, Bluemke DA, Tsai MY, Lima JAC. Association of Lipoprotein(a) Levels With Myocardial Fibrosis in the Multi-Ethnic Study of Atherosclerosis. J Am Coll Cardiol 2023; 82:2280-2291. [PMID: 38057070 DOI: 10.1016/j.jacc.2023.10.016] [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: 08/16/2023] [Revised: 09/21/2023] [Accepted: 10/04/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Lipoprotein(a) (Lp[a]) has been identified as an emerging risk factor for adverse cardiovascular (CV) outcomes, including heart failure. However, the connections among Lp(a), myocardial fibrosis (interstitial and replacement), and cardiac remodeling as pathways to CV diseases remains unclear. OBJECTIVES This study investigated the relationship between Lp(a) levels and myocardial fibrosis by cardiac magnetic resonance (CMR) T1 mapping and late gadolinium enhancement, as well as cardiac remodeling by cine CMR, in the MESA (Multi-Ethnic Study of Atherosclerosis) cohort. METHODS The study included 2,040 participants with baseline Lp(a) measurements and T1 mapping for interstitial myocardial fibrosis (IMF) evaluation in 2010. Lp(a) was analyzed as a continuous variable (per log unit) and using clinical cutoff values of 30 and 50 mg/dL. Multivariate linear and logistic regression were used to assess the associations of Lp(a) with CMR measures of extracellular volume (ECV fraction [ECV%]), native T1 time, and myocardial scar, as well as parameters of cardiac remodeling, in 2,826 participants. RESULTS Higher Lp(a) levels were associated with increased ECV% (per log-unit Lp[a]; β = 0.2%; P = 0.007) and native T1 time (per log-unit Lp[a]; β = 4%; P < 0.001). Similar relationships were observed between elevated Lp(a) levels and a higher risk of clinically significant IMF defined by prognostic thresholds per log-unit Lp(a) of ECV% (OR: 1.20; 95% CI: 1.04-1.43) and native T1 (OR: 1.2; 95% CI: 1.1-1.4) equal to 30% and 955 ms, respectively. Clinically used Lp(a) cutoffs (30 and 50 mg/dL) were associated with greater prevalence of myocardial scar (OR: 1.85; 95% CI: 1.1-3.2 and OR: 1.9; 95% CI: 1.1-3.4, respectively). Finally, higher Lp(a) levels were associated with left atrial enlargement and dysfunction. CONCLUSIONS Elevated Lp(a) levels are linked to greater subclinical IMF, increased myocardial scar prevalence, and left atrial remodeling.
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Affiliation(s)
- Omar Chehab
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ashkan Abdollahi
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Seamus P Whelton
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Colin O Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Heath, Madison, Wisconsin, USA
| | - Michael Y Tsai
- Department of Pathology, University of Minnesota, Saint Paul-Minneapolis, Minneapolis, Minnesota, USA
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.
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9
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Pezel T, Dillinger JG, Toupin S, Mirailles R, Logeart D, Cohen-Solal A, Unger A, Canuti ES, Beauvais F, Lafont A, Gonçalves T, Lequipar A, Gall E, Boutigny A, Ah-Sing T, Hamzi L, Lima JAC, Bousson V, Henry P. Left atrioventricular coupling index assessed using cardiac CT as a prognostic marker of cardiovascular death. Diagn Interv Imaging 2023; 104:594-604. [PMID: 37353467 DOI: 10.1016/j.diii.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE The purpose of this study was to investigate the prognostic value of left atrioventricular coupling index (LACI) assessed by cardiac computed tomography (CT), to predict cardiovascular death in consecutive patients referred for cardiac CT with coronary analysis. MATERIALS AND METHODS Between 2010 and 2020, we conducted a single-centre study with all consecutive patients without known cardiovascular disease referred for cardiac CT. LACI was defined as the ratio of left atrial to left ventricle end-diastolic volumes. The primary outcome was cardiovascular death. Cox regressions were used to evaluate the association between LACI and primary outcome after adjustment for traditional risk factors and cardiac CT angiography findings. RESULTS In 1,444 patients (mean age, 70 ± 12 [standard deviation] years; 43% men), 67 (4.3%) patients experienced cardiovascular death after a median follow-up of 6.8 (Q1, Q3: 5.9, 9.1) years. After adjustment, LACI was positively associated with the occurrence of cardiovascular death (adjusted hazard ratio [HR], 1.07 [95% CI: 1.05-1.09] per 1% increment; P < 0.001), and all-cause death (adjusted HR, 1.05 [95% CI: 1.03-1.07] per 1% increment; P <0.001). After adjustment, a LACI ≥ 25% showed the best improvement in model discrimination and reclassification for predicting cardiovascular death above traditional risk factors and cardiac CT findings (C-statistic improvement: 0.27; Nnet reclassification improvement = 0.826; Integrative discrimination index =0.209, all P < 0.001; likelihood-ratio-test, P < 0.001). CONCLUSION LACI measured by cardiac CT is independently associated with cardiovascular death and all-cause death in patients without known cardiovascular disease referred for cardiac CT, with an incremental prognostic value over traditional risk factors and cardiac CT findings.
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Affiliation(s)
- Théo Pezel
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France; Université Paris Cité, Department of Radiology, Hôpital Lariboisière - APHP, 75010, Paris, France.
| | - Jean-Guillaume Dillinger
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Solenn Toupin
- Siemens Healthcare France, 93200 Saint-Denis, France
| | - Raphael Mirailles
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Damien Logeart
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Alain Cohen-Solal
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Alexandre Unger
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France; Department of Cardiology, Hôpital Universitaire de Bruxelles - Hôpital Erasme, 1070 Brussels, Belgium
| | - Elena Sofia Canuti
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France; Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Florence Beauvais
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Alexandre Lafont
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Trecy Gonçalves
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Antoine Lequipar
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Emmanuel Gall
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Alexandre Boutigny
- Université Paris Cité, Service des Explorations Fonctionnelles, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
| | - Tania Ah-Sing
- Université Paris Cité, Department of Radiology, Hôpital Lariboisière - APHP, 75010, Paris, France
| | - Lounis Hamzi
- Université Paris Cité, Department of Radiology, Hôpital Lariboisière - APHP, 75010, Paris, France
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, MD 21287-0409, USA
| | - Valérie Bousson
- Université Paris Cité, Department of Radiology, Hôpital Lariboisière - APHP, 75010, Paris, France
| | - Patrick Henry
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France
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Huang S, Shi K, Li Y, Wang J, Jiang L, Gao Y, Yan WF, Shen LT, Yang ZG. Effect of Metabolic Dysfunction-Associated Fatty Liver Disease on Left Ventricular Deformation and Atrioventricular Coupling in Patients With Metabolic Syndrome Assessed by MRI. J Magn Reson Imaging 2023; 58:1098-1107. [PMID: 36591962 DOI: 10.1002/jmri.28588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Metabolic dysfunction-associated fatty liver disease (MAFLD) was recently recognized as an important risk factor for cardiovascular diseases. PURPOSE To examine the effect of MAFLD on cardiac function in metabolic syndrome by MRI. STUDY TYPE Retrospective. POPULATION One hundred seventy-nine patients with metabolic syndrome (MetS), 101 with MAFLD (MAFLD [+]) and 78 without (MAFLD [-]). Eighty-one adults without any of the components of MetS or cardiac abnormalities were included as control group. FIELD STRENGTH/SEQUENCE 3.0 T; balanced steady-state free precession sequence. ASSESSMENT Left atrial (LA) strain was assessed during three phases: reservoir strain (LA-RS), conduit strain (LA-CS), and booster strain (LA-BS). Left ventricular (LV) global longitudinal (LV-GLS) strain was also derived. The left atrioventricular coupling index (LACI) was calculated as the ratio of LA end-diastolic volume (LA-EDV) and LV-EDV. STATISTICAL TESTS Student's t test or Mann-Whitney U test; One-way analysis of variance. A P value <0.05 was considered statistically significant. RESULTS Among MetS patients, individuals with MAFLD had significantly lower magnitude LV-GLS (-11.6% ± 3.3% vs. -13.8% ± 2.7%) than those without MAFLD. For LA strains, LA-RS (36.9% ± 13.7% vs. 42.9% ± 13.5%) and LA-CS (20.0% ± 10.6% vs. 24.1% ± 9.2%) were also significantly reduced in MAFLD (+) compared to MAFLD (-). The LACIs (17.2% [12.9-21.2] % vs. 15.8% [12.2-19.7] %) were significantly higher in patients with MAFLD compared to those without MAFLD. After adjustment for other clinical factors, MAFLD was found to be independently correlated with LV-GLS (β = -0.270) and LACI (β = 0.260). DATA CONCLUSION MAFLD had an unfavorable effect on LV myocardial strain in MetS. Moreover, LA strain and atrioventricular coupling were further impaired in patients with concomitant MAFLD compared to those without MAFLD. Last, MAFLD was independently associated with subclinical LV dysfunction and atrioventricular coupling after adjustment for other clinical factors. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: 3.
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Affiliation(s)
- Shan Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jin Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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11
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Pezel T, Garot P, Toupin S, Sanguineti F, Hovasse T, Unterseeh T, Champagne S, Morisset S, Chitiboi T, Jacob AJ, Sharma P, Venkatesh BA, Lima JAC, Garot J. AI-Based Fully Automated Left Atrioventricular Coupling Index as a Prognostic Marker in Patients Undergoing Stress CMR. JACC Cardiovasc Imaging 2023; 16:1288-1302. [PMID: 37052568 DOI: 10.1016/j.jcmg.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/08/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The left atrioventricular coupling index (LACI) is a strong and independent predictor of heart failure (HF) in individuals without clinical cardiovascular disease. Its prognostic value is not established in patients with cardiovascular disease. OBJECTIVES This study sought to determine in patients undergoing stress cardiac magnetic resonance (CMR) whether fully automated artificial intelligence-based LACI can provide incremental prognostic value to predict HF. METHODS Between 2016 and 2018, the authors conducted a longitudinal study including all consecutive patients with abnormal (inducible ischemia or late gadolinium enhancement) vasodilator stress CMR. Control subjects with normal stress CMR were selected using propensity score matching. LACI was defined as the ratio of left atrial to left ventricular end-diastolic volumes. The primary outcome included hospitalization for acute HF or cardiovascular death. Cox regression was used to evaluate the association of LACI with the primary outcome after adjustment for traditional risk factors. RESULTS In 2,134 patients (65 ± 12 years, 77% men, 1:1 matched patients [1,067 with normal and 1,067 with abnormal CMR]), LACI was positively associated with the primary outcome (median follow-up: 5.2 years [IQR: 4.8-5.5 years]) before and after adjustment for risk factors in the overall propensity-matched population (adjusted HR: 1.18 [95% CI: 1.13-1.24]), in patients with abnormal CMR (adjusted HR per 0.1% increment: 1.22 [95% CI: 1.14-1.30]), and in patients with normal CMR (adjusted HR per 0.1% increment: 1.12 [95% CI: 1.05-1.20]) (all P < 0.001). After adjustment, a higher LACI of ≥25% showed the greatest improvement in model discrimination and reclassification over and above traditional risk factors and stress CMR findings (C-index improvement: 0.16; net reclassification improvement = 0.388; integrative discrimination index = 0.153, all P < 0.001; likelihood ratio test P < 0.001). CONCLUSIONS LACI is independently associated with hospitalization for HF and cardiovascular death in patients undergoing stress CMR, with an incremental prognostic value over traditional risk factors including inducible ischemia and late gadolinium enhancement.
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Affiliation(s)
- Théo Pezel
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France; Inserm UMRS 942, Service de Cardiologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Solenn Toupin
- Scientific Partnerships, Siemens Healthcare France, Saint-Denis, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Stéphane Champagne
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Stéphane Morisset
- Independent Biostatistician, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | | | - Athira J Jacob
- Digital Technologies and Innovation, Siemens Healthineers, Princeton, New Jersey, USA
| | - Puneet Sharma
- Digital Technologies and Innovation, Siemens Healthineers, Princeton, New Jersey, USA
| | - Bharath Ambale Venkatesh
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Radiology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Radiology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France.
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12
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Varadarajan V, Gidding S, Wu C, Carr J, Lima JA. Imaging Early Life Cardiovascular Phenotype. Circ Res 2023; 132:1607-1627. [PMID: 37289903 PMCID: PMC10501740 DOI: 10.1161/circresaha.123.322054] [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: 02/07/2023] [Accepted: 04/30/2023] [Indexed: 06/10/2023]
Abstract
The growing epidemics of obesity, hypertension, and diabetes, in addition to worsening environmental factors such as air pollution, water scarcity, and climate change, have fueled the continuously increasing prevalence of cardiovascular diseases (CVDs). This has caused a markedly increasing burden of CVDs that includes mortality and morbidity worldwide. Identification of subclinical CVD before overt symptoms can lead to earlier deployment of preventative pharmacological and nonpharmacologic strategies. In this regard, noninvasive imaging techniques play a significant role in identifying early CVD phenotypes. An armamentarium of imaging techniques including vascular ultrasound, echocardiography, magnetic resonance imaging, computed tomography, noninvasive computed tomography angiography, positron emission tomography, and nuclear imaging, with intrinsic strengths and limitations can be utilized to delineate incipient CVD for both clinical and research purposes. In this article, we review the various imaging modalities used for the evaluation, characterization, and quantification of early subclinical cardiovascular diseases.
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Affiliation(s)
- Vinithra Varadarajan
- Division of Cardiology, Department of Medicine Johns Hopkins University, Baltimore, MD
| | | | - Colin Wu
- Department of Medicine, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Jeffrey Carr
- Department Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN
| | - Joao A.C. Lima
- Division of Cardiology, Department of Medicine Johns Hopkins University, Baltimore, MD
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13
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Lange T, Backhaus SJ, Schulz A, Evertz R, Kowallick JT, Bigalke B, Hasenfuß G, Thiele H, Stiermaier T, Eitel I, Schuster A. Cardiovascular magnetic resonance-derived left atrioventricular coupling index and major adverse cardiac events in patients following acute myocardial infarction. J Cardiovasc Magn Reson 2023; 25:24. [PMID: 37046343 PMCID: PMC10099819 DOI: 10.1186/s12968-023-00929-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: 11/15/2022] [Accepted: 02/23/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Recently, a novel left atrioventricular coupling index (LACI) has been introduced providing prognostic value to predict cardiovascular events beyond common risk factors in patients without cardiovascular disease. Since data on cardiovascular magnetic resonance (CMR)-derived LACI in patients following acute myocardial infarction (AMI) are scarce, we aimed to assess the diagnostic and prognostic implications of LACI in a large AMI patient cohort. METHODS In total, 1046 patients following AMI were included. After primary percutaneous coronary intervention CMR imaging and subsequent functional analyses were performed. LACI was defined by the ratio of the left atrial end-diastolic volume divided by the left ventricular (LV) end-diastolic volume. Major adverse cardiac events (MACE) including death, reinfarction or heart failure within 12 months after the index event were defined as primary clinical endpoint. RESULTS LACI was significantly higher in patients with MACE compared to those without MACE (p < 0.001). Youden Index identified an optimal LACI cut-off at 34.7% to classify patients at high-risk (p < 0.001 on log-rank testing). Greater LACI was associated with MACE on univariate regression modeling (HR 8.1, 95% CI 3.4-14.9, p < 0.001) and after adjusting for baseline confounders and LV ejection fraction (LVEF) on multivariate regression analyses (HR 3.1 95% CI 1.0-9, p = 0.049). Furthermore, LACI assessment enabled further risk stratification in high-risk patients with impaired LV systolic function (LVEF ≤ 35%; p < 0.001 on log-rank testing). CONCLUSION Atrial-ventricular interaction using CMR-derived LACI is a superior measure of outcome beyond LVEF especially in high-risk patients following AMI. Trial registration ClinicalTrials.gov, NCT00712101 and NCT01612312.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Boris Bigalke
- Department of Cardiology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Berlin, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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14
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Gunsaulus M, Bueno A, Bright C, Snyder K, Das N, Dobson C, DeBrunner M, Christopher A, Hoskoppal A, Follansbee C, Arora G, Olivieri L, Alsaied T. The Use of Automated Atrial CMR Measures and a Novel Atrioventricular Coupling Index for Predicting Risk in Repaired Tetralogy of Fallot. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020400. [PMID: 36832529 PMCID: PMC9955804 DOI: 10.3390/children10020400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
Atrial size and function have been recognized as markers of diastolic function, and diastolic dysfunction has been identified as a predictor of adverse outcomes in repaired tetralogy of Fallot (rTOF). This was a retrospective single-center study with the objective of investigating the use of atrial measurements obtained via CMR for predicting outcomes in rTOF patients. Automated contours of the left and right atria (LA and RA) were performed. A novel parameter, termed the Right Atrioventricular Coupling Index (RACI), was defined as the ratio of RA end-diastolic volume to right ventricle (RV) end-diastolic volume. Patients were risk-stratified using a previously validated Importance Factor Score for the prediction of life-threatening arrhythmias in rTOF. Patients with a high-risk Importance Factor Score (>2) had a significantly larger minimum RA volume (p = 0.04) and RACI (p = 0.03) compared to those with scores ≤2. ROC analysis demonstrated RACI to be the best overall predictor of a high-risk Importance Factor Score (AUC 0.73, p = 0.03). Older age at the time of repair and a diagnosis of pulmonary atresia were associated with a larger RACI. Automated atrial CMR measurements are easily obtained from standard CMRs and have the potential to serve as noninvasive predictors of adverse outcomes in rTOF.
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15
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Influence of temporal resolution on computed tomography feature-tracking strain measurements. Eur J Radiol 2023; 158:110644. [PMID: 36525702 DOI: 10.1016/j.ejrad.2022.110644] [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: 09/17/2022] [Revised: 11/14/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Temporal resolution significantly affects strain values demonstrated by Magnetic resonance feature-tracking and speckle-tracking echocardiography. We investigated the influence of R-R interval reconstruction increments on left ventricular (LV) and left atrial (LA) strain measurements of Computed tomography feature-tracking (CT-FT). METHODS Subjects who underwent retrospective electrocardiogram-gated coronary CT angiography (CCTA) were retrospectively included, and CCTA images were reconstructed in 5% and 10% steps throughout the entire cardiac cycle (0-100% R-R interval). LV global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS), LA GLS, ejection fraction (EF), and left atrioventricular coupling indices were computed. We evaluated the consistency and variability of continuous variables between the two reconstruction increment groups, the demarcation between the LA conduit and contraction phases, and observer reproducibility in 20 randomly selected participants. RESULTS Eighty-one participants with or without cardiac disease were included. The reconstruction increment of the R-R interval significantly affected the CT-FT-derived strain values. The 5% R-R increment resulted in significantly larger absolute strain values. LV GRS had the greatest difference between the two groups. In the subgroups with heart rates greater than 80 beats per minute or impaired cardiac function, group differences were attenuated, especially for LV GLS, LV GRS, and LA GLS. The prevalence of definite demarcation between the LA conduit and contraction phases was significantly higher in the 5% R-R reconstruction increment group than in the 10% R-R reconstruction increment group. The average heart rate during CCTA scanning was a strong risk factor for indefinite demarcation, which is independent of LVEF. As average heart rate increased, so did the incidence of indefinite demarcation between the LA conduit and contraction phases. The observer reproducibility of LV and LA strain values was independent of the R-R reconstruction increment. CONCLUSION Reconstruction increment of the R-R interval is an important source of variation in LV and LA CT-FT strain values, especially with low heart rate and preserved cardiac function. It is essential to control the heart rate and apply a narrow R-R reconstruction increment to quantify phasic LA strain.
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16
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Pezel T, Michos ED, Varadarajan V, Shabani M, Venkatesh BA, Vaidya D, Kato Y, De Vasconcellos HD, Heckbert SR, Wu CO, Post WS, Bluemke DA, Allison MA, Henry P, Lima JAC. Prognostic value of a left atrioventricular coupling index in pre- and post-menopausal women from the Multi-Ethnic Study of Atherosclerosis. Front Cardiovasc Med 2022; 9:1066849. [DOI: 10.3389/fcvm.2022.1066849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
BackgroundSex hormones associated with both the left atrial (LA) and left ventricular (LV) structures in women, but the association of menopause status with left atrioventricular coupling is not established.AimTo assess the prognostic value of a left atrioventricular coupling index (LACI) in peri-menopausal women without a history of cardiovascular disease (CVD).Materials and methodsIn all women participating in MESA study with baseline cardiovascular MRI, the LACI was measured as the ratio of the LA end-diastolic volume to the LV end-diastolic volume. Cox models were used to assess the association between the LACI and the outcomes of atrial fibrillation (AF), heart failure (HF), coronary heart disease (CHD) death, and hard CVD.ResultsAmong the 2,087 women participants (61 ± 10 years), 485 cardiovascular events occurred (mean follow-up: 13.2 ± 3.3 years). A higher LACI was independently associated with AF (HR 1.70; 95%CI [1.51–1.90]), HF (HR 1.62; [1.33–1.97]), CHD death (HR 1.36; [1.10–1.68]), and hard CVD (HR 1.30; [1.13–1.51], all p < 0.001). Adjusted models with the LACI showed significant improvement in model discrimination and reclassification when compared to traditional models to predict: incident AF (C-statistic: 0.82 vs. 0.79; NRI = 0.325; IDI = 0.036), HF (C-statistic: 0.84 vs. 0.81; NRI = 0.571; IDI = 0.023), CHD death (C-statistic: 0.87 vs. 0.85; NRI = 0.506; IDI = 0.012), hard CVD (C-statistic: 0.78 vs. 0.76; NRI = 0.229; IDI = 0.012). The prognostic value of the LACI had a better discrimination and reclassification than individual LA or LV parameters.ConclusionIn a multi-ethnic population of pre- and post-menopausal women, the LACI is an independent predictor of HF, AF, CHD death, and hard CVD.Clinical trial registration[https://clinicaltrials.gov/], identifier [NCT00005487].
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Nedios S, Steven D, Sultan A. Atrioventricular coupling in hypertrophic cardiomyopathy: Partners in crime for new-onset atrial fibrillation. Int J Cardiol 2022; 367:27-28. [PMID: 35988670 DOI: 10.1016/j.ijcard.2022.08.028] [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: 08/01/2022] [Accepted: 08/15/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Sotirios Nedios
- Heart Center Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany,.
| | - Daniel Steven
- University Hospital of Cologne, Department of Electrophysiology, Cologne, Germany
| | - Arian Sultan
- University Hospital of Cologne, Department of Electrophysiology, Cologne, Germany
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18
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Leiner T. Left Atrioventricular Coupling for Early Prediction of Incident Atrial Fibrillation. Radiology 2022; 303:327-328. [PMID: 35191742 DOI: 10.1148/radiol.213293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tim Leiner
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55901
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