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Yue JY, Ji K, Liu HP, Wu QW, Liang CH, Gao JB. Evaluating the consistency in different methods for measuring left atrium diameters. BMC Med Imaging 2024; 24:57. [PMID: 38443826 PMCID: PMC10916282 DOI: 10.1186/s12880-024-01231-6] [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: 11/01/2023] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The morphological information of the pulmonary vein (PV) and left atrium (LA) is of immense clinical importance for effective atrial fibrillation ablation. The aim of this study is to examine the consistency in different LA diameter measurement techniques. METHODS Retrospective imaging data from 87 patients diagnosed with PV computed tomography angiography were included. The patients consisted of 50 males and 37 females, with an average age of (60.74 ± 8.70) years. Two physicians independently measured the anteroposterior diameter, long diameter, and transverse diameter of the LA using six different methods. Additionally, we recorded the post-processing time of the images. Physician 1 conducted measurements twice with a one-month interval between the measurements to assess intra-rater reliability. Using the intraclass correlation coefficient (ICC), the consistency of each LA diameter measurement by the two physicians was evaluated. We compared the differences in the LA diameter and the time consumed for measurements using different methods. This was done by employing the rank sum test of a randomized block design (Friedman M test) and the q test for pairwise comparisons among multiple relevant samples. RESULTS (1) The consistency of the measured LA diameter by the two physicians was strong or very strong. (2) There were statistical differences in the anteroposterior diameter, long diameter, and transverse diameter of LA assessed using different methods (χ2 = 222.28, 32.74, 293.83, P < 0.001). (3) Different methods for measuring the diameters of LA required different amounts of time (χ2 = 333.10, P < 0.001). CONCLUSION The results of left atrium (LA) diameter measurements conducted by different physicians were found to be reliable. However, the LA diameters obtained through various techniques exhibited variations. It was observed that measuring LA long diameters using only the VR (volume rendering) picture was the most clinically applicable method.
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Affiliation(s)
- Jun-Yan Yue
- Department of Radiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui Henan Province, 453200, Xinxiang, China
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, 450000, Zhengzhou, Henan Province, China
- Heart Center, The First Affiliated Hospital of Xinxiang Medical University, 453200, Henan Pro vince, Weihui, China
| | - Kai Ji
- Department of Radiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui Henan Province, 453200, Xinxiang, China
| | - Hai-Peng Liu
- Department of Radiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui Henan Province, 453200, Xinxiang, China
| | - Qing-Wu Wu
- Department of Radiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui Henan Province, 453200, Xinxiang, China
| | - Chang-Hua Liang
- Department of Radiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui Henan Province, 453200, Xinxiang, China
| | - Jian-Bo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, 450000, Zhengzhou, Henan Province, China.
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2
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Aksan G, Yanık A, Yontar OC, Boyacı F, Uçar M, Şahin MK, Soylu K. The predictive value of galectin‐3 levels on left atrial low voltage areas assessed by high‐density mapping in patients with paroxysmal atrial fibrillation. J Arrhythm 2022; 38:353-362. [PMID: 35785368 PMCID: PMC9237302 DOI: 10.1002/joa3.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/20/2022] [Accepted: 03/13/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gökhan Aksan
- Department of Cardiology Samsun Education and Research Hospital Samsun Turkey
| | - Ahmet Yanık
- Department of Cardiology Samsun Education and Research Hospital Samsun Turkey
| | - Osman Can Yontar
- Department of Cardiology Samsun Education and Research Hospital Samsun Turkey
| | - Faruk Boyacı
- Department of Cardiology Samsun Education and Research Hospital Samsun Turkey
| | - Melisa Uçar
- Department of Cardiology Samsun Education and Research Hospital Samsun Turkey
| | - Mustafa Kürşat Şahin
- Department of Family Medicine Faculty of Medicine Ondokuz Mayıs University Samsun Turkey
| | - Korhan Soylu
- Department of Cardiology, Faculty of Medicine Ondokuz Mayis University Samsun Turkey
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3
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Seewöster T, Dinov B, Nedios S, Hindricks G, Sommer P, Kornej J. Biatrial volume ratio predicts low voltage areas in atrial fibrillation. Clin Cardiol 2021; 44:1560-1566. [PMID: 34494677 PMCID: PMC8571553 DOI: 10.1002/clc.23720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/08/2021] [Accepted: 08/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Left atrial volume (LAV) and low voltage areas (LVAs) are acknowledged markers for worse rhythm outcome after ablation of atrial fibrillation (AF). Some studies reported the importance of increased right atrial volume (RAV) as a predictor for arrhythmia recurrences in AF patients. OBJECTIVE To investigate association between the LAV/RAV ratio and LVAs presence. METHODS Patients undergoing first AF ablation were included. LVAs were assessed peri-procedurally using high-density 3D maps and defined as <0.5 mV. All patients underwent pre-procedural cardiovascular magnetic resonance imaging. LAV (biplane) and RAV (monoplane 4-chamber) were assessed prior to ablation, and the LAV/RAV ratio was calculated. RESULTS The study population included 189 patients (age mean 63 ± 10 years, 33% women, 57% persistent AF, 22% LVAs). There were 149 (79%) patients with LAV > RAV. In univariable analysis LAV > RAV was associated with LVAs (OR 6.803, 95%CI 1.395-26.514, p = .016). The association remained robust in multivariable model after adjustment for persistent AF, CHA2 DS2 -VASc score, and heart rate (OR 5.981, 95%CI 1.256-28.484, p = .025). Using receiver operator curve analysis, LAV > RAV (AUC 0.668, 95%CI 0.585-0.751, p = .001) was significant predictor for LVAs. In multivariable analysis, after adjustment for age, persistent AF, and renal function, RAV≥LAV was threefold higher in males (OR 3.040, 95%CI 1.050-8.802, p = .04). CONCLUSIONS LAV > RAV is useful for the prediction of electro-anatomical substrate in AF. LAV > RAV was associated with LVAs presence, while male sex remained associated with RAV≥LAV and less LVAs.
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Affiliation(s)
- Timm Seewöster
- Department of Electrophysiology, Heart Center Leipzig - University Hospital of Cardiology, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center Leipzig - University Hospital of Cardiology, Leipzig, Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig - University Hospital of Cardiology, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig - University Hospital of Cardiology, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - Jelena Kornej
- School of Medicine - Cardiovascular Medicine, Boston University, Boston, Massachusetts, USA
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Seewöster T, Kosich F, Sommer P, Bertagnolli L, Hindricks G, Kornej J. Prediction of low-voltage areas using modified APPLE score. Europace 2021; 23:575-580. [PMID: 33279992 DOI: 10.1093/europace/euaa311] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/22/2020] [Indexed: 12/25/2022] Open
Abstract
AIMS The presence of low-voltage areas (LVAs) in patients with atrial fibrillation (AF) reflects left atrial (LA) electroanatomical substrate, which is essential for individualized AF management. However, echocardiographic anteroposterior LA diameter included into previous LVAs prediction scores does not mirror LA size accurately and impaired left ventricular ejection fraction (LV-EF) is not directly associated with atrial myopathy. Therefore, we aimed to compare a modified (m)APPLE score, which included LA volume (LAV) and LA emptying fraction (LA-EF) with the regular APPLE score for the prediction of LVAs. METHODS AND RESULTS In patients undergoing first AF catheter ablation, LVAs were determined peri-interventionally using high-density maps and defined as signal amplitude <0.5 mV. All patients underwent cardiovascular magnetic resonance imaging before intervention. The APPLE (one point for Age ≥ 65 years, Persistent AF, imPaired eGFR ≤ 60 mL/min/1.73 m2, LA diameter ≥ 43 mm, and LVEF < 50%) and (m)APPLE (last two variables changed by LAV ≥ 39 mL/m2, and LA-EF < 31%) scores were calculated at baseline. The study population included 219 patients [median age 65 (interquartile range 57-72) years, 41% females, 59% persistent AF, 25% LVAs]. Both scores were significantly associated with LVAs [OR 1.817, 95% CI 1.376-2.399 for APPLE and 2.288, 95% CI 1.650-3.172 for (m)APPLE]. Using receiver operating characteristic curves analysis, the (m)APPLE score [area under the curve (AUC) 0.779, 95% CI 0.702-0.855] showed better LVAs prediction than the APPLE score (AUC 0.704, 95% CI 0.623-0.784), however, without statistically significant difference (P = 0.233). CONCLUSION The modified (m)APPLE score demonstrated good prognostic value for LVAs prediction and was comparable with the regular APPLE score.
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Affiliation(s)
- Timm Seewöster
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Falco Kosich
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Herz-und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - Livio Bertagnolli
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Jelena Kornej
- School of Medicine-Cardiovascular Medicine, Boston University, 72 E Concord Street, Boston, MA 02118, USA
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5
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Büttner P, Seewöster T, Obradovic D, Hindricks G, Thiele H, Kornej J. NT-proANP levels in peripheral and cardiac circulation. J Interv Card Electrophysiol 2021; 63:409-415. [PMID: 34173166 DOI: 10.1007/s10840-021-01020-z] [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: 03/31/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recent studies have reported an association between N-terminal atrial natriuretic peptide (NT-proANP) and the progression of atrial fibrillation (AF). However, NT-proANP levels in peripheral and cardiac circulation in AF patients and in non-AF individuals need to be defined. The aims of the current study are (1) to analyze NT-proANP levels in peripheral and cardiac circulation in AF patients and (2) to compare NT-proANP levels in individuals with and without AF. METHODS We recruited AF patients who were undergoing their first AF catheter ablation and non-AF individuals. Blood plasma samples taken from the femoral vein and the left atrium (LA) were collected before AF ablation in the AF patients and from the cubital vein in the non-AF controls. Low voltage areas (LVAs) were determined using high-density maps during catheter ablation and defined as < 0.5 mV. RESULTS The study included 189 AF patients (64 ± 10 years, 59% male, 61% persistent AF, 30% LVAs) and 26 non-AF individuals (58 ± 10 years, 50% male). Patients with AF were significantly older and had larger LA (p < 0.05). Compared to non-AF controls, peripheral and cardiac NT-proANP levels were significantly higher in AF patients without and with LVAs (median 5.4, 10.5, 14.8 ng/ml, respectively, p < 0.001). In multivariable analysis, NT-proANP (OR 1.238, 95% CI 1.007-1.521, p = 0.043) remained significantly different between non-AF individuals and AF patients. In AF, NT-proANP levels were significantly higher in the cardiac blood samples than in the peripheral blood (median 13.0 versus 11.4 ng/ml, p = 0.003). The ability to predict LVAs was modest when using cardiac NT-proANP (AUC 0.661) and peripheral NT-proANP (AUC 0.635), without statistical difference (p = 0.937). CONCLUSIONS NT-proANP levels are higher in individuals with AF than in controls and are more pronounced in progressed AF. Elevated cardiac and peripheral NT-proANP levels similarly predict LVAs.
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Affiliation(s)
- Petra Büttner
- Department of Cardiology, Heart Center Leipzig At University of Leipzig, Leipzig, Germany
| | - Timm Seewöster
- Department of Electrophysiology, Heart Center Leipzig At University of Leipzig, Leipzig, Germany
| | - Danilo Obradovic
- Department of Cardiology, Heart Center Leipzig At University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig At University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig At University of Leipzig, Leipzig, Germany
| | - Jelena Kornej
- School of Medicine - Cardiovascular Medicine, Boston University, 72 E Concord St, Boston, MA, 02118, USA.
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Schönbauer R, Tomala J, Kirstein B, Huo Y, Gaspar T, Richter U, Piorkowski J, Schönbauer MS, Fiedler L, Roithinger FX, Hengstenberg C, Mascherbauer J, Ulbrich S, Piorkowski C. Left atrial phasic transport function closely correlates with fibrotic and arrhythmogenic atrial tissue degeneration in atrial fibrillation patients: cardiac magnetic resonance feature tracking and voltage mapping. Europace 2021; 23:1400-1408. [PMID: 33693595 DOI: 10.1093/europace/euab052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/22/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS To characterize the association of phasic left atrial (LA) transport function and LA fibrosis guided by multimodality imaging containing cardiac magnetic resonance imaging (CMR) feature tracking and bipolar voltage mapping. METHODS AND RESULTS Consecutive patients presenting for first-time ablation of atrial fibrillation (AF) were prospectively enrolled. Each patient underwent CMR prior to the ablation procedure. LA phasic indexed volumes (LA-Vi) and emptying fractions (LA-EF) were calculated and CMR feature tracking guided LA wall motion analysis was performed. LA bipolar voltage mapping was carried out in sinus rhythm to find areas of low voltage as a surrogate for fibrosis and arrhythmogenesis. One hundred and sixty-eight patients were enrolled. Low-voltage areas (LVAs) were present in 70 patients (42%). Contrary to LA volume, CMR based LA-EF [odds ratio (OR) 0.88, 95% confidence interval (CI) 0.80-0.96, P = 0.005] and LA booster pump strain rate (SR) (OR 0.98, 95% CI 0.97-0.99, P = 0.001) significantly predicted presence and extent of LVA in multivariate logistic regression analysis for patients scanned in SR. In receiver operating characteristic analysis, LA-EF <40% carried a sensitivity of 83% and specificity of 76% (area under the curve 0.8; 95% CI 0.71-0.89) to predict presence of LVA. For patients scanned in AF only minimal LA-Vi on CMR (OR: 1.06; 95% CI: 1.02-1.10; P = 0.002) predicted presence of LVA. CONCLUSION For patients scanned in SR LA-EF and LA booster pump SR are closely linked to the presence and extent of LA LVA.
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Affiliation(s)
- Robert Schönbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Jakub Tomala
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany
| | - Bettina Kirstein
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany
| | - Yan Huo
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany
| | - Thomas Gaspar
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany
| | - Utz Richter
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany
| | - Judith Piorkowski
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany.,Steinbeis Research Institute-Rhythm and Heart, Dresden, Germany
| | | | - Lukas Fiedler
- Department of Cardiology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | | | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Julia Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Stefan Ulbrich
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany
| | - Christopher Piorkowski
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany.,Abbott EP&HF Division, Minneapolis, MN, USA
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Hofer F, Hammer A, Steininger M, Kazem N, Koller L, Steinlechner B, Laufer G, Andreas M, Marculescu R, Hengstenberg C, Wojta J, Niessner A, Sulzgruber P. The Prognostic Potential of Atrial Natriuretic Peptide on the Development of Postoperative Atrial Fibrillation after Cardiac Surgery. Thromb Haemost 2021; 121:1523-1529. [DOI: 10.1055/a-1400-6096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Background Postoperative atrial fibrillation (POAF) represents a common complication after cardiac surgery associated with major adverse events and poor patient outcome. Tools for risk stratification of this arrhythmia remain scarce. Atrial natriuretic peptide (ANP) represents an easily assessable biomarker picturing atrial function and strain; however, its prognostic potential on the development of POAF has not been investigated so far.
Methods Within the present investigation, 314 patients undergoing elective cardiac surgery were prospectively enrolled. Preoperative mid-region proANP (MR-proANP) values were assessed before the surgical intervention. Patients were followed prospectively and continuously screened for the development of arrhythmic events.
Results A total of 138 individuals (43.9%) developed POAF. Median concentrations of MR-proANP were significantly higher within the POAF group (p < 0.001). MR-proANP showed a strong association with the development of POAF with a crude odds ratio (OR) of 1.68 per 1 standard deviation (1-SD; 95% confidence interval [CI]: 1.31–2.15; p < 0.001), which remained stable after comprehensive adjustment for confounders with an adjusted OR of 1.74 per 1-SD (95% CI: 1.17–2.58; p = 0.006). The discriminatory power of MR-proANP for the development of POAF was validated by the category-free net reclassification improvement (0.23 [95% CI: 0.0349–0.4193]; p = 0.022) and integrated discrimination increment (0.02 [95% CI: 0.0046–0.0397], p = 0.013).
Conclusion MR-proANP proved to be a strong and independent predictor of the development of POAF. Considering a personalized diagnostic and prognostic preoperative work-up, a standardized preoperative evaluation of MR-proANP levels might help to identify patients at risk for development of POAF after cardiac surgery.
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Affiliation(s)
- Felix Hofer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas Hammer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Matthias Steininger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Niema Kazem
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Lorenz Koller
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Günther Laufer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Johann Wojta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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8
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Seewöster T, Kornej J. Response to the Letter: The NT-proANP puzzle - a small piece that makes the big picture. Clin Cardiol 2020; 44:11-12. [PMID: 33188582 PMCID: PMC7803368 DOI: 10.1002/clc.23498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Timm Seewöster
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jelena Kornej
- Boston University, School of Medicine-Cardiovascular Medicine, Boston University, Boston, Massachusetts, USA
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9
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Arginine derivatives in atrial fibrillation progression phenotypes. J Mol Med (Berl) 2020; 98:999-1008. [PMID: 32504111 PMCID: PMC8556202 DOI: 10.1007/s00109-020-01932-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
Arginine, homoarginine (hArg), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) affect nitric oxide metabolism and altered concentrations are associated with cardiovascular morbidity and mortality. We analyzed these metabolites using liquid chromatography-tandem mass spectrometry in patients with atrial fibrillation (AF) (n = 241) with a focus on heart rhythm at blood withdrawal, AF progression phenotypes, and successful sinus rhythm (SR) restoration (n = 22). AF progression phenotypes were defined as paroxysmal AF with/without low voltage areas (LVA) and persistent AF with/without LVA. While arginine, ADMA, and hArg were within reference limits for healthy controls, SDMA was higher in the AF cohort (0.57 ± 0.12 vs. 0.53 μmol/L (97.5th percentile in reference cohort)). SR restoration in AF patients resulted in normalization of SDMA concentrations (0.465 ± 0.082 vs. 0.570 ± 0.134 μmol/L at baseline, p < 0.001). Patients with AF at the time of blood sampling had significantly lower hArg (1.65 ± 0.51 vs. 1.85 ± 0.60 μmol/L, p = 0.006) and higher ADMA concentrations (0.526 ± 0.08 vs. 0.477 ± 0.08 μmol/L, p < 0.001) compared with AF patients in SR. hArg concentrations were lower in patients with advanced AF progression phenotypes (persistent AF with LVA (p = 0.046)) independent of heart rhythm at blood sampling. Summarizing, arginine metabolism imbalance is associated with AF in general and AF progression and may contribute to associated risk. KEY MESSAGES: • Heart rhythm at blood withdrawal affects ADMA and hArg level in AF patients. • SDMA is higher in AF patients. • SDMA levels normalize after sinus rhythm restoration. • hArg levels decrease in advanced AF progression phenotypes.
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10
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Seewöster T, Büttner P, Zeynalova S, Hindricks G, Kornej J. Are the atrial natriuretic peptides a missing link predicting low-voltage areas in atrial fibrillation? Introducing the novel biomarker-based atrial fibrillation substrate prediction (ANP) score. Clin Cardiol 2020; 43:762-768. [PMID: 32462768 PMCID: PMC7368300 DOI: 10.1002/clc.23378] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In patients with atrial fibrillation (AF), left atrial (LA) enlargement, and the presence of low-voltage areas (LVAs) indicate an advanced disease stage. NT-proANP is a biomarker, which is significantly higher in both phenotypes. Prediction of LVAs before catheter ablation could impact the prognosis and therapeutical management in AF patients. OBJECTIVE The aim of this study was to (a) analyze the predictive value of a novel biomarker-based AF substrate prediction score, and (b) compare it with DR-FLASH and APPLE scores. METHODS Patients undergoing first AF catheter ablation were included. LA volume (LAV) was analyzed prior to ablation using cardiovascular magnetic resonance imaging (CMR). Blood plasma samples from the femoral vein were collected before AF ablation. NT-proANP was analyzed using commercially available assays. LVAs were determined using high-density maps during catheter ablation and defined as <0.5 mV. The novel ANP score (one point for Age ≥ 65 years, NT-proANP > 17 ng/mL, and Persistent AF) was calculated at baseline. RESULTS The study population included 156 AF patients (64 ± 10 years, 65% males, 61% persistent AF, 28% LVAs). The cut-off ANP score ≥ 2 demonstrated 77% sensitivity and 70% specificity. On logistic regression (odds ratio [OR] 3.469) and receiver operating characteristic (ROC) analysis (area under the curve [AUC] 0.778, P < .001), the ANP score significantly predicted LVAs presence. There were no differences between novel ANP score - which is a new one - is described in the Abstract; with APPLE (AUC 0.718, P = .378) and DR-FLASH (AUC 0.766, P = .856) scores. CONCLUSIONS The novel biomarker-based ANP score demonstrates good prediction of LVAs.
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Affiliation(s)
- Timm Seewöster
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Petra Büttner
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Samira Zeynalova
- Institute for Medical Informatics, Statistics, and Epidemiology, Leipzig University, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany
| | - Jelena Kornej
- Institute for Medical Informatics, Statistics, and Epidemiology, Leipzig University, Leipzig, Germany.,School of Medicine, Cardiovascular Medicine, Boston University, Boston, Massachusetts, USA
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11
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Kornej J, Zeynalova S, Büttner P, Burkhardt R, Bae YJ, Willenberg A, Baber R, Thaler A, Hindricks G, Loeffler M, Hagendorff A, Thiele H, Thiery J. Differentiation of atrial fibrillation progression phenotypes using Troponin T. Int J Cardiol 2019; 297:61-65. [DOI: 10.1016/j.ijcard.2019.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/28/2019] [Accepted: 09/04/2019] [Indexed: 12/23/2022]
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12
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Seewöster T, Kornej J. Left atrial function and NT-proANP as markers of AF progression and impaired outcome in patients with heart failure with preserved ejection fraction. Int J Cardiovasc Imaging 2019; 36:121-122. [PMID: 31587127 DOI: 10.1007/s10554-019-01701-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Timm Seewöster
- Department of Electrophysiology, Heart Center, Leipzig, Germany.
| | - Jelena Kornej
- School of Medicine - Cardiovascular Medicine, Boston University, Boston, USA
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13
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Kornej J, Sommer P. Left Atrial Size and the Risk for Recurrence After Catheter Ablation: Is a Small Left Atrial as Bad as a Large One? Circ J 2019; 83:2185-2186. [PMID: 31327808 DOI: 10.1253/circj.cj-19-0558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Philipp Sommer
- Heart and Diabetes Center NRW, University Hospital of Ruhr-University Bochum
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Tanase DM, Radu S, Al Shurbaji S, Baroi GL, Florida Costea C, Turliuc MD, Ouatu A, Floria M. Natriuretic Peptides in Heart Failure with Preserved Left Ventricular Ejection Fraction: From Molecular Evidences to Clinical Implications. Int J Mol Sci 2019; 20:ijms20112629. [PMID: 31142058 PMCID: PMC6600439 DOI: 10.3390/ijms20112629] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022] Open
Abstract
The incidence of heart failure with preserved ejection fraction (HFpEF) is increasing and its challenging diagnosis and management combines clinical, imagistic and biological data. Natriuretic peptides (NPs) are hormones secreted in response to myocardial stretch that, by increasing cyclic guanosine monophosphate (cGMP), counteract myocardial fibrosis and hypertrophy, increase natriuresis and determine vasodilatation. While their role in HFpEF is controversial, most authors focused on b-type natriuretic peptides (BNPs) and agreed that patients may show lower levels. In this setting, newer molecules with an increased specificity, such as middle-region pro-atrial natriuretic peptide (MR-proANP), emerged as promising markers. Augmenting NP levels, either by NP analogs or breakdown inhibition, could offer a new therapeutic target in HFpEF (already approved in their reduced EF counterparts) by increasing the deficient cGMP levels found in patients. Importantly, these peptides also retain their prognostic value. This narrative review focuses on NPs’ physiology, diagnosis, therapeutic and prognostic implication in HFpEF.
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Affiliation(s)
- Daniela Maria Tanase
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania.
- Internal Medicine Clinic, "Sf. Spiridon" County Clinical Emergency Hospital Iasi, 700115 Iasi, Romania.
| | - Smaranda Radu
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania.
- Cardiology Clinic, "Prof. Dr. George I.M. Georgescu" Institute of Cardiovascular Diseases, 700503 Iasi, Romania.
| | - Sinziana Al Shurbaji
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania.
- Institute of Gastroenterology and Hepatology, 700115 Iasi, Romania.
| | - Genoveva Livia Baroi
- Department of Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania.
- Vascular Surgery Clinic, "Sf. Spiridon" County Clinical Emergency Hospital Iasi, 700115 Iasi, Romania.
| | - Claudia Florida Costea
- Department of Ophthalmology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.
- 2nd Ophthalmology Clinic, "Prof. Dr. Nicolae Oblu" Emergency Clinical Hospital, 700115 Iași, Romania.
| | - Mihaela Dana Turliuc
- Department of Neurosurgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania.
- 2nd Neurosurgery Clinic, "Prof. Dr. Nicolae Oblu" Emergency Clinical Hospital, 700115 Iași, Romania.
| | - Anca Ouatu
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania.
- Internal Medicine Clinic, "Sf. Spiridon" County Clinical Emergency Hospital Iasi, 700115 Iasi, Romania.
| | - Mariana Floria
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania.
- Internal Medicine Clinic, "Sf. Spiridon" County Clinical Emergency Hospital Iasi, 700115 Iasi, Romania.
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15
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Seewöster T, Büttner P, Nedios S, Sommer P, Dagres N, Schumacher K, Bollmann A, Hilbert S, Jahnke C, Paetsch I, Hindricks G, Kornej J. Association Between Cardiovascular Magnetic Resonance-Derived Left Atrial Dimensions, Electroanatomical Substrate and NT-proANP Levels in Atrial Fibrillation. J Am Heart Assoc 2018; 7:e009427. [PMID: 30371296 PMCID: PMC6404891 DOI: 10.1161/jaha.118.009427] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/14/2018] [Indexed: 11/16/2022]
Abstract
Background Enlargement of left atrial ( LA ) size indicates advanced disease stage in patients with atrial fibrillation ( AF ) and is associated with poor success of different AF therapies. Two dimensional echocardiographic LA measurements do not reliably reflect the true size of LA anatomy. The aim of the current study was: 1) to analyze cardiovascular magnetic resonance ( CMR )-derived LA dimensions and their association with low voltage areas ( LVA ); and 2) to investigate the association between these parameters and NT -pro ANP (N-terminal proatrial natriuretic peptide) levels. Methods and Results Patients undergoing first AF catheter ablation were included. All patients underwent CMR imaging (Ingenia 1.5T Philips) before intervention. CMR data ( LA volume, superior-inferior, transversal and anterior-posterior LA diameters) were measured in all patients. LVA were determined using high-density maps and a low voltage threshold <0.5 mV. Blood plasma samples from femoral vein were collected before catheter ablation. NT -pro ANP levels were studied using commercially available assays. There were 216 patients (65±11 years, 59% males, 56% persistent AF , 26% LVA ) included into analyses. NT -pro ANP levels in patients with LVA were significantly higher than in those without (median/interquartile range 22 [13-29] versus 15 [9-22] pg/mL, P=0.004). All CMR derived LA diameters correlated significantly with persistent AF ( r²=0.291-0.468, all P<0.001), LVA ( r²=0.187-0.306, all P<0.001), and NT -pro ANP levels ( r²=0.258-0.352, P<0.01). On logistic regression multivariable analysis, age (odds ratio=1.090, 95% confidence interval: 1.030-1.153, P=0.003), females (odds ratio=2.686, 95% confidence interval: 1.047-6.891, P=0.040), and LA volume (odds ratio=1.022, 95% confidence interval: 1.009-1.035, P=0.001) remained significant predictors for LVA . Conclusions Left atrial CMR parameters are associated with persistent AF , low voltage areas and NT -pro ANP levels. LA volume is the most significant predictor for LVA .
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Affiliation(s)
- Timm Seewöster
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Petra Büttner
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Sotirios Nedios
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
- Department of CardiologyCardiovascular Research Institute Maastricht (CARIM)Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Philipp Sommer
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
- Leipzig Heart InstituteLeipzigGermany
| | - Nikolaos Dagres
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Katja Schumacher
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Andreas Bollmann
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
- Leipzig Heart InstituteLeipzigGermany
| | - Sebastian Hilbert
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Cosima Jahnke
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Ingo Paetsch
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
| | - Gerhard Hindricks
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
- Leipzig Heart InstituteLeipzigGermany
| | - Jelena Kornej
- Department of ElectrophysiologyHeart Center Leipzig—University Hospital of CardiologyLeipzigGermany
- Institute for Medical Informatics, Statistics, and EpidemiologyUniversity of LeipzigLeipzigGermany
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