Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC-NCS

Coagulation Disorders and Thrombotic Complications in Heart Failure With Preserved Ejection Fraction

Heart failure with preserved ejection fraction (HFpEF) is associated with multiple cardiovascular and noncardiovascular comorbidities and risk factors which increase the risk of thrombotic complications, such as atrial fibrillation, chronic kidney disease, arterial hypertension and type 2 diabetes mellitus. Subsequently, thromboembolic risk stratification in this population poses a great challenge. Since date from the large randomized clinical trials mostly include both patients with truly preserved EF, and those with heart failure with mildly reduced ejection fraction, there is an unmet need to characterize the patients with truly preserved EF. Considering the significant evidence gap in this area, we sought to describe the coagulation disorders and thrombotic complications in patients with HFpEF and discuss the specific thromboembolic risk factors in patients with HFpEF, with the goal to tailor risk stratification to an individual patient.

Normal left atrial diameter is associated with better performance on a cognitive screener among a cohort of ischemic stroke patients

Background

Cardiac structure is an important determinant of ischemic stroke (IS) etiology; however, whether an association between cardiac structural markers and cognition post-IS exists is not yet established. The aim of this study is to examine the association between LAD and LVEF with cognitive performance among IS patients.

Methods

IS patients admitted to the Johns Hopkins Hospital (2017-2019) underwent transthoracic echocardiography. IS was classified (TOAST) by a masked reviewer. Left atrial diameter (LAD) was evaluated as a non-linear continuous variable with one spline knot at 4 cm; left ventricle ejection fraction (LVEF) was dichotomized, then further evaluated as a non-linear continuous variable with spline knots at 50% and 70%. Patients were contacted by telephone on average 422 days post-stroke and administered the Six-Item Screener (SIS) to assess for dementia. SIS scores were dichotomized into low and high, imputing low scores for non-answerers. Multivariable logistic regression determined the association of SIS category with LAD or LVEF. A sensitivity analysis re-evaluated the association between SIS category and LAD, excluding participants with atrial fibrillation (AF).

Results

Participants (N = 108) were on average 61 years old (range = 18-89 years), 55% male, and 63% Black. Among patients considered to have a normal LAD (≤ 4 cm), a 1 mm larger LAD was associated with 1.20 greater odds (95%CI = 1.05-1.38) of scoring in the high SIS category in the final adjustment model. This association remained significant when excluding participants with prevalent AF. There was no association between a 1 mm larger LAD and SIS category among patients with a LAD >4 cm in both the primary analysis and the sensitivity analysis. There was no association between LVEF and SIS category.

Conclusions

In this prospective study, among ischemic stroke patients with a LAD within the normal range, a 1 mm increase in LAD was associated with higher scores on a telephone cognitive battery, without an association found among those with a LAD >4 cm.

Role of Cardiovascular Magnetic Resonance in the Management of Atrial Fibrillation: A Review

Atrial fibrillation (AF) is the most common arrhythmia, and its prevalence is growing with time. Since the introduction of catheter ablation procedures for the treatment of AF, cardiovascular magnetic resonance (CMR) has had an increasingly important role for the treatment of this pathology both in clinical practice and as a research tool to provide insight into the arrhythmic substrate. The most common applications of CMR for AF catheter ablation are the angiographic study of the pulmonary veins, the sizing of the left atrium (LA), and the evaluation of the left atrial appendage (LAA) for stroke risk assessment. Moreover, CMR may provide useful information about esophageal anatomical relationship to LA to prevent thermal injuries during ablation procedures. The use of late gadolinium enhancement (LGE) imaging allows to evaluate the burden of atrial fibrosis before the ablation procedure and to assess procedural induced scarring. Recently, the possibility to assess atrial function, strain, and the burden of cardiac adipose tissue with CMR has provided more elements for risk stratification and clinical decision making in the setting of catheter ablation planning of AF. The purpose of this review is to provide a comprehensive overview of the potential applications of CMR in the workup of ablation procedures for atrial fibrillation.