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1
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Antoun I, Layton GR, Abdelrazik A, Eldesouky M, Altoukhy S, Zakkar M, Somani R, Ng GA. Predicting the Outcomes of External Direct Current Cardioversion for Atrial Fibrillation: A Narrative Review of Current Evidence. J Cardiovasc Dev Dis 2025; 12:168. [PMID: 40422939 DOI: 10.3390/jcdd12050168] [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: 02/15/2025] [Revised: 04/18/2025] [Accepted: 04/23/2025] [Indexed: 05/28/2025] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia associated with significant morbidity and mortality. External direct current cardioversion (DCCV) is a cornerstone intervention for rhythm control in AF; however, its success is influenced by various patient-specific and procedural factors. This review examines the predictors of DCCV success and AF recurrence with specific focus upon demographics, biochemical, cardiovascular imaging, and P-wave parameters and their likely ability to predict procedural outcomes. Demographic factors such as age, sex, and comorbidities influence DCCV outcomes, with prolonged AF duration, obesity, and heart failure being associated with higher failure rates. Elevated biochemical markers of inflammation and fibrosis, including C-reactive protein, galectin-3, and Type III procollagen-N-peptide, were predictive of poor outcomes. Imaging parameters, particularly left atrial (LA) volume and strain, emerged as critical indicators of atrial remodelling and DCCV failure. Increased P-wave duration and dispersion on electrocardiography were associated with an increased risk of recurrence. Biphasic waveforms and antiarrhythmic drugs, such as amiodarone and flecainide, improved cardioversion success. The predictors of DCCV success and recurrence reflect the interplay of structural, biochemical, and electrical remodelling in AF. Integrating these parameters into clinical practice can guide individualised patient management and improve outcomes. Further research is needed to validate these predictors and enhance precision medicine approaches in DCCV.
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Affiliation(s)
- Ibrahim Antoun
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE5 4PW, UK
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE1 7RH, UK
| | - Georgia R Layton
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE1 7RH, UK
- Leicester British Heart Foundation Centre of Research Excellence, Glenfield Hospital, Leicester LE3 9QP, UK
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE5 4PW, UK
| | - Ahmed Abdelrazik
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE5 4PW, UK
| | - Mahmoud Eldesouky
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE5 4PW, UK
| | - Sherif Altoukhy
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE5 4PW, UK
| | - Mustafa Zakkar
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE1 7RH, UK
- Leicester British Heart Foundation Centre of Research Excellence, Glenfield Hospital, Leicester LE3 9QP, UK
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE5 4PW, UK
| | - Riyaz Somani
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE5 4PW, UK
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE1 7RH, UK
| | - G André Ng
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE5 4PW, UK
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE1 7RH, UK
- Leicester British Heart Foundation Centre of Research Excellence, Glenfield Hospital, Leicester LE3 9QP, UK
- National Institute for Health Research Leicester Research Biomedical Centre, Leicester LE5 4PW, UK
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Abdulelah ZA, Al Balbissi K, Al-Dqour M, Hammoudeh A, Abdulelah AA. Echocardiographic Findings in Jordanian Atrial Fibrillation Patients: Analysis from Jo-Fib Study. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:314. [PMID: 40005431 PMCID: PMC11857228 DOI: 10.3390/medicina61020314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Revised: 01/16/2025] [Accepted: 02/04/2025] [Indexed: 02/27/2025]
Abstract
Background and Objectives: Atrial fibrillation (AF) carries a huge socioeconomic burden as it is the most encountered cardiac arrhythmia with a significant morbidity. Echocardiographic (Echo) imaging is of monumental value in providing insight into assessing the cardiac function and anatomy, etiology, and risk stratification of AF patients, which will ultimately lead to the best management plan. Materials and Methods: A total of 2160 adult patients diagnosed with AF in 18 hospitals and 30 out-patient cardiology clinics in Jordan and 1 hospital in the Palestinian Territories were enrolled in this study from May 2019 to January 2021. Ultimately, 1776 patients were included in the analysis after going through the exclusion criteria. Results: The majority of our participants were found to have normal EF at the time of enrollment, with only 31.6% exhibiting a decreased EF. Only 40% of overall patients had Echo evidence of left ventricular hypertrophy (LVH). These patients were older (70.27 ± 10.1 vs. 66.0 ± 14.3, p < 0.001), more obese (45.2% vs. 37.3%, p-value < 0.001), and had a more frequent occurrence of HTN (89.0% vs. 65.6%, p < 0.001) and DM (49.2% vs. 40.1%, p < 0.001) when compared to patients without LVH. A proportion of 84.2% of female patients had abnormal left atrial (LA) size (>3.8 cm), in contrast to only 53.4% of males (LA > 4.2 cm). Pulmonary hypertension (PH) was only observed in 27.9% of our patients, and when comparing patients with PH vs. patients without PH, decreased EF (<50%) (36.9% vs. 20.6%, p = 0.001), a higher prevalence of OSA (6.7% vs. 3.8%, p = 0.009), female predominance (60.3% vs. 39.7%, p < 0.001), and older age (70.2 ± 10.7 vs. 66.7 ± 13.6, p < 0.001) were observed in patients with PH. Conclusion: This study provides the first reported insights on the atrial fibrillation-related echocardiographic findings in a Middle Eastern population. Notably, our study demonstrates that the majority of the studied population have no evidence of LVH and have preserved EF on baseline. However, LA enlargement was extremely frequent among females but not in males, warranting further evaluation to determine the factors contributing to such a difference.
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Affiliation(s)
- Zaid A. Abdulelah
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Hills Rd., Cambridge CB2 0QQ, UK
| | - Kais Al Balbissi
- School of Medicine, The University of Jordan, Amman 11942, Jordan;
| | - Mohammad Al-Dqour
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA;
| | - Ayman Hammoudeh
- Department of Cardiology, Istishari Hospital, Amman 11184, Jordan;
| | - Ahmed A. Abdulelah
- Royal Papworth Hospital NHS Foundation Trust, Papworth Rd., Trumpington, Cambridge CB2 0AY, UK;
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Orlandi M, Corsi M, Bini V, Palazzo R, Gitto S, Fiorillo C, Becatti M, Maglione M, Stefani L. A First Diastolic Function Evaluation in the Personalized Exercise Prescription Program for Solid Organs Transplanted Subjects: Is Atrial Strain Useful? J Pers Med 2025; 15:32. [PMID: 39852223 PMCID: PMC11766879 DOI: 10.3390/jpm15010032] [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: 11/28/2024] [Revised: 01/09/2025] [Accepted: 01/14/2025] [Indexed: 01/26/2025] Open
Abstract
Background/Objectives: Solid organ transplant recipients (OTR) have been recently involved in exercise prescription programs in order to reduce the high prevalence of cardiovascular diseases. The normal systolic and diastolic cardiac function is fundamental to personalizing the prescription. Diastolic dysfunction can be associated to a higher risk of cardiovascular events and left atrial (LA) strain is an emerging parameter in the evaluation of diastolic compromising, especially in subjects with preserved ejection fraction. Left atrial (LA) strain has never been explored in this category. The study aimed to evaluate the contribution of the LA strain in the assessment of diastolic function of OTR and its potential contribution in the exercise program. Methods: 54 solid OTR (liver and kidney transplants) regularly trained for at least 12 months in a home-based, partially supervised model at moderate intensity estimated by cardiopulmonary exercise test, underwent a complete echocardiographic analysis. The measured variables included left ventricle systolic function (ejection fraction, EF), diastolic function (E/A and E/E'), LA indexed volumes, LA peak atrial longitudinal strain (PALS) and LA peak atrial contraction strain (PACS). The data were compared to those of 44 healthy subjects (HS). Results: The OTR showed an overweight condition (BMI: 25.79 ± 2.92 vs. 22.25 ± 2.95; p < 0.01). Both groups showed a preserved systolic function (EF: OTR 63.1 ± 3.5% vs. HS 66.9 ± 6.1; p < 0.001), while diastolic standard parameters were significantly different (E/A, 1.01 ± 0.4 vs. 1.96 ± 0.74; p < 0.001; E/E', 9.2 ± 2.7 vs. 6.9 ± 1.3; p < 0.001, in OTR and HS respectively) despite being normal. LA strain was significantly lower in OTR vs. HS (4C PALS, 33.7 ± 9.7 vs. 45.4 ± 14.19; p < 0.001; 4C PACS, 15.9 ± 6.7 vs. 11.6 ± 7.5; p = 0.006; 2C PALS, 35.3 ± 11.1 vs. 47.6 ± 14.9; p < 0.001; 2C PALS, 17.4 ± 4.9 vs. 13.2 ± 14.97; p = 0.001; in OTR and HS respectively). A specific correlation of two- and four-chamber PACs and PALs with BMI has been observed (R for 4C PALS -0.406 ** and 2C PALS -0.276 *). Conclusions: These findings suggest that the coexistence of increased bodyweight in asymptomatic OTR patients can exacerbate the impairment of LA strains. LA strain detection could be useful in the development of a personalized exercise program for OTRs, especially for asymptomatic subjects and those with elevated cardiovascular risk profile, to potentially manage the exercise program in the long term. Larger studies will confirm the role via an eventual structured clinical score index.
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Affiliation(s)
- Melissa Orlandi
- Sport Medicine Centre, Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (M.O.); (M.C.); (R.P.)
| | - Marco Corsi
- Sport Medicine Centre, Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (M.O.); (M.C.); (R.P.)
| | - Vittorio Bini
- Medicine Department, University of Perugia, 06100 Perugia, Italy;
| | - Roberto Palazzo
- Sport Medicine Centre, Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (M.O.); (M.C.); (R.P.)
| | - Stefano Gitto
- Internal Medicine and Hepatology, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
| | - Claudia Fiorillo
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy; (C.F.); (M.B.)
| | - Matteo Becatti
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy; (C.F.); (M.B.)
| | - Marco Maglione
- CV Ultrasound Division, ESAOTE Spa, 50127 Florence, Italy;
| | - Laura Stefani
- Sport Medicine Centre, Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (M.O.); (M.C.); (R.P.)
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4
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Miyata M. Arterial stiffness and left atrial function. Hypertens Res 2025; 48:434-435. [PMID: 39543420 DOI: 10.1038/s41440-024-01911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 09/02/2024] [Indexed: 11/17/2024]
Affiliation(s)
- Masaaki Miyata
- School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
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Kaplinski M, Griffis H, Wang Y, Mercer-Rosa L, Banerjee A, Quartermain MD, Natarajan SS. Left Atrial Size and Strain in Hypertensive Children Compared to Age-, Sex-, and Race/Ethnicity-Matched Controls. Pediatr Cardiol 2024:10.1007/s00246-024-03719-y. [PMID: 39581915 DOI: 10.1007/s00246-024-03719-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 11/16/2024] [Indexed: 11/26/2024]
Abstract
Left atrial (LA) volume and peak longitudinal strain (LA strain) are indicators of left ventricular (LV) diastolic function in adults, but little is known about LA volume and strain in pediatric patients with hypertension (HTN). We evaluated LA volume and strain in pediatric cases with HTN compared to age-, sex-, and race/ethnicity-matched controls. This was a retrospective matched case-control study of patients who presented to the HTN clinic at CHOP from 12/2011 to 9/2018. Coarctation of the aorta, cardiomyopathy or heart transplantation cases were excluded. HTN was defined by an abnormal ambulatory blood pressure result. LA volume was measured by biplane area-length method and indexed to body surface area (BSA). LA strain and strain rate were measured using TOMTEC® software. Left ventricular mass index (LVMI) was measured by M-mode and the 5/6 area-length method indexed to height2.7. LV global longitudinal strain (LV GLS) was measured during the echocardiographic examination on the GE ultrasound machine for cases and offline using TOMTEC® software for controls. Measurements were compared using Chi-square, McNemar, or Wilcoxon signed rank tests. We included 47 cases and 47 controls. There was no difference in LA volume z-scores (- 1.9 vs. - 0.9, p = 0.068), LA strain (37.8% vs. 38.0%, p = 0.735) or LA strain rate (1.4 vs. 1.5, p = 0.852) in cases compared to controls. LVMI by M-mode and 5/6 area-length method was higher in cases compared to controls (40.0 vs. 33.7 g/m2.7, p < 0.001 and 29.9 vs 24.4 g/m2.7, p = < 0.001, respectively). LV GLS was decreased (less negative) in cases compared to controls. In summary there was no difference in LA volume or LA strain in cases compared to controls. In cases, LVMI was significantly elevated and LV GLS was significantly decreased, which may be the first response to HTN, prior to affecting LA size.
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Affiliation(s)
- Michelle Kaplinski
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Suite 325, Palo Alto, CA, 94304, USA.
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yan Wang
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anirban Banerjee
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael D Quartermain
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shobha S Natarajan
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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6
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Sonaglioni A, Nicolosi GL, Bruno A, Lombardo M, Muti P. Echocardiographic Assessment of Left Atrial Mechanics in Patients with Atrial Fibrillation Undergoing Electrical Cardioversion: A Systematic Review. J Clin Med 2024; 13:6296. [PMID: 39518435 PMCID: PMC11546254 DOI: 10.3390/jcm13216296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 10/17/2024] [Accepted: 10/20/2024] [Indexed: 11/16/2024] Open
Abstract
Background: To date, only a few studies have evaluated left atrial (LA) mechanics in patients with atrial fibrillation (AF) scheduled for electrical cardioversion (ECV). The present systematic review has been primarily designed to summarize the main findings of these studies and to examine the overall effect of AF on left atrial reservoir strain (LASr) in patients undergoing ECV. Methods: All the echocardiographic studies evaluating the effect of AF on LA mechanics in patients scheduled for ECV, selected from the PubMed and EMBASE databases, were included. There was no limitation of time period. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: The full texts of 12 studies with 880 AF patients were analyzed. The pooled ECV success rate was 91.5% (range 65.8-100%). Over a median follow-up of 5.4 months (range 0.3-12 months), 35.2% of the patients (range 5-68.8%) experienced AF recurrence. At baseline, the average LASr was 11.4% (range 6.2-17.7%). A reduced LASr before ECV was strongly correlated with reduced left atrial appendage (LAA) flow velocities and/or thrombosis. The main independent predictors of cardioversion failure were impaired LASr and previous AF history. A severe LASr deterioration was independently correlated with AF recurrence after ECV. The other independent predictors of AR relapses were LA asynchrony, reduced difference between post- and pre-ECV LASr, and reduced right atrial reservoir strain. Conclusions: LASr assessment before ECV may provide useful prognostic information about AF relapses and improve the refinement of the thromboembolic risk of AF patients scheduled for ECV.
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Affiliation(s)
| | | | - Antonino Bruno
- Laboratory of Innate Immunity, IRCCS MultiMedica, 20138 Milan, Italy;
- Laboratory of Immunology and General Pathology, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | | | - Paola Muti
- Department of Biomedical, Surgical and Dental Sciences, Università di Milano, 20122 Milan, Italy;
- Scientific Direction, IRCCS MultiMedica, 20138 Milan, Italy
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7
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Campora A, Lisi M, Pastore MC, Mandoli GE, Ferrari Chen YF, Pasquini A, Rubboli A, Henein MY, Cameli M. Atrial Fibrillation, Atrial Myopathy, and Thromboembolism: The Additive Value of Echocardiography and Possible New Horizons for Risk Stratification. J Clin Med 2024; 13:3921. [PMID: 38999487 PMCID: PMC11242512 DOI: 10.3390/jcm13133921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/22/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac sustained arrhythmia, and it is associated with increased stroke and dementia risk. While the established paradigm attributes these complications to blood stasis within the atria and subsequent thrombus formation with cerebral embolization, recent evidence suggests that atrial myopathy (AM) may play a key role. AM is characterized by structural and functional abnormalities of the atria, and can occur with or without AF. Moving beyond classifications based solely on episode duration, the 4S-AF characterization has offered a more comprehensive approach, incorporating patient's stroke risk, symptom severity, AF burden, and substrate assessment (including AM) for tailored treatment decisions. The "ABC" pathway emphasizes anticoagulation, symptom control, and cardiovascular risk modification and emerging evidence suggests broader benefits of early rhythm control strategies, potentially reducing stroke and dementia risk and improving clinical outcomes. However, a better integration of AM assessment into the current framework holds promise for further personalizing AF management and optimizing patient outcomes. This review explores the emerging concept of AM and its potential role as a risk factor for stroke and dementia and in AF patients' management strategies, highlighting the limitations of current risk stratification methods, like the CHA2DS2-VASc score. Echocardiography, particularly left atrial (LA) strain analysis, has shown to be a promising non-invasive tool for AM evaluation and recent studies suggest that LA strain analysis may be a more sensitive risk stratifier for thromboembolic events than AF itself, with some studies showing a stronger association between LA strain and thromboembolic events compared to traditional risk factors. Integrating it into routine clinical practice could improve patient management and targeted therapies for AF and potentially other thromboembolic events. Future studies are needed to explore the efficacy and safety of anticoagulation in AM patients with and without AF and to refine the diagnostic criteria for AM.
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Affiliation(s)
- Alessandro Campora
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Matteo Lisi
- Department of Emergency, Internal Medicine and Cardiology-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121 Ravenna, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Yu Fu Ferrari Chen
- Cardiovascular Division, Pisa University Hospital and University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Rubboli
- Department of Emergency, Internal Medicine and Cardiology-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121 Ravenna, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 1, 53100 Siena, Italy
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Barletta V, Canu AM, Parollo M, Di Cori A, Segreti L, De Lucia R, Bongiorni MG, Zucchelli G. A Long Atrial Electromechanical Interval is Associated with Arrhythmic Recurrence after Catheter Ablation: How to Find What Has Been Lost. J Cardiovasc Echogr 2024; 34:125-131. [PMID: 39444389 PMCID: PMC11495311 DOI: 10.4103/jcecho.jcecho_35_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/24/2024] [Accepted: 08/20/2024] [Indexed: 10/25/2024] Open
Abstract
Background Atrial fibrillation (AF) results in electrical and structural remodeling of the atria, which extent is known to be associated with a higher AF recurrence rate after catheter ablation (CA). Recently, a novel echocardiographic parameter derived from tissue Doppler imaging (TDI) [PA-TDI] has been introduced to assess the total atrial activation time, as a noninvasive surrogate of fibrosis and remodeling. The aim of the study is to investigate the role of PA-TDI interval as a predictor of AF ablation efficacy. Methods We retrospectively included patients with paroxysmal symptomatic drug-refractory AF referred to our institution for CA procedure, who presented sinus rhythm at admission. A complete transthoracic echocardiogram was performed before the ablation procedure, including the assessment of PA-TDI interval. Results From January 2015 to April 2018, 128 patients (mean age: 61.86 ± 9.08 years, 68% male, body surface area: 1.97 ± 0.21 mq, body mass index: 26.98 ± 3.86 kg/mq, and ejection fraction: 59% ±6.06%) with symptomatic drug-refractory AF who received radiofrequency CA were enrolled. During the follow-up of 15.80 ± 6.7 months, 30 patients (23%) developed AF recurrence out of the blanking period. Compared with those without recurrence (group 1), patients with recurrence (group 2) had a larger left atrium (LA) size (Group 1 vs. Group 2: mean LA area: 22.2 ± 4.6 cmq vs. 25 ± 6.6 cmq, P = 0.015; mean indexed LA volume: 35 ± 10 mL/mq vs. 40 ± 12 mL/mq, P = 0.04) and longer PA-TDI interval (Group 1 vs. Group 2: 162 ± 33 ms vs. 133 ± 26 ms, P < 0.0001). A cutoff of PA-TDI > 150 ms identified patients with recurrence after ablation with a sensibility of 82% and specificity of 83% (area under the curve 0.879). Conclusions The total activation time assessed by PA-TDI is an independent predictor of AF recurrence and can be used to predict the efficacy of transcatheter ablation.
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Affiliation(s)
- Valentina Barletta
- Department of Cardiac-Thoracic and Vascular, Second Division of Cardiology, Pisa University Hospital, Pisa, Italy
| | - Antonio Maria Canu
- Department of Cardiac-Thoracic and Vascular, Second Division of Cardiology, Pisa University Hospital, Pisa, Italy
| | - Matteo Parollo
- Department of Cardiac-Thoracic and Vascular, Second Division of Cardiology, Pisa University Hospital, Pisa, Italy
| | - Andrea Di Cori
- Department of Cardiac-Thoracic and Vascular, Second Division of Cardiology, Pisa University Hospital, Pisa, Italy
| | - Luca Segreti
- Department of Cardiac-Thoracic and Vascular, Second Division of Cardiology, Pisa University Hospital, Pisa, Italy
| | - Raffaele De Lucia
- Department of Cardiac-Thoracic and Vascular, Second Division of Cardiology, Pisa University Hospital, Pisa, Italy
| | - Maria Grazia Bongiorni
- Department of Cardiac-Thoracic and Vascular, Second Division of Cardiology, Pisa University Hospital, Pisa, Italy
| | - Giulio Zucchelli
- Department of Cardiac-Thoracic and Vascular, Second Division of Cardiology, Pisa University Hospital, Pisa, Italy
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9
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Pawar SG, Saravanan PB, Gulati S, Pati S, Joshi M, Salam A, Khan N. Study the relationship between left atrial (LA) volume and left ventricular (LV) diastolic dysfunction and LV hypertrophy: Correlate LA volume with cardiovascular risk factors. Dis Mon 2024; 70:101675. [PMID: 38262769 DOI: 10.1016/j.disamonth.2024.101675] [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] [Indexed: 01/25/2024]
Abstract
Heart failure (HF) with normal ejection fraction - the isolated diastolic heart failure, depicts increasing prevalence and health care burden in recent times. Having less mortality rate compared to systolic heart failure but high morbidity, it is evolving as a major cardiac concern. With increasing clinical use of Left atrial volume (LAV) quantitation in clinical settings, LAV has emerged as an important independent predictor of cardiovascular outcome in HF with normal ejection fraction. This article is intended to review the diastolic and systolic heart failure, their association with left atrial volume, in depth study of Left atrial function dynamics with determinants of various functional and structural changes.
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Affiliation(s)
| | | | | | | | - Muskan Joshi
- Tbilisi State Medical University, Tbilisi, Georgia
| | - Ajal Salam
- Government Medical College, Kottayam, Kerala, India
| | - Nida Khan
- Jinnah Sindh Medical University, Karachi, Pakistan
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10
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Ferkh A, Clark A, Thomas L. Left atrial phasic function: physiology, clinical assessment and prognostic value. Heart 2023; 109:1661-1669. [PMID: 36918267 DOI: 10.1136/heartjnl-2022-321609] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023] Open
Abstract
Left atrial (LA) phasic function provides significant insights into the pathophysiology of cardiovascular disease. LA function is described in three phases: reservoir (atrial filling, during systole), conduit (passive emptying, during early diastole) and contractile (active emptying, during late diastole). LA phasic function can be evaluated by different imaging modalities, and a variety of techniques including volumetric analysis, deformation (strain) and Doppler methods. LA phasic function (particularly LA reservoir strain) is more sensitive and provides earlier detection of LA dysfunction than alterations in LA volume. LA function parameters have also demonstrated significant diagnostic and prognostic value, particularly in heart failure, atrial fibrillation and stroke. However, there remain barriers to implementation of phasic function parameters in clinical practice and guidelines. This review outlines the physiology of LA phasic function, methods of assessment, and its diagnostic and prognostic utility in varying pathologies.
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Affiliation(s)
- Aaisha Ferkh
- Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Amy Clark
- Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Liza Thomas
- Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
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11
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Deissler PM, Tran KL, Falk V, Pieske B, Grubitzsch H, Primessnig U, Heinzel FR. Functional reserve and contractile phenotype of atrial myocardium from patients with atrial remodeling without and with atrial fibrillation. Am J Physiol Heart Circ Physiol 2023; 325:H729-H738. [PMID: 37594484 DOI: 10.1152/ajpheart.00355.2023] [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: 06/19/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
Atrial contractility and functional reserve in atrial remodeling (AR) without (AR/-AF) or with atrial fibrillation (AR/+AF) are not well characterized. In this study, functional measurements were performed in right atrial muscle strips (n = 71) obtained from patients (N = 22) undergoing routine cardiac surgery with either no AR [left atrial (LA) diameter < 40 mm and no history of AF (hAF)], AR/-AF (LA diameter ≥ 40 mm, no hAF), or AR/+AF (hAF and LA diameter ≥ 40 mm or LAEF < 45%). AR/-AF and AR/+AF were associated with a prolongation of half-time-to-peak (HTTP, P < 0.001) and time-to-peak (TTP) contraction (P < 0.01) when compared with no AR. This effect was seen at baseline and during β-adrenergic stimulation with isoproterenol (Iso). Early relaxation assessed by half-relaxation time (HRT) was prolonged in AR/-AF (P = 0.03) but not in AR/+AF when compared with no AR at baseline, but this delay in relaxation in AR/-AF was attenuated with Iso. Late relaxation (τ) did not differ between AR/-AF and no AR but was consistently shorter in AR/+AF than no AR before (P = 0.04) and during Iso (P = 0.01), indicating accelerated late relaxation in AR/+AF. Relative force increase during Iso was higher (P = 0.01) and more dispersed (P = 0.047) in patients with AR/+AF. Relative adrenergic response was unaltered in the myocardium of patients with AR/-AF and AR/+AF. In conclusion, AR/-AF and AR/+AF are associated with changes in myocardial inotropic reserve and contractility. The changes are particularly pronounced in patients with AR/+AF, suggesting that the progression from AR/-AF to AR/+AF is associated with progressive alterations in atrial function that may contribute to arrhythmogenesis.NEW & NOTEWORTHY Mechanical alterations in atrial remodeling without (AR/-AF) and with atrial fibrillation (AR/+AF) have not been studied in detail in human atrial tissue preparations. To our knowledge, this is the first study to compare the mechanical phenotype and inotropic reserve in human atrial myocardial preparations from patients with no atrial remodeling, AR/-AF, and AR/+AF. We identify specific patterns of contractile dysfunction and heterogeneity for both, AR/-AF and AR/+AF, indicating the progression of atrial disease.
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Affiliation(s)
- Peter M Deissler
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Khai Liem Tran
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Volkmar Falk
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | | | - Herko Grubitzsch
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Uwe Primessnig
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Frank R Heinzel
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- 2. Medizinische Klinik-Kardiologie, Angiologie, Intensivmedizin, Städtisches Klinikum Dresden, Dresden, Germany
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12
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Tomaselli M, Badano LP, Cannone V, Radu N, Curti E, Perelli F, Heilbron F, Gavazzoni M, Rella V, Oliverio G, Caravita S, Baratto C, Perego GB, Parati G, Brasca F, Muraru D. Incremental Value of Right Atrial Strain Analysis to Predict Atrial Fibrillation Recurrence After Electrical Cardioversion. J Am Soc Echocardiogr 2023; 36:945-955. [PMID: 37302440 DOI: 10.1016/j.echo.2023.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although the assessment of left atrial (LA) mechanics has been reported to refine atrial fibrillation (AF) risk prediction, it doesn't completely predict AF recurrence. The potential added role of right atrial (RA) function in this setting is unknown. Accordingly, this study sought to evaluate the added value of RA longitudinal reservoir strain (RASr) for the prediction of AF recurrence after electrical cardioversion (ECV). METHODS We retrospectively studied 132 consecutive patients with persistent AF who underwent elective ECV. Complete two-dimensional and speckle-tracking echocardiography analyses of LA and RA size and function were obtained in all patients before ECV. The end point was AF recurrence. RESULTS During a 12-month follow-up, 63 patients (48%) showed AF recurrence. Both LASr and RASr were significantly lower in patients experiencing AF recurrence than in patients with persistent sinus rhythm (LASr, 10% ± 6% vs 13% ± 7%; RASr, 14% ± 10% vs 20% ± 9%, respectively; P < .001 for both). Right atrial longitudinal reservoir strain (area under the curve = 0.77; 95% CI, 0.69-0.84; P < .0001) was more strongly associated with the recurrence of AF after ECV than LASr (area under the curve = 0.69; 95% CI, 0.60-0.77; P < .0001). Kaplan-Meier curves showed that patients with both LASr ≤ 10% and RASr ≤ 15% had a significantly increased risk for AF recurrence (log-rank, P < .001). However, at multivariable Cox regression, RASr (hazard ratio, 3.26; 95% CI, 1.73-6.13; P < .001) was the only parameter independently associated with AF recurrence. Right atrial longitudinal reservoir strain was more strongly associated with the occurrence of AF relapse after ECV than LASr, and LA and RA volumes. CONCLUSION Right atrial longitudinal reservoir strain was independently and more strongly associated than LASr with AF recurrence after elective ECV. This study highlights the importance of assessing the functional remodeling of both the RA and LA in patients with persistent AF.
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Affiliation(s)
- Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luigi P Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Vincenzo Cannone
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Noela Radu
- Carol Davila University of Medicine and Pharmacy, Prof. Dr. C. C. Iliescu Institute, Bucharest, Romania
| | - Emanuele Curti
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesco Perelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesca Heilbron
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Valeria Rella
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giorgio Oliverio
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Sergio Caravita
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Claudia Baratto
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giovanni B Perego
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesco Brasca
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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13
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Wałek P, Roskal-Wałek J, Dłubis P, Wożakowska-Kapłon B. Echocardiographic Evaluation of Atrial Remodelling for the Prognosis of Maintaining Sinus Rhythm after Electrical Cardioversion in Patients with Atrial Fibrillation. J Clin Med 2023; 12:5158. [PMID: 37568560 PMCID: PMC10419596 DOI: 10.3390/jcm12155158] [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: 05/02/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
Atrial fibrillation (AF) is the most common atrial tachyarrhythmia. One of the methods of AF treatment is direct current cardioversion (DCCV), but in the long-term follow-up we observe quite a high percentage of AF recurrences after this procedure. In order to assess the prognosis of DCCV effectiveness, we use clinical, biochemical and echocardiographic parameters. The objective of this review is to systematise the current knowledge on echocardiographic measurements in patients with persistent AF used to assess the progress of remodelling of the atrial wall, which affects the likelihood of maintaining sinus rhythm after DCCV. In this article, echocardiographic parameters for the evaluation of remodelling of the atrial wall are divided into groups referring to structural, mechanical, and electrical remodelling, as well as parameters for the evaluation of left ventricular filling pressure. The article aims to draw attention to the clinical value of echocardiographic measurements, which is the selection of patients who will maintain sinus rhythm after DCCV in the long-term follow-up, which will allow to avoid unnecessary risks associated with the procedure and enable the selection of the appropriate treatment strategy.
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Affiliation(s)
- Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (P.D.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Joanna Roskal-Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (P.D.); (B.W.-K.)
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland
| | - Patryk Dłubis
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (P.D.); (B.W.-K.)
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (P.D.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
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14
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Enríquez-Vázquez D, Quintanilla JG, García-Escolano A, Couselo-Seijas M, Simón-Chica A, Lee P, Alfonso-Almazán JM, Mahía P, Redondo-Rodríguez A, Modrego J, Ortega-Hernández A, Marcos-Alberca P, Magni R, Calvo E, Gómez-Gordo R, Yan P, La Rosa G, Bustamante-Madrión J, Pérez-García CN, Martín-Sánchez FJ, Calvo D, de la Hera JM, García-Torrent MJ, García-Osuna Á, Ordonez-Llanos J, Vázquez J, Pérez-Villacastín J, Pérez-Castellano N, Loew LM, Sánchez-González J, Gómez-Garre D, Filgueiras-Rama D. Non-invasive electromechanical assessment during atrial fibrillation identifies underlying atrial myopathy alterations with early prognostic value. Nat Commun 2023; 14:4613. [PMID: 37542075 PMCID: PMC10403561 DOI: 10.1038/s41467-023-40196-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
Electromechanical characterization during atrial fibrillation (AF) remains a significant gap in the understanding of AF-related atrial myopathy. This study reports mechanistic insights into the electromechanical remodeling process associated with AF progression and further demonstrates its prognostic value in the clinic. In pigs, sequential electromechanical assessment during AF progression shows a progressive decrease in mechanical activity and early dissociation from its electrical counterpart. Atrial tissue samples from animals with AF reveal an abnormal increase in cardiomyocytes death and alterations in calcium handling proteins. High-throughput quantitative proteomics and immunoblotting analyses at different stages of AF progression identify downregulation of contractile proteins and progressive increase in atrial fibrosis. Moreover, advanced optical mapping techniques, applied to whole heart preparations during AF, demonstrate that AF-related remodeling decreases the frequency threshold for dissociation between transmembrane voltage signals and intracellular calcium transients compared to healthy controls. Single cell simulations of human atrial cardiomyocytes also confirm the experimental results. In patients, non-invasive assessment of the atrial electromechanical relationship further demonstrate that atrial electromechanical dissociation is an early prognostic indicator for acute and long-term rhythm control.
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Affiliation(s)
- Daniel Enríquez-Vázquez
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Servicio de Cardiología, Instituto de Investigación Biomédica A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jorge G Quintanilla
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Alba García-Escolano
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Marinela Couselo-Seijas
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Ana Simón-Chica
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Peter Lee
- Essel Research and Development Inc., Toronto, ON, Canada
| | - José Manuel Alfonso-Almazán
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Patricia Mahía
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Andrés Redondo-Rodríguez
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Javier Modrego
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Laboratorio de Microbiota y Biología Vascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Adriana Ortega-Hernández
- Laboratorio de Microbiota y Biología Vascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pedro Marcos-Alberca
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ricardo Magni
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Enrique Calvo
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rubén Gómez-Gordo
- Laboratorio de Microbiota y Biología Vascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ping Yan
- Richard D. Berlin Center for Cell Analysis and Modeling, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Giulio La Rosa
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - José Bustamante-Madrión
- Emergency Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carlos Nicolás Pérez-García
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - F Javier Martín-Sánchez
- Emergency Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Calvo
- Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Jesús M de la Hera
- Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | | | - Álvaro García-Osuna
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca de l'Hospital Santa Creu i Sant Pau, Institut d'Investigacions Biomèdiques, IIB Sant Pau, Barcelona, Spain
| | - Jordi Ordonez-Llanos
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universidad Autónoma, Barcelona, Spain
- Foundation for Clinical Biochemistry & Molecular Pathology, Madrid, Spain
| | - Jesús Vázquez
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Julián Pérez-Villacastín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Nicasio Pérez-Castellano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Leslie M Loew
- Richard D. Berlin Center for Cell Analysis and Modeling, University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Dulcenombre Gómez-Garre
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Laboratorio de Microbiota y Biología Vascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Filgueiras-Rama
- Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
- Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
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15
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Yoon SJ, Park S, Choi EY, Seo HS, Shim CY, Ahn CM, Kim SA, Ha JW. Left Atrial Velocity Vector Imaging Can Assess Early Diastolic Dysfunction in Left Ventricular Hypertrophy and Hypertrophic Cardiomyopathy. J Cardiovasc Imaging 2023; 31:41-48. [PMID: 36693344 PMCID: PMC9880349 DOI: 10.4250/jcvi.2022.0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/07/2022] [Accepted: 09/05/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The function of left atrium (LA) is difficult to assess because of its ventricle-dependent, dynamic movement. The aim of this study was to assess LA function using velocity vector imaging (VVI) and compare LA function in patients with hypertrophic cardiomyopathy (HCMP) and left ventricular hypertrophy (LVH) with normal controls. METHODS Fourteen patients with HCMP (72% male, mean age of 52.6 ± 9.8), 15 hypertensive patients with LVH (88% male, mean age of 54.0 ± 15.3), and 10 age-matched controls (83% male, mean age of 50.0 ± 4.6) were prospectively studied. Echocardiographic images of the LA were analyzed with VVI, and strain rate (SR) was compared among the 3 groups. RESULTS The e' velocity (7.7 ± 1.1; 5.1 ± 0.8; 4.5 ± 1.3 cm/sec, p = 0.013), E/e' (6.8 ± 1.6; 12.4 ± 3.3; 14.7 ± 4.2, p = 0.035), and late diastolic SR at mid LA (-1.65 ± 0.51; -0.97 ± 0.55; -0.82 ± 0.32, p = 0.002) were significantly different among the groups (normal; LVH; HCMP, respectively). The e' velocity, E/e', and late diastolic SR at mid LA were significantly different between normal and LVH (p = 0.001; 0.022; 0.018), whereas LA size was similar between normal and LVH (p = 0.592). The mean late diastolic peak SR of mid LA was significantly correlated with indices of diastolic function (E/e', e', and LA size). CONCLUSIONS The SR is a useful tool for detailed evaluation of LA function, especially early dysfunction of LA in groups with normal LA size.
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Affiliation(s)
- Se-Jung Yoon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eui-Young Choi
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye-Sun Seo
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Ai Kim
- Division of Cardiology, Hallym University Medical Center, Pyungchon, Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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16
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Wałek P, Roskal-Wałek J, Dłubis P, Tracz J, Wożakowska-Kapłon B. Left Atrial Wall Motion Velocity Assessed during Atrial Fibrillation Predicts Sinus Rhythm Maintenance after Electrical Cardioversion in Patients with Persistent Atrial Fibrillation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15508. [PMID: 36497585 PMCID: PMC9740887 DOI: 10.3390/ijerph192315508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
Reduced left atrial wall motion velocity measured during AF (LAWMV) indicates left atrial remodeling. The aim of this study was to investigate whether LAWMV assessed with tissue Doppler imaging during atrial fibrillation (AF) predicts sinus rhythm (SR) maintenance after direct current cardioversion (DCCV) for persistent AF. The study included 126 patients who underwent DCCV and were followed for 12 months. At 12 months, maintained SR was reported in 55 patients (43.7%). We noted that LAWMV was higher in patients with maintained SR at 12 months than in those with recurrent AF (3.69 ± 0.84 vs. 2.86 ± 1.09; p < 0.001). In the multivariable regression model containing echocardiographic variables, LAWMV was an independent predictor of SR maintenance at 12 months (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.1-2.69; p = 0.017). Similarly, LAWMW was an independent predictor of SR maintenance at 12 months (OR 1.81, 95% CI 1.19-2.77; p = 0.006) in the multivariate regression model containing both echocardiographic and clinical variables. LAWMV predicts SR maintenance after DCCV for persistent AF. Echocardiographic markers of left atrial mechanical remodeling are better at predicting SR maintenance than markers of structural remodeling.
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Affiliation(s)
- Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| | - Joanna Roskal-Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland
| | - Patryk Dłubis
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
| | - Justyna Tracz
- Clinic of Neurology, Swietokrzyskie Neurology Center, 25-736 Kielce, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
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17
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Mishima RS, Ariyaratnam JP, Pitman BM, Malik V, Emami M, McNamee O, Stokes MB, Lau DH, Sanders P, Elliott AD. Cardiorespiratory fitness, obesity and left atrial function in patients with atrial fibrillation. IJC HEART & VASCULATURE 2022; 42:101083. [PMID: 35971520 PMCID: PMC9375161 DOI: 10.1016/j.ijcha.2022.101083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/26/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
Background Low cardiorespiratory fitness (CRF) and obesity are related to the development and maintenance of atrial fibrillation (AF). The aim of this study was to determine the association between CRF, obesity and left atrial (LA) mechanical parameters in patients with AF. Methods A cohort of 154 consecutive paroxysmal and persistent AF patients (Age: 62 ± 10, 26% female) referred for exercise stress testing and transthoracic echocardiography were included. We included patients in sinus rhythm with preserved left ventricular ejection fraction who were able to complete a maximal exercise test. Left atrial strain in the reservoir (LASr), booster (LASb) and conduit (LASc) phases were assessed using dedicated software. LA stiffness, emptying fraction (LAEF) and LA to LV ratio were calculated using previously described formulas. Results CRF was positively associated with LAEF (β = 1.3, 95% CI 0.1–2.3, p = 0.02), reservoir (β = 1.5, 95% CI 0.9–2.1, p < 0.001), booster (β = 0.8, 95% CI 0.4–1.2, p < 0.001) and conduit strain (β = 0.7, 95% CI 0.3–1.1, p = 0.001). We observed an inverse association between CRF and both LA stiffness index (β = −0.02, 95% CI (−0.03)–(−0.01), p < 0.001) and LA to LV ratio (β = −0.03, 95% CI (−0.04)–(−0.01), p < 0.001). Obese patients had significantly higher indexed LA volumes compared to overweight and normal BMI patients. The association between obesity and measures of LA function and stiffness did not reach statistical significance. Conclusion Among AF patients, higher CRF was independently associated with greater LA function and compliance. Obesity was associated with higher LA volumes yet preserved mechanical function.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Adrian D. Elliott
- Corresponding author at: Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide 5000, Australia.
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18
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Choi JH, Kim JY, Hwang JK, Kim HR, Chung TW, Kim J, Park SW, Kang IS, Song J, Park SJ, Park KM, On YK, Kim JS, Huh J. Assessment of left atrial remodeling using speckle tracking echocardiography after percutaneous atrial septal defect closure in adult patients. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-022-00074-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is a well-known, long-term complication of atrial septal defect (ASD) in adults, even after device closure. Left atrial (LA) strain rate applied to the analysis of chamber function has been demonstrated to be an important predictor of LA reverse remodeling. This study aimed to determine the changes in chamber function after device closure of ASD.
Methods
This prospective study enrolled adults with secundum ASD undergoing transcatheter device closure from December 2016 to August 2017. We analyzed the clinical characteristics and LA strain rate before and six months after ASD closure.
Results
A total of 11 patients were enrolled. The mean age was 42.6 ± 9.9 years, and six (54.5%) were females. There was no significant change of conventional echocardiographic parameters after ASD closure. The mean global LA reservoir strain rate before ASD closure was 1.17 ± 0.34 and 0.85 ± 0.30 after ASD closure (p = 0.030). The median global LA conduit strain rate was 0.68 (0.42–1.16) and 0.41 (0.16–0.79) before and after ASD closure (p = 0.213), respectively. The mean global LA contractile strain rate at the six-month follow-up showed significant improvement compared with pre-procedural strain rate (0.33 ± 0.65 vs. − 0.43 ± 0.38, p = 0.006).
Conclusions
LA functional changes occurred during the six-month follow-up, while LA and right atrial (RA) geometric changes were not significant. LA reverse remodeling was proved by restoration of LA late diastolic contractile function.
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19
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Ji M, He L, Gao L, Lin Y, Xie M, Li Y. Assessment of Left Atrial Structure and Function by Echocardiography in Atrial Fibrillation. Diagnostics (Basel) 2022; 12:1898. [PMID: 36010248 PMCID: PMC9406407 DOI: 10.3390/diagnostics12081898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia with significant morbidity and mortality. Exacerbated by the aging population, the prevalence of AF is gradually increasing. Accurate evaluation of structure and function of left atrium (LA) has important prognostic significance in patients with AF. Echocardiography is the imaging technique of first choice to assess LA structure and function due to its better availability, accessibility and safety over cardiac computed tomography and cardiac magnetic resonance. Therefore, the aim of this review is to summarize the recent research progress of evaluating LA size by three-dimensional echocardiography and LA function by speckle tracking echocardiography (STE) in predicting the occurrence and recurrence of AF and determining the risk of stroke in AF. In addition, we summarized the role of traditional echocardiography in detecting AF patients that are at high risk of heart failure or cardiovascular death.
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Affiliation(s)
- Mengmeng Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lin He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lang Gao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
- Tongji Medical College and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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20
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Mojica-Pisciotti ML, Panovský R, Masárová L, Pešl M, Stárek Z, Holeček T, Feitová V, Opatřil L, Doležalová K, Kincl V. Left atrium phasic impairments in paroxysmal atrial fibrillation patients assessed by cardiovascular magnetic resonance feature tracking. Sci Rep 2022; 12:7539. [PMID: 35534637 PMCID: PMC9085809 DOI: 10.1038/s41598-022-11233-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/06/2022] [Indexed: 11/12/2022] Open
Abstract
Atrial fibrillation (AF) is an abnormal and irregular heartbeat caused by uncoordinated electrical impulses in the left atrium (LA), which could induce lasting changes in the heart tissue or could be a consequence of underlying cardiac disease. This study aimed to assess the left atrial phasic function and deformation in paroxysmal AF (PAF) patients—who had not received radiofrequency ablation and had no signs of permanent AF—using the cardiovascular magnetic resonance (CMR) feature-tracking (FT) technique. Fifty subjects (27 PAF patients and 23 controls) were included and examined with CMR. Their LA volume, LA function, LA longitudinal strain (LS) and LA strain rate were assessed in the LA reservoir, conduit, and contractile phases. PAF patients exhibited higher LA volumes than controls, while their LA emptying fraction and LA LS was significantly lower in all three phases. In contrast, the corresponding emptying volumes (total, passive and active) were similar in both groups. The LA volumetric rates from CMR-derived volume curves differed significantly in PAF patients vs controls in the reservoir and contractile phases. In contrast, the equivalent LV volumetric rates were similar. This study suggests that assessing the LA phasic function could offer insight into early LA impairments for PAF patients.
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21
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Samrat S, Sofi NU, Aggarwal P, Sinha SK, Pandey U, Sharma AK, Razi M, Sachan M, Shukla P, Thakur R. Assessment of the Left Atrial Reservoir Function and Left Atrial Volume After Percutaneous Balloon Mitral Valvuloplasty Using Peak Atrial Longitudinal Strain. Cureus 2022; 14:e22395. [PMID: 35371802 PMCID: PMC8938600 DOI: 10.7759/cureus.22395] [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] [Accepted: 02/19/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To evaluate the impact of successful percutaneous balloon mitral valvuloplasty (BMV) on left atrial (LA) reservoir function and LA volume in patients with severe mitral stenosis (MS) using peak atrial longitudinal strain (PALS). Method This was a prospective, non-randomized observational study conducted at the Laxmipat Singhania (LPS) Institute of Cardiology, Kanpur from August 2018 to February 2020 among patients with severe rheumatic MS undergoing BMV to assess LA reservoir function and its volume after BMV using PALS. Inclusion criteria were symptomatic severe rheumatic MS (NYHA ≥II), normal ventricular systolic function, and suitable valve morphology. Exclusion criteria were the coexistence of aortic valve involvement, left atrial appendage clot, mitral leak more than mild, pregnancy, hypertension, diabetes, and coronary artery disease. To assess LA reservoir function and its volume after BMV, PALS was used. LA was divided into six regions of interest and longitudinal strain curves of individual segments together with global strain were recorded. PALS was calculated at baseline 24 hours following the intervention, and at three months of follow-up. Result Successful BMV was performed in 260 patients (109 or 41.9% males and 151 or 58.1% females), resulting in significant improvement in mitral valve area (MVA) (0.89±0.11 cm2 vs. 1.83±0.3 cm2; p<0.001). The mean age of patients was 26.7±4.7 years; 214 (82.3%) patients were in normal sinus rhythm (NSR) while 46 (17.7%) had atrial fibrillation (AF). Significant improvement in PALS was noted immediately following the procedure (6.5±11.6% vs. 7.7±10.5%; p< 0.001) and it continued to improve at three months of follow-up (6.5±11.6% vs. 11.3±12.5%; p<0.001), which was 24% and 74% improvement from baseline respectively. Significant reduction in indexed left atrial (LA) volume was observed immediately following the procedure (56.8±14.3 ml/m2 vs 48.4±12.5 ml/m2; p=0.003), and at three months of follow-up (56.8±14.3 ml/m2 vs. 45.4±13.3 ml/m2; p=0.002). Those with AF had lesser improvement in PALS in comparison to those with NSR (60% vs. 84%; p=0.044) at three months of follow-up. At three months, the increase in PALS was also lower in patients with a history of stroke as compared to those without it (55% vs 80%; p=0.039). Both LA volume and indexed LA volume reduced significantly immediately at 24 hours and during follow-up. Conclusion LA reservoir function, as assessed by PALS, is reduced in patients with severe MS. It improved significantly within 24 hours following BMV and continued to improve at three months of follow-up. It is an underutilized modality among patients of MS for decision-making prior to intervention and to assess the effect of the intervention.
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Affiliation(s)
- Siddharth Samrat
- Cardiology, Laxmipat Singhania Institute of Cardiology, Kanpur, IND
| | - Najeeb U Sofi
- Cardiology, Laxmipat Singhania Institute of Cardiology, Kanpur, IND
| | - Puneet Aggarwal
- Cardiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, Delhi, IND
| | - Santosh K Sinha
- Cardiology, Laxmipat Singhania Institute of Cardiology, Kanpur, IND
| | - Umeshwar Pandey
- Cardiology, Laxmipat Singhania Institute of Cardiology, Kanpur, IND
| | | | - Mahmodullah Razi
- Cardiology, Laxmipat Singhania Institute of Cardiology, Kanpur, IND
| | - Mohit Sachan
- Cardiology, Laxmipat Singhania Institute of Cardiology, Kanpur, IND
| | - Praveen Shukla
- Cardiology, Laxmipat Singhania Institute of Cardiology, Kanpur, IND
| | - Ramesh Thakur
- Cardiology, Laxmipat Singhania Institute of Cardiology, Kanpur, IND
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22
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Charitakis E, OKarlsson L, Carlhäll CJ, Liuba I, Jönsson AH, Walfridsson H, Alehagen U. Endocrine and Mechanical Cardiacfunction Four Months after Radiofrequency Ablation of Atrialfibrillation. J Atr Fibrillation 2021; 14:20200454. [PMID: 34950357 DOI: 10.4022/jafib.20200454] [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: 01/03/2021] [Revised: 02/17/2021] [Accepted: 06/15/2021] [Indexed: 11/10/2022]
Abstract
Background Radiofrequency ablation (RFA)is an important treatment option for patients with atrial fibrillation (AF). During RFA, a significant amount of energy is delivered into the left atrium (LA), resulting in considerable LA-injury. The impact of this damage on mechanical and endocrine LA-function, however, is often disregarded.We therefore aimed to evaluate the endocrine- and mechanical function of the heart 4-months after RFA of AF. Methods In total 189 patients eligible for RFA of AF were studied. The levels of the N-terminal pro-B-natriuretic peptide (NT-proBNP) and the mid-regional fragment of the N-terminal pro-atrial natriuretic peptide (MR-proANP)were measured. The maximum LAvolume (LAVmax),the LAejection fraction (LAEF) and the LA peak longitudinal strain (PALS), were measured usingtransthoracic echocardiography. The measurements were performed before and 4-months after the intervention. Results 87 patients had a recurrence during a mean follow-up of 143±36 days.NT-proBNPand MR-proANPdecreased significantly at follow-up. This reduction was greater in patients who did not suffer any recurrence after RFA.The LAVmax decreased significantly, whereasthe PALS only improved in patients who did not suffer from any recurrence. On the other hand, LAEF did not change significantly after RFA of AF. Conclusions Despite extensiveablation during RFA of AF, the endocrine function of the heart improved 4-months after the index procedure. Patients with no arrhythmia recurrence showed a more pronounced improvement in their endocrinal function. Mechanically, the LAVmax was reduced, and the LA strain improved significantly.
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Affiliation(s)
- Emmanouil Charitakis
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars OKarlsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Department of Clinical physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Division of Cardiovascular Medicine and CMIV, Linköping University, Linköping, Sweden
| | - Ioan Liuba
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anders Hassel Jönsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Håkan Walfridsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Urban Alehagen
- Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
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23
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Philippsen TJ, Christensen LS, Nybo M, Hansen MS, Dahl JS, Brandes A. Circulating biomarkers, echocardiographic parameters, and incident subclinical atrial fibrillation in patients with diabetes and hypertension. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:35-42. [PMID: 34739729 DOI: 10.1111/pace.14399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/23/2021] [Accepted: 10/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Long-term rhythm monitoring (LTRM) can detect undiagnosed atrial fibrillation (AF) in patients at high risk of AF and stroke. Biomarkers and echocardiographic parameters could, however, help identify patients benefitting most from LTRM. The aim of this study was to investigate, whether circulating biomarkers of cardiac and vascular function (brain natriuretic peptide (BNP), cardiac troponin I (cTnI), copeptin, and mid-regional proadrenomedullin (MR-proADM)) and echocardiographic parameters were associated with incident subclinical AF (SCAF) in a population at high risk of stroke in the presence of AF. For this purpose, we investigated individuals ≥65 years of age with hypertension and diabetes mellitus, but no history or symptoms of AF or other cardiovascular disease (CVD). METHODS We included 82 consecutive patients (median age 71.3 years (IQR 67.4-75.1)). All patients received an insertable cardiac monitor (ICM) and were followed for a median of 588 days (IQR 453-712). On the day of ICM implantation, a comprehensive echocardiogram and blood samples were obtained. RESULTS During a median follow-up of 588 days (IQR: 453-712 days), incident SCAF occurred in 17 patients (20.7%) with a median time to first-detected episode of 91 days (IQR 41-251 days). MR-proADM (median 0.87 nmol/L (IQR 0.76-1.02) vs 0.78 nmol/L (IQR 0.68-0.98)) and copeptin (median 13 pmol/L (IQR 9-17) vs 8 pmol/L (IQR 4-18)) levels were insignificantly higher in patients with incident SCAF. BNP and cTnI concentrations and echocardiographic parameters were similar in the two groups. CONCLUSIONS MR-proADM, BNP, cTnI, copeptin, and several echocardiographic parameters were not associated with incident SCAF in this cohort of patients with hypertension and diabetes, but without any underlying CVD.
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Affiliation(s)
- Tine J Philippsen
- Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark.,OPEN - Open Patient Data Explorative Network, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Lene S Christensen
- Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Michael S Hansen
- Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Internal Medicine - Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark
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24
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Kaufmann R, Rezar R, Strohmer B, Wernly B, Lichtenauer M, Hitzl W, Meissnitzer M, Hergan K, Granitz M. Left Atrial Ejection Fraction Assessed by Prior Cardiac CT Predicts Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation. J Clin Med 2021; 10:jcm10040752. [PMID: 33668541 PMCID: PMC7918780 DOI: 10.3390/jcm10040752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 12/03/2022] Open
Abstract
Assuming that atrial fibrillation (AF) is associated with left atrial remodeling and dysfunction, we hypothesize that left atrial and left atrial appendage ejection fractions (LAEF and LAAEF) are useful and may be more sensitive outcome predictors of pulmonary vein isolation (PVI). Fifty patients who underwent PVI at our institution with available pre-interventional cardiac computed tomography (CT) for procedure planning were included in this retrospective study. The patients were separated into two groups by recurrence and non-recurrence of AF and subgroups of paroxysmal and persistent AF. Semiautomatic volumetric analysis of the left atrium was used to calculate morphological and functional parameters and optimal cut-offs were calculated using the Youden index. LAEF (accuracy 94%, sensitivity 67%) and LAAEF (accuracy 90%, sensitivity 67%) were significantly reduced in patients with AF recurrence (16% vs. 36%, p = 0.00002; 16% vs. 42%, p = 0.000002), and in the subgroup analysis, the functional parameters were independent from AF type (paroxysmal and persistent). With a cut-off of <23% for both LAEF and LAAEF (area under the curve (AUC) 0.94, 95%CI 0.84–0.99 and AUC 0.96, 95%CI 0.86–0.99, respectively), AF recurrence occurred in 77.8%, within a mean follow-up period of 229 days. In conclusion, left atrial function on prior cardiac CT offers useful parameters for predicting AF recurrence after PVI.
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Affiliation(s)
- Reinhard Kaufmann
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (K.H.); (M.G.)
- Correspondence:
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (R.R.); (B.S.); (B.W.); (M.L.)
| | - Bernhard Strohmer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (R.R.); (B.S.); (B.W.); (M.L.)
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (R.R.); (B.S.); (B.W.); (M.L.)
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (R.R.); (B.S.); (B.W.); (M.L.)
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
| | - Matthias Meissnitzer
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (K.H.); (M.G.)
| | - Klaus Hergan
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (K.H.); (M.G.)
| | - Marcel Granitz
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (K.H.); (M.G.)
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25
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The prognostic value of left atrial dyssynchrony measured by speckle tracking echocardiography in the general population. Int J Cardiovasc Imaging 2021; 37:1679-1688. [PMID: 33506346 DOI: 10.1007/s10554-020-02154-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
LA dyssynchrony is a predictor of cardiovascular morbidity in various patient populations. However, the prognostic value of LA dyssynchrony as evaluated by two-dimensional speckle tracking (2D-STE) in the general population is unknown. A cohort of 375 participants without atrial fibrillation (AF), ischemic heart disease (IHD), heart failure (HF) or previous ischemic stroke (IS) had an echocardiogram, including LA 2D-STE, performed. LA dyssynchrony was defined as the standard deviation of the time to peak regional LA reservoir strain values. The endpoints were all-cause mortality, a combined endpoint of AF and IS, and a combined endpoint of major adverse cardiovascular events (MACE) comprised of acute myocardial infarction (AMI), HF or cardiovascular death (CVD). During a median follow up of 16.1 years (IQR 15.0-16.3 years), 83 (22%) participants died, 60 (15%) reached the composite endpoint of AF and IS, and 38 (10%) reached the composite MACE endpoint. LA dyssynchrony was a univariable predictor of all-cause mortality (HR 1.07, 95% CI 1.02-1.11, p = 0.001) but was not significantly associated with the combined endpoint of AF and IS (HR 1.05, p = 0.064) nor MACE (HR 1.04, p = 0.22). However, when adjusted for age, LA dyssynchrony did not predict all-cause mortality (HR 1.03, p = 0.28). Similarly, after further adjustments for clinical and echocardiographic parameters LA dyssynchrony did not predict any of the study outcomes. In this general population study, LA dyssynchrony was not an independent predictor of all-cause mortality and did not predict MACE nor a composite outcome consisting of AF and IS.
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26
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NATARAJAN KARTHIK, MANSURI ZEESHAN, JOSHI DINESH, SHUKLA ANAND, SHARMA VISHAL, PANDEY VIMLESH, BHATIA SANJEEV, PATEL KRUTIKA. Association of Structure and Function of left atrial Appendage with Left atrial appendage Thrombus formation in patients with Rheumatic Heart Disease. HEART INDIA 2021; 9:78-82. [DOI: 10.4103/heartindia.heartindia_40_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2025] Open
Abstract
Context:
In patients with rheumatic heart disease (RHD), left atrial appendage (LAA) dilation and thrombus formation is widely known. LAA thrombus formation is a risk factor for stroke even in patients with sinus rhythm. The aim of this study was to determine an association between LAA structure and function with respect to thrombus formation and differences in LAA size and velocity between patients with sinus rhythm and those with atrial fibrillation (AF).
Materials and Methods:
We prospectively studied LAA structure and function in 120 patients with RHD by transthoracic echocardiography and/or transesophageal echocardiography by measuring left atrial (LA) dimension, LA area, LAAmax/min, LAA ejection fraction (EF), and LAA emptying velocity.
Results:
Four out of 48 patients with sinus rhythm had LAA thrombus. In 72 patients with AF, 32 had LAA thrombus. Patients with LAA thrombus had lower mean LAA EF and emptying velocity both variables P-value is same (P<0.0001 and P<0.0001) Patients with LAA thrombus had increased mean LAA max and LAA min as compared to LAA max and LAA min in patients without LAA thrombus (P 0.008 for mean LAA max and P<0.0001 for LAA min respectively). Patients with AF with LAA thrombus had greater LAAmax compared to that in patients with AF without LAA thrombus (P < 0.0001). Doppler demonstrated a recognizable sawtooth LAA outflow velocity pattern in 32 of 36 (88.9%) patients with LAA thrombus versus 32 of 84 (38.1%) patients without LAA thrombus.
Conclusions:
We conclude that LAA contractility is reduced in RHD with LAA thrombus, and loss of both contractility and LAA dilation is associated with increased risk of thrombus formation and hence the risk of stroke.
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27
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Siam-Tsieu V, Urtado S, Charron P, Hergault H, Szymanski C, Mallet S, Dubourg O, Mansencal N. Assessment of atrial function by myocardial deformation techniques in hypertrophic cardiomyopathy. Echocardiography 2021; 38:230-237. [PMID: 33382507 DOI: 10.1111/echo.14968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/18/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diastolic dysfunction in hypertrophic cardiomyopathy (HCM) is common, but its assessment is difficult using conventional echocardiography. AIMS To assess left atrial (LA) function in HCM by longitudinal strain and determine its role in understanding of symptoms. METHODS We studied 144 patients divided into 3 age- and sex-matched groups: 48 consecutive patients with HCM, 48 control subjects, and 48 athlete subjects. We assessed LA function by conventional echocardiographic parameters and by longitudinal atrial strain (early-diastolic left atrial strain during reservoir phase [LASr]; end-diastolic left atrial strain during conduit phase; end-systolic peak of the left atrial strain during contraction phase). RESULTS NYHA classification was as follows in HCM group: I in 46%, II in 31%, III in 19%, and IV in 4%. Conventional echocardiographic parameters of diastolic function were depressed in the HCM group as compared to the control and athlete groups, but not related to symptoms. All longitudinal atrial strain parameters were significantly reduced in HCM group as compared to two groups (P < .0001). LASr was significantly correlated to peak VO2 (r = 0.44, P = .01) and was the best parameter for detecting symptomatic patients presenting with HCM, with a cutoff value of 15%: Sensitivity was 71%, specificity was 79%, PPV was 77%, and NPV was 73%. CONCLUSION Assessment of LA function in HCM is feasible using longitudinal strain, and this technique is more reliable than conventional echocardiographic parameters for the understanding of determinants of symptoms.
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Affiliation(s)
- Valerie Siam-Tsieu
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne, France
| | - Sophie Urtado
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne, France
| | - Philippe Charron
- INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif, France.,AP-HP, Centre de référence des maladies cardiaques héréditaires, ICAN, Hôpital Pitié-Salpêtrière, Paris & Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Hélène Hergault
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne, France
| | - Catherine Szymanski
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne, France.,INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif, France
| | - Sophie Mallet
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne, France
| | - Olivier Dubourg
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne, France.,INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif, France
| | - Nicolas Mansencal
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne, France.,INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif, France
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Liao JN, Chao TF, Hung CL, Chen SA. The decrease in peak atrial longitudinal strain in patients with atrial fibrillation as a practical parameter for stroke risk stratification. Heart Rhythm 2020; 18:538-544. [PMID: 33385571 DOI: 10.1016/j.hrthm.2020.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/05/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Decreased peak atrial longitudinal strain (LA strain) derived from 2-dimensional speckle tracking is frequently observed in patients with atrial fibrillation (AF) and associated with the risk of ischemic stroke. OBJECTIVES We aimed to study the predictive power of the decrease in LA strain in population with AF and hypothesize that the difference in LA strain between reference values could be used in a stratified way for prognostication. METHODS Echocardiography examination was performed using the GE system [GE Vivid i system (GE Healthcare, Horten, Norway)]. The standard score of LA strain (ZLA) was calculated, and patients were classified into 5 groups: Z0 (0 to -1), Z-1 (-1 to -2), Z-2 (-2 to -3), Z-3, (-3 to -4), and Z-4 (≤-4). The clinical end point was an ischemic stroke. RESULTS Of the 1364 subjects with AF (mean age 71.4 ± 12.1 years; 759 men (55.6%), 105 encountered ischemic strokes during a mean follow-up period of 3.1 ± 1.6 years. No patients in the Z0 and Z-1 groups encountered ischemic stroke. The Kaplan-Meier analysis showed higher rates of stroke in worse ZLA groups. Compared with the Z-2 group, a significantly increased risk of stroke was found in the Z-3 (hazard ratio 3.697; 95% confidence interval 1.966-6.951; P < .001) and Z-4 (hazard ratio 6.447; 95% confidence interval 2.990-13.904; P < .001) groups in univariate Cox regression analysis. The results remained consistent after multivariate Cox regression analysis. CONCLUSION The decrease in LA strain could be applied in a stratified manner and is significantly associated with the risk of stroke independent of the baseline covariates.
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Affiliation(s)
- Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan; Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan; Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan.
| | - Shih-Ann Chen
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, and Taipei Veterans General Hospital, Taipei, Taiwan.
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Wałek P, Ciesla E, Gorczyca I, Wożakowska-Kapłon B. Left atrial wall dyskinesia assessed during contractile phase as a predictor of atrial fibrillation recurrence after electrical cardioversion performed due to persistent atrial fibrillation. Medicine (Baltimore) 2020; 99:e23333. [PMID: 33285712 PMCID: PMC7717756 DOI: 10.1097/md.0000000000023333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Direct current cardioversion (DCCV) is one of the basic methods for restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). Left atrial (LA) strain is one of the parameters used to assess the risk of AF recurrence following DCCV. Assessing the strain also allows for the detection of segmental disorders of LA wall contractility, including dispersion or dyskinesia. In the present study, we determined the predictive value of LA wall dyskinesia in assessing the risk of AF recurrence after DCCV. We performed a comprehensive echocardiography in 89 patients with persistent AF following successful DCCV. We assessed the strain and strain rate in the reservoir (r), conduit, and contractile (ct) phases by using speckle tracking echocardiography. Dyskinesia was diagnosed when the strain rate of any segment of the LA wall displayed positive values during contraction. After 12 months, 47.2% of patients maintained SR. Patients who maintained SR had a significantly lower LA strain (LAS)r assessed in the apical 4-chamber view (4c) (11.38 ± 4.63 vs 14.54 ± 5.11; P = .004) and 2-chamber view (2c) (11.05 ± 4.1 vs 14.93 ± 6.82%; P = .006), LASct4c (2.51 ± 2.3 vs 5.09 ± 3.29%; P < .001), LASct2c (3.6 ± 2.98 vs 5.67 ± 4.23%; P = .008), peak strain rate (pLASR) ct4c (0.36 ± 0.24 s vs 0.62 ± 0.4; P < .001) and pLASRct2c (0.49 ± 0.30 vs 0.79 ± 0.53 s; P = .01). LA dyskinesia was observed less frequently in the 4c view in patients who maintained SR (59.57 vs 17.5%; P < .001). Multivariable logistic regression showed that the LASct4c (odds ratio (OR) 0.78; 95%CI 0.63-0.97; P = .027) and LA dyskinesia observed in the 4c view (OR 3.53; 95%CI 1.16-10.76; P = .027) were significant independent predictors of AF recurrence at 12 months. We conclude that LA dyskinesia observed in the 4c view and LASct4c are independent risk factors for AF recurrence following DCCV.
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Affiliation(s)
- Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, Kielce
- 1st Clinic of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Elzbieta Ciesla
- Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, Kielce
| | - Iwona Gorczyca
- Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, Kielce
- 1st Clinic of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 19 IX Wieków Kielc Street, Kielce
- 1st Clinic of Cardiology and Electrotherapy, Voivodship Hospital Kielce, Grunwaldzka 45, 25-736 Kielce, Poland
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30
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Seo JS, Park YA, Wi JH, Jin HY, Han IY, Jang JS, Yang TH, Kim DK, Kim DS. Long-Term Left Atrial Function after Device Closure and Surgical Closure in Adult Patients with Atrial Septal Defect. J Cardiovasc Imaging 2020; 29:123-132. [PMID: 33605098 PMCID: PMC8099578 DOI: 10.4250/jcvi.2020.0142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Studies comparing left atrial (LA) function after surgical closure or percutaneous closure in patients with an atrial septal defect (ASD) are lacking. METHODS Between 1 and 3 years after ASD treatment, we retrospectively analyzed the medical records and transthoracic echocardiographic images of patients who had been diagnosed with an ASD after 20 years of age and who had undergone surgical closure (ASD-S) or percutaneous device closure (ASD-D). We measured LA peak systolic, early diastolic, and late diastolic strain values using 2-dimensional (2D) speckle tracking echocardiography (STE) and calculated reservoir, conduit, and contraction strain. RESULTS The reservoir strain value of the ASD-D groups was 25.2% ± 7.4%, which was lower compared to the control group (33.6% ± 5.5%) (p = 0.004). The LA conduit strain and the LA contraction values of the ASD-D group were also lower compared to the control group (−13.8% ± 5.8% vs. −20.4% ± 4.7%, p = 0.034; −11.3% ± 4.2% vs. −13.2% ± 2.5%, p = 0.037, respectively). The reservoir, conduit, and contraction strains of the ASD-S group were 27.8% ± 8.8%, −15.3% ± 6.4%, and −12.5% ± 5.8%, respectively, and were not different from those of the control group or the ASD-D group. CONCLUSIONS The 2D STE is a suitable method for evaluating LA function after ASD closure. Our results demonstrate that 1 year after device closure, the LA reservoir, conduit and contraction function were reduced in ASD-D group compared to healthy controls, while there was no difference between the ASD-S and ASD-D groups.
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Affiliation(s)
- Jeong Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea.
| | - Young Ah Park
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Jin Hong Wi
- Department of Thoracic and Cardiovascular Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Han Young Jin
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Il Yong Han
- Department of Thoracic and Cardiovascular Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Jae Sik Jang
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Tae Hyun Yang
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Dae Kyeong Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Dong Soo Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
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Left atrial emptying fraction determined during atrial fibrillation predicts maintenance of sinus rhythm after direct current cardioversion in patients with persistent atrial fibrillation. PLoS One 2020; 15:e0238002. [PMID: 32822402 PMCID: PMC7446797 DOI: 10.1371/journal.pone.0238002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022] Open
Abstract
Echocardiography is the basic imaging technique used to determine the odds of maintaining sinus rhythm (SR) following direct current cardioversion (DCCV) for persistent atrial fibrillation (AF). However, most studies are focused on the echocardiographic parameters obtained during SR resulting from successful DCCV. The aim of this study was to assess the value of the echocardiographic parameters measured before DCCV for the prognosis of SR maintenance after DCCV. The study included 146 patients with persistent AF who underwent DCCV. Clinical and echocardiographic data were collected directly before DCCV and, for patients with SR, one month, six months, and 12 months after DCCV. We found that left atrial emptying fraction (LAEF) assessed during atrial fibrillation was significantly larger in the group with SR maintenance after 12 months than in the group with AF recurrence (30.8±8.3 vs. 24.6±10.4%; p<0.001). In multivariable logistic regression analysis with a model containing echocardiographic parameters, LAEF (OR 1.053; 95% CI 1.011-1.096; p = 0.013) and the E/e'mean ratio (OR 0.883; 95% CI 0.788-0.990; p = 0.033) were independent predictors of SR maintenance. Analyzing a model including clinical and echocardiographic variables, only LAEF (OR 1.046; 95% CI 1-1.095; p = 0.049) and beta-blockers used before DCCV (OR 14.694; 95% CI 1.622-133.139; p = 0.017) were independent predictors of SR maintenance after 12 months. Our results indicate that LAEF measured during AF is a significant predictor of SR maintenance in the 12 months following DCCV due to persistent AF. Our findings confirm the recently raised hypothesis about the superiority of echocardiographic parameters assessing mechanical remodeling over parameters assessing structural remodeling of left atrium in predicting sinus rhythm maintenance after electrical cardioversion.
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Liao JN, Chao TF, Kuo JY, Sung KT, Tsai JP, Lo CI, Lai YH, Su CH, Hung CL, Yeh HI. Global Left Atrial Longitudinal Strain Using 3-Beat Method Improves Risk Prediction of Stroke Over Conventional Echocardiography in Atrial Fibrillation. Circ Cardiovasc Imaging 2020; 13:e010287. [DOI: 10.1161/circimaging.119.010287] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Atrial fibrillation (AF) is associated with a risk of ischemic stroke, and functional myocardial imaging has offered novel insights on its pathophysiology and prognosis, but its use in AF-related stroke remains limited. We aimed to evaluate the feasibility of left atrial (LA) deformations and its prognostic values of ischemic stroke in a large-scale AF population.
Methods:
Peak atrial longitudinal strain (LA strain), left ventricular strain (global longitudinal strain), LA strain rate (LA SR) at reservoir (LA longitudinal systolic strain rate), and early diastolic conduit (LA longitudinal early diastolic strain rate) phases were analyzed using 2-dimensional speckle tracking echocardiography. Consecutive 3-beat averaged values of strain and SR were used. The clinical end point was ischemic stroke.
Results:
Among 1457 AF participants, the mean LA strain, LA longitudinal systolic strain rate, and LA longitudinal early diastolic strain rate values were 12.9±4.8%, 0.80±0.28 s
−
1
, and −1.17±0.46 s
−
1
, respectively. There were strong positive linear relationships of 3-beat average with index-beat analysis (R=0.94, 0.94, and 0.94 for LA strain, LA longitudinal systolic strain rate, and LA longitudinal early diastolic strain rate, respectively; all
P
<0.001). Multivariate Cox regression models incorporating conventional echocardiography parameters demonstrated LA strain and SRs to be independent prognosticators of ischemic stroke during a median follow-up of 37.6 months. Utilization of LA strain further provided incremental value over CHA
2
DS
2
-VASc scoring (
C
statistics, 0.78–0.81;
P
=0.006) for ischemic stroke. Overall, the prognostic performances of LA deformations were attenuated after adding global longitudinal strains in models.
Conclusions:
LA deformations by the 3-beat method are feasible and reproducible during AF. LA strain provided additional prognostic implication over clinical information and conventional echocardiographic measures for ischemic stroke in the AF population but not incremental to global longitudinal strains.
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Affiliation(s)
- Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (J.-N.L., T.-F.C.)
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (J.-N.L., T.-F.C.)
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (J.-N.L., T.-F.C.)
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan (J.-N.L., T.-F.C.)
| | - Jen-Yuan Kuo
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
| | - Kuo-Tzu Sung
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
| | - Jui-Peng Tsai
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
| | - Chi-In Lo
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
| | - Yau-Huei Lai
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
| | - Cheng-Huang Su
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
| | - Chung-Lieh Hung
- Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan (C.-L.H.)
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
| | - Hung-I Yeh
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.)
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Impact of baseline left atrial function on long-term outcome after catheter ablation for paroxysmal atrial fibrillation. J Cardiol 2020; 75:352-359. [DOI: 10.1016/j.jjcc.2019.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/05/2019] [Accepted: 08/16/2019] [Indexed: 11/17/2022]
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Left atrial mechanical remodelling assessed as the velocity of left atrium appendage wall motion during atrial fibrillation is associated with maintenance of sinus rhythm after electrical cardioversion in patients with persistent atrial fibrillation. PLoS One 2020; 15:e0228239. [PMID: 31995607 PMCID: PMC6988946 DOI: 10.1371/journal.pone.0228239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/11/2020] [Indexed: 11/19/2022] Open
Abstract
The velocity of left atrium appendage (LAA) wall motion during atrial fibrillation (AF) is a potential marker of mechanical remodelling. In this study, we investigated whether the velocity of LAA wall motion during AF predicted the success of electrical cardioversion and long-term sinus rhythm maintenance. Standard echocardiographic data were obtained by transthoracic echocardiography, and LAA wall motion velocities were measured by transoesophageal echocardiography. With logistic regression and receiver operating characteristic curve analyses, we related echocardiographic and clinical data to cardioversion outcomes and sinus rhythm maintenance at 12 months. Of 121 patients prospectively included in the study, electrical cardioversion restored sinus rhythm in 97 (81.2%), and 51 (42%) patients maintained sinus rhythm at 12 months. Patients in whom cardioversion restored sinus rhythm had higher LAA wall motion velocities than did the patients with failed cardioversions (p <0.001). Compared to patients with AF at 12 months, patients who maintained sinus rhythm had lower maximum and end-diastolic left atrial volumes (p ≤ 0.01), lower E/e’ ratios (p = 0.005), higher s’ values (p = 0.013), and higher LAA motion velocities (p < 0.001). On multivariate logistic regression, only LAA wall motion velocity and E/e’ ratios remained significant predictors of sinus rhythm maintenance at 12 months (p ≤ 0.04). LAA wall motion velocity was also a significant predictor of sinus rhythm maintenance when corrected for clinical variables (p = 0.039). Conclusion: LAA wall motion velocity, as a marker of mechanical remodelling, can predict short-term and long-term sinus rhythm maintenance after electrical cardioversion in AF.
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Cheung YF, So EKF, Hwang GYY, Chan GCF, Ha SY. Left and Right Atrial Function and Remodeling in Beta-Thalassaemia Major. Pediatr Cardiol 2019; 40:1001-1008. [PMID: 30972436 DOI: 10.1007/s00246-019-02105-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/05/2019] [Indexed: 01/17/2023]
Abstract
This study aimed to assess left (LA) and right atrial (RA) function in patients with beta-thalassaemia major. Thirty-eight patients (19 males) aged 34.5 ± 10.7 years and 43 (18 males) controls aged 30.3 ± 12.6 years (p = 0.12) were studied. The maximum RA and LA areas were measured using two-dimensional planimetry, while atrial and ventricular strain and strain rates were quantified using speckle-tracking echocardiography. Compared with controls, patients had significantly reduced LA and RA peak positive strain and total strain, and LA strain rate during ventricular systole and at atrial contraction (all p < 0.05). The LA and RA strain parameters were significantly associated (all p < 0.05). The maximum LA (10.2 ± 1.6 cm2/m2 vs. 8.6 ± 1.3 cm2/m2, p < 0.001) and RA (9.2 ± 1.2 cm2/m2 vs. 7.5 ± 1.3 cm2/m2, p < 0.001) areas were significantly greater in patients than controls. The LV and RV strain and early strain rates were similar between patients and controls (all p > 0.05). Four patients with significant myocardial iron overload had larger LA area (p < 0.001) than those without. Functional and structural remodeling of both the right and left atria occurs in patients with beta-thalassaemia major, even in the absence of ventricular diastolic dysfunction.
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Affiliation(s)
- Yiu-Fai Cheung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. .,Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. .,Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, 102, Pokfulam Road, Hong Kong, China.
| | - Edwina Kam-Fung So
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Gloria Yu-Yan Hwang
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Godfrey Chi-Fung Chan
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Shau-Yin Ha
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP. Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73:1961-1977. [PMID: 31000000 DOI: 10.1016/j.jacc.2019.01.059] [Citation(s) in RCA: 443] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/15/2019] [Indexed: 01/31/2023]
Abstract
Defining left atrial (LA) function has recently emerged as a powerful parameter, particularly in evaluation of left ventricular (LV) diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction. Echocardiographic assessment of LVDD by echocardiography remains a challenging task; recent recommendations provide a simpler approach than previous. However, the shortcomings of the proposed approach (including transmitral flow, tissue velocity, maximum left atrial volume [LAV], and estimated pulmonary artery systolic pressure), lead to the presence and severity of LVDD remaining undetermined in a significant proportion of patients. Maximum LAV is a surrogate measure of the chronicity and severity of LVDD, but LAV alone is an insensitive biomarker of early phases of LVDD, because the LA may take time to remodel. Because the primary function of the LA is to modulate LV filling, it is not surprising that functional LA changes become evident at the earliest stages of LVDD. Moreover, LA function may provide additive value, not only in diagnosing LVDD, but also in grading its severity and in monitoring the effects of treatment. The current review provides a critical appraisal on the existing evidence for the role of LA metrics in evaluation of LVDD and consequent heart failure with preserved ejection fraction.
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Affiliation(s)
- Liza Thomas
- University of Sydney, Sydney, NSW, Australia; Department of Cardiology Westmead Hospital; South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Thomas H Marwick
- Baker IDI heart and Diabetes Institute and the Alfred Hospital, Melbourne, Victoria, Australia
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Department of Cardiology, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu," Bucharest, Romania
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Luigi P Badano
- University of Milano-Bicocca, Milan, Italy; IRCCS, Istituto Auxologico Italiano, S. Luca Hospital, Milan, Italy
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Dilaveris P, Antoniou CK, Manolakou P, Tsiamis E, Gatzoulis K, Tousoulis D. Biomarkers Associated with Atrial Fibrosis and Remodeling. Curr Med Chem 2019; 26:780-802. [PMID: 28925871 DOI: 10.2174/0929867324666170918122502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/16/2016] [Accepted: 12/23/2016] [Indexed: 12/22/2022]
Abstract
Atrial fibrillation is the most common rhythm disturbance encountered in clinical practice. Although often considered as solely arrhythmic in nature, current evidence has established that atrial myopathy constitutes both the substrate and the outcome of atrial fibrillation, thus initiating a vicious, self-perpetuating cycle. This myopathy is triggered by stress-induced (including pressure/volume overload, inflammation, oxidative stress) responses of atrial tissue, which in the long term become maladaptive, and combine elements of both structural, especially fibrosis, and electrical remodeling, with contemporary approaches yielding potentially useful biomarkers of these processes. Biomarker value becomes greater given the fact that they can both predict atrial fibrillation occurrence and treatment outcome. This mini-review will focus on the biomarkers of atrial remodeling (both electrical and structural) and fibrosis that have been validated in human studies, including biochemical, histological and imaging approaches.
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Affiliation(s)
- Polychronis Dilaveris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panagiota Manolakou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Tsiamis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Gatzoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Mandoli GE, Cameli M, Lisi E, Minardi S, Capone V, Pastore MC, Mondillo S. Left Atrial Fractional Shortening: A Simple and Practical "Strain" for Everyone. J Cardiovasc Echogr 2019; 29:52-57. [PMID: 31392119 PMCID: PMC6657461 DOI: 10.4103/jcecho.jcecho_74_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: The function of the left atrium (LA) is reduced in many cardiac diseases even with normal size. The assessment of its compliance could represent an added value in an echocardiographic report in case the gold standard technique (speckle-tracking echocardiography [STE]) is not available. We sought to test a simple and quick method as surrogate of STE: the dynamic measurement of the LA anteroposterior diameter (APD) that we called LA fractional shortening (LAFS). Materials and Methods: A total of 153 consecutive patients underwent a transthoracic echocardiography in our echo laboratory between January and June 2017. The only inclusion criteria were the presence of an acoustic window and the informed consent. We chose to not apply exclusion criteria to assess LAFS feasibility. The LAFS was calculated as (maxAPD−minAPD)/(maxAPD) × 100 in parasternal long-axis view. We evaluated the correlation of its value with the peak atrial longitudinal strain (PALS) and the LA emptying fraction (EF). Results: Mean execution time was 32.1 ± 5 s for LAFS, 2.3 ± 0.7 min for LAEF, and 2 ± 1 min for PALS. LAFS, with a feasibility of about 97%, was moderately correlated with PALS and LAEF (R between 0.20 and 0.30, P < 0.05). LAFS fractional shortening also emerged as surrogate for PALS via the relationship PALS = 21.07 + 0.364x (LAFS). Conclusions: LAFS demonstrated a correlation with PALS, a short execution time, a high feasibility, and the possibility to be used as a surrogate of PALS, applying a specific formula.
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Affiliation(s)
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Edoardo Lisi
- Department of Mathematics, Imperial College, London, UK
| | - Simona Minardi
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Valentina Capone
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
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khedr L, Elasfar A, Hekal S, ElGendy E, Abdulaal M, Elsokkary H, Ashmawy M. Assessment of left and right atrial geometrical changes in patients with stable coronary artery disease: Left and right atrial strain and strain rate imaging study. Egypt Heart J 2018; 70:101-106. [PMID: 30166890 PMCID: PMC6112359 DOI: 10.1016/j.ehj.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/13/2018] [Indexed: 11/18/2022] Open
Abstract
Objective In patients with coronary artery disease (CAD), there are several studies that assessed the left ventricular (LV) function by strain (S) and strain rate (SR) imaging. The aim of this study is to evaluate the function of both atria in patients with CAD using strain and strain rate imaging, and to correlate this with the severity of CAD. Methods We conducted a prospective, single center case control study for 40 consecutive patients who presented to our department with chronic stable angina and were candidates for invasive coronary angiography. We enrolled patients from December 2013 to May 2014 and each patient was subjected to echocardiographic assessment of E/e' of mitral valve, left atrial volume index (LAVI), right atrial volume index (RAVI), and peak atrial longitudinal strain (es) and strain rate (SR) during LV systole. This was followed by invasive coronary angiography for assessment of the severity of CAD using Gensini score. Patients were classified according to angiographic results into 3 groups: Group I (Gensini score = zero), Group II (Gensini score > 0 and < 20) and Group III (Gensini score ≥ 20). Results There was no statistically significant difference between the three groups in either LA volumes (Vmin, Vmax) and distensibility with p value of 0.272, 0.126, and 0.243 respectively or RA volumes and distensibility with a p value of 0.671, 0.183, and 0.259 respectively. On the other hand, LA & RA systolic S and SR were significantly lower among CAD patients in comparison with the group of normal coronaries. Mean LA S and SR was decreased in group III than group II (15.97 ± 3.73, 21.8 ± 6.75 % and 1.11 ± 0.30, 1.81 ± 1.23 s-1) with p value of 0.005&0.041 respectively. RA systolic S and SR were significantly lower in the 2 groups with CAD than the group with normal coronaries with a p value of 0.001 and 0.002 respectively. Conclusion In patients with CAD and normal EF, borderline E/e' ratio and normal atrial size, there are decreased LA and RA systolic S and SR parameters with no effect on atrial volumes or distensibility. Accordingly, this could prove that atrial wall deformation occurs early in CAD even before any changes in atrial volumes or dimensions.
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Affiliation(s)
- Lamiaa khedr
- Department of Cardiology, Tanta University, Egypt
| | | | | | - Ehab ElGendy
- Department of Cardiology, Tanta University, Egypt
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Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G, Donal E, Sade LE, Ernande L, Garbi M, Grapsa J, Hagendorff A, Kamp O, Magne J, Santoro C, Stefanidis A, Lancellotti P, Popescu B, Habib G. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2018; 18:1301-1310. [PMID: 29045589 DOI: 10.1093/ehjci/jex244] [Citation(s) in RCA: 495] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/11/2017] [Indexed: 12/28/2022] Open
Abstract
Aims This European Association Cardiovascular Imaging (EACVI) Expert Consensus document aims at defining the main quantitative information on cardiac structure and function that needs to be included in standard echocardiographic report following recent ASE/EACVI chamber quantification, diastolic function, and heart valve disease recommendations. The document focuses on general reporting and specific pathological conditions such as heart failure, coronary artery and valvular heart disease, cardiomyopathies, and systemic diseases. Methods and results Demographic data (age, body surface area, blood pressure, and heart rhythm and rate), type (vendor and model) of ultrasound system used and image quality need to be reported. In addition, measurements should be normalized for body size. Reference normal values, derived by ASE/EACVI recommendations, shall always be reported to differentiate normal from pathological conditions. This Expert Consensus document suggests avoiding the surveillance of specific variable using different ultrasound techniques (e.g. in echo labs with high expertise in left ventricular ejection fraction by 3D and not by 2D echocardiography). The report should be also tailored in relation with different cardiac pathologies, quality of images, and needs of the caregivers. Conclusion The conclusion should be concise reflecting the status of left ventricular structure and function, the presence of left atrial and/or aortic dilation, right ventricular dysfunction, and pulmonary hypertension, leading to an objective communication with the patient health caregiver. Variation over time should be considered carefully, taking always into account the consistency of the parameters used for comparison.
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Affiliation(s)
- Maurizio Galderisi
- Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, Naples, Italy
| | - Bernard Cosyns
- CHVZ (Centrum voor Hart en Vaatziekten)-Universitair ziekenhuis Brussel; and ICMI (In Vivo Cellular and Molecular Imaging) laboratory, Brussels, Belgium
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Nuno Cardim
- Echocardiography Laboratory, Hospital da Luz, Lisbon, Portugal
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden 2300RC, The Netherlands
| | - Giovanni Di Salvo
- Pediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Erwan Donal
- Cardiologie, LTSI-INSERM U 1099, CHU Rennes, Université Rennes 1, Rennes, France
| | | | - Laura Ernande
- Department of Physiology, INSERM U955, Université Paris-Est Creteil, Henri Mondor Hospital, DHU-ATVB, AP-HP, Créteil, France
| | - Madalina Garbi
- King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS UK
| | - Julia Grapsa
- Department of Cardiovascular Sciences, Imperial College of London, London, UK
| | - Andreas Hagendorff
- Department of Cardiology-Angiology, Echokardiographie-Labore des Universitätsklinikums AöR, University of Leipzig, Leipzig, Germany
| | - Otto Kamp
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042 France
| | - Ciro Santoro
- Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, Naples, Italy
| | - Alexandros Stefanidis
- 1st Department of Cardiology, General Hospital of Nikea, 3 P. Mela str., 184 54, Athens, Greece
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Bogdan Popescu
- University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Gilbert Habib
- Aix- Aix-Marseille Univ, URMITE, Aix Marseille Université-UM63, CNRS 7278, IRD 198, INSERM 1095.,Cardiology Department, APHM, La Timone Hospital, Boulevard Jean Moulin, Marseille 13005, France
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Assessment of left atrial function using speckle tracking echocardiography in ankylosing spondylitis: a case-control study. Int J Cardiovasc Imaging 2018; 34:1863-1868. [PMID: 30014361 DOI: 10.1007/s10554-018-1411-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
The aim of this study is to assess the left atrium (LA) deformation parameters by using 2D speckle tracking echocardiography (2D-STE) in ankylosing spondylitis (AS) patients and to evaluate the relationship between these parameters and AS clinical indexes. 30 patients with AS (22 males, 8 females) and 30 healthy individuals (19 males, 11 females) were enrolled in this study. Transthoracic echocardiography was performed to both groups. Besides the conventional echocardiographic parameters, the LA strain parameters; including systolic-reservoir (LA S-S), early diastolic-conduit (LA S-E), late diastolic-contraction (LA S-A) were measured. No significant difference was found between two groups in terms of conventional echocardiographic parameters except mean deceleration time (DT). Mean DT was prolonged in the AS patients compare with the control group (173.5 ± 22.5 vs. 155.3 ± 36.7, p = 0.025). In the AS patients, LA S-S (48.3 ± 9.4 vs. 56.9 ± 10.1, p = 0.001), LA S-E (26.4 ± 6.4 vs. 31.6 ± 7.3, p = 0.005) and LA S-A (21.9 ± 4.7 vs. 25.4 ± 5.7, p = 0.013) values were statistically lower than the control group. Also a negative correlation was observed between the Bath Ankylosing Spondylitis Metrology Index (BASMI) and LA S-S (r = - 0.509, p = 0.004), LA S-E (r = - 0.501, p = 0.005). Our study demonstrated that 2D-STE is a useful method to determine the left atrial involvement in AS patients without the clinical evident of cardiovascular disease.
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Sahebjam M, Montazeri V, Zoroufian A, Hosseinsabet A, Lotfi-Tokaldany M, Jalali A. The correlation between conventional echocardiography and two-dimensional speckle strain imaging for evaluating left atrial function in patients with moderate to severe mitral stenosis. Echocardiography 2018; 35:1550-1556. [DOI: 10.1111/echo.14088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Mohammad Sahebjam
- Tehran Heart Center; Tehran University of Medical Sciences; Tehran Iran
| | - Vahide Montazeri
- Tehran Heart Center; Tehran University of Medical Sciences; Tehran Iran
| | - Arezoo Zoroufian
- Tehran Heart Center; Tehran University of Medical Sciences; Tehran Iran
| | - Ali Hosseinsabet
- Tehran Heart Center; Tehran University of Medical Sciences; Tehran Iran
| | | | - Arash Jalali
- Tehran Heart Center; Tehran University of Medical Sciences; Tehran Iran
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Mahfouz RA, Galal I, Ghareb MS, Abdelghafar AS. Association between left atrial stiffness and aortic plaque thickness in hypertensive patients with stroke. Echocardiography 2018; 35:949-956. [DOI: 10.1111/echo.13877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ragab A. Mahfouz
- Cardiology Department; Zagazig University Hospital; Zagazig Egypt
| | - Islam Galal
- Cardiology Department; Zagazig University Hospital; Zagazig Egypt
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Risk Factors for Failure of Direct Current Cardioversion in Patients with Type 2 Diabetes Mellitus and Atrial Fibrillation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5936180. [PMID: 29721508 PMCID: PMC5867679 DOI: 10.1155/2018/5936180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 12/03/2017] [Accepted: 02/08/2018] [Indexed: 01/31/2023]
Abstract
Introduction Type 2 diabetes mellitus (T2DM) is a well-recognised risk factor for cardiovascular disease and the prevalence of atrial fibrillation (AF) is higher among patients with T2DM. Direct current cardioversion (DCCV) is an important management option in persistent AF. We sought to determine independent risk factors for immediate and short-term outcomes of DCCV for treatment of AF in patients with T2DM. Methods Retrospective outcome analysis of DCCV for persistent AF in 102 T2DM patients compared with 102 controls. Results DCCV was successful in 68 (66.6%) people with T2DM compared to 86 (84.3%) in the control group (P = 0.003). After initial successful cardioversion, only 38 (37.2%) T2DM patients remained in sinus rhythm compared to 63 (61.8%) in the control group (P = 0.007) at a median follow-up of 74.5 days (IQR 69.4-77.4). Multiple logistic regression analysis showed that the presence of T2DM (P = 0.014), digoxin use (P = 0.01), statin use (P = 0.005), left-atrial size (P = 0.01), and LV ejection fraction (P = 0.008) were independent risk factors for immediate DCCV failure. T2DM (P = 0.034) was an independent risk factor for AF relapse. Among patients with T2DM, previous DCCV (P = 0.033), digoxin use (P = 0.035), left-atrial size (P = 0.01), LV ejection fraction (P = 0.036), and HbA1c (P = 0.011) predicted immediate failure of DCCV whilst digoxin use (P = 0.026) was an independent risk factor for relapse of AF. Conclusion T2DM, higher HbA1c, digoxin treatment, and structural and functional cardiac abnormalities are independent risk factors for immediate DCCV failure and AF relapse.
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Affiliation(s)
- Ramanathan Parameswaran
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Victoria, Australia
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Baron Toaldo M, Romito G, Guglielmini C, Diana A, Pelle NG, Contiero B, Cipone M. Prognostic value of echocardiographic indices of left atrial morphology and function in dogs with myxomatous mitral valve disease. J Vet Intern Med 2018; 32:914-921. [PMID: 29572938 PMCID: PMC5980607 DOI: 10.1111/jvim.15093] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 11/28/2017] [Accepted: 02/08/2018] [Indexed: 11/28/2022] Open
Abstract
Background The prognostic relevance of left atrial (LA) morphological and functional variables, including those derived from speckle tracking echocardiography (STE), has been little investigated in veterinary medicine. Objectives To assess the prognostic value of several echocardiographic variables, with a focus on LA morphological and functional variables in dogs with myxomatous mitral valve disease (MMVD). Animals One‐hundred and fifteen dogs of different breeds with MMVD. Methods Prospective cohort study. Conventional morphologic and echo‐Doppler variables, LA areas and volumes, and STE‐based LA strain analysis were performed in all dogs. A survival analysis was performed to test for the best echocardiographic predictors of cardiac‐related death. Results Most of the tested variables, including all LA STE‐derived variables were univariate predictors of cardiac death in Cox proportional hazard analysis. Because of strong correlation between many variables, only left atrium to aorta ratio (LA/Ao > 1.7), mitral valve E wave velocity (MV E vel > 1.3 m/s), LA maximal volume (LAVmax > 3.53 mL/kg), peak atrial longitudinal strain (PALS < 30%), and contraction strain index (CSI per 1% increase) were entered in the univariate analysis, and all were predictors of cardiac death. However, only the MV E vel (hazard ratio [HR], 4.45; confidence interval [CI], 1.76‐11.24; P < .001) and LAVmax (HR, 2.32; CI, 1.10‐4.89; P = .024) remained statistically significant in the multivariable analysis. Conclusions and Clinical Importance The assessment of LA dimension and function provides useful prognostic information in dogs with MMVD. Considering all the LA variables, LAVmax appears the strongest predictor of cardiac death, being superior to LA/Ao and STE‐derived variables.
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Affiliation(s)
- Marco Baron Toaldo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giovanni Romito
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Carlo Guglielmini
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
| | - Alessia Diana
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Nazzareno G Pelle
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Barbara Contiero
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
| | - Mario Cipone
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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Interatrial block and atrial remodeling assessed using speckle tracking echocardiography. BMC Cardiovasc Disord 2018; 18:38. [PMID: 29466939 PMCID: PMC5822665 DOI: 10.1186/s12872-018-0776-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/13/2018] [Indexed: 01/29/2023] Open
Abstract
Background To evaluate the possibility of left atrial (LA) remodeling using speckle tracking echocardiography (STE) in patients with interatrial block (IAB). Methods We performed a cross-sectional study with three groups of patients: 56 without IAB, 21 with partial IAB (pIAB), and 22 with advanced IAB (aIAB). Transthoracic echocardiographic (TTE) STE was performed and clinical and echocardiographic findings were analyzed. Results TTE showed higher LA volume/body surface area in the patients with IAB. With STE, the absolute value of strain rate during atrial booster pump function (SRa) and early reservoir period (SRs) decreased in the pIAB group and even more in the aIAB group, compared to the group without IAB. The independent variables were the echocardiographic measures of LA size and function. After adjusting for confounders, both multiple linear regression and multivariate multinomial regression showed good correlation with dependent variables: longer P-wave duration on electrocardiography and with the type of IAB, respectively. SRa (p < 0.001), SRs (p < 0.001), and maximal peak LA longitudinal strain in the reservoir period (p = 0.009) were independently associated with P-wave duration. SRa was also associated with the presence of pIAB (OR = 11.5; 95% confidence interval (CI): 2.7–49.0; p = 0.001) and aIAB, (OR = 98.2; 95% CI: 16–120.4; p < 0.001) and SRs was associated with pIAB (OR: 0.03; CI: 0.003–0.29; p = 0.003) and with aIAB (OR: 0.008; CI: 0.001–0.12; p = 0.004). Conclusions IAB correlates directly with structural remodeling and a decrease in the absolute value of LA SRa and SRs determined using STE. Electronic supplementary material The online version of this article (10.1186/s12872-018-0776-6) contains supplementary material, which is available to authorized users.
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Abstract
The left atrium has an important role in modulating left ventricular filling and is an important biomarker of cardiovascular disease and adverse cardiovascular outcomes. While previously left atrial (LA) size was utilised, the role of LA function as a biomarker is increasingly being evaluated, both independently and also in combination with LA size. Strain analysis has been utilised for evaluation of LA function and can be measured throughout the cardiac cycle, thereby enabling the evaluation of LA reservoir, conduit and contractile function. Strain evaluates myocardial deformation while strain rate examines the rate of change in strain. This review will focus on the various types of strain analysis for evaluation of LA function, alterations in LA strain in physiological and pathologic states that alter LA function and finally evaluate its utility as a prognostic marker.
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Affiliation(s)
- Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Blacktown, NSW, Australia.,University of New South Wales, Sydney, Australia
| | | | - Anita Boyd
- University of Sydney, Sydney, NSW, Australia.,Westmead Private Cardiology, Westmead, NSW, Australia
| | - Liza Thomas
- University of New South Wales, Sydney, Australia.,University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
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Luo Y, Zhu Y, Guan X, Lin Y. Assessment of mitral annulus and mitral leaflet in nonvalvular atrial fibrillation patients with various degrees of mitral regurgitation: Real time 3D transesophageal echocardiography. Echocardiography 2018; 35:481-486. [PMID: 29349803 DOI: 10.1111/echo.13810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Yongjuan Luo
- Department of Ultrasound; Tianjin Chest Hospital; Tian Jin China
| | - Yanbo Zhu
- Department of Ultrasound; Tianjin Chest Hospital; Tian Jin China
| | - Xin Guan
- Department of Ultrasound; Tianjin Chest Hospital; Tian Jin China
| | - Yunjia Lin
- Department of Ultrasound; Tianjin Chest Hospital; Tian Jin China
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