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Mangia M, D'Andrea E, Cecchetto A, Beccari R, Mele D, Nistri S. Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function. J Cardiovasc Dev Dis 2024; 11:241. [PMID: 39195149 DOI: 10.3390/jcdd11080241] [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: 04/25/2024] [Revised: 07/28/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular (CV) diseases. The assessment of LA function by echocardiography primarily includes volumetric measurements (LA ejection fraction [LAEF]), tissue Doppler imaging (TDI) (mitral annular late diastolic velocity [a']), and speckle-tracking methods, such as LA longitudinal reservoir strain (LA strain). This review analyzes and discusses the current medical evidence and potential clinical usefulness of these different methods to analyze LA function.
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Affiliation(s)
- Mario Mangia
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Emilio D'Andrea
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Antonella Cecchetto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Riccardo Beccari
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Donato Mele
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Stefano Nistri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
- Cardiology Service, CMSR Veneto Medica, 36077 Altavilla Vicentina, Italy
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Sillett C, Razeghi O, Lee AWC, Solis Lemus JA, Roney C, Mannina C, de Vere F, Ananthan K, Ennis DB, Haberland U, Xu H, Young A, Rinaldi CA, Rajani R, Niederer SA. A three-dimensional left atrial motion estimation from retrospective gated computed tomography: application in heart failure patients with atrial fibrillation. Front Cardiovasc Med 2024; 11:1359715. [PMID: 38596691 PMCID: PMC11002108 DOI: 10.3389/fcvm.2024.1359715] [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: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background A reduced left atrial (LA) strain correlates with the presence of atrial fibrillation (AF). Conventional atrial strain analysis uses two-dimensional (2D) imaging, which is, however, limited by atrial foreshortening and an underestimation of through-plane motion. Retrospective gated computed tomography (RGCT) produces high-fidelity three-dimensional (3D) images of the cardiac anatomy throughout the cardiac cycle that can be used for estimating 3D mechanics. Its feasibility for LA strain measurement, however, is understudied. Aim The aim of this study is to develop and apply a novel workflow to estimate 3D LA motion and calculate the strain from RGCT imaging. The utility of global and regional strains to separate heart failure in patients with reduced ejection fraction (HFrEF) with and without AF is investigated. Methods A cohort of 30 HFrEF patients with (n = 9) and without (n = 21) AF underwent RGCT prior to cardiac resynchronisation therapy. The temporal sparse free form deformation image registration method was optimised for LA feature tracking in RGCT images and used to estimate 3D LA endocardial motion. The area and fibre reservoir strains were calculated over the LA body. Universal atrial coordinates and a human atrial fibre atlas enabled the regional strain calculation and the fibre strain calculation along the local myofibre orientation, respectively. Results It was found that global reservoir strains were significantly reduced in the HFrEF + AF group patients compared with the HFrEF-only group patients (area strain: 11.2 ± 4.8% vs. 25.3 ± 12.6%, P = 0.001; fibre strain: 4.5 ± 2.0% vs. 15.2 ± 8.8%, P = 0.001), with HFrEF + AF patients having a greater regional reservoir strain dyssynchrony. All regional reservoir strains were reduced in the HFrEF + AF patient group, in whom the inferior wall strains exhibited the most significant differences. The global reservoir fibre strain and LA volume + posterior wall reservoir fibre strain exceeded LA volume alone and 2D global longitudinal strain (GLS) for AF classification (area-under-the-curve: global reservoir fibre strain: 0.94 ± 0.02, LA volume + posterior wall reservoir fibre strain: 0.95 ± 0.02, LA volume: 0.89 ± 0.03, 2D GLS: 0.90 ± 0.03). Conclusion RGCT enables 3D LA motion estimation and strain calculation that outperforms 2D strain metrics and LA enlargement for AF classification. Differences in regional LA strain could reflect regional myocardial properties such as atrial fibrosis burden.
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Affiliation(s)
- Charles Sillett
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
| | - Angela W. C. Lee
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jose Alonso Solis Lemus
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Caroline Roney
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
| | - Carlo Mannina
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Felicity de Vere
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Kiruthika Ananthan
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Daniel B. Ennis
- Department of Radiology, Stanford University, Stanford, CA, United States
| | | | - Hao Xu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Alistair Young
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Turing Research and Innovation Cluster: Digital Twins, The Alan Turing Institute, London, United Kingdom
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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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Left atrial strain evaluation to assess left ventricle diastolic dysfunction and heart failure with preserved ejection fraction: a guide to clinical practice : Left atrial strain and diastolic function. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1083-1096. [PMID: 36826616 DOI: 10.1007/s10554-023-02816-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/11/2023] [Indexed: 02/25/2023]
Abstract
Although frequently unrecognized, left atrium (LA) function plays a key role in global cardiac performance as it modulates left ventricle (LV) filling through three main functions: the LA reservoir, conduit and booster pump. Given the interdependence between the LA and the LV, it is known that LA dimension and/or LA function can be used as a surrogate for LV diastolic function.Recently, LA deformation analysis using 2-dimensional (2D) speckle tracking echocardiography (STE) strain emerged as a promising non-invasive technique that can help to estimate LV filling pressures (LVFP) and diagnose heart failure with preserved ejection fraction (HFpEF), as recently proposed in the recent 2022 European Association of Cardiovascular Imaging (EACVI) consensus which included LA reservoir strain as an additive parameter to estimate LVFP.This article aims to review the latest evidence regarding the role of LA strain in the assessment and management of LV diastolic dysfunction (LVDD) and HFpEF, providing a clinical guide with tips and tricks to use LA strain as a new technique to help to estimate LVFP.
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Kulka C, Lorbeer R, Askani E, Kellner E, Reisert M, von Krüchten R, Rospleszcz S, Hasic D, Peters A, Bamberg F, Schlett CL. Quantification of Left Atrial Size and Function in Cardiac MR in Correlation to Non-Gated MR and Cardiovascular Risk Factors in Subjects without Cardiovascular Disease: A Population-Based Cohort Study. Tomography 2022; 8:2202-2217. [PMID: 36136881 PMCID: PMC9498662 DOI: 10.3390/tomography8050185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: In magnetic resonance imaging (MRI), the comparability of gated and non-gated measurements of the left atrial (LA) area and function and their association with cardiovascular risk factors have not been firmly established. Methods: 3-Tesla MRIs were performed on 400 subjects enrolled in the KORA (Cooperative Health Research in the Augsburg Region) MRI study. The LA maximum and minimum sizes were segmented in gated CINE four-chamber sequences (LAmax and LAmin) and non-gated T1 VIBE-Dixon (NGLA). The area-based LA function was defined as LAaf = (LAmax − LAmin)/LAmax. Inter-and intra-reader reliability tests were performed (n = 31). Linear regression analyses were conducted to link LA size and function with cardiovascular risk factors. Results: Data from 378 subjects were included in the analysis (mean age: 56.3 years, 57.7 % male). The measurements were highly reproducible (all intraclass correlation coefficients ≥ 0.98). The average LAmax was 19.6 ± 4.5 cm2, LAmin 11.9 ± 3.5 cm2, NGLA 16.8 ± 4 cm2 and LAaf 40 ± 9%. In regression analysis, hypertension was significantly associated with larger gated LAmax (β = 1.30), LAmin (β = 1.07), and non-gated NGLA (β = 0.94, all p ≤ 0.037). Increasing age was inversely associated with LAaf (β = −1.93, p < 0.001). Conclusion: LA enlargement, as measured in gated and non-gated CMR is associated with hypertension, while the area-based LA function decreases with age.
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Affiliation(s)
- Charlotte Kulka
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilians-University Hospital, 80336 Munich, Germany
| | - Esther Askani
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Radiology, Medical Centre, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Radiology, Medical Centre, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Ricarda von Krüchten
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Dunja Hasic
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University, 81377 Munich, Germany
- German Center for Diabetes Research, München-Neuherberg, 85764 Neuherberg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christopher L. Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Essayagh B, Benfari G, Antoine C, Maalouf J, Pislaru S, Thapa P, Michelena HI, Enriquez‐Sarano M. Incremental Prognosis by Left Atrial Functional Assessment: The Left Atrial Coupling Index in Patients With Floppy Mitral Valves. J Am Heart Assoc 2022; 11:e024814. [PMID: 35470696 PMCID: PMC9238580 DOI: 10.1161/jaha.121.024814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/04/2022] [Indexed: 11/16/2022]
Abstract
Background Emerging data suggest important prognostic value to left atrial (LA) characteristics, but the independent impact of LA function on outcome remains unsubstantiated. Thus, we aimed to define the incremental prognostic value of LA coupling index (LACI), coupling volumetric and mechanical LA characteristics and calculated as the ratio of left atrial volume index to tissue Doppler imaging a', in a large cohort of patients with isolated floppy mitral valve. Methods and Results All consecutive 4792 patients (61±16 years, 48% women) with isolated floppy mitral valve in sinus rhythm diagnosed at Mayo Clinic from 2003 to 2011, comprehensively characterized and with prospectively measured left atrial volume index and tissue Doppler imaging a' in routine practice, were enrolled, and their long-term survival analyzed. Overall, LACI was 5.8±3.7 and was <5 in 2422 versus ≥5 in 2370 patients. LACI was independently higher with older age, more mitral regurgitation (no 3.8±2.3, mild 5.1±3.0, moderate 6.5±3.8, and severe 7.8±4.3), and with diastolic (higher E/e') and systolic (higher end-systolic dimension) left ventricular dysfunction (all P≤0.0001). At diagnosis, higher LACI was associated with more severe presentation (more dyspnea, more severe functional tricuspid regurgitation, and elevated pulmonary artery pressure, all P≤0.0001) independently of age, sex, comorbidity index, ventricular function, and mitral regurgitation severity. During 7.0±3.0 years follow-up, 1146 patients underwent mitral valve surgery (94% repair, 6% replacement), and 880 died, 780 under medical management. In spline curve analysis, LACI ≥5 was identified as the threshold for excess mortality, with much reduced 10-year survival under medical management (60±2% versus 85±1% for LACI <5, P<0.0001), even after comprehensive adjustment (adjusted hazard ratio, 1.30 [95% CI, 1.10-1.53] for LACI ≥5; P=0.002). Association of LACI ≥5 with higher mortality persisted, stratifying by mitral regurgitation severity of LA enlargement grade (all P<0.001) and after propensity-score matching (P=0.02). Multiple statistical methods confirmed the significant incremental predictive power of LACI over left atrial volume index (all P<0.0001). Conclusions LA functional assessment by LACI in routine practice is achievable in a large number of patients with floppy mitral valve using conventional Doppler echocardiographic measurements. Higher LACI is associated with worse clinical presentation, but irrespective of baseline characteristics, LACI is strongly, independently, and incrementally determinant of outcome, demonstrating the crucial importance of LA functional response to mitral valve disease.
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Affiliation(s)
- Benjamin Essayagh
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Department of Cardiovascular MedicineSimone Veil HospitalCannesFrance
| | - Giovanni Benfari
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Department of Cardiovascular MedicineUniversity of VeronaVeronaItaly
| | | | - Joseph Maalouf
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Sorin Pislaru
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Prabin Thapa
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | | | - Maurice Enriquez‐Sarano
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Minneapolis Heart InstituteMinneapolisMN
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Katogiannis K, Makavos G, Tsilivarakis D, Plotas P, Lambadiari V, Parissis J, Noutsias M, Ikonomidis I. Left atrial deformation in heart failure: a clinical update. Curr Probl Cardiol 2022:101183. [DOI: 10.1016/j.cpcardiol.2022.101183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/15/2022]
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Johansson B, Fengsrud E, Lundin F, Bojö L, Poci D. The a' velocity by tissue-Doppler echocardiography correlates to invasive mean left atrial pressure in patients with normal ejection fraction. SCAND CARDIOVASC J 2022; 56:6-12. [PMID: 35137668 DOI: 10.1080/14017431.2022.2032317] [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] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the correlation of a' velocity by tissue-Doppler measurements with invasively measured mean left atrial pressure in patients with normal ejection fraction. DESIGN In this retrospective study, we evaluated the septal a', lateral a' and average a' velocity by tissue-Doppler echocardiography, in 125 in-hospital patients, 1-12 h before an elective pulmonary vein isolation due to intermittent atrial fibrillation, and compared to invasively measured mean left atrial pressure (LAP) during the invasive procedure. The patients, aged 35-81 years, had to be in sinus rhythm at both examinations, no atrial fibrillation during two procedures, no or mild valve disease and normal ejection fraction (>50%). RESULTS Invasively measured mean LAP correlated well to septal a' (r = -0.435), lateral a' (r = -0.473) and average a' velocity (r = -0.491). Normal mean LAP (≤12 mmHg) was found in 95 patients and elevated mean LAP (>12 mmHg) in 30 patients. The patients with elevated mean LAP had a lower septal a' velocity (6.5 ± 2.7 vs 8.6 ± 2.3 cm/s; p < .01), lateral a' velocity (5.9 ± 2.3 vs 8.6 ± 2.1 cm/s; p < .01) and average a' velocity (6.2 ± 2.4 vs 8.8 ± 2.1 cm/s; p < .01) compared to patients with normal mean LAP. Septal a', lateral a' and average a' velocity were good predictors of elevated mean LAP with AUC of 0.78, 0.83 and 0.82. Average a' velocity with cut-off < 7.25 cm/s had a sensitivity of 83% and a specificity of 77% to predict elevated mean LAP. CONCLUSION The a' velocity is a good indicator of mean LAP and might be considered in the evaluation of left ventricle filling pressure in patients with normal ejection fraction.
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Affiliation(s)
- Benny Johansson
- Department of Heart-Lung and Clinical Physiology, School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - Espen Fengsrud
- Department of Heart-Lung and Clinical Physiology, School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - Fredrik Lundin
- Centre for statistical Clinical Research, County Council of Värmland, Värmland, Sweden
| | - Leif Bojö
- Department of Clinical Physiology, Central Hospital, Karlstad, Sweden
| | - Dritan Poci
- Department of Heart-Lung and Clinical Physiology, School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
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Yoon SJ. Evaluation of LA Dynamics: a Classical Yet Still Challenging Topic until Now. J Cardiovasc Imaging 2022; 30:47-49. [PMID: 35086169 PMCID: PMC8792720 DOI: 10.4250/jcvi.2021.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Se-Jung Yoon
- Division of Cardiology, NHIS Ilsan Hospital, Goyang, Korea.
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Park I, Jeong DS, Ahn JH, Park PW. Five-Year Outcomes of Concomitant Maze Procedure Using Nitrous Oxide versus Argon-Based Cryoablation. Ann Thorac Surg 2021; 114:2244-2252. [PMID: 34953787 DOI: 10.1016/j.athoracsur.2021.11.036] [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: 07/08/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cryoablation is effective for ablating the myocardium but maintaining the structure of the ablated tissue. However, data comparing nitrous oxide (N2O)-based and argon gas-based cryoprobes are limited. METHODS This study was a follow-up study of a single-center, prospective, randomized controlled trial in which 60 patients were randomly allocated to either the N2O group or the argon group. The primary endpoint of this study was sinus rhythm maintenance, and the key secondary endpoint was a composite of major adverse cardiovascular and cerebrovascular events (MACCEs) (i.e., cardiac death, stroke, major bleeding, and readmission for heart failure). RESULTS The baseline and operative characteristics of the patients in the N2O and argon groups were comparable. At the 5-year follow-up, the rate of sinus rhythm maintenance was 81.8% in the N2O group, whereas it was 78.5% in the argon group (p > 0.999). No significant differences in the rate of freedom from MACCEs (80.6% in the N2O group vs. 81.9% in the argon group; P = .978) was observed at the 5-year follow-up. The left atrial volume index decreased over time from 114.65 mL/m2 to 65.74 mL/m2 (P < .0001) and reached similar values in the two groups (P = .279) at the 5-year follow-up. CONCLUSIONS Both N2O- and argon gas-based cryoprobes showed similar rates of sinus rhythm maintenance and freedom from MACCEs at the 5-year follow-up. Both cryoprobes might have similar efficacy and safety in the arrested heart in the long term.
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Affiliation(s)
- Ilkun Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Joong Hyun Ahn
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Incheon Sejong Hospital, Incheon, Gyeonggi-do, Republic of Korea
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11
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Gan GCH, Bhat A, Chen HHL, Fernandez F, Byth K, Eshoo S, Thomas L. Determinants of LA reservoir strain: Independent effects of LA volume and LV global longitudinal strain. Echocardiography 2020; 37:2018-2028. [PMID: 33211337 DOI: 10.1111/echo.14922] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Left atrial (LA) deformation during the reservoir phase (LASr) has demonstrated strong prognostic value in different clinical settings. Although determinants of left atrial reservoir strain including left atrial relaxation, left atrial compliance, and left ventricular longitudinal systolic function are fairly well defined, there is incomplete information regarding the effect of left atrial volume on this relationship which is the focus of our study. METHOD Consecutive patients without prior cardiac disease referred for transthoracic echocardiography were prospectively recruited. All participants underwent clinical assessment, transthoracic echocardiography (TTE), and screening exercise stress test. Only patients with normal left ventricular ejection fraction (LVEF) without left ventricular hypertrophy (LVH) or myocardial ischemia on stress testing were included. RESULTS A total of 260 patients (57% male, mean age 59 ± 14 years) were included. 70% had hypertension, 33% had diabetes mellitus, and 31% had both HTN and DM. On multivariate analysis, age, e', LAVI, and LV GLS (P < .01 for all) showed an independent association with LASr. Of interest, at lower tertiles of LAVI, a linear decrease in LASr was observed parallel to worsening LV GLS, whilst at higher tertiles of LAVI, the reduction in LASr was non-linear implying that LA enlargement, consequent to LA remodeling, had an incremental effect on LASr. CONCLUSION Age, e', LV GLS, and LAVI were independently associated with LASr. LA remodeling reflected by larger LAVI had an incremental negative association with LASr independent of LV GLS.
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Affiliation(s)
- Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
| | - Fernando Fernandez
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Karen Byth
- Biostatistics Unit, Research and Education Network, Westmead Hospital and The University of Sydney, Sydney, NSW, Australia
| | - Suzanne Eshoo
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
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12
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Travers G, González-Alonso J, Riding N, Nichols D, Shaw A, Périard JD. Exercise heat acclimation has minimal effects on left ventricular volumes, function and systemic hemodynamics in euhydrated and dehydrated trained humans. Am J Physiol Heart Circ Physiol 2020; 319:H965-H979. [DOI: 10.1152/ajpheart.00466.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study demonstrates that 10 days of exercise heat acclimation has minimal effects on left ventricular volumes, intrinsic cardiac function, and systemic hemodynamics during prolonged, repeated semirecumbent exercise in moderate heat, where heart rate and blood volume are similar to preacclimation levels. However, progressive dehydration is consistently associated with similar degrees of hyperthermia and tachycardia and reductions in blood volume, diastolic filling of the left ventricle, stroke volume, and cardiac output, regardless of acclimation state.
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Affiliation(s)
- Gavin Travers
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Centre for Human Performance, Exercise and Rehabilitation, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - José González-Alonso
- Centre for Human Performance, Exercise and Rehabilitation, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Nathan Riding
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - David Nichols
- Sport Development Centre, Loughborough University, Loughborough, United Kingdom
| | - Anthony Shaw
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Julien D. Périard
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia
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13
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Thomas L, Muraru D, Popescu BA, Sitges M, Rosca M, Pedrizzetti G, Henein MY, Donal E, Badano LP. Evaluation of Left Atrial Size and Function: Relevance for Clinical Practice. J Am Soc Echocardiogr 2020; 33:934-952. [DOI: 10.1016/j.echo.2020.03.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 01/05/2023]
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14
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Akamatsu K, Ito T, Miyamura M, Kanzaki Y, Sohmiya K, Hoshiga M. Usefulness of tissue Doppler-derived atrial electromechanical delay for identifying patients with paroxysmal atrial fibrillation. Cardiovasc Ultrasound 2020; 18:22. [PMID: 32571347 PMCID: PMC7310390 DOI: 10.1186/s12947-020-00205-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background Tissue Doppler imaging (TDI)-derived atrial electromechanical delay (AEMD) has been reported to be useful for detecting paroxysmal atrial fibrillation (PAF). However, its usefulness remains unknown when analyzed along with patients seemingly at high-risk for AF as controls. From this standpoint, we investigated whether AEMD would be of use for identifying patients with PAF. Methods We retrospectively analyzed TDI recordings to obtain AEMD in 63 PAF patients. Thirty-three patients with multiple cardiovascular risk factors (MRFs) but without history of AF and 50 healthy individuals served as disease and healthy controls, respectively. AEMD was defined as the time-interval between the electrocardiogram P-wave and the beginning of the spectral TDI-derived A’ for the septal (septal EMD) and lateral (lateral EMD) sides of the mitral annulus. Results There was no significant difference in the left atrial volume index between PAF patients and disease controls (28 ± 9 mL/m2 vs. 27 ± 5 mL/m2). PAF patients had longer AEMD, particularly for the lateral EMD (75 ± 23 ms), compared with disease (62 ± 22 ms, P = 0.009) and healthy (54 ± 24 ms, P < 0.001) controls. Multivariate logistic regression analysis revealed that the lateral EMD (OR 1.25, 95%CI 1.03–1.52, P = 0.023), along with the left atrial volume index (OR 2.25, 95%CI 1.44–3.51, P < 0.001), was one of the significant independent associates of identifying PAF patients. Conclusions This cross-sectional study indicates that even analyzed together with MRFs patients, AEMD remains useful for identifying patients at risk for AF. Our results need to be confirmed by a large-scale prospective study.
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Affiliation(s)
- Kanako Akamatsu
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan
| | - Takahide Ito
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan.
| | - Masatoshi Miyamura
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan
| | - Yumiko Kanzaki
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan
| | - Koichi Sohmiya
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan
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15
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Tracy E, Rowe G, LeBlanc AJ. Cardiac tissue remodeling in healthy aging: the road to pathology. Am J Physiol Cell Physiol 2020; 319:C166-C182. [PMID: 32432929 DOI: 10.1152/ajpcell.00021.2020] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This review aims to highlight the normal physiological remodeling that occurs in healthy aging hearts, including changes that occur in contractility, conduction, valve function, large and small coronary vessels, and the extracellular matrix. These "normal" age-related changes serve as the foundation that supports decreased plasticity and limited ability for tissue remodeling during pathophysiological states such as myocardial ischemia and heart failure. This review will identify populations at greater risk for poor tissue remodeling in advanced age along with present and future therapeutic strategies that may ameliorate dysfunctional tissue remodeling in aging hearts.
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Affiliation(s)
- Evan Tracy
- Department of Physiology, Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky
| | - Gabrielle Rowe
- Department of Physiology, Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky
| | - Amanda J LeBlanc
- Department of Physiology, Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky
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16
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Left atrial strain in left ventricular diastolic dysfunction: have we finally found the missing piece of the puzzle? Heart Fail Rev 2019; 25:409-417. [DOI: 10.1007/s10741-019-09889-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Johansson B, Lundin F, Tegeback R, Bojö L. E/a' ratio is closely related to pulmonary vein flow profile in patients with normal ejection fraction. SCAND CARDIOVASC J 2019; 53:312-316. [PMID: 31328575 DOI: 10.1080/14017431.2019.1645348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives. To compare the ability of the E/a' ratio and the recommended diastolic parameters in the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI), in predicting a dominant diastolic pulmonary vein flow in patients with normal ejection fraction. Design. We retrospectively evaluated the diastolic function according to the ASE/EACVI guidelines, the S/D ratio and the septal, lateral and average E/a' ratio in 293 unselected in-hospital patients, aged 39-86 years, in sinus rhythm and with no or mild valve disease, having a normal systolic function (EF > 50%). Results. The S/D ratio had a positive association to septal, lateral and average E/a ratio (R2 = 0.25, 0.35 and 0.32). The association to average E/e' ratio, LA vol index and TR velocity was weak (R2 = 0.037, 0.033 and 0.087) and for e' velocity negatively. In patients with S/D ratio <1, septal, lateral, average E/a' ratio, average E/e ratio, LA vol index (p<.001) and TR velocity (p<.05) were significantly higher compared to patients with S/D ratio ≥1. No significant difference was seen in e' velocity. The septal, lateral and average E/a' ratio were significantly higher in patients with S/D ratio <1 regardless a normal or impaired diastolic function according to the ASE/EACVI guidelines (p<.001). The ASE/EACVI algorithm detected 21 patients with S/D ratio <1 compared to 28 patients using average E/a' ratio with cut-off >14. Conclusion: E/a' ratio might be a useful new diastolic parameter in patients with a normal ejection fraction as it is more closely related to the S/D ratio than the established ASE/EACVI diastolic parameters.
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Affiliation(s)
- Benny Johansson
- Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden
| | - Fredrik Lundin
- Centre for statistical Clinical Research, County Council of Värmland, Karlstad, Sweden
| | - Rolf Tegeback
- Department of Clinical Physiology, Länssjukhuset Sundsvall-Harnosand, Sundsvall, Sweden
| | - Leif Bojö
- Department of Clinical Physiology, Central Hospital, Karlstad, Sweden
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18
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Rusinovich Y, Rusinovich V. Cardiac Doppler in patients with primary varicose veins of lower extremities. Phlebology 2019; 35:62-66. [PMID: 31088217 DOI: 10.1177/0268355519848895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim This study examines the characteristics of cardiac Doppler in patients with primary varicose veins of lower extremities. Material and methods We performed retrospective descriptive statistical analysis of cardiac Doppler data of 85 patients with primary varicose veins and compared obtained parameters with normal values. Results Patients with primary varicose veins in comparison with normal controls have significantly lower early diastolic mitral and tricuspid inflow velocities (E wave), significantly higher late diastolic mitral and tricuspid inflow and annular velocities (A and a′ waves), significantly higher systolic mitral and tricuspid annular velocities (s′ wave), and they have normal early diastolic mitral and tricuspid annular velocities (e′ wave). Conclusion Cardiac Doppler in patients with primary varicose veins differs significantly from the actual normal values. Possible mechanism of this finding is compensatory increased atrial ejection fraction due to altered preload in patients with primary varicose veins.
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Affiliation(s)
- Yury Rusinovich
- Department of Vascular Surgery, Krankenhausgesellschaft Sankt Vincenz GmbH, Limburg, Germany
| | - Volha Rusinovich
- Department of Postgraduate Medical Education, Biermann Verlag GmbH, Koln, Germany
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19
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Tsai JP, Sung KT, Su CH, Lai YH, Kuo JY, Yun CH, Yen CH, Hou CJY, Wu TH, Peng MC, Hung TC, Yeh HI, Hung CL. Diagnostic accuracy of left atrial remodelling and natriuretic peptide levels for preclinical heart failure. ESC Heart Fail 2019; 6:723-732. [PMID: 30993903 PMCID: PMC6676297 DOI: 10.1002/ehf2.12430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 02/15/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Left atrial (LA) remodelling is an important predictor of cardiovascular events of heart failure (HF) and atrial fibrillation. Data regarding diagnostic value of LA remodelling on diastolic dysfunction (DD) and preclinical HF remain largely unexplored. METHODS AND RESULTS We assessed LA dimension (LAD) in 8368 consecutive asymptomatic Asians (mean age: 49.7, 38.9% women) and related such measure to updated American Society of Echocardiography (ASE) DD criteria and newly revised N-terminal pro-brain natriuretic peptide (NT-proBNP) cut-off (≥125 pg/mL) and HF with preserved ejection fraction criteria incorporating NT-proBNP and echocardiography parameters by the European Society of Cardiology (ESC). LAD and indexed LAD (LADi) were both inversely correlated with myocardial relaxation e' and positively associated with indexed LA volume, left ventricular E/e', and tricuspid regurgitation velocity (all P < 0.001) and showed significantly graded increase across ASE-defined 'normal', 'inconclusive', and 'DD' categories (30.9, 34.4, and 36.5 mm; 16.7, 19.1, and 20.6 mm/m2 , for LAD/LADi, both P for trend: <0.001, respectively). Substantial differences of LAD/LADi (31.3 vs. 33.6 mm/16.7 vs. 19.2 mm/m2 , both P < 0.001) between ESC low and high HF probability using NT-proBNP cut-off were also observed. Multivariate linear and logistic models demonstrated that LAD set at 34 mm was independently associated with ASE-defined diastolic indices, DD existence, and elevated NT-proBNP (all P < 0.05). The use of LAD further yielded high diagnostic accuracy in DD (area under receiving operative characteristic curve: 0.77, 95% confidence interval [0.73, 0.80]; negative predictive value: 97.9%) and in ESC-recommended HF with preserved ejection fraction criteria (area under receiving operative characteristic curve: 0.70, 95% confidence interval [0.65, 0.75]; negative predictive value: 98.7%) with high predictive value in LA remodelling (>34 mL/m2 ; positive predictive value: 96%) and well-discriminated ESC-recommended NT-proBNP (≥125 pg/mL, LAD: 37 mm) for HF. CONCLUSIONS Single utilization of atrial remodelling is highly useful for ruling out presence of DD and provides practical threshold for identifying preclinical HF based on most updated guidelines.
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Affiliation(s)
- Jui-Peng Tsai
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Kuo-Tzu Sung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Huang Su
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Yau-Huei Lai
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Jen-Yuan Kuo
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Chun-Ho Yun
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Hsuan Yen
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Charles Jia-Yin Hou
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
| | - Ming-Cheng Peng
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ta-Chuan Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Hung-I Yeh
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,The Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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20
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Negishi K. Incremental Predictive Value of Left Atrial Parameters Over Clinical Risk Scores for Subsequent Atrial Fibrillation: Function Beyond Size. JACC Cardiovasc Imaging 2018; 12:990-992. [PMID: 30448126 DOI: 10.1016/j.jcmg.2018.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Kazuaki Negishi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Royal Hobart Hospital, Hobart, Australia.
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21
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Watanabe R, Amano H, Saito F, Toyoda S, Sakuma M, Abe S, Nakajima T, Inoue T. Echocardiographic surrogates of right atrial pressure in pulmonary hypertension. Heart Vessels 2018; 34:477-483. [PMID: 30244380 DOI: 10.1007/s00380-018-1264-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/14/2018] [Indexed: 12/22/2022]
Abstract
Right atrial pressure (RAP), a representative parameter of right heart failure, is very important for prognostic evaluation and risk assessment in pulmonary hypertension. However, its measurement requires invasive cardiac catheterization. In this study, we determined the most accurate echocardiographic surrogate of catheterization-based RAP. In 23 patients with pulmonary hypertension, a total of 66 cardiac catheterization procedures were performed along with 2-dimensional echocardiography. We evaluated tricuspid E/A, E', A' and E/E', and estimated RAP by the respirophasic variation of the inferior vena cava diameter (eRAP-IVCd) as possible surrogates of catheterization-based RAP. In simple linear regression analysis, E/A (R = 0.452, P = 0.0001) and eRAP-IVCd (R = 0.505, P < 0.0001) were positively correlated with catheterization-based RAP, whereas A' (R = - 0.512, P < 0.0001) was negatively correlated with RAP. In multiple regression analysis, A' was the most significant independent predictor of catheterization-based RAP (R = - 0.375, P = 0.0007). In 16 patients who had multiple measurements, there were a total of 43 measurements before and after medication changes. The absolute change in catheterization-based RAP was negatively correlated with the percent change in A'. Receiver operating characteristic curve analysis indicated that the optimal cut-off value of A' to predict a catheterization-based RAP > 10 mmHg was 11.3 cm/s (area under the curve = 0.782, sensitivity = 0.70, specificity = 0.78). In 20 measurements of 20 patients with left heart failure, catheterization-based RAP was not correlated with any of 5 echocardiographic parameters. However, it was closely correlated with catheterization-based pulmonary capillary wedge pressure. The echocardiographic parameter, A', was the best surrogate of catheterization-based RAP in patients with pulmonary hypertension.
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Affiliation(s)
- Ryo Watanabe
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Hirohisa Amano
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Fumiya Saito
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Shigeru Toyoda
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Masashi Sakuma
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Shichiro Abe
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Toshiaki Nakajima
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Teruo Inoue
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
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22
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Determinants of Normal Left Atrial Volume in Heart Failure with Moderate-to-Severely Reduced Ejection Fraction. Cardiol Res Pract 2018; 2018:7512758. [PMID: 29850229 PMCID: PMC5937574 DOI: 10.1155/2018/7512758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/16/2018] [Accepted: 03/04/2018] [Indexed: 01/08/2023] Open
Abstract
Background Indexed left atrial volume (LAVi) is a robust predictor of adverse cardiovascular events. A minority of patients with moderate-to-severe left ventricular (LV) systolic dysfunction maintain normal LAVi. We followed clinical and echocardiographic parameters for at least 6 months to understand how this population is different from patients with similar systolic dysfunction and dilated left atria. Methods and Results We searched our electronic medical records for "normal" (n=817) and "severely dilated" (n=1094) LA size and LV ejection fraction (EF) ≤ 35% on echocardiogram reports from 2009 to 2015. We analyzed 115 subjects for LAVi, biplane EF, and diastolic parameters over 2 echocardiograms at least 6 months apart. Younger age, white race, being on an angiotensin-converting enzyme inhibitor, smaller end-diastolic LV volume (LVEDV), and longer deceleration time (DT) were associated with having a normal LAVi. The receiver-operating characteristic curve has an area under the curve of 0.95 (p < 0.0001) for this model. An increase in LVESVi and early mitral flow velocity and a decrease in DT explain 32% of the variance seen in LAVi increase over time. Conclusion In patients with moderate-to-severely reduced EF, younger age, being on heart failure therapies, and better diastolic dysfunction were independently associated with a normal LAVi. Improvement in systolic and diastolic performances was associated with decreasing LAVi with 6-month to 1-year follow-up.
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23
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Johansson B, Lundin F, Tegeback R, Bojö L. The a´ velocity in the tissue Doppler predicts S/D ratio <1 in patients with a normal ejection fraction. SCAND CARDIOVASC J 2018; 52:183-188. [PMID: 29652185 DOI: 10.1080/14017431.2018.1455989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To compare the ability of the a´ velocity and the e´ velocity in predicting a dominant diastolic pulmonary vein flow (S/D ratio <1) in patients with normal ejection fraction. DESIGN We retrospectively evaluated the diastolic function according to the ASE/EACVI guidelines, the S/D ratio and the septal, lateral and average a´ velocity in 293 unselected in-hospital patients, aged 39-86 years, in sinus rhythm and with no or mild valve disease, having a normal systolic function (EF >50%). RESULTS There was a good linear correlation between the S/D ratio and the a´ velocity, but a tendency towards a negative correlation between the S/D ratio and the e´ velocity. S/D ratio <1 was seen in 43 patients. These patients had a significantly lower a´ velocity compared to those with S/D-ratio ≥1, septal (6,1 ± 2,4 v 8,8 ± 2,1 cm/s; p < .001) and lateral (6,0 ± 2,6 v 9,3 ± 2,5 cm/s; p < .001) No significant difference was seen in the septal e´ velocity (6,8 ± 2,4 v 6,8 ± 2,1 cm/s), lateral e´ velocity (9,4 ± 2,6 v 9,1 ± 2,8 cm/s) or in the ejection fraction (58,6 ± 4,4% v 58,7 ± 4,0%). A diastolic dysfunction was present in 62 patients, normal diastolic function in 231 patients. The a´ velocity was significantly lower in patients with S/D ratio <1 in both groups (p < .01). CONCLUSION The a´ velocity is superior to the e´ velocity in predicting S/D ratio <1 in patients with normal ejection fraction regardless the ASE/EACVI diastolic classification. A failing left atrium seems to be the explanation.
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Affiliation(s)
- Benny Johansson
- a Department of Clinical Physiology , Örebro University Hospital , Örebro , Sweden
| | - Fredrik Lundin
- b Centre for Statistical Clinical Research , Karlstad , Sweden
| | - Rolf Tegeback
- c Department of Clinical Physiology , Central Hospital , Sundsvall , Sweden
| | - Leif Bojö
- d Department of Clinical Physiology , Central Hospital , Karlstad , Sweden
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24
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Iyngkaran P, Anavekar NS, Neil C, Thomas L, Hare DL. Shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup. World J Methodol 2017; 7:117-128. [PMID: 29354484 PMCID: PMC5746665 DOI: 10.5662/wjm.v7.i4.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/29/2017] [Accepted: 11/22/2017] [Indexed: 02/06/2023] Open
Abstract
The symptom cluster of shortness of breath (SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.
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Affiliation(s)
- Pupalan Iyngkaran
- Department of Medicine, Northern Territory Medical School, Flinders University, Charles Darwin University Campus, Casuarina, NT 0815, Australia
| | - Nagesh S Anavekar
- Department of Cardiology, Northern Hospital, Northern Health, University of Melbourne, Melbourne, VIC 3076, Australia
| | - Christopher Neil
- Cardiology Unit Western Health, Department of Medicine, Western Precinct, University of Melbourne, Melbourne, VIC 3076, Australia
| | - Liza Thomas
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 214, Australia
- Westmead Hospital, Westmead Clincal School, University of Sydney, NSW 2145, Australia
| | - David L Hare
- Cardiovascular Research, University of Melbourne, Melbourne, VIC 3076, Australia
- Heart Failure Services, Austin Health, Melbourne, VIC 3084, Australia
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25
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Johansson B, Lundin F, Tegerback R, Bojö L. E/a´ ratio a simple detector of left ventricular dysfunction in patients with decreased ejection fraction. SCAND CARDIOVASC J 2017; 52:20-27. [PMID: 29237305 DOI: 10.1080/14017431.2017.1414954] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Could a diastolic dysfunction and an increased LV-filling pressure according to ASE/EACVI guidelines be detected or ruled out by the E/a´ratio in patients with decreased ejection fraction. DESIGN We retrospectively evaluated the diastolic function of 113 unselected in-hospital patients, aged 40-84 years, in sinus rhythm and with no or mild valve disease, having a decreased systolic function (EF ≤50%) using the new ASE/EACVI guidelines and compared these results with the E/a´ratio derived from the E wave in the mitral flow and the a´velocity in the tissue Doppler. RESULTS The average E/a´ ratio is a strong predictor of a grade II-III diastolic dysfunction and an elevated left atrial pressure according to ASE/EACVI guidelines with an AUC of 0.92. An average E/a´ ratio with a cut-off >10 had a sensitivity of 97.6% and a negative predictive value of 98.2% in detecting or ruling out a grade II-III diastolic dysfunction and an elevated left atrial pressure according to the current guidelines. CONCLUSION The average E/a´ ratio might be useful as a fast screening tool of a left ventricular dysfunction and an increased left ventricular filling pressure in patients with a decreased ejection fraction.
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Affiliation(s)
- Benny Johansson
- a Department of Clinical Physiology , Örebro University Hospital , Örebro , Sweden
| | - Fredrik Lundin
- b Centre for statistical Clinical Research , County Council of Värmland , Karlstad , Sweden
| | - Rolf Tegerback
- c Department of Clinical Physiology , Central Hospital , Sundsvall , Sweden
| | - Leif Bojö
- d Department of Clinical Physiology , Central Hospital , Karlstad , Sweden
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Sabry ASM, Mansour HAEK, Abo El-Azm TH, Mostafa SA, Zahid BS. Echocardiographic predictors of atrial fibrillation after mitral valve replacement. Egypt Heart J 2017; 69:281-288. [PMID: 29622989 PMCID: PMC5883501 DOI: 10.1016/j.ehj.2017.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 07/12/2017] [Indexed: 11/23/2022] Open
Abstract
Objectives Detection of the echocardiographic predictors of post-operative atrial fibrillation in patients with rheumatic mitral valve disease undergoing mitral valve replacement. Methods The study included 50 patients with rheumatic mitral valve disease undergoing mitral valve replacement. Preoperative assessment included standard two-dimensional echocardiography to assess LA diameter, volume, and emptying fraction, LV volume and ejection fraction. TDI derived velocity, strain of the left atrium and speckle tracking to assess left ventricular function then postoperative follow up for 1 month for occurrence of atrial fibrillation. Results The incidence of postoperative AF was 44%; these patients were significantly older (P = 0.001) and show higher prevalence of DM (P = 0.001) and HTN (P = 0.001). Also, LA diameters (antero-posterior, transverse and longitudinal) and LA volumes (maximal and minimal) were increased (P < 0.001), but no difference in LA emptying fraction (P > 0.05). Systolic LA strain and left ventricular global longitudinal strain were significantly reduced in those patients (P value <0.001). Echocardiographic predictors of AF were LA systolic strain (P value <0.001) and LV global longitudinal strain (P value = 0.003). Cutoff value for systolic LA strain ≤23 had sensitivity 90.91% and specificity 93.33% in predicting POAF. While, left ventricular global longitudinal strain ≤−14.9% had sensitivity 63.6% and specificity 100.0% in predicting AF. Conclusion LA systolic strain and LV global longitudinal strain were significant predictors of POAF. Echocardiographic parameters can identify patients at greater risk of developing POAF who can benefit from preventive measure and guide the selection of prosthesis.
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Hoit BD. Evaluation of Left Atrial Function: Current Status. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1353718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Brian D. Hoit
- Professor of Medicine, Physiology and Biophysics, Case Western Reserve University, and Director of Echocardiography, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Möttönen MJ, Ukkola O, Lumme J, Kesäniemi YA, Huikuri HV, Perkiömäki JS. Cardiac Remodeling from Middle Age to Senescence. Front Physiol 2017; 8:341. [PMID: 28603501 PMCID: PMC5445175 DOI: 10.3389/fphys.2017.00341] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/09/2017] [Indexed: 01/19/2023] Open
Abstract
Background: The data on cardiac remodeling outside the scope of myocardial infarction and heart failure are limited. Methods: A cohort of middle-aged hypertensive subjects with age- and gender-matched control subjects without hypertension (n = 1,045, aged 51 ± 6 years) were randomly selected for the OPERA study (Oulu Project Elucidating Risk of Atherosclerosis study). The majority of those who were still alive after more than 20 years of follow-up underwent thorough re-examinations. Results: Left ventricular mass index (LVMI) increased significantly from 106.5 ± 27.1 (mean ± SD) to 114.6 ± 29.1 g/m2 (p < 0.001), the thickness of the left ventricular posterior wall (LVPW) from 10.0 ± 1.8 to 10.6 ± 1.7 mm (p < 0.001), fractional shortening (FS) from 35.0 ± 5.7 to 38.4 ± 7.2 % (p < 0.001), and left atrial diameter (LAD) from 38.8 ± 5.2 to 39.4 ± 6.7 mm (p = 0.028) during the 20-year follow-up. After multivariate adjustments, hypertension treated with antihypertensive medication and male gender predicted a smaller increase in the thickness of LVPW (p = 0.017 to <0.001). Baseline higher fasting plasma insulin level, larger intima media thickness of the carotid artery, greater height and antihypertensive medication (p = 0.046-0.002) predicted a smaller (less favorable) change of FS. The increase of LAD was associated with higher baseline diastolic blood pressure (p = 0.034) and greater height (p = 0.006). Conclusion: Aging from middle age to senescence increases the echocardiographic indexes of LVMI, LVPW thickness, FS and LAD. Several baseline factors are associated with these changes.
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Affiliation(s)
- Mikko J Möttönen
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of OuluOulu, Finland
| | - Olavi Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of OuluOulu, Finland
| | - Jarmo Lumme
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of OuluOulu, Finland
| | - Y Antero Kesäniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of OuluOulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of OuluOulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of OuluOulu, Finland
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Saghiv MS, Sira DB, Goldhammer E, Sagiv M. The effects of aerobic and anaerobic exercises on circulating soluble-Klotho and IGF-I in young and elderly adults and in CAD patients. J Circ Biomark 2017; 6:1849454417733388. [PMID: 29081845 PMCID: PMC5644364 DOI: 10.1177/1849454417733388] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/09/2017] [Indexed: 12/15/2022] Open
Abstract
Different studies support the notion that chronic aerobic exercises training can influence the circulating levels of soluble-Klotho (s-Klotho) and insulin-like growth factor 1 (IGF-I). The effects of s-Klotho include improving the quality of life, alleviating the negative impact of age on the body's work capacity, and possibly increasing longevity. This review provides an overview of the latest findings in this field of research in humans. The different modes of dynamic exercise and their impact on circulating levels of s-Klotho and IGF-I in young adult athletes, untrained young adults, trained healthy older adults, untrained healthy older adults, and coronary artery disease (CAD) patients are reviewed and discussed. Together these findings suggest that long-lasting (chronic) aerobic exercise training is probably one of the antiaging factors that counteract the aging and CAD process by increasing the circulating s-Klotho and lowering the IGF-I levels. However, following anaerobic exercise training the opposite occurs. The exact metabolic and physiological pathways involved in the activity of these well-trained young and master sportsmen should be further studied and elucidated. The purpose of this review was to provide a clarification regarding the roles of s-Klotho and intensities and durations of different exercise on human health.
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Affiliation(s)
- Moran S Saghiv
- Exercise Physiology Department, University of Mary, Bismarck, ND, USA
| | - D Ben Sira
- Life Sciences Department, Wingate College, Wingate, Israel
| | - E Goldhammer
- Heart Institute Bnai-Zion Haifa Medical Center, Technion Institute, Haifa, Israel
| | - M Sagiv
- Life Sciences Department, Wingate College, Wingate, Israel
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Maceira AM, Cosin-Sales J, Prasad SK, Pennell DJ. Characterization of left and right atrial function in healthy volunteers by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2016; 18:64. [PMID: 27719670 PMCID: PMC5056480 DOI: 10.1186/s12968-016-0284-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/15/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Left and right atrial function show a different pattern in advanced age in order to maintain adequate ventricular filling. It has been shown that left atrial (LA) function has a prognostic value in a number of heart conditions. Cardiovascular magnetic resonance (CMR) provides high quality images of the left and right atria using high temporal resolution steady state free precession (SSFP) cine sequences. We used SSFP cines to characterize atrial function in healthy, normotensive, volunteers. METHODS We measured maximum, preatrial contraction and minimum left and right atrial volumes in 120 healthy subjects after careful exclusion of cardiovascular abnormality (60 men, 60 women; 20 subjects per age decile from 20 to 80 years). Data were generated from 3-dimensional modeling, including tracking of the atrioventricular ring motion and time-volume curves analysis. With those measurements, all the usual parameters for left and right atrial function were calculated. RESULTS Gender had significant influence on some parameters of left and right atrial conduit and booster pump function. Age significantly influenced the majority of parameters of both left and right atrial function, with typically lower reservoir and conduit functions and higher booster pump function, both in males and females belonging to older age groups. CMR normal ranges were modelled for clinical use with normalization, where appropriate, for body surface area and gender, displaying parameters with respect to age. CONCLUSIONS CMR normal reference ranges for components of left and right atrial function are provided for males and females for a wide age range.
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Affiliation(s)
- Alicia M. Maceira
- Cardiovascular Imaging Unit, ERESA Medical Center, MR Unit, Hospital Arnau de Vilanova, Valencia, RIC Spain
- Department of Medicine, Health Sciences School, CEU Cardenal Herrera University, Valencia, Spain
| | - Juan Cosin-Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
| | - Sanjay K. Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Dudley J. Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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31
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Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on Atrial cardiomyopathies: Definition, characterisation, and clinical implication. J Arrhythm 2016; 32:247-78. [PMID: 27588148 PMCID: PMC4996910 DOI: 10.1016/j.joa.2016.05.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hô pitaux de Paris, Pitié-Salpêtrière Hospital, Sorbonne University, INSERM UMR_S1166, Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundació n and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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32
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Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace 2016; 18:1455-1490. [PMID: 27402624 DOI: 10.1093/europace/euw161] [Citation(s) in RCA: 497] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Sorbonne University; INSERM UMR_S1166; Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundación and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada .,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Heart Rhythm 2016; 14:e3-e40. [PMID: 27320515 DOI: 10.1016/j.hrthm.2016.05.028] [Citation(s) in RCA: 229] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 12/21/2022]
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Risk Factors and Prognostic Role of Left Atrial Enlargement in Patients with Cardiac Light-Chain Amyloidosis. Am J Med Sci 2016; 351:271-8. [DOI: 10.1016/j.amjms.2015.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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35
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Gaber R, Salama M. Left atrial appendage dysfunction in acute embolic stroke young patients with sinus rhythm: Correlation with Tissue Doppler mitral annular systolic velocity. Artery Res 2016. [DOI: 10.1016/j.artres.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Franzoso FD, Wohlmuth C, Greutmann M, Kellenberger CJ, Oxenius A, Voser EM, Valsangiacomo Buechel ER. Atrial Function after the Atrial Switch Operation for Transposition of the Great Arteries: Comparison with Arterial Switch and Normals by Cardiovascular Magnetic Resonance. CONGENIT HEART DIS 2015; 11:426-436. [DOI: 10.1111/chd.12323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Francesca D. Franzoso
- Division of Cardiology; Pediatric Heart Center, University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center, University Children's Hospital Zurich; Zurich Switzerland
| | - Christoph Wohlmuth
- Children's Research Center, University Children's Hospital Zurich; Zurich Switzerland
- Department of Gynecology and Obstetrics; Paracelsus Medical University Salzburg; Salzburg Austria
| | - Matthias Greutmann
- Department of Cardiology; University Hospital Zurich; Zurich Switzerland
| | - Christian J. Kellenberger
- Children's Research Center, University Children's Hospital Zurich; Zurich Switzerland
- Department of Diagnostic Imaging; University Children's Hospital Zurich; Zurich Switzerland
| | - Angela Oxenius
- Division of Cardiology; Pediatric Heart Center, University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center, University Children's Hospital Zurich; Zurich Switzerland
- Department of Cardiology; University Hospital Zurich; Zurich Switzerland
| | - Eva M. Voser
- Division of Cardiology; Pediatric Heart Center, University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center, University Children's Hospital Zurich; Zurich Switzerland
| | - Emanuela R. Valsangiacomo Buechel
- Division of Cardiology; Pediatric Heart Center, University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center, University Children's Hospital Zurich; Zurich Switzerland
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Prediction of improvement in left atrial function index after catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 2015; 44:151-60. [PMID: 26267740 DOI: 10.1007/s10840-015-0043-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Although left atrial function index is reportedly a possible predictor of hospitalization for heart failure and of stroke irrespective of the presence or not of atrial fibrillation (AF), the effects of catheter ablation on left atrial function index have not yet been reported. METHODS We performed catheter ablation on 55 patients (age 56.6 ± 9.6 years; 44 men; 30 with paroxysmal and 25 with persistent, long-standing AF) and evaluated them by transthoracic echocardiography preoperatively and 3 monthly for 12-24 months after catheter ablation. We then compared clinical characteristics and echocardiographic variables before catheter ablation between two groups: the 42 subjects with the most recent left atrial function index <30 and the 13 in which it was ≥30. RESULTS Left atrial function index improved after catheter ablation in both groups, plateauing 6 months after the procedure. Univariate analysis showed statistically significant differences in the prevalence of chronic AF and left atrial emptying fraction, diameter, and maximum and minimum volume (prevalence of chronic AF, p < 0.05; others, p < 0.01) between the groups. Multivariate analysis showed that only maximum left atrial volume predicts left atrial function index after catheter ablation (p < 0.05). In addition, we used ROC analysis to calculate a cutoff value for LA maximum volume as a good predictor and found that a good cutoff value was 63.5 mL, the sensitivity and specificity being 0.75 and 0.75, respectively. CONCLUSIONS Catheter ablation improves left atrial function index. However, in patients with left atrial maximum volume of over 63.5 mL on echocardiography, the index did not recover to within the normal range after catheter ablation.
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Abstract
Transthoracic echocardiography is the most widely used imaging test in cardiology. Although completely noninvasive, transthoracic echocardiography has a well-established role in the diagnosis of numerous cardiovascular diseases, and also provides critical qualitative and quantitative information on their prognosis and pathophysiological processes. The aim of this Review is to outline the broad principles of transthoracic echocardiography, including the traditional techniques of two-dimensional, colour, and spectral Doppler echocardiography, and newly developed advances including tissue Doppler, myocardial deformation imaging, torsion, stress echocardiography, contrast and three-dimensional echocardiography. The advantages and disadvantages, clinical application, prognostic value, and salient research findings of each modality are described. Advances in complex imaging techniques are expected to continue unabated, and this Review highlights technical improvements that will influence the diagnosis and improve our understanding of cardiovascular function and disease.
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Affiliation(s)
- Anita C Boyd
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Corner Elizabeth/Goulburn Street, NSW 2170, Australia
| | - Nelson B Schiller
- University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Liza Thomas
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Corner Elizabeth/Goulburn Street, NSW 2170, Australia
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Kadappu KK, Thomas L. Tissue Doppler Imaging in Echocardiography: Value and Limitations. Heart Lung Circ 2015; 24:224-33. [DOI: 10.1016/j.hlc.2014.10.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
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40
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Suwa K, Saitoh T, Takehara Y, Sano M, Nobuhara M, Saotome M, Urushida T, Katoh H, Satoh H, Sugiyama M, Wakayama T, Alley M, Sakahara H, Hayashi H. Characteristics of intra-left atrial flow dynamics and factors affecting formation of the vortex flow – analysis with phase-resolved 3-dimensional cine phase contrast magnetic resonance imaging. Circ J 2014; 79:144-52. [PMID: 25391258 DOI: 10.1253/circj.cj-14-0562] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The intra-left atrial (LA) blood flow from pulmonary veins (PVs) to the left ventricle (LV) changes under various conditions and might affect global cardiac function. By using phase-resolved 3-dimensional cine phase contrast magnetic resonance imaging (4D-Flow), the intra-LA vortex formation was visualized and the factors affecting the intra-LA flow dynamics were examined. METHODS AND RESULTS Thirty-two patients with or without organic heart diseases underwent 4D-Flow and transthoracic echocardiography. The intra-LA velocity vectors from each PV were post-processed to delineate streamline and pathline images. The vector images revealed intra-LA vortex formation in 20 of 32 patients. All the vortices developed during the late systolic and early diastolic phases and were directed counter-clockwise when viewed from the subjects' cranial side. The flow vectors from the right PVs lengthened predominantly toward the mitral valves and partly toward the LA appendage, whereas those from the left PVs directed rightward along the posterior wall and joined the vortex. Patients with vortex had less organic heart diseases, smaller LV and LA volume, and greater peak flow velocity and volume mainly in the left PVs, although the flow directions from each PV or PV areas did not differ. CONCLUSIONS 4D-Flow can clearly visualize the intra-LA vortex formation and analyze its characteristic features. The vortex formation might depend on LV and LA volume and on flow velocity and volume from PVs.
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Affiliation(s)
- Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University Hospital
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Nakamura K, Osuga T, Morishita K, Suzuki S, Morita T, Yokoyama N, Ohta H, Yamasaki M, Takiguchi M. Prognostic value of left atrial function in dogs with chronic mitral valvular heart disease. J Vet Intern Med 2014; 28:1746-52. [PMID: 25327889 PMCID: PMC4895618 DOI: 10.1111/jvim.12441] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/26/2014] [Accepted: 07/23/2014] [Indexed: 11/28/2022] Open
Abstract
Background A strong correlation between left atrial (LA) dysfunction and the severity of cardiac disease has been described in human patients with various cardiac diseases. The role of LA dysfunction in dogs with chronic mitral valvular heart disease (CMVHD) has not been addressed. Objectives To investigate the correlation between LA function and the prognosis of dogs with CMVHD. Animals Thirty‐eight client‐owned dogs with CMVHD. Methods Prospective clinical cohort study. Dogs were divided into 2 groups (survivors and nonsurvivors) based on the onset of cardiac‐related death within 1 year. Physical examination and echocardiographic variables were compared between the groups. For the assessment of the comparative accuracy in identifying patients with cardiac‐related death, receiver operating characteristic (ROC) curves and multivariate logistic analysis were used. Results The highest accuracy was obtained for the LA active fractional area change (LA‐FACact), with an area under the ROC curve (AUC) of 0.95, followed by the left atrial to aortic root ratio (LA/Ao), with an AUC of 0.94; peak early diastolic mitral inflow velocity (E), with an AUC of 0.85; and LA total fractional area change (LA‐FACtotal), with an AUC of 0.85. In the multivariate logistic regression analysis, LA‐FACact emerged as the only independent correlate of cardiac‐related death within 1 year (odds ratio = 1.401, P = .002). Conclusions and Clinical Importance Regarding both the size and function, the LA has a strong correlation with the prognosis of dogs with CMVHD. The most significant independent predictor of mortality in this study was LA‐FACact.
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Affiliation(s)
- K Nakamura
- Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Veterinary Teaching Hospital, Sapporo, Hokkaido, Japan
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42
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Kaneko K, Otaki Y, Kadowaki S, Narumi T, Saito H, Kiribayashi N, Omi K, Sasaki T, Niizeki T, Sugawara S, Kubota I. Left atrial appendage dysfunction in acute cerebral embolism patients with sinus rhythm: correlation with pulse wave tissue Doppler imaging. Int J Cardiovasc Imaging 2014; 30:1245-54. [DOI: 10.1007/s10554-014-0455-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/16/2014] [Indexed: 11/30/2022]
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43
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Kuklik P, Molaee P, Podziemski P, Ganesan AN, Brooks AG, Worthley SG, Sanders P. Quantitative description of the 3D regional mechanics of the left atrium using cardiac magnetic resonance imaging. Physiol Meas 2014; 35:763-75. [PMID: 24671140 DOI: 10.1088/0967-3334/35/5/763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The left atrium (LA) plays an important role in the maintenance of hemodynamic and electrical stability of the heart. One of the conditions altering the atrial mechanical function is atrial fibrillation (AF), leading to an increased thromboembolic risk due to impaired mechanical function. Preserving the regions of the LA that contribute the greatest to atrial mechanical function during curative strategies for AF is important. The purpose of this study is to introduce a novel method of regional assessment of mechanical function of the LA. We used cardiac MRI to reconstruct the 3D geometry of the LA in nine control and nine patients with paroxysmal atrial fibrillation (PAF). Regional mechanical function of the LA in pre-defined segments of the atrium was calculated using regional ejection fraction and wall velocity. We found significantly greater mechanical function in anterior, septal and lateral segments as opposed to roof and posterior segments, as well as a significant decrease of mechanical function in the PAF group. We suggest that in order to minimize the impact of the AF treatment on global atrial mechanical function, damage related to therapeutic intervention, such as catheter ablation, in those areas should be minimized.
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Affiliation(s)
- P Kuklik
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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44
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45
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BaronToaldo M, Guglielmini C, Diana A, Sarcinella F, Cipone M. Feasibility and reproducibility of echocardiographic assessment of regional left atrial deformation and synchrony by tissue Doppler ultrasonographic imaging in healthy dogs. Am J Vet Res 2014; 75:59-66. [DOI: 10.2460/ajvr.75.1.59] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Agoston-Coldea L, Lupu S, Hicea S, Mocan T. Left atrium systolic and diastolic function assessment in hypertensive patients with preserved ejection fraction. ACTA ACUST UNITED AC 2013; 100:140-52. [PMID: 23524181 DOI: 10.1556/aphysiol.100.2013.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Left atrium remodeling is a physiological response to pressure overload in hypertensive patients. The aim of this study is to determine the relationship between left atrium remodeling and left ventricle diastolic dysfunction in hypertensive patients with preserved systolic function. MATERIALS AND METHODS We conducted a prospective study on 96 hypertensive patients (48.75 ± 5.01 years, 50 men) and 96 healthy control subjects (48.17 ± 8.52 years, 56 men), whose data were all evaluated by echocardiography measuring left atrium volumes during the reservoir,conduit and pump phases. Standard indices reflecting left ventricular filling were also assessed. RESULTS Medium left atrium volume indexed for body surface was significantly higher in hypertensive patients – 30.87 (6.38) mL/m² vs.21.72 (2.52) mL/m². Indexed left atrium volume was strongly associated with left ventricle diastolic function (p <0.0001). When compared to normal subjects, patients with mild diastolic dysfunction had lower corrected passive emptying volumes ( p < 0.0001) and higher corrected active emptying volumes (p = 0.001), thus leading to similar corrected total emptying volumes ( p < 0.001). However, patients with moderate diastolic dysfunction had smaller active emptying volumes, but higher passive and total emptying volumes when compared to normal controls and patients with mild diastolic dysfunction. CONCLUSIONS Left atrium indexed volumes evaluation during the reservoir,conduit and pump phases proved to be essential for early diastolic dysfunction assessment in hypertensive patients.
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Affiliation(s)
- Lucia Agoston-Coldea
- "Iuliu Hatieganu" University of Medicine and Pharmacy Department of Medical Sciences Cluj-Napoca Romania "Iuliu Hatieganu" University of Medicine and Pharmacy 2-4 Clinicilor 400006 Cluj-Napoca Romania
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47
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Indexed maximal left atrial volume predicts response to cardiac resynchronization therapy. Int J Cardiol 2013; 168:3629-33. [DOI: 10.1016/j.ijcard.2013.05.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 01/29/2013] [Accepted: 05/04/2013] [Indexed: 11/20/2022]
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48
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Sun JP, Yang Y, Guo R, Wang D, Lee APW, Wang XY, Lam YY, Fang F, Yang XS, Yu CM. Left atrial regional phasic strain, strain rate and velocity by speckle-tracking echocardiography: Normal values and effects of aging in a large group of normal subjects. Int J Cardiol 2013; 168:3473-9. [DOI: 10.1016/j.ijcard.2013.04.167] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 04/16/2013] [Accepted: 04/19/2013] [Indexed: 12/12/2022]
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49
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Yoon JH, Moon J, Chung HM, Choi EY, Kim JY, Min PK, Yoon YW, Lee BK, Hong BK, Kwon HM, Rim SJ. Left atrial function assessed by Doppler echocardiography rather than left atrial volume predicts recurrence in patients with paroxysmal atrial fibrillation. Clin Cardiol 2013; 36:235-40. [PMID: 23495006 DOI: 10.1002/clc.22105] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/30/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Paroxysmal atrial fibrillation (PaAF) may present as a single self-terminating episode of atrial fibrillation (AF) or a more persistent form after sinus conversion. We investigated predictors of recurrence in patients with PaAF. HYPOTHESIS Left atrial function would be an useful parameter for predicting PaAF recurrence. METHODS The study population included 228 PaAF patients (131 males, age 64±14 years) who underwent transthoracic echocardiography immediately after spontaneous sinus conversion at initial AF diagnosis. We followed the study patients for AF recurrence. RESULTS AF recurrence was demonstrated in 45 patients (20%, age 68±13 years) after spontaneous sinus conversion. Patients with recurrence had larger left atrial volume index (32±12 vs 25±10 mL/m2, P<0.001), left ventricle mass index (107±34 vs 93±25 g/m2, P=0.012), and left ventricle filling pressure (E/e'') (14±7 vs 12±5, P=0.012), whereas early diastolic mitral annular velocity (e') (5±2 vs 6±3 cm/s, P=0.021), late diastolic mitral annular velocity (A') (7±3 vs 9±2 cm/s, P<0.001), and peak systolic mitral annular velocity (7±2 vs 8±2 cm/s, P=0.045) were significantly lower. In multivariate Cox regression analysis detecting independent predictors of PaAF recurrence, lower A' (hazard ratio: 0.623, 95% confidence interval: 0.476-0.815, P=0.001) was a significant predictor of AF recurrence. CONCLUSIONS A', which indicates left atrial (LA) contractile function after sinus conversion, was the independent predictor of PaAF recurrence, whereas LA volume was not. LA function may be more important than LA volume in predicting recurrence particularly in patients with PaAF.
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Affiliation(s)
- Ji Hyun Yoon
- Cardiology Division, Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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50
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Sahebjam M, Zoroufian A, Sadeghian H, Roomi ZS, Sardari A, Mirzamani SS, Tokaldany ML, Jalali A. Relationship between Left Atrial Function and Size and Level of Left Ventricular Dyssynchrony in Heart Failure Patients. Echocardiography 2013; 30:772-7. [DOI: 10.1111/echo.12148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Mohammad Sahebjam
- Echocardiography Department; Tehran Heart Center; Tehran University of Medical Sciences; Tehran; Iran
| | - Arezou Zoroufian
- Echocardiography Department; Tehran Heart Center; Tehran University of Medical Sciences; Tehran; Iran
| | - Hakimeh Sadeghian
- Echocardiography Department; Tehran Heart Center; Tehran University of Medical Sciences; Tehran; Iran
| | - Zahra Savand Roomi
- Echocardiography Department; Tehran Heart Center; Tehran University of Medical Sciences; Tehran; Iran
| | - Akram Sardari
- Echocardiography Department; Tehran Heart Center; Tehran University of Medical Sciences; Tehran; Iran
| | - Shirin Sadat Mirzamani
- General Cardiology Department; Tehran Heart Center; Tehran University of Medical Sciences; Tehran; Iran
| | | | - Arash Jalali
- Research Department; Tehran Heart Center; Tehran University of Medical Sciences; Tehran; Iran
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