Prediction of improvement in left atrial function index after catheter ablation for atrial fibrillation

Left atrial function index and left atrial electromechanical functions in anxiety disorders

BACKGROUND

There is a close linkage between anxiety disorders (ADs), and development of cardiovascular disease (CVD) and atrial fibrillation (AF). We aimed to investigate left atrial function index (LAFI) and its components, LA mechanical functions and atrial conduction times in AD patients and age- and gender-matched control group patients for the first time in the literature.

METHODS

A total of 48 AD patients and 33 healthy subjects were enrolled to the study prospectively. Echocardiographic parameters including two-dimensional conventional echocardiography, diastolic functions, LA mechanical functions, LAFI, atrial conduction times and atrial electromechanical delay (AEMD) were calculated.

RESULTS

The velocity-time integral of the LV outflow tract (LVOT-VTI), LAFI and LA conduit volume were significantly lower in AD patients. Atrial electromechanical coupling as established from lateral mitral annulus (PA lateral) was significantly higher in AD group than control group. Inter-AEMD and left intra-AEMD were also higher in AD group compared to control group. Age, gender, body surface area (BSA), conduit volume, LVOT-VTI and LAFI were significant factors associated with AD in univariate analysis. However, only BSA and LVOT-VTI (Odds ratio [OR]: 0.79, 95 CI%: 0.66-0.95, p = 0.013) were independently associated with AD in multivariate analysis. Age, gender, conduit volume and LAFI (OR: 0.25, 95 CI%: 0.03-2.12, p = 0.204) were not found to be independent associates of AD.

CONCLUSION

LAFI is impaired in patients suffering from AD compared to their age- and gender-matched counterparts but this impairment originates from lower levels of LVOT-VTI calculations in AD patients. Thus, LVOT-VTI, but not LAFI, is independently associated with AD.

Left atrial function index predicts poor outcomes in acute myocardial infarction patients treated with percutaneous coronary intervention

Background and aims

The left atrial function index (LAFI) is an index that combines the left atrial emptying fraction, adjusted left atrial volume and stroke volume. The prognostic value of LAFI in acute myocardial infarction (AMI) patients treated with percutaneous coronary intervention (PCI) is unknown. This study aims to determine whether LAFI predicts prognosis in AMI patients treated with PCI.

Methods

Patients with newly diagnosed AMI who were treated with PCI at Hunan Provincial People's Hospital from March 2020 to October 2021 were prospectively enrolled. All patients underwent transthoracic echocardiography (TTE) at baseline and follow-up. The endpoint events included rehospitalization due to unstable angina, nonfatal myocardial infarction, rehospitalization due to heart failure and cardiovascular death.

Results

A total of 368 patients with AMI (92 women; mean age, 61.45 ± 11.91 years) were studied with a median follow-up of 14 ± 6.58 months. Sixty-nine patients had endpoint events. Patients who presented with events had a significantly lower LAFI than patients without events (34.25 ± 12.86 vs. 48.38 ± 19.42, P < 0.0001). Multivariate Cox analysis demonstrated that LAFI (HR = 0.97 [95% CI: 0.95; 0.99]; P = 0.012) and the Killip classification (HR = 1.51 [95% CI: 1.03; 2.22]; P = 0.034) were independently predictive of endpoint events. Kaplan-Meier survival curves showed that patients with LAFI ≤ 40.17 cm/ml/m2 had higher events than patients with LAFI > 40.17 cm/ml/m2 (HR = 8.53 [95% CI: 4.74; 15.35]; P < 0.0001).

Conclusion

LAFI is a strong and independent predictor of adverse events and can be used for risk stratification in patients with AMI treated with PCI.

Left atrial function index (LAFI) and outcome in patients undergoing transcatheter aortic valve replacement

Background

Clinical data regarding the association between the left atrial function index (LAFI) and outcome in patients undergoing transcatheter aortic valve replacement (TAVR) are limited.

Objectives

We aimed to investigate the association between the left atrial function index (LAFI) and outcome in patients undergoing TAVR.

Methods

In this retrospective multicenter study, we assessed baseline LAFI in 733 patients undergoing TAVR for severe aortic stenosis in two German high-volume centers between 2008 and 2019. Based on receiver operating characteristic curves, patients were stratified according to their baseline LAFI into two groups (LAFI ≤ 13.5 vs. LAFI > 13.5) and assessed for post-procedural outcome. The primary endpoint of our study was the 1-year all-cause mortality.

Results

Patients with a LAFI ≤ 13.5 had significantly more often atrial fibrillation (p < 0.001), lower LVEF (p < 0.001) and higher levels of NT-proBNP (p < 0.001). After TAVR, a significant improvement in the LAFI as compared to baseline was observed at 12 months after the procedure (28.4 vs. 32.9; p = 0.001). Compared to patients with a LAFI > 13.5, those with a LAFI ≤ 13.5 showed significantly higher rate of 1-year mortality (7.9% vs. 4.0%; p = 0.03). A lower LAFI has been identified as independent predictor of mortality in multivariate analysis (HR (95% CI) 2.0 (1.1–3.9); p = 0.03).

Conclusion

A reduced LAFI is associated with adverse outcome and an independent predictor of mortality in TAVR patients. TAVR improves LAFI within 12 months after the procedure.

Graphical abstract

Left Atrial Function Index (LAFI) in Patients undergoing Transcatheter Aortic Valve Implantation. A Kaplan–Meier survival analysis of 1-year all-cause mortality in patients with LAFI ≤ 13.5 compared with patients with LAFI > 13.5. Comparing rates of 1-year all-cause mortality between the different LAFI groups, we found a significant association between left atrial function and mortality. LAFI Left atrial function index. B Comparison of the mean LAFI before and after TAVR. After long-term follow-up the LAFI improved significantly. LAFI Left atrial function index; FU follow-up. C Assessment of the left atrial function index using the pre-procedural transthoracic echocardiography. A Measurement of the minimal left atrial volume (LAEDV). B Assessment of the maximal left atrial volume (LAESV).

Supplementary Information

The online version contains supplementary material available at 10.1007/s00392-022-02010-5.

Progress in the Study of the Left Atrial Function Index in Cardiovascular Disease: A Literature Review

Some studies have shown that left ventricular structure and function play an important role in the risk stratification and prognosis of cardiovascular disease. The clinical application of left atrial function in cardiovascular disease has gradually attracted attention in the cardiovascular field. There are many traditional methods to evaluate left atrial function. Left atrial function related indexes measured by echocardiography has been identified as a powerful predictor of cardiovascular disease in recent years, but they have some limitations. The left atrial function index has been found to evaluate left atrial function more effectively than traditional parameters. Furthermore, it is a valuable predictor of the risk stratification and prognosis in patients with clinical cardiovascular disease such as heart failure, atrial fibrillation, hypertension, and coronary heart disease.

Clinical and Echocardiographic Correlates of Left Atrial Function Index: The Framingham Offspring Study

BACKGROUND

Left atrial (LA) remodeling is a predictor of cardiovascular disease (CVD). We performed measurement of the LA function index (LAFI), a composite measure of LA structure and function, in a community-based cohort and here report the distribution and cross-sectional correlates of LAFI.

METHODS

In 1,719 Framingham Offspring Study participants (54% women, mean age 66 ± 9 years), we derived LAFI from the LA emptying fraction, left ventricular (LV) outflow tract velocity time integral, and indexed maximal LA volume. We used multivariable linear regression to assess the clinical and echocardiographic correlates of LAFI adjusting for age, sex, anthropometric measurements, and CVD risk factors.

RESULTS

The average LAFI was 35.2 ± 12.1. Overall, LAFI declined with advancing age (β = -0.27, P < .001). LAFI was significantly higher (37.5 ± 11.6) in a subgroup of participants free of CVD and CVD risk factors compared with those with either of these conditions (34.5 ± 12.2). In multivariable models, LAFI was inversely related to antihypertensive use (β = -1.26, P = .038), prevalent atrial fibrillation (β = -4.46, P = .001), heart failure (β = -5.86, P = .008), and coronary artery disease (β = -2.01, P = .046). In models adjusting for echocardiographic variables, LAFI was directly related to LV ejection fraction (β = 14.84, P < .001) and inversely related to LV volume (β = -7.03, P < .001).

CONCLUSIONS

LAFI was inversely associated with antihypertensive use and prevalent CVD and was related to established echocardiographic traits of LV remodeling. Our results offer normative ranges for LAFI in a white community-based sample and suggest that LAFI represents a marker of pathological atrial remodeling.

Association of Left Atrial Function Index With Late Atrial Fibrillation Recurrence after Catheter Ablation

INTRODUCTION

Although catheter ablation (CA) for atrial fibrillation (AF) is commonly used to improve symptoms, AF recurrence is common and new tools are needed to better inform patient selection for CA. Left atrial function index (LAFI), an echocardiographic measure of atrial mechanical function, has shown promise as a noninvasive predictor of AF. We hypothesized that LAFI would relate to AF recurrence after CA.

METHODS AND RESULTS

All AF patients undergoing index CA were enrolled in a prospective institutional AF Treatment Registry between 2011 and 2014. LAFI was measured post hoc from pre-ablation clinical echocardiographic images in 168 participants. Participants were mostly male (33% female), middle-aged (60 ± 10 years), obese and had paroxysmal AF (64%). Mean LAFI was 25.9 ± 17.6. Over 12 months of follow-up, 78 participants (46%) experienced a late AF recurrence. In logistic regression analyses adjusting for factors known to be associated with AF, lower LAFI remained associated with AF recurrence after CA [OR 0.04 (0.01-0.67), P = 0.02]. LAFI discriminated AF recurrence after CA slightly better than CHADS2 (C-statistic 0.60 LAFI, 0.57 CHADS2). For participants with persistent AF, LAFI performed significantly better than CHADS2 score (C statistic = 0.79 LAFI, 0.56 CHADS2, P = 0.02).

CONCLUSION

LAFI, an echocardiographic measure of atrial function, is associated with AF recurrence after CA and has improved ability to discriminate AF recurrence as compared to the CHADS-2 score, especially among persistent AF patients. Since LAFI can be calculated using standard 2D echocardiographic images, it may be a helpful tool for predicting AF recurrence.