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Saito N, Shiraki S, Ono S, Yanagi S, Toyoshima K, Ueda H. Efficiency and feasibility of semi-automated software for measuring left atrial volume in routine echocardiography in a pediatric population. J Ultrasound 2024:10.1007/s40477-024-00918-4. [PMID: 38900365 DOI: 10.1007/s40477-024-00918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/11/2024] [Indexed: 06/21/2024] Open
Abstract
PURPOSE The traditional method for measuring left atrial volume (LAV) involves manual tracing. Recently, semi-automated techniques for measuring LAV, based on 2D speckle tracking echocardiography (STE) and 3D echocardiography (3DE), have become commercially available. This study aimed to investigate the efficiency and feasibility of these semi-automated software methods for LAV measurement in pediatric patients. METHODS We analyzed 207 pediatric patients with 2D and 3D echocardiographic images of the left atrium. The maximum LAV was measured using three techniques: (1) manual tracing, (2) STE-based semi-automated measurement, and (3) 3DE-based semi-automated measurement. We compared both LAV and the time required for LAV measurement among these three techniques. Intra- and inter-observer reproducibility of the LAV measurements was assessed using the intraclass correlation (ICC). RESULTS There was no difference in the LAV between the manual tracing and the STE-based method, but the LAV measured by 3DE-based method was slightly smaller than manual tracing. The measurement time was 32.6 ± 3.5, 53.8 ± 10.8, and 33.8 ± 13.0 s for manual tracing, STE-based, and 3DE-based techniques, respectively. There was no difference the time for LAV measurement between the manual tracing and the 3D-based technique. The agreement and ICC for intra-observer reproducibility was similar across all three techniques, but inter-observer reproducibility was superior with the 3DE-based technique. CONCLUSIONS Although the maximum LAV obtained through the 3DE-based techniques was slightly smaller compared with the traditional manual tracing method, the 3DE-based technique is anticipated to be integrated into routine examinations owing to its short measurement time and superior reproducibility.
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Affiliation(s)
- Naka Saito
- Department of Clinical Laboratory, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
| | - Saki Shiraki
- Department of Clinical Laboratory, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Shin Ono
- Department of Pediatric Cardiology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Sadamitsu Yanagi
- Department of Pediatric Cardiology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Katsuaki Toyoshima
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Hideaki Ueda
- Department of Pediatric Cardiology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
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2
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Tomaselli M, Radu DN, Badano LP, Perelli FP, Heilbron F, Cascella A, Gavazzoni M, Hădăreanu DR, Mihaila S, Oliverio G, Penso M, Caravita S, Baratto C, Fisicaro S, Parati G, Muraru D. Right Atrial Remodeling and Outcome in Patients with Secondary Tricuspid Regurgitation. J Am Soc Echocardiogr 2024; 37:495-505. [PMID: 38218553 DOI: 10.1016/j.echo.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/31/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND In patients with secondary tricuspid regurgitation (STR), right atrial remodeling (RAR) is a proven marker of disease progression. However, the prognostic value of RAR, assessed by indexed right atrial volume (RAVi) and reservoir strain (RAS), remains to be clarified. Accordingly, the aim of our study is to investigate the association with outcome of RAR in patients with STR. METHODS We enrolled 397 patients (44% men, 72.7 ± 13 years old) with mild to severe STR. Complete two-dimensional and speckle-tracking echocardiography analysis of right atrial and right ventricular (RV) size and function were obtained in all patients. The primary end point was the composite of death from any cause and heart failure hospitalization. RESULTS After a median follow-up of 15 months (interquartile range, 6-23), the end point was reached by 158 patients (39%). Patients with RAS <13% and RAVi >48 mL/m2 had significantly lower survival rates compared to patients with RAS ≥13% and RAVi ≤48 mL/m2 (log-rank P < .001). On multivariable analysis, RAS <13% (hazard ratio, 2.11; 95% CI, 1.43-3.11; P < .001) and RAVi > 48 mL/m2 (hazard ratio, 1.49; 95% CI, 1.01-2.18; P = .04) remained associated with the combined end point, even after adjusting for RV free-wall longitudinal strain, significant chronic kidney disease, and New York Heart Association class. Secondary tricuspid regurgitation excess mortality increased exponentially with values of 18.2% and 51.3 mL/m2 for RAS and RAVi, respectively. In nested models, the addition of RAS and RAVi provided incremental prognostic value over clinical, conventional echocardiographic parameters of RV size and function and RV free-wall longitudinal strain. CONCLUSIONS In patients with STR, RAR was independently associated with mortality and heart failure hospitalization. Assessment of RAR could improve risk stratification of patients with STR, potentially identifying those who may benefit from optimization of medical therapy and a closer follow-up.
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Affiliation(s)
- Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Daniela N Radu
- Carol Davila University of Medicine and Pharmacy, Prof. Dr. C. C. Iliescu Institute, Bucharest, Romania
| | - Luigi P Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Francesco P Perelli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesca Heilbron
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Andrea Cascella
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Diana R Hădăreanu
- Department of Cardiology, Clinical Emergency County Hospital of Craiova, Craiova, Romania
| | - Sorina Mihaila
- Cardiology Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania; Cardiology and Cardiovascular Surgery Department, Emergency and University Hospital, Bucharest, Romania
| | - Giorgio Oliverio
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Marco Penso
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Sergio Caravita
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Claudia Baratto
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Samantha Fisicaro
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Alam AB, Toledo‐Atucha E, Romaguera D, Alonso‐Gómez AM, Martínez‐Gonzalez MA, Tojal‐Sierra L, Mora MN, Mas‐Llado C, Li L, Gonzalez‐Casanova I, Salas‐Salvadó J, Fitó M, Alonso A. Associations of Alcohol Consumption With Left Atrial Morphology and Function in a Population at High Cardiovascular Risk. J Am Heart Assoc 2024; 13:e031915. [PMID: 38533958 PMCID: PMC11179787 DOI: 10.1161/jaha.123.031915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/28/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Excessive alcohol consumption has been associated with increased risk of atrial fibrillation, although the underlying mechanisms remain unclear. An enlarged left atrium and impaired left atrial function may lead to atrial fibrillation. The association of alcohol consumption with structural and functional left atrial measures, however, has received limited attention. METHODS AND RESULTS We studied 503 participants from the PREDIMED-Plus (Prevención con Dieta Mediterránea) trial, a randomized trial testing intensive weight loss intervention with an energy-reduced Mediterranean diet and physical activity promotion in preventing cardiovascular disease in adults with metabolic syndrome. Participants underwent transthoracic echocardiography at baseline, year 3, and year 5 of the study. Outcomes of interest included volume index and reservoir, conduit, and contractile strains of the left atrium. Alcohol consumption was calculated through food frequency questionnaires and presented as drinks consumed per day. Multiple linear regression and mixed models estimated the association of alcohol consumption with left atrial measurements at baseline and through follow-up. Cross-sectionally, higher alcohol consumption (per 1 drink/day increases) was associated with larger left atrial volume (0.65 mL/m2 [95% CI, 0.18-1.11]) and lower left atrial reservoir and contractile strain (-0.44% [95% CI, -0.87 to -0.01]; and -0.44% [95% CI, -0.75 to -0.14]). Baseline alcohol consumption was not associated with changes in left atrial measurements, but increases in alcohol consumption (per 1 drink/day increase) during follow-up were associated with left atrial enlargement (0.71 mL/m2 [95% CI, 0.17-1.26]). CONCLUSIONS In a population at high cardiovascular risk, increased alcohol consumption was associated with left atrial enlargement and worsening atrial function. REGISTRATION URL: http://www.controlled-trials.com; Unique identifier: ISRCTN89898870.
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Affiliation(s)
- Aniqa B. Alam
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Estefania Toledo‐Atucha
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn)Carlos III Health Institute (ISCIII)MadridSpain
- Navarra’s Health Research Institute (IdiSNA), Navarra Institute for Health ResearchPamplonaSpain
- Department of Preventive Medicine and Public HealthUniversity of NavarraPamplonaSpain
| | - Dora Romaguera
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn)Carlos III Health Institute (ISCIII)MadridSpain
- Health Research Institute of the Balearic Islands (IdISBa)Palma de MallorcaSpain
| | - Angel M. Alonso‐Gómez
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn)Carlos III Health Institute (ISCIII)MadridSpain
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHUVitoria‐GasteizSpain
| | - Miguel A. Martínez‐Gonzalez
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn)Carlos III Health Institute (ISCIII)MadridSpain
- Navarra’s Health Research Institute (IdiSNA), Navarra Institute for Health ResearchPamplonaSpain
- Department of Preventive Medicine and Public HealthUniversity of NavarraPamplonaSpain
| | - Lucas Tojal‐Sierra
- Navarra’s Health Research Institute (IdiSNA), Navarra Institute for Health ResearchPamplonaSpain
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHUVitoria‐GasteizSpain
| | - Marta Noris Mora
- Health Research Institute of the Balearic Islands (IdISBa)Palma de MallorcaSpain
- Department of CardiologyHospital Universitari Son EspasesPalmaSpain
| | - Caterina Mas‐Llado
- Health Research Institute of the Balearic Islands (IdISBa)Palma de MallorcaSpain
- Cardiology Department, Hospital de ManacorManacorSpain
- Facultad de MedicinaUniversitat de les Illes Balears (UIB)PalmaSpain
| | - Linzi Li
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Ines Gonzalez‐Casanova
- Department of Applied Health ScienceIndiana University‐Bloomington, School of Public HealthBloomingtonIndianaUSA
| | - Jordi Salas‐Salvadó
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn)Carlos III Health Institute (ISCIII)MadridSpain
- Human Nutrition Unit, Department of Biochemistry and BiotechnologyRovira i Virigili UniversityReusSpain
- Human Nutrition Unit, Pere Virgili Health Research Institute (IISPV)ReusSpain
| | - Montserrat Fitó
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn)Carlos III Health Institute (ISCIII)MadridSpain
- Cardiovascular Risk and Nutrition Group, Hospital del Mar Medical Research Institute (IMIM)BarcelonaSpain
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
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Hădăreanu CD, Hădăreanu DR, Stoiculescu FM, Raicea VC, Târtea GC, Florescu C, Radu RI, Donoiu I. The Added Value of Advanced Echocardiography for the Morpho-Functional and Prognostic Evaluation of the Right Heart in Dilated Cardiomyopathy: Do Not Forget about the Right Atrium. J Clin Med 2024; 13:1400. [PMID: 38592247 PMCID: PMC10932129 DOI: 10.3390/jcm13051400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/18/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Introduction and Aims: Right ventricular (RV) remodeling significantly impacts the prognosis of dilated cardiomyopathy (DCM) patients, and right atrial (RA) size and function are still often neglected in DCM patients. Accordingly, our aims were to (i) evaluate right heart subclinical changes and (ii) the prognostic value of RA compared to left atrial (LA) size and function in patients with DCM by advanced echocardiography. (2) Materials and Methods: Sixty-eight patients with DCM (with a mean age of 60 years; 35 men) were evaluated by comprehensive transthoracic echocardiography, compared to 62 age- and sex-matched healthy controls (with a mean age of 61 years; 32 men), and followed up for 12.4 ± 5 months. (3) Results: DCM patients have RV and RA global longitudinal dysfunction by 2DSTE, higher RA minimum volumes and tricuspid annulus areas despite having normal RV volumes, ejection fractions, and RA maximum volumes by 3DE compared to the controls. The RA strain and RV strain are correlated with each other. The RA reservoir strain (with an AUC = 0.769) has an increased value for outcome prediction compared to that of the LA strain. (4) Conclusion: Patients with DCM have RV longitudinal dysfunction and decreased RA function, in the absence of clinical RV involvement or atrial arrhythmias, and the RA strain is associated with an increased risk of hospitalization and cardiac death.
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Affiliation(s)
- Călin-Dinu Hădăreanu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
- Department of Cardiovascular Surgery, Clinical Emergency County Hospital of Craiova, 1 Tabaci St., 200642 Craiova, Romania
| | - Diana-Ruxandra Hădăreanu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
- Department of Cardiology, Clinical Emergency County Hospital of Craiova, 1 Tabaci St., 200642 Craiova, Romania
| | - Flavia-Mihaela Stoiculescu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
- Department of Cardiology, Clinical Emergency County Hospital of Craiova, 1 Tabaci St., 200642 Craiova, Romania
| | - Victor-Cornel Raicea
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
- Department of Cardiovascular Surgery, Clinical Emergency County Hospital of Craiova, 1 Tabaci St., 200642 Craiova, Romania
| | - Georgică-Costinel Târtea
- Department of Cardiology, Clinical Emergency County Hospital of Craiova, 1 Tabaci St., 200642 Craiova, Romania
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
| | - Cristina Florescu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
- Department of Cardiology, Filantropia Clinical Hospital, 28 Sararilor St., 200516 Craiova, Romania
| | - Răzvan Ilie Radu
- Department of Interventional Cardiology, Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, 258 Fundeni St., 022328 Bucharest, Romania
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bld., 050474 Bucharest, Romania
| | - Ionuț Donoiu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
- Department of Cardiology, Clinical Emergency County Hospital of Craiova, 1 Tabaci St., 200642 Craiova, Romania
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5
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Rossello X, Ramallal R, Romaguera D, Alonso-Gómez ÁM, Alonso A, Tojal-Sierra L, Fernández-Palomeque C, Martínez-González MÁ, Garrido-Uriarte M, López L, Díaz A, Zaldua-Irastorza O, Shah AJ, Salas-Salvadó J, Fitó M, Toledo E. Effect of an intensive lifestyle intervention on the structural and functional substrate for atrial fibrillation in people with metabolic syndrome. Eur J Prev Cardiol 2023:zwad380. [PMID: 38102071 DOI: 10.1093/eurjpc/zwad380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/30/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
AIMS To evaluate the effect of an intensive lifestyle intervention (ILI) on the structural and functional cardiac substrate of atrial fibrillation (AF) in overweight or obese people with metabolic syndrome (MetS). METHODS Participants of the PREDIMED-PLUS trial (n = 6874) were randomised 1:1 to an ILI program based on an energy-reduced Mediterranean diet, increased physical activity, and cognitive-behavioural weight management, or to a control intervention of low-intensity dietary advice. Left atrial (LA) strain, function, and volumes were evaluated by a core echocardiography lab in 534 participants at baseline, 3-year and 5-year follow-up. Mixed models were used to evaluate the effect of the ILI on LA structure and function. RESULTS In the subsample, baseline mean age was 65 years (SD 5 years), and 40% of the participants were women. Mean weight change after 5-years was -3.9 kg (SD 5.3 kg) in the ILI group and -0.3 kg (SD 5.1 kg) in the control group. Over the 5-year period, both groups experienced worsening of LA structure and function, with increases in LA volumes and stiffness index and decreases in LA longitudinal strain, LA function index and LA emptying fraction over time. Changes in the ILI and control group were not significantly different for any of the primary outcomes (LA emptying fraction: -0.95% (95%CI -0.93, -0.98) in control group, -0.97% (95%CI -0.94, -1.00) in ILI group, pbetween groups = 0.80; LA longitudinal strain: 0.82% (95%CI 0.79, 0.85) in control group, 0.85% (95%CI 0.82, 0.89) in ILI group, pbetween groups = 0.24) or any of the secondary outcomes. CONCLUSIONS In overweight or obese people with MetS, an ILI had no impact on the underlying structural and functional left atrial substrate measurements associated with AF risk.
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Affiliation(s)
- Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Raúl Ramallal
- Department of Cardiology, University Hospital of Navarra, Servicio Navarro de Salud Osasunbidea, IDISNA, Pamplona, Spain
| | - Dora Romaguera
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Ángel M Alonso-Gómez
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lucas Tojal-Sierra
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Carlos Fernández-Palomeque
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Miguel Ángel Martínez-González
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA, Pamplona, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - María Garrido-Uriarte
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Luis López
- Cardiology Service, Hospital de Manacor, Manacor, Spain
| | - Agnes Díaz
- Cardiology Service, Clinica Universidad de Navarra, Pamplona, Spain
| | - Olatz Zaldua-Irastorza
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jordi Salas-Salvadó
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Rovira i Virigili University, Reus, Spain
| | - Montserrat Fitó
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Estefania Toledo
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA, Pamplona, Spain
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6
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Machino-Ohtsuka T, Minami K, Yamasaki H, Nakatsukasa T, Kawamatsu N, Sato K, Yamamoto M, Maruo K, Ishizu T, Kawakami Y, Ieda M. Efficacy of Low-Dose Isoproterenol Infusion for the Exclusion of a Left Atrial Appendage Thrombus in Patients With Dense Spontaneous Echo Contrast Caused by Atrial Fibrillation. Circ J 2023; 87:1800-1808. [PMID: 37394572 DOI: 10.1253/circj.cj-23-0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUND In patients with atrial fibrillation (AF) and severe blood stasis in the left atrial appendage (LAA), dense spontaneous echo contrast (SEC) disturbs the distinct visualization of the LAA interior, thus making thrombus diagnosis inconclusive. We aimed to prospectively assess the efficacy and safety of a protocol for a low-dose isoproterenol (ISP) infusion to reduce SEC to exclude an LAA thrombus.Methods and Results: We enrolled 17 patients with AF and dense SEC (Grade 4 or sludge). ISP was infused with gradually increasing doses of 0.01, 0.02, and 0.03 μg/kg/min at 3-min intervals. After increasing the dose to 0.03 μg/kg/min for 3 min, or when the LAA interior was visible, the infusion was terminated. We reassessed the SEC grade, presence of an LAA thrombus, LAA function, and left ventricular ejection fraction (LVEF) within 1 min of ISP termination. Compared with baseline, ISP significantly increased LAA flow velocity, the LAA emptying fraction, LAA wall velocities, and LVEF (all P<0.01). ISP administration significantly reduced the SEC grade (median) from 4 to 1 (P<0.001). The SEC grade decreased to ≤2 in 15 (88%) patients, and the LAA thrombus was excluded. There were no adverse events. CONCLUSIONS Low-dose ISP infusion may be effective and safe to reduce SEC and exclude an LAA thrombus by improving LAA function and LVEF.
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Affiliation(s)
- Tomoko Machino-Ohtsuka
- Department of Cardiology, Institute of Medicine, University of Tsukuba
- Department of Clinical Laboratory Medicine, Institute of Medicine, University of Tsukuba
| | - Kentaro Minami
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | - Hiro Yamasaki
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | | | - Naoto Kawamatsu
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | - Kimi Sato
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | | | - Kazushi Maruo
- Department of Biostatistics, Institute of Medicine, University of Tsukuba
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | - Yasushi Kawakami
- Department of Clinical Laboratory Medicine, Institute of Medicine, University of Tsukuba
| | - Masaki Ieda
- Department of Cardiology, Institute of Medicine, University of Tsukuba
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7
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Rossello X, Ramallal R, Romaguera D, Alonso-Gómez ÁM, Alonso A, Tojal-Sierra L, Fernández-Palomeque C, Martínez-González MÁ, Garrido-Uriarte M, López L, Díaz A, Zaldua-Irastorza O, Shah AJ, Salas-Salvadó J, Fitó M, Toledo E. Effect of an intensive lifestyle intervention on the structural and functional substrate for atrial fibrillation in people with metabolic syndrome. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.02.23293550. [PMID: 37577657 PMCID: PMC10418292 DOI: 10.1101/2023.08.02.23293550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Aims To evaluate the effect of an intensive lifestyle intervention (ILI) on the structural and functional cardiac substrate of atrial fibrillation (AF) in overweight or obese people with metabolic syndrome (MetS). Methods Participants of the PREDIMED-PLUS trial (n=6874) were randomised 1:1 to an ILI program based on an energy-reduced Mediterranean diet, increased physical activity, and cognitive-behavioural weight management, or to a control intervention of low-intensity dietary advice. Left atrial (LA) strain, function, and volumes were evaluated by a core echocardiography lab in 534 participants at baseline, 3-year and 5-year follow-up. Mixed models were used to evaluate the effect of the ILI on LA structure and function. Results In the subsample, baseline mean age was 65 years (SD 5 years), and 40% of the participants were women. Over the 5-year period, both groups experienced worsening of LA structure and function, with increases in LA volumes and stiffness index and decreases in LA longitudinal strain, LA function index and LA emptying fraction over time. Changes in the ILI and control group were not significantly different for any of the primary outcomes (LA emptying fraction: -0.95% (95%CI -0.93, -0.98) in control group, -0.97% (95%CI -0.94, -1.00) in ILI group, p between groups =0.80; LA longitudinal strain: 0.82% (95%CI 0.79, 0.85) in control group, 0.85% (95%CI 0.82, 0.89) in ILI group, p between groups =0.24) or any of the secondary outcomes. Conclusions In overweight or obese people with MetS, an ILI had no impact on the underlying structural and functional left atrial substrate measurements associated with AF risk.
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8
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Tomaselli M, Badano LP, Cannone V, Radu N, Curti E, Perelli F, Heilbron F, Gavazzoni M, Rella V, Oliverio G, Caravita S, Baratto C, Perego GB, Parati G, Brasca F, Muraru D. Incremental Value of Right Atrial Strain Analysis to Predict Atrial Fibrillation Recurrence After Electrical Cardioversion. J Am Soc Echocardiogr 2023; 36:945-955. [PMID: 37302440 DOI: 10.1016/j.echo.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although the assessment of left atrial (LA) mechanics has been reported to refine atrial fibrillation (AF) risk prediction, it doesn't completely predict AF recurrence. The potential added role of right atrial (RA) function in this setting is unknown. Accordingly, this study sought to evaluate the added value of RA longitudinal reservoir strain (RASr) for the prediction of AF recurrence after electrical cardioversion (ECV). METHODS We retrospectively studied 132 consecutive patients with persistent AF who underwent elective ECV. Complete two-dimensional and speckle-tracking echocardiography analyses of LA and RA size and function were obtained in all patients before ECV. The end point was AF recurrence. RESULTS During a 12-month follow-up, 63 patients (48%) showed AF recurrence. Both LASr and RASr were significantly lower in patients experiencing AF recurrence than in patients with persistent sinus rhythm (LASr, 10% ± 6% vs 13% ± 7%; RASr, 14% ± 10% vs 20% ± 9%, respectively; P < .001 for both). Right atrial longitudinal reservoir strain (area under the curve = 0.77; 95% CI, 0.69-0.84; P < .0001) was more strongly associated with the recurrence of AF after ECV than LASr (area under the curve = 0.69; 95% CI, 0.60-0.77; P < .0001). Kaplan-Meier curves showed that patients with both LASr ≤ 10% and RASr ≤ 15% had a significantly increased risk for AF recurrence (log-rank, P < .001). However, at multivariable Cox regression, RASr (hazard ratio, 3.26; 95% CI, 1.73-6.13; P < .001) was the only parameter independently associated with AF recurrence. Right atrial longitudinal reservoir strain was more strongly associated with the occurrence of AF relapse after ECV than LASr, and LA and RA volumes. CONCLUSION Right atrial longitudinal reservoir strain was independently and more strongly associated than LASr with AF recurrence after elective ECV. This study highlights the importance of assessing the functional remodeling of both the RA and LA in patients with persistent AF.
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Affiliation(s)
- Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luigi P Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Vincenzo Cannone
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Noela Radu
- Carol Davila University of Medicine and Pharmacy, Prof. Dr. C. C. Iliescu Institute, Bucharest, Romania
| | - Emanuele Curti
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesco Perelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesca Heilbron
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Valeria Rella
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giorgio Oliverio
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Sergio Caravita
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Claudia Baratto
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giovanni B Perego
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesco Brasca
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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9
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Jiang X, Zhou YX, Zhou Q, Cao S. The 2-year postoperative left heart function in marginal donor heart recipients assessing by speckle tracking echocardiography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1449-1459. [PMID: 37184761 DOI: 10.1007/s10554-023-02867-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
This study analyzed the differences and explored the donor/recipient factors between marginal and standard donor heart recipients after heart transplantation (HT) by speckle tracking echocardiography (STE). Seventy-two HT patients were enrolled: 25 standard and 47 marginal donor heart recipients. Thirty HT patients completed 2-year continuous follow-up (1, 6, 12, 24 months). Thirty healthy volunteers were controls. STE was used to track the strain characteristics of the left ventricle and atrium for detecting early changes in marginal donor heart recipients, including left ventricular global longitudinal, circumferential and radial strain (LVGLS, LVGCS, LVGRS) and left atrial strain in systole (LAS-S) and late diastole (LAS-A). The perioperative parameters were similar between the standard and marginal groups. No significant differences were found in left heart size, systolic and diastolic function parameters. Left ventricular systolic strain (LVGLS, LVGCS, LVGRS) and systolic and late diastolic left atrial strain (LAS-S, LAS-A) were lower in the HT recipients than the control group (P < 0.05), but there was no difference between the marginal and standard groups (P > 0.05). LVGLS, LVGCS, and LAS-S were low in the marginal group 1 month after surgery but recovered gradually at 6 months. The patients with donor/recipient body weight ratio < 0.8 group had lower LVGLS and LAS-S. STE showed no significant difference between marginal and standard donor recipients. The LVGLS and LAS-S were lower in those with a smaller donor/recipient body weight ratio. The cardiac function of HT patients was lower in the early postoperative period but gradually recovered over time.
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Affiliation(s)
- Xin Jiang
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China
| | - Yan-Xiang Zhou
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China
| | - Qing Zhou
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China.
| | - Sheng Cao
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China.
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10
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Iovănescu ML, Hădăreanu DR, Toader DM, Florescu C, Istrătoaie O, Donoiu I, Militaru C. The Impact of Atrial Fibrillation on All Heart Chambers Remodeling and Function in Patients with Dilated Cardiomyopathy-A Two- and Three-Dimensional Echocardiography Study. Life (Basel) 2023; 13:1421. [PMID: 37374203 DOI: 10.3390/life13061421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Atrial fibrillation is frequently seen in patients with dilated cardiomyopathy (DCM), and its presence impacts the function of the heart, with clinical and prognostic consequences. In this prospective single-center study, we aimed to assess the impact of atrial fibrillation on cardiac structure and function, using comprehensive two- and three-dimensional echocardiography. We included 41 patients with DCM and persistent or permanent atrial fibrillation (38 male, age 58.8 ± 11 years), as well as 47 patients with DCM and in sinus rhythm (35 male, age 58 ± 12.5 years). Cardiac chambers and mitral and tricuspid valves' structure and function were assessed via standard two-dimensional, speckle-tracking, and three-dimensional echocardiography (3DE). Patients with DCM and atrial fibrillation had a more impaired left ventricular global longitudinal strain, higher 3DE left atrial volumes, and reduced function compared to patients in sinus rhythm in the presence of similar left ventricle volumes. Mitral annulus configuration was altered in atrial fibrillation DCM patients. Also, right heart volumes were larger, with more severe atrial and ventricular dysfunction, despite similar estimated pulmonary artery pressures and severity of tricuspid regurgitation. Using advanced echocardiography techniques, we demonstrated that atrial fibrillation induces significant remodeling in all heart chambers.
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Affiliation(s)
- Maria L Iovănescu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Clinical Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Diana R Hădăreanu
- Clinical Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Despina M Toader
- Clinical Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Cristina Florescu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Filantropia Clinical Hospital, 200516 Craiova, Romania
| | - Octavian Istrătoaie
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Clinical Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Ionuţ Donoiu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Clinical Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Constantin Militaru
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Clinical Emergency County Hospital of Craiova, 200642 Craiova, Romania
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11
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Ciampi P, Badano LP, Florescu DR, Villella F, Tomaselli M, Torlasco C, Gavazzoni M, Parati G, Muraru D. Comparison of RA Volumes Obtained Using the Standard Apical 4-Chamber and the RV-Focused Views. JACC Cardiovasc Imaging 2023; 16:248-250. [PMID: 36648037 DOI: 10.1016/j.jcmg.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/20/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022]
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12
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Muraru D, Gavazzoni M, Heilbron F, Mihalcea DJ, Guta AC, Radu N, Muscogiuri G, Tomaselli M, Sironi S, Parati G, Badano LP. Reference ranges of tricuspid annulus geometry in healthy adults using a dedicated three-dimensional echocardiography software package. Front Cardiovasc Med 2022; 9:1011931. [PMID: 36176994 PMCID: PMC9513148 DOI: 10.3389/fcvm.2022.1011931] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTricuspid annulus (TA) sizing is essential for planning percutaneous or surgical tricuspid procedures. According to current guidelines, TA linear dimension should be assessed using two-dimensional echocardiography (2DE). However, TA is a complex three-dimensional (3D) structure.AimIdentify the reference values for TA geometry and dynamics and its physiological determinants using a commercially available three-dimensional echocardiography (3DE) software package dedicated to the tricuspid valve (4D AutoTVQ, GE).MethodsA total of 254 healthy volunteers (113 men, 47 ± 11 years) were evaluated using 2DE and 3DE. TA 3D area, perimeter, diameters, and sphericity index were assessed at mid-systole, early- and end-diastole. Right atrial (RA) and ventricular (RV) end-diastolic and end-systolic volumes were also measured by 3DE.ResultsThe feasibility of the 3DE analysis of TA was 90%. TA 3D area, perimeter, and diameters were largest at end-diastole and smallest at mid-systole. Reference values of TA at end-diastole were 9.6 ± 2.1 cm2 for the area, 11.2 ± 1.2 cm for perimeter, and 38 ± 4 mm, 31 ± 4 mm, 33 ± 4 mm, and 34 ± 5 mm for major, minor, 4-chamber and 2-chamber diameters, respectively. TA end-diastolic sphericity index was 81 ± 11%. All TA parameters were correlated with body surface area (BSA) (r from 0.42 to 0.58, p < 0.001). TA 3D area and 4-chamber diameter were significantly larger in men than in women, independent of BSA (p < 0.0001). There was no significant relationship between TA metrics with age, except for the TA minor diameter (r = −0.17, p < 0.05). When measured by 2DE in 4-chamber (29 ± 5 mm) and RV-focused (30 ± 5 mm) views, both TA diameters resulted significantly smaller than the 4-chamber (33 ± 4 mm; p < 0.0001), and the major TA diameters (38 ± 4 mm; p < 0.0001) measured by 3DE. At multivariable linear regression analysis, RA maximal volume was independently associated with both TA 3D area at mid-systole (R2 = 0.511, p < 0.0001) and end-diastole (R2 = 0.506, p < 0.0001), whereas BSA (R2 = 0.526, p < 0.0001) was associated only to mid-systolic TA 3D area.ConclusionsReference values for TA metrics should be sex-specific and indexed to BSA. 2DE underestimates actual 3DE TA dimensions. RA maximum volume was the only independent echocardiographic parameter associated with TA 3D area in healthy subjects.
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Affiliation(s)
- Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- *Correspondence: Mara Gavazzoni
| | - Francesca Heilbron
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Diana J. Mihalcea
- University of Medicine and Pharmacy Carol Davila Bucharest, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Andrada C. Guta
- Department of Cardiology, Methodist DeBakey Heart Center, Houston Methodist Hospital, Houston, TX, United States
| | - Noela Radu
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- University of Medicine and Pharmacy Carol Davila Bucharest, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Giuseppe Muscogiuri
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sandro Sironi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Radiology Department, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Luigi P. Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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13
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Donal E, Sade LE, Thomas L. Left atrial function: the
HbA1c
for the cardiologist and even more. Eur J Heart Fail 2022; 24:494-496. [DOI: 10.1002/ejhf.2438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI – UMR 1099 F‐35000 Rennes France
| | - L. Elif Sade
- University of Pittsburgh – Heart & Vascular Institute UPMC Pittsburg PA USA
- Baskent University – Cardiology Department Ankara Turkey
| | - Liza Thomas
- Faculty of Medicine and Health The University of Sydney Camperdown NSW 2006 Australia
- Department of Cardiology Westmead Hospital, Westmead Sydney NSW 2145 Australia
- South Western Sydney Clinical School University of New South Wales Liverpool NSW 2170 Australia
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