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Olsen FJ, Diederichsen SZ, Jørgensen PG, Jensen MT, Dahl A, Landler NE, Graff C, Brandes A, Krieger D, Haugan K, Køber L, Højberg S, Svendsen JH, Biering-Sørensen T. Left Atrial Strain Predicts Subclinical Atrial Fibrillation Detected by Long-term Continuous Monitoring in Elderly High-Risk Individuals. Circ Cardiovasc Imaging 2024; 17:e016197. [PMID: 38440875 DOI: 10.1161/circimaging.123.016197] [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: 09/29/2023] [Accepted: 01/24/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Left atrial (LA) speckle tracking provides detailed information on atrial function. Its utility for predicting subclinical atrial fibrillation (SCAF) is unclear. Therefore, we sought to investigate whether LA strain measures could predict SCAF detected by long-term continuous rhythm monitoring. METHODS This was an echocardiographic substudy of the LOOP study, where elderly at risk of stroke were randomized to receive a loop recorder (Reveal LINQ) or control. Participants who received a loop recorder were included in this analysis. Echocardiography included LA reservoir, conduit, and contraction strain. Participants were followed with continuous rhythm monitoring for SCAF (≥6 minutes). Cox proportional hazards regression was applied to adjust for atrial fibrillation risk factors. RESULTS In total, 956 participants were eligible for analysis. Median continuous rhythm monitoring was 35 months (IQR, 20-40 months), during which 278 (29%) were diagnosed with SCAF. The mean age was 74 years, 56% were male, median CHA2DS2-VASc-score was 4. LA reservoir strain was an independent predictor of SCAF after multivariable adjustments (HR, 1.04 [1.02-1.05], per 1% decrease) and so was contraction strain. The findings were unchanged in competing risk analyses and in participants with normal LA size and diastolic function. Participants with low reservoir strain (<33%) had a significantly higher risk of SCAF compared with those with high reservoir strain (incidence rate, 14.5 [12.4-16.9] versus 9.8 [8.2-11.8] events/100 person-years). The same was noted for low versus high contraction strain. CONCLUSIONS LA reservoir and contraction strain are independent predictors of SCAF in elderly at risk of stroke. This also applies to individuals with normal LA size and diastolic function. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02036450.
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Affiliation(s)
- Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark (F.J.O., P.G.J., A.D., N.E.L., T.B.-S.)
- Department of Biomedical Sciences (F.J.O., N.E.L., T.B.-S.), University of Copenhagen, Copenhagen, Denmark
| | - Søren Zöga Diederichsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark (S.Z.D., L.K., J.H.S., T.B.-S.)
| | - Peter Godsk Jørgensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark (F.J.O., P.G.J., A.D., N.E.L., T.B.-S.)
| | | | - Anders Dahl
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark (F.J.O., P.G.J., A.D., N.E.L., T.B.-S.)
| | - Nino Emanuel Landler
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark (F.J.O., P.G.J., A.D., N.E.L., T.B.-S.)
- Department of Biomedical Sciences (F.J.O., N.E.L., T.B.-S.), University of Copenhagen, Copenhagen, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark (C.G.)
| | - Axel Brandes
- Department of Cardiology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, Denmark (A.B.)
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark (A.B.)
| | - Derk Krieger
- University Hospital Zurich, University of Zurich, Zurich, Switzerland (D.K.)
- Stroke Unit, Mediclinic City Hospital, Dubai, UAE (D.K.)
| | - Ketil Haugan
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (K.H.)
| | - Lars Køber
- Department of Clinical Medicine (L.K., J.H.S.), University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark (S.Z.D., L.K., J.H.S., T.B.-S.)
| | - Søren Højberg
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark (S.H.)
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine (L.K., J.H.S.), University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark (S.Z.D., L.K., J.H.S., T.B.-S.)
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark (F.J.O., P.G.J., A.D., N.E.L., T.B.-S.)
- Department of Biomedical Sciences (F.J.O., N.E.L., T.B.-S.), University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark (S.Z.D., L.K., J.H.S., T.B.-S.)
- Steno Diabetes Center, Copenhagen, Denmark (M.T.J., T.B-S.)
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3
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Hopman LHGA, Mulder MJ, van der Laan AM, Bhagirath P, Demirkiran A, von Bartheld MB, Kemme MJB, van Rossum AC, Allaart CP, Götte MJW. Left atrial strain is associated with arrhythmia recurrence after atrial fibrillation ablation: Cardiac magnetic resonance rapid strain vs. feature tracking strain. Int J Cardiol 2023; 378:23-31. [PMID: 36804765 DOI: 10.1016/j.ijcard.2023.02.019] [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: 11/25/2022] [Revised: 01/17/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE The present study assesses different left atrial (LA) strain approaches in relation to atrial fibrillation (AF) recurrence after ablation and compares LA feature tracking (FT) strain to novel rapid LA strain approaches in AF patients. METHODS This retrospective single-center study comprised of 110 prospectively recruited AF patients who underwent cardiac magnetic resonance (CMR) imaging in sinus rhythm prior to their first pulmonary vein isolation ablation. LA rapid strain (long axis strain and atrioventricular (AV)-junction strain), LA FT strain, and LA volumes were derived from 2-chamber and 4-chamber cine images. AF recurrence was followed up for 12 months using either 12‑lead ECGs or rhythm Holter monitoring. RESULTS Arrhythmia recurrence was observed in 39 patients (36%) after the 90-day blanking period, occurring at a median of 181 (122-286) days. LA long axis strain, AV-junction strain, and FT strain were all more impaired in patients with AF recurrence compared to patients without AF recurrence (long axis strain: P < 0.01; AV-junction strain: P < 0.001; FT strain: P < 0.01, respectively). Area under the curve (AUC) values for LA remodeling parameters in association with AF recurrence were 0.68 for long axis strain, 0.68 for AV-junction strain, 0.66 for FT strain, 0.66 for LA volume index. Phasic FT LA strain demonstrated that contractile strain had the highest AUC (0.70). CONCLUSION Both LA rapid strain and LA FT strain are associated with arrhythmia recurrence after ablation in AF patients. LA rapid strain can be a convenient and reproducible alternative for LA FT strain to assess LA function in clinical practice.
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Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | | | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
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4
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Althoff TF, Eichenlaub M, Padilla-Cueto D, Lehrmann H, Garre P, Schoechlin S, Ferro E, Invers E, Ruile P, Hein M, Schlett C, Figueras i Ventura RM, Prat-Gonzalez S, Mueller-Edenborn B, Bohnen M, Porta-Sanchez A, Tolosana JM, Guasch E, Roca-Luque I, Arbelo E, Neumann FJ, Westermann D, Sitges M, Brugada J, Arentz T, Mont L, Jadidi A. Predictive value of late gadolinium enhancement cardiovascular magnetic resonance in patients with persistent atrial fibrillation: dual-centre validation of a standardized method. EUROPEAN HEART JOURNAL OPEN 2022; 3:oeac085. [PMID: 36654964 PMCID: PMC9838794 DOI: 10.1093/ehjopen/oeac085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
Aims With recurrence rates up to 50% after pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF), predictive tools to improve patient selection are needed. Patient selection based on left atrial late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been proposed previously (UTAH-classification). However, this approach has not been widely established, in part owed to the lack of standardization of the LGE quantification method. We have recently established a standardized LGE-CMR method enabling reproducible LGE-quantification. Here, the ability of this method to predict outcome after PVI was evaluated. Methods and results This dual-centre study (n = 219) consists of a prospective derivation cohort (n = 37, all persistent AF) and an external validation cohort (n = 182; 66 persistent, 116 paroxysmal AF). All patients received an LGE-CMR prior to first-time PVI-only ablation. LGE was quantified based on the signal-intensity-ratio relative to the blood pool, applying a uniform LGE-defining threshold of >1.2. In patients with persistent AF in the derivation cohort, left atrial LGE-extent above a cut-off value of 12% was found to best predict relevant low-voltage substrate (≥2 cm two with <0.5 mV during sinus rhythm) and arrhythmia-free survival 12 months post-PVI. When applied to the external validation cohort, this cut-off value was also predictive of arrhythmia-free survival for both, the total cohort and the subgroup with persistent AF (LGE < 12%: 80% and 76%; LGE > 12%: 55% and 44%; P = 0.007 and P = 0.029, respectively). Conclusion This dual-centre study established and validated a standardized, reproducible LGE-CMR method discriminating PVI responders from non-responders, which may improve choice of therapeutic approach or ablation strategy for patients with persistent AF.
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Affiliation(s)
- Till F Althoff
- Corresponding author. Tel: +34 93 2275551, Fax: +34 93 4513045,
| | | | - David Padilla-Cueto
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain
| | - Heiko Lehrmann
- Division of Cardiology and Angiology, University Heart Center Freiburg—Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Paz Garre
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain
| | - Simon Schoechlin
- Division of Cardiology and Angiology, University Heart Center Freiburg—Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Elisenda Ferro
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain
| | - Eric Invers
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain
| | - Philipp Ruile
- Division of Cardiology and Angiology, University Heart Center Freiburg—Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Manuel Hein
- Division of Cardiology and Angiology, University Heart Center Freiburg—Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Christopher Schlett
- Division of Cardiology and Angiology, University Heart Center Freiburg—Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | | | - Susanna Prat-Gonzalez
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036 Barcelona, Spain
| | - Bjoern Mueller-Edenborn
- Division of Cardiology and Angiology, University Heart Center Freiburg—Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Marius Bohnen
- Division of Cardiology and Angiology, University Heart Center Freiburg—Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Andreu Porta-Sanchez
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Jose Maria Tolosana
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Eduard Guasch
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Ivo Roca-Luque
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Elena Arbelo
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology, University Heart Center Freiburg—Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Dirk Westermann
- Division of Cardiology and Angiology, University Heart Center Freiburg—Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
| | - Marta Sitges
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Josep Brugada
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Thomas Arentz
- Division of Cardiology and Angiology, University Heart Center Freiburg—Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany
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5
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Larsen BS, Olsen FJ, Andersen DM, Madsen CV, Møgelvang R, Jensen GB, Schnohr P, Aplin M, Høst NB, Christensen H, Sajadieh A, Biering-Sørensen T. Left Atrial Volumes and Function, and Long-Term Incidence of Ischemic Stroke in the General Population. J Am Heart Assoc 2022; 11:e027031. [PMID: 36073645 DOI: 10.1161/jaha.122.027031] [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: 11/16/2022]
Abstract
Background Left atrial (LA) volumes and emptying fraction in the general population may address structural and functional aspects of atrial cardiomyopathy associated with long-term risk of ischemic stroke in the absence of atrial fibrillation or prior stroke. We investigated the association between LA volumes and function and ischemic stroke. Methods and Results In a community-based cohort, we measured LA minimal volume, LA maximal volume, and LA emptying fraction by transthoracic echocardiography. The primary end point was ischemic stroke. Participants with known atrial fibrillation or prior ischemic stroke were excluded, which resulted in 1866 participants. The mean age was 58±16 years, and 57% were women. During a median follow-up of 16.5 years (interquartile range: 11.4-16.8 years), 176 (9.4%) ischemic strokes occurred. In multivariable cause-specific regression models and competing risk models with death as a competing risk, LA emptying fraction was associated with ischemic stroke (hazard ratio [HR], 1.14 per 10% decrease [95% CI, 1.02-1.28]) and (subdistribution HR, 1.14 [95% CI, 1.01-1.29]). This association remained when adjusting for participants who developed atrial fibrillation during follow-up (HR, 1.12 per 10% decrease [95% CI, 1.00-1.26]). Indexed LA volumes were not associated with ischemic stroke in the same models. LA emptying fraction and indexed LA volumes were not associated with all-cause mortality. Conclusions Lower LA emptying fraction measured by transthoracic echocardiography was associated with future ischemic stroke independently of incident atrial fibrillation. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02993172.
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Affiliation(s)
- Bjørn Strøier Larsen
- Department of Cardiology Copenhagen University Hospital - Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Flemming Javier Olsen
- Department of Cardiology Copenhagen University Hospital - Herlev and Gentofte Copenhagen Denmark
| | - Ditte Madsen Andersen
- Department of Cardiology Copenhagen University Hospital - Herlev and Gentofte Copenhagen Denmark
| | | | - Rasmus Møgelvang
- Copenhagen City Heart Study Bispebjerg & Frederiksberg Hospital Copenhagen Denmark.,Department of Cardiology Copenhagen University Hospital - Rigshospitalet Copenhagen Denmark
| | - Gorm Boje Jensen
- Copenhagen City Heart Study Bispebjerg & Frederiksberg Hospital Copenhagen Denmark
| | - Peter Schnohr
- Copenhagen City Heart Study Bispebjerg & Frederiksberg Hospital Copenhagen Denmark
| | - Mark Aplin
- Department of Cardiology Copenhagen University Hospital - Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Nis Baun Høst
- Department of Cardiology Copenhagen University Hospital - Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Hanne Christensen
- Department of Neurology Copenhagen University Hospital - Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Ahmad Sajadieh
- Department of Cardiology Copenhagen University Hospital - Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology Copenhagen University Hospital - Herlev and Gentofte Copenhagen Denmark
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6
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Kreimer F, Gotzmann M. Left Atrial Cardiomyopathy - A Challenging Diagnosis. Front Cardiovasc Med 2022; 9:942385. [PMID: 35845077 PMCID: PMC9280085 DOI: 10.3389/fcvm.2022.942385] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/14/2022] [Indexed: 01/08/2023] Open
Abstract
Left atrial cardiomyopathy (LACM) has been an ongoing focus of research for several years. There is evidence that LACM is responsible for atrial fibrillation and embolic strokes of undetermined sources. Therefore, the correct diagnosis of LACM is of clinical importance. Various techniques, including electrocardiography, echocardiography, cardiac magnetic resonance imaging, computed tomography, electroanatomic mapping, genetic testing, and biomarkers, can both identify and quantify structural, mechanical as well as electrical dysfunction in the atria. However, the question arises whether these techniques can reliably diagnose LACM. Because of its heterogeneity, clinical diagnosis is challenging. To date, there are no recommendations for standardized diagnosis of suspected LACM. However, standardization could help to classify LACM more precisely and derive therapeutic directions to improve individual patient management. In addition, uniform diagnostic criteria for LACM could be important for future studies. Combining several parameters and relating them seems beneficial to approach the diagnosis of LACM. This review provides an overview of the current evidence regarding the diagnosis of LACM, in which several potential parameters are discussed and, consequently, a proposal for a diagnostic algorithm is presented.
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Affiliation(s)
- Fabienne Kreimer
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr University Bochum, Bochum, Germany
| | - Michael Gotzmann
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr University Bochum, Bochum, Germany
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