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Noubiap JJ, Nyaga UF, Middeldorp ME, Stokes MB, Sanders P. Cardiac imaging correlates and predictors of stroke in patients with atrial fibrillation: a meta-analysis. J Cardiovasc Med (Hagerstown) 2024; 25:280-293. [PMID: 38407860 DOI: 10.2459/jcm.0000000000001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND New nonclinical parameters are needed to improve the current stroke risk stratification schemes for patients with atrial fibrillation. This study aimed to summarize data on potential cardiac imaging correlates and predictors of stroke or systemic embolism in patients with atrial fibrillation. METHODS MEDLINE, EMBASE, and Web of Science were searched to identify all published studies providing relevant data through 16 November 2022. Random effects meta-analysis method was used to pool estimates. RESULTS We included 64 studies reporting data from a pooled population of 56 639 patients. Left atrial spontaneous echo-contrast [adjusted odds ratio (aOR) 3.32, 95% confidence interval (CI) 1.98-5.49], nonchicken wing left atrial appendage (LAA) morphology (aOR 2.15, 95% CI 1.11-4.18), left atrial enlargement (aOR 2.12, 95% CI 1.45-3.08), and higher LAA orifice diameter (aOR 1.56, 95% CI 1.18-2.05) were highly associated with stroke. Other parameters associated with stroke included higher left atrial sphericity (aOR 1.14, 95% CI 1.01-1.29), higher left atrial volume (aOR 1.03, 95% CI 1.01-1.04), higher left atrial volume index (aOR 1.014, 95% CI 1.004-1.023), lower left atrial reservoir strain [adjusted hazard ratio (aHR) 0.86, 95% CI 0.76-0.98], higher left ventricular mass index (aOR 1.010, 95% CI 1.005-1.015) and E / e' ratio (aOR 1.12, 95% CI 1.07-1.16). There was no association between LAA volume (aOR 1.37, 95% CI 0.85-2.21) and stroke. CONCLUSION These cardiac imaging parameters identified as potential predictors of thromboembolism may improve the accuracy of stroke risk stratification schemes in patients with atrial fibrillation. Further studies should evaluate the performance of holistic risk scores including clinical factors, biomarkers, and cardiac imaging.
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Affiliation(s)
- Jean Jacques Noubiap
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | | | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Smidt Heart Institute, Cedar-Sinai Medical Centre, Los Angeles, California, USA
| | - Michael B Stokes
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
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Kuznetsova T, Daels Y, Ntalianis E, Santana EJ, Sabovčik F, Haddad F, Cauwenberghs N. Clinical and biochemical predictors of longitudinal changes in left atrial structure and function: A general population study. Echocardiography 2024; 41:e15780. [PMID: 38372342 DOI: 10.1111/echo.15780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 02/20/2024] Open
Abstract
PURPOSE There is a need for better understanding the factors that modulate left atrial (LA) dysfunction. Therefore, we determined associations of clinical and biochemical biomarkers with serial changes in echocardiographic indexes of LA function in the general population. METHODS We measured LA maximal and minimal volume indexes (LAVImax and LAVImin) by echocardiography and LA reservoir strain (LARS) by two-dimensional speckle-tracking in 627 participants (mean age 50.8 years, 51.2% women) at baseline and after 4.8 years. RESULTS During follow-up, LARS decreased significantly in men (-.90%, P = .033) but not in women (-.23%, P = .60). In stepwise regression analysis, stronger decrease in LARS over time was associated with male sex, a higher age, body mass index (BMI), mean arterial pressure (MAP) and serum insulin at baseline and with a greater increase in BMI and MAP over time (P ≤ .018). Similarly, an increased risk of developing or retaining abnormal LARS was observed in older participants, in subjects with a higher baseline BMI, MAP, heart rate (HR), troponin T and ΔMAP, and in those who used β-blockers at baseline. Both LAVImax and LAVImin increased significantly over time (P ≤ .0007). This increase was associated with a higher baseline age, pulse pressure and a lower HR at baseline and a greater increase in pulse pressure over time (P ≤ .029). Higher serum insulin and D-dimer were independently associated with a stronger increase in LAVImin (P ≤ .0034). CONCLUSION Subclinical worsening in LA dysfunction was associated with older age, hypertension, obesity, insulin resistance and troponin T levels. Cardiovascular risk management strategies may delay LA deterioration.
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Affiliation(s)
- Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Yne Daels
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Evangelos Ntalianis
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Everton J Santana
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - František Sabovčik
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Francois Haddad
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Soulat-Dufour L, Ichou F, Ponnaiah M, Lang S, Ederhy S, Adavane-Scheuble S, Chauvet-Droit M, Capderou E, Arnaud C, Le Goff W, Boccara F, Hatem SN, Cohen A. Left atrial strain: A memory of the severity of atrial myocardial stress in atrial fibrillation. Arch Cardiovasc Dis 2024; 117:134-142. [PMID: 38290892 DOI: 10.1016/j.acvd.2023.11.015] [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: 10/04/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Left atrial (LA) strain is a simple marker of LA function. The aim of the study was to evaluate the determinants of atrial cardiomyopathy in AF. METHODS In this pilot study, we prospectively evaluated clinical, biological, metabolomic and echocardiographic parameters for 85 consecutive patients hospitalized for atrial fibrillation (AF) with restoration of sinus rhythm at 6 months. Eighty-one patients with an analysable LA strain at 6 months were divided into groups according to median reservoir strain:<23.3% (n=40) versus≥23.3% (n=41). RESULTS Compared to patients with the highest LA strain, patients with lowest LA strain had multiple differences at admission: clinical (older age; more frequent history of AF; more patterns of persistent AF); biological (higher fasting blood glucose levels, glycated haemoglobin, high-sensitivity C-reactive protein, and urea; lower glomerular filtration rate); metabolomic (higher levels of kynurenine, kynurenine/tryptophan, and urea/creatinine; lower levels of arginine and methionine/methionine sulfoxide); and echocardiographic (higher two-dimensional end-systolic LA volume [LAV] indexes; higher three-dimensional end-systolic and end-diastolic LAV and right atrial volume indexes; lower LA and right atrial emptying fractions and three-dimensional right ventricular ejection fraction) (all P<0.05). Area under the receiver operating characteristic curve to predict LA strain alteration at 6 months was highest for a combined score including clinical, biological, metabolomic and echocardiographic variables at admission (area under the receiver operating characteristic curve 0.871; P<0.0001). CONCLUSIONS LA reservoir strain could be a memory of initial atrial myocardial stress in AF. It can be predicted using a combination of clinical, biological, metabolomic and echocardiographic admission variables.
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Affiliation(s)
- Laurie Soulat-Dufour
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France; Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France
| | - Farid Ichou
- Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France
| | - Maharajah Ponnaiah
- Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France
| | - Sylvie Lang
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Stéphane Ederhy
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France; Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France
| | - Saroumadi Adavane-Scheuble
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Marion Chauvet-Droit
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Elodie Capderou
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Camille Arnaud
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Wilfried Le Goff
- Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France
| | - Franck Boccara
- Inserm 938, Faculté de Médecine Sorbonne Université Site Saint-Antoine, 75571 Paris, France
| | - Stéphane N Hatem
- Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France
| | - Ariel Cohen
- Department of Cardiology, Saint Antoine and Tenon Hospitals, AP-HP, Sorbonne Université, 75012 Paris, France; Inserm UMRS 1166, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, 75013 Paris, France.
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Hirose K, Nakanishi K, Daimon M, Iwama K, Yoshida Y, Mukai Y, Yamamoto Y, Nakao T, Oshima T, Matsubara T, Shimizu Y, Oguri G, Kojima T, Hasumi E, Fujiu K, Morita H, Komuro I. Association of Atrial Fibrillation Progression With Left Atrial Functional Reserve and Its Reversibility. J Am Heart Assoc 2024; 13:e032215. [PMID: 38156556 PMCID: PMC10863802 DOI: 10.1161/jaha.123.032215] [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: 09/09/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) progression is closely related to heart failure occurrence, and catheter ablation carries a beneficial effect for heart failure prevention. Recently, particular attention has been given to left atrial (LA) function and functional reserve in the pathogenesis linking AF and heart failure, although its significance and reversibility is not well studied. METHODS AND RESULTS We prospectively investigated 164 patients with AF with normal left ventricular systolic function and free from heart failure who underwent first catheter ablation and pre-/postprocedural echocardiography. Conventional and speckle-tracking echocardiography were performed at rest and during passive leg lifting to assess LA size, LA reservoir strain (LARS), and functional reserve calculated as passive leg lifting-LARS - rest-LARS. Patients were categorized into 3 AF subtypes: paroxysmal AF (N=95), persistent AF (PeAF; N=50), and long-standing persistent AF (LS-PeAF; N=19). The PeAF and LS-PeAF groups had larger LA size and reduced LARS compared with the paroxysmal AF group (all P<0.05). LA functional reserve was significantly impaired in the LS-PeAF group (P=0.003). In multivariable analysis, LS-PeAF and advanced age were significantly associated with impaired LA functional reserve. Among 149 patients with sinus rhythm 1 to 2 days after catheter ablation, LARS was significantly improved in both PeAF and LS-PeAF groups but was still lower than that in the paroxysmal AF group. Sinus rhythm restoration also led to amelioration of LA functional reserve in patients with LS-PeAF. CONCLUSIONS AF progression was related to impaired LARS and LA functional reserve, and restoration of sinus rhythm might contribute to early LA reverse remodeling.
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Affiliation(s)
| | - Koki Nakanishi
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Masao Daimon
- Department of Cardiovascular MedicineUniversity of TokyoJapan
- Department of Clinical LaboratoryUniversity of TokyoJapan
| | - Kentaro Iwama
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Yuriko Yoshida
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Yasuhiro Mukai
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Yuko Yamamoto
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Tomoko Nakao
- Department of Cardiovascular MedicineUniversity of TokyoJapan
- Department of Clinical LaboratoryUniversity of TokyoJapan
| | - Tsukasa Oshima
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | | | - Yu Shimizu
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Gaku Oguri
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Toshiya Kojima
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Eriko Hasumi
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Katsuhito Fujiu
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Hiroyuki Morita
- Department of Cardiovascular MedicineUniversity of TokyoJapan
| | - Issei Komuro
- Department of Cardiovascular MedicineUniversity of TokyoJapan
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Almeida ALC, Melo MDTD, Bihan DCDSL, Vieira MLC, Pena JLB, Del Castillo JM, Abensur H, Hortegal RDA, Otto MEB, Piveta RB, Dantas MR, Assef JE, Beck ALDS, Santo THCE, Silva TDO, Salemi VMC, Rocon C, Lima MSM, Barberato SH, Rodrigues AC, Rabschkowisky A, Frota DDCR, Gripp EDA, Barretto RBDM, Silva SME, Cauduro SA, Pinheiro AC, Araujo SPD, Tressino CG, Silva CES, Monaco CG, Paiva MG, Fisher CH, Alves MSL, Grau CRPDC, Santos MVCD, Guimarães ICB, Morhy SS, Leal GN, Soares AM, Cruz CBBV, Guimarães Filho FV, Assunção BMBL, Fernandes RM, Saraiva RM, Tsutsui JM, Soares FLDJ, Falcão SNDRS, Hotta VT, Armstrong ADC, Hygidio DDA, Miglioranza MH, Camarozano AC, Lopes MMU, Cerci RJ, Siqueira MEMD, Torreão JA, Rochitte CE, Felix A. Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023. Arq Bras Cardiol 2023; 120:e20230646. [PMID: 38232246 DOI: 10.36660/abc.20230646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Central Illustration : Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023 Proposal for including strain in the integrated diastolic function assessment algorithm, adapted from Nagueh et al.67 Am: mitral A-wave duration; Ap: reverse pulmonary A-wave duration; DD: diastolic dysfunction; LA: left atrium; LASr: LA strain reserve; LVGLS: left ventricular global longitudinal strain; TI: tricuspid insufficiency. Confirm concentric remodeling with LVGLS. In LVEF, mitral E wave deceleration time < 160 ms and pulmonary S-wave < D-wave are also parameters of increased filling pressure. This algorithm does not apply to patients with atrial fibrillation (AF), mitral annulus calcification, > mild mitral valve disease, left bundle branch block, paced rhythm, prosthetic valves, or severe primary pulmonary hypertension.
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Affiliation(s)
| | | | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felicio Rocho, Belo Horizonte, MG - Brasil
| | | | - Henry Abensur
- Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | - Vera Maria Cury Salemi
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - Camila Rocon
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Márcio Silva Miguel Lima
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardiaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Veronica Camara Dos Santos
- Departamento de Cardiologia Pediátrica (DCC/CP) da Sociedade Brasileira de Cardiologia (SBC), São Paulo, SP - Brasil
- Sociedade Brasileira de Oncologia Pediátrica, São Paulo, SP - Brasil
| | | | | | - Gabriela Nunes Leal
- Instituto da Criança e do Adolescente do Hospital das Clinicas Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | | | - Viviane Tiemi Hotta
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Grupo Fleury, São Paulo, SP - Brasil
| | | | - Daniel de Andrade Hygidio
- Hospital Nossa Senhora da Conceição, Tubarão, SC - Brasil
- Universidade do Sul de Santa Catarina (UNISUL), Tubarão, SC - Brasil
| | - Marcelo Haertel Miglioranza
- EcoHaertel - Hospital Mae de Deus, Porto Alegre, RS - Brasil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS - Brasil
| | | | | | | | | | - Jorge Andion Torreão
- Hospital Santa Izabel, Salvador, BA - Brasil
- Santa Casa da Bahia, Salvador, BA - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Alex Felix
- Diagnósticos da América SA (DASA), São Paulo, SP - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
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6
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Akintoye E, Majid M, Klein AL, Hanna M. Prognostic Utility of Left Atrial Strain to Predict Thrombotic Events and Mortality in Amyloid Cardiomyopathy. JACC Cardiovasc Imaging 2023; 16:1371-1383. [PMID: 37940322 DOI: 10.1016/j.jcmg.2023.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/21/2022] [Accepted: 01/05/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND There is currently no thromboembolic risk stratification tool for amyloid cardiomyopathy (ACM) and the current survival staging systems for ACM have only modest discriminatory ability. OBJECTIVES This study aims to evaluate the prognostic value of left atrial (LA) strain to predict incident thrombotic event (TE) and improve survival staging systems in ACM. METHODS The authors identified patients with light chain (AL) or transthyretin (ATTR) ACM and no history of atrial fibrillation (AF) at diagnosis. Three components of LA strain (reservoir, conduit, and contractile) were measured and their predictive value for TE and mortality was determined. In addition, the authors evaluated the incremental utility of adding LA strain to current prognostic staging systems. RESULTS The authors included 448 patients (50.2% AL; 49.8% ATTR) with median follow-up of 3.8 years. There were 64 (14.3%) TE cases, 103 (23%) AF cases, and 234 (52.2%) deaths. Notably, 75% of TEs occurred without preceding AF documented. LA strain reservoir and LA contractile strain significantly predicted both events: HRs for TE were 2.22 (95% CI: 1.27-3.85; P = 0.006) and 2.63 (95% CI: 1.25-5.00; P = 0.01) per SD decrease in LA strain reservoir and LA contractile strain, respectively. The respective HRs for mortality were 1.32 (95% CI: 1.09-1.59; P < 0.001) and 1.49 (95% CI: 1.22-1.75; P < 0.001). Also, LA strain reservoir and LA contractile strain significantly improved the C-statistics of the Mayo AL staging from 0.65 to 0.68 and 0.70, respectively (P ≤ 0.02); Mayo ATTR staging (0.73 to 0.79 and 0.80, respectively; P < 0.001); and Gillmore ATTR staging (0.70 to 0.79 and 0.80, respectively; P < 0.001). CONCLUSIONS LA strain identifies ACM patients with high thrombotic risk (independent of AF) and improves current ACM-specific survival staging.
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Affiliation(s)
- Emmanuel Akintoye
- Section of Cardiovascular Imaging, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - Muhammad Majid
- Section of Cardiovascular Imaging, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - Allan L Klein
- Section of Cardiovascular Imaging, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Ohio, USA
| | - Mazen Hanna
- Section of Heart Failure and Cardiac Transplantation, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Ohio, USA.
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Elliott AD, Ariyaratnam J, Howden EJ, La Gerche A, Sanders P. Influence of exercise training on the left atrium: implications for atrial fibrillation, heart failure, and stroke. Am J Physiol Heart Circ Physiol 2023; 325:H822-H836. [PMID: 37505470 DOI: 10.1152/ajpheart.00322.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
The left atrium (LA) plays a critical role in receiving pulmonary venous return and modulating left ventricular (LV) filling. With the onset of exercise, LA function contributes to the augmentation in stroke volume. Due to the growing focus on atrial imaging, there is now evidence that structural remodeling and dysfunction of the LA is associated with adverse outcomes including incident cardiovascular disease. In patients with established disease, pathological changes in atrial structure and function are associated with exercise intolerance, increased hospital admissions and mortality, independent of left ventricular function. Exercise training is widely recommended in patients with cardiovascular disease to improve patient outcomes and maintain functional capacity. There are widely documented changes in LV function with exercise, yet less attention has been given to the LA. In this review, we first describe LA physiology at rest and during exercise, before exploring its association with cardiac disease outcomes including atrial fibrillation, heart failure, and stroke. The adaptation of the LA to short- and longer-term exercise training is evaluated through review of longitudinal studies of exercise training in healthy participants free of cardiovascular disease and athletes. We then consider the changes in LA structure and function among patients with established disease, where adverse atrial remodeling may be implicated in the disease process. Finally, we consider important future directions for assessment of atrial structure and function using novel imaging modalities, in response to acute and chronic exercise.
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Affiliation(s)
- Adrian D Elliott
- Center for Heart Rhythm Disorders, University of Adelaide, South Australian Health and Medical Research Institute and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jonathan Ariyaratnam
- Center for Heart Rhythm Disorders, University of Adelaide, South Australian Health and Medical Research Institute and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Erin J Howden
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Prashanthan Sanders
- Center for Heart Rhythm Disorders, University of Adelaide, South Australian Health and Medical Research Institute and Royal Adelaide Hospital, Adelaide, South Australia, Australia
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8
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Takagi T, Hosomi T. Peak atrial longitudinal strain represents atrial fibrillation burden in daily practice: clinical implication of routine left atrial strain measurements. J Echocardiogr 2023; 21:113-121. [PMID: 36564608 DOI: 10.1007/s12574-022-00595-4] [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] [Received: 02/08/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Usefulness of left atrial (LA) strain measurements using speckle tracking echocardiography has been reported in various clinical settings. However, clinical implication of routine LA strain measurements in daily practice remains unclear. The purpose of this study was to evaluate clinical utility of routine LA strain measurements in daily practice. METHODS From January 6, 2020 to December 28, 2021, 338 consecutive patients underwent echocardiography in Takagi Cardiology Clinic, and all comers were enrolled to the study. Echocardiographic measurements including peak atrial longitudinal strain (PALS) measurement using speckle tracking echocardiography were attempted in all patients. RESULTS PALS was obtained in 335 patients (age 71 ± 16 years, male 43%, hypertensive 74%), and mean value was 22.3 ± 11.5%. PALS was progressively impaired with worsening atrial fibrillation (AF) burden. PALS in patients without AF, in patients with history of AF (paroxysmal AF &/or ablation therapy), and in patients with AF onsite were 26.8 ± 9.8%, 20.3 ± 7.9%, and 8.1 ± 3.3%, respectively (anova p < 0.0001). In patients without history of AF at the time of echocardiography, using cut-off value of 15.0% (i.e., mean + 2SD of PALS in AF patients), Kaplan-Meier analysis revealed that impaired PALS was associated with increased new-onset AF during follow-up period (log-rank p < 0.0001). CONCLUSION In daily practice, PALS represents AF burden. Furthermore, impaired PALS is associated with increased new-onset AF. Therefore, routine LA strain measurements using speckle tracking echocardiography will be useful in risk stratification of AF in daily practice.
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Affiliation(s)
- Tsutomu Takagi
- Takagi Cardiology Clinic, Mibu Kayogosho-cho 3-3, Nakagyo-ku, Kyoto, 604-8811, Japan.
| | - Takeshi Hosomi
- Takagi Cardiology Clinic, Mibu Kayogosho-cho 3-3, Nakagyo-ku, Kyoto, 604-8811, Japan
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9
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Spartera M, Stracquadanio A, Pessoa-Amorim G, Harston G, Mazzucco S, Young V, Von Ende A, Hess AT, Ferreira VM, Kennedy J, Neubauer S, Casadei B, Wijesurendra RS. Reduced Left Atrial Rotational Flow Is Independently Associated With Embolic Brain Infarcts. JACC Cardiovasc Imaging 2023; 16:1149-1159. [PMID: 37204381 DOI: 10.1016/j.jcmg.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/22/2023] [Accepted: 03/10/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Up to 25% of embolic strokes occur in individuals without atrial fibrillation (AF) or other identifiable mechanisms. OBJECTIVES This study aims to assess whether left atrial (LA) blood flow characteristics are associated with embolic brain infarcts, independently of AF. METHODS The authors recruited 134 patients: 44 with a history of ischemic stroke and 90 with no history of stroke but CHA2DS2VASc score ≥1. Cardiac magnetic resonance (CMR) evaluated cardiac function and LA 4-dimensional flow parameters, including velocity and vorticity (a measure of rotational flow), and brain magnetic resonance imaging (MRI) was performed to detect large noncortical or cortical infarcts (LNCCIs) (likely embolic), or nonembolic lacunar infarcts. RESULTS Patients (41% female; age 70 ± 9 years) had moderate stroke risk (median CHA2DS2VASc = 3, Q1-Q3: 2-4). Sixty-eight (51%) had diagnosed AF, of whom 58 (43%) were in AF during CMR. Thirty-nine (29%) had ≥1 LNCCI, 20 (15%) had ≥1 lacunar infarct without LNCCI, and 75 (56%) had no infarct. Lower LA vorticity was significantly associated with prevalent LNCCIs after adjustment for AF during CMR, history of AF, CHA2DS2VASc score, LA emptying fraction, LA indexed maximum volume, left ventricular ejection fraction, and indexed left ventricular mass (OR: 2.06 [95% CI: 1.08-3.92 per SD]; P = 0.027). By contrast, LA flow peak velocity was not significantly associated with LNCCIs (P = 0.21). No LA parameter was associated with lacunar infarcts (all P > 0.05). CONCLUSIONS Reduced LA flow vorticity is significantly and independently associated with embolic brain infarcts. Imaging LA flow characteristics may aid identification of individuals who would benefit from anticoagulation for embolic stroke prevention, regardless of heart rhythm.
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Affiliation(s)
- Marco Spartera
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom.
| | - Antonio Stracquadanio
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Guilherme Pessoa-Amorim
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; CTSU Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - George Harston
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Sara Mazzucco
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, Oxford, United Kingdom
| | - Victoria Young
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Adam Von Ende
- CTSU Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Aaron T Hess
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - James Kennedy
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Rohan S Wijesurendra
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; CTSU Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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10
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AlKassas A, Fouda M, Fassini G, Sanhoury M. Pre-procedural high serum visfatin and tumor necrosis factor-α might predict recurrent atrial fibrillation after catheter ablation. Egypt Heart J 2023; 75:63. [PMID: 37466800 DOI: 10.1186/s43044-023-00383-0] [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: 02/24/2023] [Accepted: 06/25/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Many patients would require repeated ablation procedures owing to recurrent atrial fibrillation with its associated symptoms. Identifying those who are at risk of recurrent AF could assist us to develop preventive strategies and to properly select those who will benefit more from catheter ablation. Our aim is to study the role of preprocedural serum level of certain biomarkers in the prediction of AF recurrence after catheter ablation. RESULTS The present study included 117 patients: 26 patients with persistent and 91 patients with paroxysmal AF. Blood samples for estimation of serum levels of studied cytokines were obtained prior to the procedure. Pulmonary vein isolation was performed in all patients through point-by point radiofrequency ablation guided by 3D electroanatomical mapping system. Patients were followed for 12 months for AF recurrence. Forty-one (35%) patients developed AF recurrence. Those patients were significantly older, had significantly higher BMI, lower ejection fraction, and wider maximal left atrial diameter (LAD). Serum hs-CRP, IL-6, TNF-α, visfatin, and adiponectin levels were significantly higher compared to those who did not develop AF recurrence. Correlation analysis showed positive correlations between the incidence of RAF and patients' age, BMI, and maximum LAD and elevated cytokine levels and maximal LAD showed significant correlations with the type of AF and elevated serum TNF-α, visfatin, and adiponectin. Statistical analyses defined elevated serum levels of TNF-α, visfatin, and adiponectin as positive predictors for RAF, and automatic linear modeling analysis showed that elevated serum visfatin, TNF-α, and adiponectin can predict RAF by accuracy rates of 50%, 34%, and 16%, respectively. CONCLUSIONS RAF is most probably an outcome of the interplay between patients' clinical data, obesity, and inflammation. Pre-procedural estimation of serum levels of visfatin and TNF-α might determine patients with probability for RAF.
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Affiliation(s)
- Amr AlKassas
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Fouda
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Gaetano Fassini
- Cardiac Arrhythmia Research Centre, Department of Cardiovascular Sciences, Centro Cardiologico Monzino, University of Milan, Milan, Italy
| | - Mohamed Sanhoury
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
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11
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Zhang JC, Bhat A. Atrial Cardiopathy: Redefining Stroke Risk Beyond Atrial Fibrillation. Am J Cardiol 2023; 201:177-184. [PMID: 37385172 DOI: 10.1016/j.amjcard.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 07/01/2023]
Abstract
Atrial fibrillation (AF) and ischemic stroke are dual epidemics in society, both associated with poor clinical outcomes, patient disability, and significant healthcare expenditure. The conditions are interrelated and share complex causal pathways. Risk stratification algorithms such as the CHADS2 and CHA2DS2-VASc score offer predictive value in stroke and systemic embolism risk in the AF population, however, have limitations. Recent evidence suggests that an intrinsically prothrombotic atrial substrate may precede and promote AF and lead to thromboembolic events independent of the arrhythmia, allowing for a window of intervention before arrhythmia detection and development of ischemic stroke. Initial work has found incremental value in addition of parameters of atrial cardiopathy to traditional stroke risk stratification algorithms, however, requires evaluation with dedicated prospective randomized studies before use in real-world clinical practice. In this narrative review, we explore current evidence and literature on the use of measures of atrial cardiopathy in stroke risk stratification and management.
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Affiliation(s)
- Jessica Chu Zhang
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia; School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia; School of Medicine, Western Sydney University, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
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12
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Guo J, Wang D, Jia J, Zhang J, Peng F, Lu J, Zhao X, Liu Y. Atrial cardiomyopathy and incident ischemic stroke risk: a systematic review and meta-analysis. J Neurol 2023:10.1007/s00415-023-11693-3. [PMID: 37014420 DOI: 10.1007/s00415-023-11693-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND AND PURPOSE Growing evidence suggests that atrial cardiomyopathy may play an essential role in thrombosis and ischemic stroke. The aim of this systematic review and meta-analysis was to quantify the values of cardiomyopathy markers for predicting ischemic stroke risk. METHODS PubMed, Embase, and the Cochrane Library were searched for longitudinal cohort studies evaluating the association between cardiomyopathy markers and incident ischemic stroke risk. RESULTS We included 25 cohort studies examining electrocardiographic, structural, functional, and serum biomarkers of atrial cardiomyopathy involving 262,504 individuals. P-terminal force in the precordial lead V1 (PTFV1) was found to be an independent predictor of ischemic stroke as both a categorical variable (HR 1.29, CI 1.06-1.57) and a continuous variable (HR 1.14, CI 1.00-1.30). Increased maximum P-wave area (HR 1.14, CI 1.06-1.21) and mean P-wave area (HR 1.12, CI 1.04-1.21) were also associated with an increased risk of ischemic stroke. Left atrial (LA) diameter was independently associated with ischemic stroke as both a categorical variable (HR 1.39, CI 1.06-1.82) and a continuous variable (HR 1.20, CI 1.06-1.35). LA reservoir strain independently predicted the risk of incident ischemic stroke (HR 0.88, CI 0.84-0.93). N-terminal pro-brain natriuretic peptide (NT-proBNP) was also associated with incident ischemic stroke risk, both as a categorical variable (HR 2.37, CI 1.61-3.50) and continuous variable (HR 1.42, CI 1.19-1.70). CONCLUSION Atrial cardiomyopathy markers, including electrocardiographic markers, serum markers, LA structural and functional markers, can be used to stratify the risk of incident ischemic stroke.
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Affiliation(s)
- Jiahuan Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fanyang Street 119, Beijing, 100070, China
| | - Dandan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fanyang Street 119, Beijing, 100070, China
| | - Jiaokun Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fanyang Street 119, Beijing, 100070, China
| | - Jia Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fanyang Street 119, Beijing, 100070, China
| | - Fei Peng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fanyang Street 119, Beijing, 100070, China
| | - Jingjing Lu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fanyang Street 119, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fanyang Street 119, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
| | - Yanfang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Fanyang Street 119, Beijing, 100070, China.
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Total atrial conduction time provides novel information in prediction for stroke in patients with sinus rhythm. Heart Vessels 2023; 38:543-550. [PMID: 36264502 PMCID: PMC9986205 DOI: 10.1007/s00380-022-02189-7] [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: 05/07/2022] [Accepted: 10/13/2022] [Indexed: 11/04/2022]
Abstract
The total atrial conduction time (TACT) measured by echocardiography predicts the risk of atrial fibrillation (AF). This study aimed to investigate whether adding the TACT to the revised Framingham stroke risk profile (rFSRP) improves the efficacy of predicting stroke incidence in patients without prior stroke or known AF. The TACT was measured in 376 consecutive patients > 18 years (58.5 ± 16.3 years; 46% male) receiving echocardiography without any prior history of stroke or AF. The primary endpoint was the occurrence of ischemic stroke, and the secondary endpoint was any documentation of AF during the 2 years of follow-up. During the follow-up period, ischemic strokes occurred in 10 patients (2.65%), and AF in 22 patients (5.85%). The TACT was significantly longer in those who later had a stroke compared with those who did not (169.4 vs. 142.7 ms, p < 0.001). Both rFSRP and TACT predicted the risk for stroke incidence. The univariate model showed that the TACT was a predictor of ischemic stroke incidence (p < 0.001; hazard ratio of 1.94 for every 10 ms; 95% confidence interval, 1.49-2.54). The addition of TACT to rFSRP significantly improved the area under the receiver operating characteristic curve (0.79 vs. 0.85, p = 0.001). Stroke risk prediction was significantly improved by the addition of TACT to rFSRP. The utility of the TACT should be further investigated in large-scale randomized clinical trials.
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Pozios I, Vouliotis AI, Dilaveris P, Tsioufis C. Electro-Mechanical Alterations in Atrial Fibrillation: Structural, Electrical, and Functional Correlates. J Cardiovasc Dev Dis 2023; 10:jcdd10040149. [PMID: 37103028 PMCID: PMC10141162 DOI: 10.3390/jcdd10040149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Atrial fibrillation is the most common arrhythmia encountered in clinical practice affecting both patients’ survival and well-being. Apart from aging, many cardiovascular risk factors may cause structural remodeling of the atrial myocardium leading to atrial fibrillation development. Structural remodelling refers to the development of atrial fibrosis, as well as to alterations in atrial size and cellular ultrastructure. The latter includes myolysis, the development of glycogen accumulation, altered Connexin expression, subcellular changes, and sinus rhythm alterations. The structural remodeling of the atrial myocardium is commonly associated with the presence of interatrial block. On the other hand, prolongation of the interatrial conduction time is encountered when atrial pressure is acutely increased. Electrical correlates of conduction disturbances include alterations in P wave parameters, such as partial or advanced interatrial block, alterations in P wave axis, voltage, area, morphology, or abnormal electrophysiological characteristics, such as alterations in bipolar or unipolar voltage mapping, electrogram fractionation, endo-epicardial asynchrony of the atrial wall, or slower cardiac conduction velocity. Functional correlates of conduction disturbances may incorporate alterations in left atrial diameter, volume, or strain. Echocardiography or cardiac magnetic resonance imaging (MRI) is commonly used to assess these parameters. Finally, the echocardiography-derived total atrial conduction time (PA-TDI duration) may reflect both atrial electrical and structural alterations.
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15
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Lin J, Cai Y, Meng X, Liu S, Wang F, Liu L, Zhu Z, Liu M, Ding L, Wu W, Wang H, Yao Y. Left atrial reservoir strain measurements derived from intracardiac echocardiography in patients with atrial fibrillation: comparison with transthoracic echocardiography. Cardiovasc Ultrasound 2023; 21:4. [PMID: 36829216 PMCID: PMC9951450 DOI: 10.1186/s12947-023-00302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/05/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Intracardiac echocardiography (ICE) provides accurate left atrial (LA) anatomical information in the procedure of atrial fibrillation (AF) ablation but lacks LA functional assessment. LA reservoir strain (LASr) is an excellent marker of LA reservoir function. This study aimed to assess the agreement between LASr derived from ICE and transthoracic echocardiography (TTE) in AF patients and analyze the reproducibility of LASr assessed by ICE combined with speckle tracking imaging. METHODS This study prospectively enrolled 110 patients with a clinical diagnosis of AF who were ready for AF ablation, including 71 patients with paroxysmal AF and 39 with persistent AF. TTE and ICE examinations were performed on each individual before AF ablation. LASr measurements derived from ICE and TTE images were using dedicated LA-tracking software. Pearson correlation coefficients (r) and Bland-Altman plots were used to evaluate the agreement of LASr between the two modalities. Intraclass correlation coefficients (ICCs) were used to assess intra- and inter-observer reproducibility. RESULTS The agreement between LASr obtained from ICE and TTE, especially between LASrLPV (LASr derived from LA left pulmonary vein view of ICE) and LASrTTE (LASr derived from TTE) were good in both paroxysmal and persistent AF patients [r = 0.890 (P < 0.001) for overall population; r = 0.815 (P < 0.001) and Bias ± LOA: -0.3 ± 9.9% for paroxysmal AF; r = 0.775 (P < 0.001) and Bias ± LOA: -2.6 ± 3.9% for persistent AF, respectively]. But the values of LASr derived from ICE were slightly lower than those of TTE, especially in patients with persistent AF. The ICCs for LASr derived from ICE were excellent (all ICCs > 0.90). CONCLUSIONS In patients with AF, LASr derived from ICE demonstrated excellent reproducibility and showed good agreement with LASr obtained from TTE. Obtaining LASr from ICE images may be a supplementary method to evaluate LA reservoir function in AF patients and expands the potential of ICE in the field of cardiac function assessment.
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Affiliation(s)
- Jingru Lin
- grid.506261.60000 0001 0706 7839Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuqi Cai
- grid.506261.60000 0001 0706 7839Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Meng
- grid.506261.60000 0001 0706 7839Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shangyu Liu
- grid.506261.60000 0001 0706 7839Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengyang Wang
- Department of Cardiology, Songyuan Central Hospital, Songyuan, China
| | - Limin Liu
- grid.506261.60000 0001 0706 7839Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenhui Zhu
- grid.506261.60000 0001 0706 7839Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengyi Liu
- grid.506261.60000 0001 0706 7839Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ligang Ding
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Weichun Wu
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. .,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China.
| | - Hao Wang
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yan Yao
- grid.506261.60000 0001 0706 7839Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Effects of Atrial Ischemia on Left Atrial Remodeling in Patients with ST-Segment Elevation Myocardial Infarction. J Am Soc Echocardiogr 2023; 36:163-171. [PMID: 35977632 DOI: 10.1016/j.echo.2022.08.006] [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: 07/29/2021] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Adverse left atrial (LA) remodeling after ST-segment elevation myocardial infarction (STEMI) has been associated with poor prognosis. Flow impairment in the dominant coronary atrial branch (CAB) may affect large areas of LA myocardium, potentially leading to adverse LA remodeling during follow-up. The aim of this study was to assess echocardiographic LA remodeling in patients with STEMI with impaired coronary flow in the dominant CAB. METHODS Of 897 patients with STEMI, 69 patients (mean age, 62 ± 11 years; 83% men) with impaired coronary flow in the dominant CAB (defined as Thrombolysis In Myocardial Infarction flow grade < 3) were retrospectively compared with an age- and sex-matched control group of 138 patients with normal dominant CAB coronary flow. RESULTS Patients with dominant CAB-impaired flow had higher peak troponin T (3.9 μg/L [interquartile range, 2.2-8.2 μg/L] vs 3.2 μg/L [interquartile range, 1.5-5.6 μg/L], P = .009). No differences in left ventricular ejection fraction or mitral regurgitation were observed between groups at baseline or at follow-up. LA remodeling assessment included maximum LA volume, speckle-tracking echocardiography-derived LA strain, and total atrial conduction time assessed on Doppler tissue imaging at baseline, 6 months, and 12 months. Patients with dominant CAB-impaired flow presented larger LA maximal volumes (26.9 ± 10.9 vs 18.1 ± 7.1 mL/m2, P < .001) and longer total atrial conduction time (150 ± 23 vs 124 ± 22 msec, P < .001) at 6 months, remaining unchanged at 12 months. However, all LA strain parameters were significantly lower from baseline (reservoir, 20.3 ± 10.1% vs 27.1 ± 14.5% [P < .001]; conduit, 9.1 ± 5.6% vs 12.8 ± 8% [P < .001]; booster, 9.1 ± 5.6% vs 12.8 ± 8% [P < .001]), these differences being sustained at 6- and 12-month follow-up. CONCLUSIONS Atrial ischemia resulting from impaired coronary flow in the dominant CAB in patients with STEMI is associated with LA adverse anatomic and functional remodeling. Reduced LA strain preceded LA anatomic remodeling in early phases after STEMI.
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Echocardiographic evaluation of left atrial strain for predicting iron overload in pediatric patients with β-thalassemia with preserved ejection fraction. Int J Cardiovasc Imaging 2023; 39:895-906. [PMID: 36607471 DOI: 10.1007/s10554-022-02788-5] [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: 11/06/2022] [Accepted: 12/24/2022] [Indexed: 01/07/2023]
Abstract
Pediatric patients with β-thalassemia (β-TM) with preserved ejection fraction may experience early myocardial damage. This prospective study aimed to investigate left atrial (LA) function restructure in pediatric patients with β-TM by two-dimensional speckle tracking echocardiography (2D-STE) and evaluate the value of LA strain for predicting myocardial iron overload (MIO). We recruited 50 β-TM pediatric patients and 30 healthy children aged 3-14 years. The patients were assigned to a normal left ventricular (LV) lesion group (n = 20) and an enlarged LV lesion group (n = 30). Subjects all underwent echocardiography to measure conventional cardiac function parameters and LA strain parameters. The results displayed that LA reservoir strain (LASr), conduit strain (LAScd), contractile strain (LASct) and strain rate were significantly reduced in pediatric patients with β-TM with preserved ejection fraction. LASr, LAScd, and LASct were negatively correlated with the E/e' ratio, of which LASr had the most significant correlation (r = - 0.69, P < 0.001). LASr and LASct correlated positively with T2* (r = 0.70 and 0.62, respectively, all P < 0.001). In the multiple regression, LASr and LASct were independent predictors for T2*. The areas under the curve for LASr and LASct were 0.87 (P < 0.001) and 0.78 (P = 0.004), respectively. Our results demonstrated that LA strains were dramatically impaired in pediatric patients with β-TM, and LASr is an efficient indicator for detecting LV early diastolic dysfunction in β-TM pediatric patients and reflects early myocardial damage. LASr and LASct were independently predictive of MIO, but LASr was a more sensitive predictor.
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Maheshwari A, Norby FL, Inciardi RM, Wang W, Zhang MJ, Soliman EZ, Alonso A, Johansen MC, Gottesman RF, Solomon SD, Shah AM, Chen LY. Left Atrial Mechanical Dysfunction and the Risk for Ischemic Stroke in People Without Prevalent Atrial Fibrillation or Stroke : A Prospective Cohort Study. Ann Intern Med 2023; 176:39-48. [PMID: 36534978 DOI: 10.7326/m22-1638] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Atrial myopathy-characterized by changes in left atrial function and size-may precede and promote atrial fibrillation (AF) and cardiac thromboembolism. In people without prior AF or stroke, whether analysis of left atrial function and size can improve ischemic stroke prediction is unknown. OBJECTIVE To evaluate the association of echocardiographic left atrial function (reservoir, conduit, and contractile strain) and left atrial size (left atrial volume index) with ischemic stroke and determine whether these measures can improve the stroke prediction achieved by CHA2DS2-VASc score variables. DESIGN Prospective cohort study. SETTING ARIC (Atherosclerosis Risk in Communities) study. PARTICIPANTS 4917 ARIC participants without prevalent stroke or AF. MEASUREMENTS Ischemic stroke events (2011 to 2019) were adjudicated by physicians. Left atrial strain was measured using speckle-tracking echocardiography. RESULTS Over 5 years, the cumulative incidences of ischemic stroke in the lowest quintiles of left atrial reservoir, conduit, and contractile strain were 2.99% (95% CI, 1.89% to 4.09%), 3.18% (CI, 2.14% to 4.22%), and 2.15% (CI, 1.09% to 3.21%), respectively, and that of severe left atrial enlargement was 1.99% (CI, 0.23% to 3.75%). On the basis of the Akaike information criterion, left atrial reservoir strain plus CHA2DS2-VASc variables was the best predictive model. With the addition of left atrial reservoir strain to CHA2DS2-VASc variables, 11.6% of the 112 participants with stroke after 5 years were reclassified to higher risk categories and 1.8% to lower risk categories. Among the 4805 participants who did not develop stroke, 12.2% were reclassified to lower and 12.7% to higher risk categories. Decision curve analysis showed a predicted net benefit of 1.34 per 1000 people at a 5-year risk threshold of 5%. LIMITATION Underascertainment of subclinical AF. CONCLUSION In people without prior AF or stroke, when added to CHA2DS2-VASc variables, left atrial reservoir strain improves stroke prediction and yields a predicted net benefit, as shown by decision curve analysis. PRIMARY FUNDING SOURCE National Heart, Lung, and Blood Institute of the National Institutes of Health.
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Affiliation(s)
- Ankit Maheshwari
- Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (A.M.)
| | - Faye L Norby
- Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California (F.L.N.)
| | - Riccardo M Inciardi
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts (R.M.I., S.D.S., A.M.S.)
| | - Wendy Wang
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota (W.W.)
| | - Michael J Zhang
- Cardiovascular Division, Department of Medicine, and Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota (L.Y.C, M.J.Z.)
| | - Elsayed Z Soliman
- Department of Epidemiology, Wake Forest University, Winston-Salem, North Carolina (E.Z.S.)
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia (A.A.)
| | - Michelle C Johansen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland (M.C.J.)
| | - Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland (R.F.G.)
| | - Scott D Solomon
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts (R.M.I., S.D.S., A.M.S.)
| | - Amil M Shah
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts (R.M.I., S.D.S., A.M.S.)
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, and Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota (L.Y.C, M.J.Z.)
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19
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Zhubi Bakija F, Bagyura Z, Fábián A, Ferencz A, Kiss L, Szenczi O, Vadas R, Dósa E, Nguyen DT, Csobay-Novák C, Jermendy ÁL, Szelid Z, Soós P, Kovács A, Merkely B. Long-term prognostic value of left atrial longitudinal strain in an elderly community-based cohort. GeroScience 2022; 45:613-625. [PMID: 36482260 PMCID: PMC9886757 DOI: 10.1007/s11357-022-00673-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022] Open
Abstract
Despite the well-known importance of left atrial (LA) mechanics in diastolic function, data are scarce regarding the prognostic power of LA longitudinal strain and its potential added value in the risk stratification of an elderly population. Accordingly, our aim was to determine the long-term prognostic importance of 2D speckle-tracking echocardiography-derived peak atrial longitudinal strain (PALS) in a community-based screening sample. Three hundred and fourteen volunteers were retrospectively identified from a population-based screening program (mean age 62 ± 11 years; 58% female) with a median follow-up of 9.5 years. All subjects who participated in the screening program underwent 2D echocardiography to measure left ventricular (LV) ejection fraction (EF), global longitudinal strain (GLS), and PALS, as well as low-dose cardiac CT to determine the Agatston score. The primary endpoint was all-cause mortality. Thirty-nine subjects (12.4%) met the primary endpoint. Subjects with adverse outcomes had significantly lower LV GLS (dead vs. alive; - 19.2 ± 4.3 vs. - 20.6 ± 3.5%, p < 0.05) and PALS (32.3 ± 12.0 vs. 41.8 ± 14.2%, p < 0.001), whereas LV EF did not show a difference between the two groups (51.1 ± 7.0 vs. 52.1 ± 6.2, %, p = NS). By multivariable Cox regression analysis, PALS was found to be a significant predictor of adverse outcomes independent of LV GLS, and Agatston and Framingham scores. In subjects with PALS values below the standard cut-off of 39%, the risk of all-cause mortality was almost 2.5 times higher (hazard ratio: 2.499 [95% confidence interval: 1.334-4.682], p < 0.05). Beyond the assessment of LV EF and LV GLS, PALS offers incremental value in cardiovascular risk stratification in a community-based elderly cohort. PALS was found to be a significant and independent predictor of long-term mortality among other classical cardiovascular risk estimators.
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Affiliation(s)
- Fjolla Zhubi Bakija
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122 Hungary ,Clinic of Cardiology, University and Clinical Center of Kosovo, Prishtina, Kosovo
| | - Zsolt Bagyura
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122 Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122 Hungary
| | - Andrea Ferencz
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122 Hungary
| | - Loretta Kiss
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122 Hungary
| | - Orsolya Szenczi
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122 Hungary
| | - Réka Vadas
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Edit Dósa
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122 Hungary
| | - Dat Tin Nguyen
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122 Hungary
| | - Csaba Csobay-Novák
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122 Hungary
| | - Ádám L. Jermendy
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122 Hungary
| | - Zsolt Szelid
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122 Hungary
| | - Pál Soós
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122 Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122, Hungary.
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor str. 68, Budapest, 1122, Hungary.
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20
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Deal O, Rayner J, Stracquadanio A, Wijesurendra RS, Neubauer S, Rider O, Spartera M. Effect of Weight Loss on Early Left Atrial Myopathy in People With Obesity But No Established Cardiovascular Disease. J Am Heart Assoc 2022; 11:e026023. [PMID: 36346054 PMCID: PMC9750071 DOI: 10.1161/jaha.122.026023] [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] [Indexed: 11/10/2022]
Abstract
Background Obesity is associated with left atrial (LA) remodeling (ie, dilatation and dysfunction) which is an independent determinant of future cardiovascular events. We aimed to assess whether LA remodeling is present in obesity even in individuals without established cardiovascular disease and whether it can be improved by intentional weight loss. Methods and Results Forty-five individuals with severe obesity without established cardiovascular disease (age, 45±11 years; body mass index; 39.1±6.7 kg/m2; excess body weight, 51±18 kg) underwent cardiac magnetic resonance for quantification of LA and left ventricular size and function before and at a median of 373 days following either a low glycemic index diet (n=28) or bariatric surgery (n=17). Results were compared with those obtained in 27 normal-weight controls with similar age and sex. At baseline, individuals with obesity displayed reduced LA reservoir function (a marker of atrial distensibility), and a higher mass and LA maximum volume (all P<0.05 controls) but normal LA emptying fraction. On average, weight loss led to a significant reduction of LA maximum volume and left ventricular mass (both P<0.01); however, significant improvement of the LA reservoir function was only observed in those at the upper tertile of weight loss (≥47% excess body weight loss). Following weight loss, we found an average residual increase in left ventricular mass compared with controls but no residual significant differences in LA maximum volume and strain function (all P>0.05). Conclusions Obesity is linked to subtle LA myopathy in the absence of overt cardiovascular disease. Only larger volumes of weight loss can completely reverse the LA myopathic phenotype.
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Affiliation(s)
- Oscar Deal
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
| | - Jennifer Rayner
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
- The University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Antonio Stracquadanio
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
- The University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Rohan S. Wijesurendra
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
| | - Oliver Rider
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
- The University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
| | - Marco Spartera
- Division of Cardiovascular MedicineRadcliffe Department of Medicine, University of OxfordUnited Kingdom
- The University of Oxford Centre for Clinical Magnetic Resonance ResearchOxfordUnited Kingdom
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21
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Bax M, Ajmone Marsan N, Delgado V, Bax JJ, van der Bijl P. Effect of Bi-Atrial Size and Function in Patients With Paroxysmal or Permanent Atrial Fibrillation. Am J Cardiol 2022; 183:33-39. [PMID: 36114023 DOI: 10.1016/j.amjcard.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022]
Abstract
Atrial fibrillation (AF) remains the most common arrhythmia in clinical practice. The choice between a rate-control and rhythm-control strategy depends on various factors, including the anatomical and functional substrate. This study investigates the anatomical and functional characteristics of both atria in patients with AF and explores the potential therapeutic implications. From an ongoing registry of patients with paroxysmal or permanent AF, those who underwent cardiac computed tomography (CCT) were included. Left atrial (LA) and right atrial (RA) sizes were measured on CCT, whereas bi-atrial function was quantified with speckle tracking strain echocardiography. The mean LA volume index was 41.6 ± 5.6 ml/m2, and the mean RA volume index was 71.0 ± 21.6 ml/m2. Mean LA reservoir strain was 24.3 ± 15.1%, compared with the mean RA reservoir strain of 21.6 ± 13.2%. Patients with smaller LA volumes had higher LA reservoir strain values than those with larger LA volumes (24.6% [interquartile range (IQR) 15.8 to 35.8] vs 16.5% [IQR 11.2 to 25.0], p <0.001). Patients with permanent AF had larger LA volumes (44.0 [IQR 33.7 to 55.2] ml/m2 vs 36.9 [IQR 30.1 to 47.1] ml/m2, p = 0.025) compared with paroxysmal AF. Patients with permanent AF had more impaired LA reservoir strain (15.5% [IQR 11.6 to 22.7] vs 26.9% [IQR 17.4 to 35.6], p <0.001) compared with paroxysmal AF. Similar trends were observed in the RA. In conclusion, atrial substrate characterization by CCT and speckle tracking strain echocardiography may have therapeutic implications, especially for choosing between a rate-control and rhythm-control strategy.
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Affiliation(s)
- Maxim Bax
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, The Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Pieter van der Bijl
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, The Netherlands.
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22
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Pradella M, Anastasopoulos C, Yang S, Moor M, Badertscher P, Gehweiler JE, Spies F, Haaf P, Zellweger M, Sommer G, Stieltjes B, Bremerich J, Osswald S, Kühne M, Sticherling C, Knecht S. Associations between fully-automated, 3D-based functional analysis of the left atrium and classification schemes in atrial fibrillation. PLoS One 2022; 17:e0272011. [PMID: 35969532 PMCID: PMC9377598 DOI: 10.1371/journal.pone.0272011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background Atrial fibrillation (AF) has been linked to left atrial (LA) enlargement. Whereas most studies focused on 2D-based estimation of static LA volume (LAV), we used a fully-automatic convolutional neural network (CNN) for time-resolved (CINE) volumetry of the whole LA on cardiac MRI (cMRI). Aim was to investigate associations between functional parameters from fully-automated, 3D-based analysis of the LA and current classification schemes in AF. Methods We retrospectively analyzed consecutive AF patients who underwent cMRI on 1.5T systems including a stack of oblique-axial CINE series covering the whole LA. The LA was automatically segmented by a validated CNN. In the resulting volume-time curves, maximum, minimum and LAV before atrial contraction were automatically identified. Active, passive and total LA emptying fractions (LAEF) were calculated and compared to clinical classifications (AF Burden score (AFBS), increased stroke risk (CHA2DS2VASc≥2), AF type (paroxysmal/persistent), EHRA score, and AF risk factors). Moreover, multivariable linear regression models (mLRM) were used to identify associations with AF risk factors. Results Overall, 102 patients (age 61±9 years, 17% female) were analyzed. Active LAEF (LAEF_active) decreased significantly with an increase of AFBS (minimal: 44.0%, mild: 36.2%, moderate: 31.7%, severe: 20.8%, p<0.003) which was primarily caused by an increase of minimum LAV. Likewise, LAEF_active was lower in patients with increased stroke risk (30.7% vs. 38.9%, p = 0.002). AF type and EHRA score did not show significant differences between groups. In mLRM, a decrease of LAEF_active was associated with higher age (per year: -0.3%, p = 0.02), higher AFBS (per category: -4.2%, p<0.03) and heart failure (-12.1%, p<0.04). Conclusions Fully-automatic morphometry of the whole LA derived from cMRI showed significant relationships between LAEF_active with increased stroke risk and severity of AFBS. Furthermore, higher age, higher AFBS and presence of heart failure were independent predictors of reduced LAEF_active, indicating its potential usefulness as an imaging biomarker.
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Affiliation(s)
- Maurice Pradella
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- * E-mail:
| | | | - Shan Yang
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Manuela Moor
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Julian E. Gehweiler
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Florian Spies
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Zellweger
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gregor Sommer
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - Bram Stieltjes
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
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23
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Assessment of Left Atrial Structure and Function by Echocardiography in Atrial Fibrillation. Diagnostics (Basel) 2022; 12:diagnostics12081898. [PMID: 36010248 PMCID: PMC9406407 DOI: 10.3390/diagnostics12081898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia with significant morbidity and mortality. Exacerbated by the aging population, the prevalence of AF is gradually increasing. Accurate evaluation of structure and function of left atrium (LA) has important prognostic significance in patients with AF. Echocardiography is the imaging technique of first choice to assess LA structure and function due to its better availability, accessibility and safety over cardiac computed tomography and cardiac magnetic resonance. Therefore, the aim of this review is to summarize the recent research progress of evaluating LA size by three-dimensional echocardiography and LA function by speckle tracking echocardiography (STE) in predicting the occurrence and recurrence of AF and determining the risk of stroke in AF. In addition, we summarized the role of traditional echocardiography in detecting AF patients that are at high risk of heart failure or cardiovascular death.
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24
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Lang RM, Cameli M, Sade LE, Faletra FF, Fortuni F, Rossi A, Soulat-Dufour L. Imaging assessment of the right atrium: anatomy and function. Eur Heart J Cardiovasc Imaging 2022; 23:867-884. [PMID: 35079782 DOI: 10.1093/ehjci/jeac011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/12/2022] [Indexed: 01/07/2023] Open
Abstract
The right atrium (RA) is the cardiac chamber that has been least well studied. Due to recent advances in interventional cardiology, the need for greater understanding of the RA anatomy and physiology has garnered significant attention. In this article, we review how a comprehensive assessment of RA dimensions and function using either echocardiography, cardiac computed tomography, and magnetic resonance imaging may be used as a first step towards a better understanding of RA pathophysiology. The recently published normative data on RA size and function will likely shed light on RA atrial remodelling in atrial fibrillation (AF), which is a complex phenomenon that occurs in both atria but has only been studied in depth in the left atrium. Changes in RA structure and function have prognostic implications in pulmonary hypertension (PH), where the increased right ventricular (RV) afterload first induces RV remodelling, predominantly characterized by hypertrophy. As PH progresses, RV dysfunction and dilatation may begin and eventually lead to RV failure. Thereafter, RV overload and increased RV stiffness may lead to a proportional increase in RA pressure. This manuscript provides an in-depth review of RA anatomy, function, and haemodynamics with particular emphasis on the changes in structure and function that occur in AF, tricuspid regurgitation, and PH.
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Affiliation(s)
- Roberto M Lang
- Heart and Vascular Center, University of Chicago, 5758 S Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Leila E Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA.,Department of Cardiology, University of Baskent, Ankara, Turkey
| | | | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexia Rossi
- Department of Nuclear Medicine, Zurich University Hospital, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Zurich, Switzerland
| | - Laurie Soulat-Dufour
- Saint Antoine and Tenon Hospital, AP-HP, Pr Ariel Cohen, Sorbonne Université, INSERM, Unité de recherche sur les maladies cardiovasculaires, le métabolisme et la nutrition, ICAN, Paris F-75013, France
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25
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Chen C, Yang Y, Ma W, Qi L, Zhang B, Zhang Y. Left atrial phasic function remodeling during its enlargement: a two-dimensional speckle-tracking echocardiography study. BMC Cardiovasc Disord 2022; 22:231. [PMID: 35590247 PMCID: PMC9118856 DOI: 10.1186/s12872-022-02672-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left atrial (LA) size is often used as a surrogate marker of LA function in clinical practice, with larger atrial thought to represent a "dysfunctioning" atrium, since there is no accepted 'gold' standard to evaluate LA function. The exact relationship between LA size and phasic function, and whether LA dysfunction occur before LA enlargement (LAE) may be of clinical interest while have not been fully studied. Two-dimensional speckle-tracking echocardiography (2D STE) was showed a promising method in measuring LA physical deformation. MATERIALS AND METHODS A community cohort of 715 subjects at cardiovascular disease high risk accepted comprehensive echocardiography. LA longitudinal phasic strain Sa (absolute peak strain during atrial contraction), Se (peak strain at early diastole) and Stot (total atrial strain = Sa + Se), representing contractile, conduit, and reservoir function respectively, were measured using off-line 2D STE software in apical 4 chamber view, and data were compared among groups at different LA size and between subgroups in normal LA size with and without hypertension (HT). RESULTS With LAE (from normal size, mild, moderate to severe LAE), the Stot (21.74 ± 5.97, 20.75 ± 4.99, 20.49 ± 5.27, 17.75 ± 4.71, respectively, ANOVA P = 0.003) and Sa (11.84 ± 3.92, 11.00 ± 3.29, 10.11 ± 2.57, 8.55 ± 2.88, respectively, ANOVA P < 0.001) reduced while Se had no change. Stot of Severe LAE group was significantly lower than that of Normal LA size group (P = 0.002). Sa of the three LAE groups were all significantly lower than that of Normal LA size group (P = 0.024, P = 0.002, P < 0.001, respectively). In normal sized LA subgroups, Stot (21.35 ± 5.91 vs. 23.01 ± 6.02, P = 0.008) and Se (9.51 ± 4.41 vs. 11.17 ± 4.89, P < 0.001) reduced in subjects with HT comparing with those without. CONCLUSION LA phasic function remodeling occurs before LAE and continues with LAE, with reservoir, conduit and contractile function being affected unparalleled.
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Affiliation(s)
- Chuyun Chen
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Ying Yang
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,Echocardiography Core Lab, Institute of Cardiovascular Disease, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Wei Ma
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Echocardiography Core Lab, Institute of Cardiovascular Disease, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Litong Qi
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Baowei Zhang
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, 100034, China
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26
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Molnár AÁ, Merkely B. The Added Value of Atrial Strain Assessment in Clinical Practice. Diagnostics (Basel) 2022; 12:diagnostics12040982. [PMID: 35454030 PMCID: PMC9025202 DOI: 10.3390/diagnostics12040982] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 12/28/2022] Open
Abstract
Speckle tracking echocardiography has emerged as a sensitive tool to analyze myocardial function with improved diagnostic accuracy and prognostic value. Left atrial strain assessment has become a novel imaging method in cardiology with superior prognostic value compared to conventional left atrial volume indices. Left atrial function is divided into three phases, reservoir function being the most important. This review summarizes the added value of speckle tracking echocardiography derived left atrial strain assessment in clinical practice. Recently published data suggest the prognostic value of left atrial reservoir function in heart failure, atrial fibrillation, stroke and valvular heart disease. Furthermore, left atrial reservoir strain proved to be a predictor of cardiovascular morbidity and mortality in the general population. Thus, routine assessment of left atrial function can be an optimal strategy to improve cardiovascular risk prediction and supplement the current risk prediction models.
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27
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Soulat-Dufour L, Lang S, Addetia K, Ederhy S, Adavane-Scheuble S, Chauvet-Droit M, Jean ML, Nhan P, Ben Said R, Kamami I, Issaurat P, Capderou E, Arnaud C, Boccara F, Lang RM, Cohen A. Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation. J Am Coll Cardiol 2022; 79:951-961. [PMID: 35272799 DOI: 10.1016/j.jacc.2021.12.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiac chamber remodeling in atrial fibrillation (AF) reflects the progression of cardiac rhythm and may affect functional regurgitation. OBJECTIVES The purpose of this study was to explore the 3-dimensional echocardiographic variables of cardiac cavity remodeling and the impact on functional regurgitation in patients with AF with/without sinus rhythm restoration at 12 months. METHODS A total of 117 consecutive patients hospitalized for AF were examined using serial 3-dimensional transthoracic echocardiography at admission, at 6 months, and at 12 months (337 examinations). RESULTS During follow-up, 47 patients with active restoration of sinus rhythm (SR) (through cardioversion and/or ablation) had a decrease in all atrial indexed volumes (Vi), end-systolic (ES) right ventricular (RV) Vi, an increase in end-diastolic (ED) left ventricular Vi, and an improvement in 4-chambers function (P < 0.05). Patients with absence/failure of restoration of SR (n = 39) had an increase in ED left atrial Vi and ED/ES RV Vi without modification of 4-chambers function, except for a decrease in left atrial emptying fraction (P < 0.05). Patients with spontaneous restoration of SR (n = 31) had no changes in Vi or function. The authors found an improvement vs baseline in severity of functional regurgitation in patients with active restoration of SR (tricuspid and mitral regurgitation) and in spontaneous restoration of SR (tricuspid regurgitation) (P < 0.05). In multivariable analysis, right atrial and/or left atrial reverse remodeling exclusively correlated with intervention (cardioversion and/or ablation) during 12-month follow-up. CONCLUSIONS Management of AF should focus on restoration of SR to induce anatomical (all atrial Vi, ES RV Vi) and/or functional (4 chambers) cardiac cavity reverse remodeling and reduce severity of functional regurgitation. (Thromboembolic and Bleeding Risk Stratification in Patients With Non-valvular Atrial Fibrillation [FASTRHAC]; NCT02741349).
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Affiliation(s)
- Laurie Soulat-Dufour
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Unité INSERM UMRS 1166 Unité de recherche sur les maladies cardiovasculaires et métaboliques, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), F-75013, Sorbonne Université, Paris, France. https://twitter.com/lsoulatdufour
| | - Sylvie Lang
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Karima Addetia
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois, USA
| | - Stephane Ederhy
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | | | - Marion Chauvet-Droit
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Marie-Liesse Jean
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Pascal Nhan
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Rim Ben Said
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Iris Kamami
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Pauline Issaurat
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Elodie Capderou
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Camille Arnaud
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Franck Boccara
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Sorbonne Université, GRC n°22, C(2)MV-Complications Cardiovasculaires et Métaboliques chez les patients vivant avec le Virus de l'immunodéficience humaine, Inserm UMR_S 938, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Roberto M Lang
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois, USA
| | - Ariel Cohen
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Unité INSERM UMRS 1166 Unité de recherche sur les maladies cardiovasculaires et métaboliques, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), F-75013, Sorbonne Université, Paris, France.
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Lisi DD, Di Caccamo L, Damerino G, Portelli MC, Comparato F, Stefano VD, Brighina F, Corrado E, Galassi AR, Novo G. Effectiveness and Safety of oral anticoagulants in cardiac amyloidosis: lights and shadows. Curr Probl Cardiol 2022:101188. [DOI: 10.1016/j.cpcardiol.2022.101188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/22/2022] [Indexed: 12/18/2022]
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Arnăutu SF, Morariu VI, Arnăutu DA, Tomescu MC, Dan TF, Dragos Jianu C. Left Atrial Strain Helps Identifying the Cardioembolic Risk in Transient Ischemic Attacks Patients with Silent Paroxysmal Atrial Fibrillation. Ther Clin Risk Manag 2022; 18:213-222. [PMID: 35299625 PMCID: PMC8922319 DOI: 10.2147/tcrm.s359490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/03/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose Patients with transient ischemic attacks often present asymptomatic and paroxysmal atrial fibrillation. Since atrial fibrillation initiates in the atria, we aimed to identify whether the abnormalities in left atrial structure and function could identify the cardioembolic etiology of the transient ischemic attacks in patients at sinus rhythm. Patients and Methods A total of 190 patients over 50 years old with sinus rhythm discharged after a transient ischemic attack were included in the study and divided into two groups according to the presence (group I) or absence (group II) of documented paroxysmal atrial fibrillation. The documentation of paroxysmal atrial fibrillation was based on the examination of medical registers. Cardiac ultrasound assessment was performed at a minimum of 14 days after the onset of the transient ischemic attack, to avoid assessment of atrial stunning. Results The group I patients were older, more frequent women, with a history of stroke or transient ischemic attack and a higher CHA2DS2-VASc score. They also presented larger left atrial volumes, lower left atrial emptying fraction, and significantly impaired left atrial deformation patterns. Multivariate logistic regression identified three variables that were independently associated with paroxysmal atrial fibrillation: age, left atrial reservoir strain, and left atrial emptying fraction (P < 0.0001). The cut-off levels for the variables were age > 55 years, reservoir strain < −17%, and emptying fraction < 51%. Conclusion The present study demonstrates that the LA strain is independently associated with paroxysmal atrial fibrillation in transient ischemic attack patients and might be of great help in identifying their cardioembolic etiology and preventing subsequent strokes by the initiation of anticoagulant therapy.
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Affiliation(s)
- Sergiu Florin Arnăutu
- Neurology Department, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
- Neurology Clinic, Pius Brînzeu County Clinical Emergency Hospital, Timisoara, Romania
| | - Vlad Ioan Morariu
- Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Cardiology Clinic, Timisoara Municipal Clinical Emergency Hospital, Timisoara, Romania
| | - Diana Aurora Arnăutu
- Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Cardiology Clinic, Timisoara Municipal Clinical Emergency Hospital, Timisoara, Romania
- Correspondence: Diana Aurora Arnăutu; Mirela Cleopatra Tomescu, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, Timisoara, 300041, Romania, Tel +40 734600550; +40722979516, Fax +40 256220636, Email ;
| | - Mirela Cleopatra Tomescu
- Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Cardiology Clinic, Timisoara Municipal Clinical Emergency Hospital, Timisoara, Romania
| | - Traian Flavius Dan
- Neurology Department, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
- Neurology Clinic, Pius Brînzeu County Clinical Emergency Hospital, Timisoara, Romania
| | - Cătălin Dragos Jianu
- Neurology Department, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
- Neurology Clinic, Pius Brînzeu County Clinical Emergency Hospital, Timisoara, Romania
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30
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Rivner H, Goldberger JJ. Optimal therapy for stroke prevention in atrial fibrillation: Is it left atrial appendage closure? J Card Surg 2022; 37:1142-1144. [PMID: 35194833 DOI: 10.1111/jocs.16344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Harold Rivner
- Cardiovascular Division, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Jeffrey J Goldberger
- Cardiovascular Division, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
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31
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Suwa Y, Miyasaka Y, Taniguchi N, Harada S, Nakai E, Shiojima I. Atrial fibrillation and stroke: importance of left atrium as assessed by echocardiography. J Echocardiogr 2022; 20:69-76. [DOI: 10.1007/s12574-021-00561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/04/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
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32
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Bhat A, Mahajan V, Chen HHL, Gan GCH, Pontes-Neto OM, Tan TC. Embolic Stroke of Undetermined Source: Approaches in Risk Stratification for Cardioembolism. Stroke 2021; 52:e820-e836. [PMID: 34706562 DOI: 10.1161/strokeaha.121.034498] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Ischemic stroke is a leading cause of morbidity and mortality worldwide. Embolic stroke of undetermined source has been recently proposed to categorize nonlacunar ischemic strokes without confirmed etiology after adequate investigation with a likely embolic stroke mechanism. A strategy of empirical anticoagulation for embolic stroke of undetermined source patients is attractive but may only be beneficial in a select subset of patients. Strategies which would help identify the subset of embolic stroke of undetermined source patients most likely to have cardioembolic origin of stroke, and hence benefit from anticoagulation, are needed. This article will review current evidence which may be useful in the development of a risk stratification approach based on arrhythmia monitoring, cardiac imaging, and clinical risk stratification. This approach may be beneficial in clinical practice in improving patient outcomes and reducing stroke recurrence in this population; however, further work is required with active trials underway.
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Affiliation(s)
- Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, Australia (A.B., V.M., H.H.L.C., G.C.H.G., T.C.T.).,School of Public Health and Community Medicine (A.B., T.C.T.), University of New South Wales, Sydney, Australia.,School of Medicine, Western Sydney University, Australia (A.B., G.C.H.G., T.C.T.)
| | - Vipul Mahajan
- Department of Cardiology, Blacktown Hospital, Sydney, Australia (A.B., V.M., H.H.L.C., G.C.H.G., T.C.T.)
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, Australia (A.B., V.M., H.H.L.C., G.C.H.G., T.C.T.)
| | - Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, Australia (A.B., V.M., H.H.L.C., G.C.H.G., T.C.T.).,School of Medicine (G.C.H.G.), University of New South Wales, Sydney, Australia.,School of Medicine, Western Sydney University, Australia (A.B., G.C.H.G., T.C.T.)
| | - Octavio M Pontes-Neto
- Stroke Service, Neurology Division, Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Brazil (O.M.P.-N.)
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Sydney, Australia (A.B., V.M., H.H.L.C., G.C.H.G., T.C.T.).,School of Public Health and Community Medicine (A.B., T.C.T.), University of New South Wales, Sydney, Australia.,School of Medicine, Western Sydney University, Australia (A.B., G.C.H.G., T.C.T.)
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33
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Sachdeva S, Desai R, Andi K, Vyas A, Deliwala S, Sachdeva R, Kumar G. Reduced left atrial strain can predict stroke in atrial fibrillation - A meta-analysis. IJC HEART & VASCULATURE 2021; 36:100859. [PMID: 34485678 PMCID: PMC8391018 DOI: 10.1016/j.ijcha.2021.100859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Sonali Sachdeva
- Section of Cardiovascular Medicine, Boston University School Of Medicine, Boston, MA, USA
| | - Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA
| | - Kartik Andi
- Department of Internal Medicine, Osmania Medical College, Hyderabad, India
| | - Ankit Vyas
- Department of Internal Medicine, Baptist Hospitals Of Southeast Texas, Beaumont, TX, USA
| | - Smit Deliwala
- Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA
| | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA.,Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
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34
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Chen L, Zhang C, Wang J, Guo L, Wang X, Liu F, Li X, Zhao Y. Left atrial strain measured by 4D Auto LAQ echocardiography is significantly correlated with high risk of thromboembolism in patients with non-valvular atrial fibrillation. Quant Imaging Med Surg 2021; 11:3920-3931. [PMID: 34476178 DOI: 10.21037/qims-20-1381] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/08/2021] [Indexed: 11/06/2022]
Abstract
Background The 4-dimensional automated left atrial quantification (4D Auto LAQ) tool is a new software for analysis of the structure and function of the left atrium (LA). This study aimed to evaluate the relationship between LA strain (LAS) as measured by 4D Auto LAQ echocardiography and thromboembolism risk in patients with non-valvular atrial fibrillation (NVAF). Methods Eight-five patients with NVAF were recruited from the cardiovascular center of our hospital, including 39 patients at high risk and 46 patients at low risk of thromboembolism. The study participants were assessed by routine echocardiography; 4D images were obtained, after which 4D Auto LAQ assessment was performed. Results In the thromboembolism high-risk group, the rates of impaired LA reservoir strain, LA contraction strain, LA reservoir circumferential strain, LA conduit circumferential strain, and LA contraction circumferential strain were found to be significantly higher than in the low-risk group. However, there was no significant difference in volume at onset of LA contraction or LA ejection fraction (LAEF) between the 2 groups. LA contraction circumferential strain was found to be an independent high risk factor for thromboembolism [odds ratio (OR): 2.52; P=0.008]. LA contraction circumferential strain >-4.5% was the cut-off for differentiating between participants with high and low risk of thromboembolism, with an area under the curve (AUC) of 0.95 (P<0.0001), a sensitivity of 0.872, and a specificity of 0.978. Sequential analysis revealed that LA contraction circumferential strain had a high diagnostic efficacy for stroke, as well as a specified accuracy in the diagnosis of hypertension and diabetes in patients aged ≥65 years old. However, it was not found to be effective in the diagnosis of heart failure and vascular diseases. Conclusions LAS is a useful index for the dynamic evaluation of LA function in patients with non-valvular AF, with higher sensitivity and accuracy than LA volume. LA contraction circumferential strain is an independent high risk factor for thromboembolism, and LA contraction circumferential strain >-4.5% is a valuable cut-off to guide the use of anticoagulant therapy in patients with non-valvular AF.
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Affiliation(s)
- Lili Chen
- Department of Ultrasound, Second Affiliated Hospital of Nanchang University, Nanhang, China
| | - Chunquan Zhang
- Department of Ultrasound, Second Affiliated Hospital of Nanchang University, Nanhang, China
| | | | - Liangyun Guo
- Department of Ultrasound, Second Affiliated Hospital of Nanchang University, Nanhang, China
| | - Xiaolin Wang
- Department of Ultrasound, Second Affiliated Hospital of Nanchang University, Nanhang, China
| | - Fengzhen Liu
- Department of Ultrasound, Second Affiliated Hospital of Nanchang University, Nanhang, China
| | - Xia Li
- Department of Ultrasound, Second Affiliated Hospital of Nanchang University, Nanhang, China
| | - Yu Zhao
- Department of Ultrasound, Second Affiliated Hospital of Nanchang University, Nanhang, China
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Echocardiography-derived total atrial conduction time (PA-TDI duration): risk stratification and guidance in atrial fibrillation management. Clin Res Cardiol 2021; 110:1734-1742. [PMID: 34453577 PMCID: PMC8563556 DOI: 10.1007/s00392-021-01917-9] [Citation(s) in RCA: 3] [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: 02/08/2021] [Accepted: 08/02/2021] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is a major cause of cardiovascular morbidity and mortality. To early detect and to avoid AF-related complications, several cardiac imaging modalities and approaches aim to quantify the severity of the underlying atrial cardiomyopathy (i.e., the extent of atrial remodeling). However, most established cardiac imaging modalities just incorporate single components of atrial remodeling and do not reflect the complete multifactorial process, which may contribute to their limited predictive value. Echocardiography-derived PA-TDI duration is a sophisticated echocardiographic parameter to assess total atrial conduction time and directly reflects both electrical and structural changes to the atria. Therefore, PA-TDI duration provides a more comprehensive quantification of the extent of atrial remodeling than other imaging modalities. In this article we review the role of PA-TDI duration as a marker of atrial remodeling and summarize the available data on PA-TDI duration to identify patients at risk for AF, as well as to guide AF management. Moreover, we discuss how to assess PA-TDI duration and provide recommendations on the implementation of PA-TDI duration into routine clinical care.
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36
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Forslund T, Braunschweig F, Holzmann MJ, Siddiqui AJ. Early Risk of Stroke in Patients Undergoing Acute Versus Elective Cardioversion for Atrial Fibrillation. J Am Heart Assoc 2021; 10:e021716. [PMID: 34387131 PMCID: PMC8475048 DOI: 10.1161/jaha.121.021716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Electrical cardioversion (ECV) is routinely used to restore sinus rhythm in patients with symptomatic atrial fibrillation. The European guidelines have been updated in recent years. Current information on differences in the risk for stroke after acute versus elective ECV is lacking. Methods And Results All patients with a first‐time acute or elective ECV in the Stockholm regional health care data warehouse from 2011 to 2018 were included. Cox regression analyses were performed evaluating ischemic or unspecified stroke within 30 days after ECV with adjustments for the CHA2DS2‐VASc score, medical treatment, and year of inclusion. The study included 9139 patients, 3094 after acute and 6045 after elective ECV. The mean age was 65.9±11.3 years, 69.5% were men, and the mean CHA2DS2‐VASc score was 2.4±1.7. Before the intervention, 49.6% of patients with an acute ECV and 96.4% of those with an elective ECV had claimed an oral anticoagulant prescription. Ischemic or unspecified stroke occurred in 26 (0.28%) patients within 30 days. The unadjusted risk was higher after acute compared with elective ECV (hazard ratio [HR], 2.29; 95% CI, 1.06–4.96), whereas there was no difference after multivariable adjustments (adjusted HR, 0.99; 95% CI, 0.36–2.72). Both non–vitamin K oral anticoagulants (adjusted HR, 0.28; 95% CI, 0.08–0.98) and warfarin (adjusted HR, 0.17; 95% CI, 0.05–0.53) were associated with a lower risk for stroke compared with no anticoagulation. Conclusions Acute ECV was associated with a higher unadjusted risk for stroke than elective ECV, but the risk was similar after adjustment for anticoagulant treatment. This study indicates the importance of anticoagulation before ECV according to recent European guidelines.
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Affiliation(s)
- Tomas Forslund
- Department of Medicine Karolinska Institutet Solna Stockholm Sweden.,Department of Healthcare Development Stockholm Region Stockholm Sweden
| | - Frieder Braunschweig
- Department of Cardiology Karolinska InstitutetKarolinska University Hospital Stockholm Sweden
| | - Martin J Holzmann
- Department of Medicine Karolinska Institutet Solna Stockholm Sweden.,Department of Emergency Medicine Karolinska University Hospital Huddinge Stockholm Sweden
| | - Anwar J Siddiqui
- Department of Medicine Karolinska Institutet Solna Stockholm Sweden.,Department of Emergency Medicine Karolinska University Hospital Huddinge Stockholm Sweden
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37
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Bandera F, Martone R, Chacko L, Ganesananthan S, Gilbertson JA, Ponticos M, Lane T, Martinez-Naharro A, Whelan C, Quarta C, Rowczenio D, Patel R, Razvi Y, Lachmann H, Wechelakar A, Brown J, Knight D, Moon J, Petrie A, Cappelli F, Guazzi M, Potena L, Rapezzi C, Leone O, Hawkins PN, Gillmore JD, Fontana M. Clinical Importance of Left Atrial Infiltration in Cardiac Transthyretin Amyloidosis. JACC Cardiovasc Imaging 2021; 15:17-29. [PMID: 34419399 PMCID: PMC8724534 DOI: 10.1016/j.jcmg.2021.06.022] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/20/2021] [Accepted: 06/01/2021] [Indexed: 01/01/2023]
Abstract
Objectives The aim of this study was to characterize left atrial (LA) pathology in explanted hearts with transthyretin amyloid cardiomyopathy (ATTR-CM); LA mechanics using echocardiographic speckle-tracking in a large cohort of patients with ATTR-CM; and to study the association with mortality. Background The clinical significance of LA involvement in ATTR-CM is of great clinical interest. Methods Congo red staining and immunohistochemistry was performed to assess the presence, type, and extent of amyloid and associated changes in 5 explanted ATTR-CM atria. Echo speckle tracking was used to assess LA reservoir, conduit, contractile function, and stiffness in 906 patients with ATTR-CM (551 wild-type (wt)-ATTR-CM; 93 T60A-ATTR-CM; 241 V122I-ATTR-CM; 21 other). Results There was extensive ATTR amyloid infiltration in the 5 atria, with loss of normal architecture, vessels remodeling, capillary disruption, and subendocardial fibrosis. Echo speckle tracking in 906 patients with ATTR-CM demonstrated increased atrial stiffness (median [25th-75th quartile] 1.83 [1.15-2.92]) that remained independently associated with prognosis after adjusting for known predictors (lnLA stiff: HR: 1.23; 95% CI: 1.03-1.49; P = 0.029). There was substantial impairment of the 3 phasic functional atrial components (reservoir 8.86% [5.94%-12.97%]; conduit 6.5% [4.53%-9.28%]; contraction function 4.0% [2.29%-6.56%]). Atrial contraction was absent in 22.1% of patients whose electrocardiograms showed sinus rhythm (SR) “atrial electromechanical dissociation” (AEMD). AEMD was associated with poorer prognosis compared with patients with SR and effective mechanical contraction (P = 0.0018). AEMD conferred a similar prognosis to patients in atrial fibrillation. Conclusions The phenotype of ATTR-CM includes significant infiltration of the atrial walls, with progressive loss of atrial function and increased stiffness, which is a strong independent predictor of mortality. AEMD emerged as a distinctive phenotype identifying patients in SR with poor prognosis.
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Affiliation(s)
- Francesco Bandera
- Cardiology University Department, Heart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department for Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Raffaele Martone
- Tuscan Regional Amyloid Center, Careggi University Hospital (AOUC), Florence, Italy
| | - Liza Chacko
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | | | - Janet A Gilbertson
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Markella Ponticos
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Thirusha Lane
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Carol Whelan
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Cristina Quarta
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Dorota Rowczenio
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Rishi Patel
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Yousuf Razvi
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Helen Lachmann
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Ashutosh Wechelakar
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - James Brown
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Daniel Knight
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - James Moon
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Aviva Petrie
- Eastman Dental Institute, University College London, Grays Inn Road, London, United Kingdom
| | - Francesco Cappelli
- Tuscan Regional Amyloid Center, Careggi University Hospital (AOUC), Florence, Italy
| | - Marco Guazzi
- Cardiology University Department, Heart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department for Biomedical Sciences for Health, University of Milano, Milan, Italy
| | | | - Claudio Rapezzi
- University Cardiological Center, University of Ferrara, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Ornella Leone
- Academic Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom.
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Sotiriadou M, Papadopoulos CE, Antoniadis AP, Roumelis P, Vergopoulos S, Konstantinidis P, Pagkourelias ED, Tzikas S, Fragakis N, Vassilikos V. The impact of atrial mechanical function on age-dependent presentation of neurocardiogenic syncope. Clin Cardiol 2021; 44:1440-1447. [PMID: 34374094 PMCID: PMC8495094 DOI: 10.1002/clc.23704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022] Open
Abstract
Background The contribution of atrial and ventricular function in neurocardiogenic syncope (NCS) pathophysiology is elusive. Hypothesis We assessed the influence of echocardiographic properties to the age of presentation and NCS recurrences. Methods We assigned 124 patients with symptoms suggesting NCS, to those with syncope initiation at age <35 (group A, n = 56) and >35 years (group B, n = 68). Echocardiographic indices were measured before head‐up tilt test (HUTT). Results A total of 55 had positive HUTT (44%) with a trend favoring group A (p = .08). Group A exhibited lower left atrial (LA) volume index (17 ± 6 vs. 22 ± 11 ml/m2, p = .015), higher LA ejection fraction (69 ± 10 vs. 63 ± 11%, p = .008), LA peak strain (reservoir phase 41 ± 13 vs. 31 ± 14%, p = .001, contraction phase 27 ± 11 vs. 15 ± 10%, p < .001) and LA peak strain rate (reservoir phase 1.83 ± 1.04 vs. 1.36 ± 0.96 1/s, p = .012, conduit phase 2.36 ± 1.25 vs. 1.36 ± 0.78 1/s, p = .001). Group A showed smaller minimum right atrial (RA) volume, better RA systolic function, superior left ventricular diastolic indices, and lower filling pressures. Group A patients were more likely to have >3 recurrences (82.0% vs. 50.1%, p < .05). Conclusions Patients with younger age of NCS onset and more syncopal recurrences manifest smaller LA and RA dimensions with distinct patterns of systolic and diastolic function and better LA reservoir and contraction properties. These findings may indicate an increased susceptibility to preload reduction, thereby triggering the NCS mechanism.
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Affiliation(s)
- Melani Sotiriadou
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Antonios P Antoniadis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Panagiotis Roumelis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Stavros Vergopoulos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Periklis Konstantinidis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Efstathios D Pagkourelias
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Stergios Tzikas
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
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Ble M, Benito B, Cuadrado-Godia E, Pérez-Fernández S, Gómez M, Mas-Stachurska A, Tizón-Marcos H, Molina L, Martí-Almor J, Cladellas M. Left Atrium Assessment by Speckle Tracking Echocardiography in Cryptogenic Stroke: Seeking Silent Atrial Fibrillation. J Clin Med 2021; 10:jcm10163501. [PMID: 34441797 PMCID: PMC8397042 DOI: 10.3390/jcm10163501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 01/01/2023] Open
Abstract
Silent atrial fibrillation (AF) may be the cause of some cryptogenic strokes (CrS). The aim of the study was to analyse atrial size and function by speckle tracking echocardiography in CrS patients to detect atrial disease. Patients admitted to the hospital due to CrS were included prospectively. Echocardiogram analysis included left atrial ejection fraction (LAEF) and atrial strain. Insertable cardiac monitor was implanted, and AF was defined as an episode of ≥1 min in the first year after stroke. Left atrial enlargement was defined as indexed volume > 34 mL/m2. Seventy-five consecutive patients were included, aged 76 ± 9 years (arterial hypertension 75%). AF was diagnosed in 49% of cases. The AF group had higher atrial volume and worse atrial function: peak atrial longitudinal strain (PALs) 19.6 ± 5.7% vs. 29.5 ± 7.2%, peak atrial contraction strain (PACs) 8.9 ± 3.9% vs. 16.5 ± 6%, LAEF 46.8 ± 11.5% vs. 60.6 ± 5.2%; p < 0.001. AF was diagnosed in 20 of 53 patients with non-enlarged atrium, and in 18 of them, atrial dysfunction was present. The multivariate logistic regression analysis demonstrated an independent association between detection of AF and atrial volume, LAEF, and strain. Cut-off values were obtained: LAEF < 55%, PALs < 21.4%, and PACs < 12.9%. In conclusion, speckle tracking echocardiography in CrS patients improves silent atrial disease diagnosis, with or without atrial enlargement.
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Affiliation(s)
- Mireia Ble
- Medicine Department, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain;
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Correspondence: ; Tel.: +34-932-483-018
| | - Begoña Benito
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
- Neurology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
| | - Sílvia Pérez-Fernández
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
- CIBER of Cardiovascular Diseases (CIBERCV), 08003 Barcelona, Spain
| | - Miquel Gómez
- Cardiology Department, Hospital de Barcelona, 08034 Barcelona, Spain;
| | - Aleksandra Mas-Stachurska
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
| | - Helena Tizón-Marcos
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
| | - Lluis Molina
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
- Cardiology Department, Hospital de Barcelona, 08034 Barcelona, Spain;
| | - Julio Martí-Almor
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
| | - Mercè Cladellas
- Medicine Department, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain;
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
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Cohen A, Donal E, Delgado V, Pepi M, Tsang T, Gerber B, Soulat-Dufour L, Habib G, Lancellotti P, Evangelista A, Cujec B, Fine N, Andrade MJ, Sprynger M, Dweck M, Edvardsen T, Popescu BA. EACVI recommendations on cardiovascular imaging for the detection of embolic sources: endorsed by the Canadian Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2021; 22:e24-e57. [PMID: 33709114 DOI: 10.1093/ehjci/jeab008] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
Cardioaortic embolism to the brain accounts for approximately 15-30% of ischaemic strokes and is often referred to as 'cardioembolic stroke'. One-quarter of patients have more than one cardiac source of embolism and 15% have significant cerebrovascular atherosclerosis. After a careful work-up, up to 30% of ischaemic strokes remain 'cryptogenic', recently redefined as 'embolic strokes of undetermined source'. The diagnosis of cardioembolic stroke remains difficult because a potential cardiac source of embolism does not establish the stroke mechanism. The role of cardiac imaging-transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), cardiac computed tomography (CT), and magnetic resonance imaging (MRI)-in the diagnosis of potential cardiac sources of embolism, and for therapeutic guidance, is reviewed in these recommendations. Contrast TTE/TOE is highly accurate for detecting left atrial appendage thrombosis in patients with atrial fibrillation, valvular and prosthesis vegetations and thrombosis, aortic arch atheroma, patent foramen ovale, atrial septal defect, and intracardiac tumours. Both CT and MRI are highly accurate for detecting cavity thrombosis, intracardiac tumours, and valvular prosthesis thrombosis. Thus, CT and cardiac magnetic resonance should be considered in addition to TTE and TOE in the detection of a cardiac source of embolism. We propose a diagnostic algorithm where vascular imaging and contrast TTE/TOE are considered the first-line tool in the search for a cardiac source of embolism. CT and MRI are considered as alternative and complementary tools, and their indications are described on a case-by-case approach.
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Affiliation(s)
- Ariel Cohen
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20141, Milan, Italy
| | - Teresa Tsang
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernhard Gerber
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvainAv Hippocrate 10/2803, B-1200 Brussels, Belgium
| | - Laurie Soulat-Dufour
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Gilbert Habib
- Aix Marseille Univ, IRD, MEPHI, IHU-Méditerranée Infection, APHM, La Timone Hospital, Cardiology Department, Marseille, France
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU SartTilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Arturo Evangelista
- Servei de Cardiologia. Hospital Universitari Vall d'Hebron-VHIR. CIBER-CV. Pº Vall d'Hebron 119. 08035. Barcelona. Spain
| | - Bibiana Cujec
- Division of Cardiology, University of Alberta, 2C2.50 Walter Mackenzie Health Sciences Center, 8440 112 St NW, Edmonton, Alberta, Canada T6G 2B7
| | - Nowell Fine
- University of Calgary, Libin Cardiovascular Institute, South Health Campus, 4448 Front Street Southeast, Calgary, Alberta T3M 1M4, Canada
| | - Maria Joao Andrade
- Maria Joao Andrade Cardiology Department, Hospital de Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos 2790-134 Carnaxide, Portugal
| | - Muriel Sprynger
- Department of Cardiology-Angiology, University Hospital Liège, Liège, Belgium
| | - Marc Dweck
- British Heart Foundation, Centre for Cardiovascular Science, Edinburgh and Edinburgh Imaging Facility QMRI, University of Edinburgh, United Kingdom
| | - Thor Edvardsen
- Faculty of medicine, Oslo University, Oslo, Norway and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bogdan A Popescu
- Cardiology Department, University of Medicine and Pharmacy 'Carol Davila', Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
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41
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Shang L, Zhang L, Guo Y, Sun H, Zhang X, Bo Y, Zhou X, Tang B. A Review of Biomarkers for Ischemic Stroke Evaluation in Patients With Non-valvular Atrial Fibrillation. Front Cardiovasc Med 2021; 8:682538. [PMID: 34277733 PMCID: PMC8281032 DOI: 10.3389/fcvm.2021.682538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/03/2021] [Indexed: 01/06/2023] Open
Abstract
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and results in a significantly increased ischemic stroke (IS) risk. IS risk stratification tools are widely being applied to guide anticoagulation treatment decisions and duration in patients with non-valvular AF (NVAF). The CHA2DS2-VASc score is largely validated and currently recommended by renowned guidelines. However, this score is heavily dependent on age, sex, and comorbidities, and exhibits only moderate predictive power. Finding effective and validated clinical biomarkers to assist in personalized IS risk evaluation has become one of the promising directions in the prevention and treatment of NVAF. A number of studies in recent years have explored differentially expressed biomarkers in NVAF patients with and without IS, and the potential role of various biomarkers for prediction or early diagnosis of IS in patients with NVAF. In this review, we describe the clinical application and utility of AF characteristics, cardiac imaging and electrocardiogram markers, arterial stiffness and atherosclerosis-related markers, circulating biomarkers, and novel genetic markers in IS diagnosis and management of patients with NVAF. We conclude that at present, there is no consensus understanding of a desirable biomarker for IS risk stratification in NVAF, and enrolling these biomarkers into extant models also remains challenging. Further prospective cohorts and trials are needed to integrate various clinical risk factors and biomarkers to optimize IS prediction in patients with NVAF. However, we believe that the growing insight into molecular mechanisms and in-depth understanding of existing and emerging biomarkers may further improve the IS risk identification and guide anticoagulation therapy in patients with NVAF.
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Affiliation(s)
- Luxiang Shang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, China
| | - Ling Zhang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yankai Guo
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Huaxin Sun
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaoxue Zhang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yakun Bo
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xianhui Zhou
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Baopeng Tang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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42
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Singh N, Singh A, Besser SA, Lang RM, Mor-Avi V, Kosuri S, Bishop MR, DeCara JM. Echocardiographic predictors of new-onset atrial arrhythmias in patients undergoing hematopoietic stem cell transplantation. Int J Cardiol 2021; 339:225-231. [PMID: 34174337 DOI: 10.1016/j.ijcard.2021.06.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/08/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Atrial arrhythmias following hematopoietic stem cell transplantation (HSCT) have been associated with increased length of stay, need for intensive care, and increased mortality within one-year post-transplant. We sought to identify echocardiographic parameters that may predict the development of new atrial arrhythmias post-HSCT. METHODS We performed a retrospective chart review of 753 consecutive patients who underwent HSCT at the University of Chicago from January 2015 through December 2019. Patients with baseline echocardiogram within 6 months prior to transplantation were included. Those with prior transplants, history of atrial arrhythmias, or unavailable echocardiographic images were excluded, resulting in 187 patients included for final analysis. Baseline clinical and demographic variables, as well as echocardiographic parameters, were compared between patients who developed new atrial arrhythmias post-HSCT versus those who did not. RESULTS Of the 187 patients included for analysis, 25 (13%) developed new atrial arrhythmias, with 13 of these occurring within 30 days of transplantation. Despite no significant difference in left atrial (LA) end-systolic volume between those with and without new arrhythmia following HSCT (OR 1.04; 95% CI 0.91-1.09, p = 0.233), univariable analysis demonstrated that patients who developed atrial arrhythmias had reduced LA function, as reflected by lower LA emptying fraction (OR 0.94; 95% CI 0.91-0.98, p = 0.003) and lower LA reservoir strain (OR 0.95; 95% CI 0.92-0.99, p = 0.009). CONCLUSIONS Echocardiographic indices of LA function, namely LA emptying fraction and LA reservoir strain, can identify patients at risk for developing new atrial arrhythmias post-HSCT, prior to the development of morphologic changes in the LA.
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Affiliation(s)
- Nikhil Singh
- Section of Cardiology, Department of Medicine, UChicago Medicine, Chicago, IL 60636, USA
| | - Amita Singh
- Section of Cardiology, Department of Medicine, UChicago Medicine, Chicago, IL 60636, USA
| | - Stephanie A Besser
- Section of Cardiology, Department of Medicine, UChicago Medicine, Chicago, IL 60636, USA
| | - Roberto M Lang
- Section of Cardiology, Department of Medicine, UChicago Medicine, Chicago, IL 60636, USA
| | - Victor Mor-Avi
- Section of Cardiology, Department of Medicine, UChicago Medicine, Chicago, IL 60636, USA
| | - Satyajit Kosuri
- Section of Hematology/Oncology, Department of Medicine, UChicago Medicine, Chicago, IL 60637, USA
| | - Michael R Bishop
- Section of Hematology/Oncology, Department of Medicine, UChicago Medicine, Chicago, IL 60637, USA
| | - Jeanne M DeCara
- Section of Cardiology, Department of Medicine, UChicago Medicine, Chicago, IL 60636, USA.
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43
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Comprehensive assessment of left atrial and ventricular remodeling in paroxysmal atrial fibrillation by the cardiovascular magnetic resonance myocardial extracellular volume fraction and feature tracking strain. Sci Rep 2021; 11:10941. [PMID: 34035345 PMCID: PMC8149643 DOI: 10.1038/s41598-021-90117-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/28/2021] [Indexed: 01/18/2023] Open
Abstract
Atrial fibrillation (AF) is a progressive disease that starts with structural or functional changes in the left atrium and left ventricle, and evolves from paroxysmal toward sustained forms. Early detection of structural or functional changes in the left atrium and left ventricle in the paroxysmal stage could be useful for identifying a higher risk of progression to persistent AF and future cardio-cerebrovascular events. The aim of this study was to test the hypothesis that the feature tracking (FT) left atrial (LA) strain and left ventricular (LV) extracellular volume fraction (ECV) derived from cardiovascular magnetic resonance (CMR) could detect early changes in remodeling of the left atrium and ventricle in the paroxysmal AF (PAF) stage. The participants were comprised of 106 PAF patients (age, 66.1 ± 10.7 years; 66% male) who underwent clinical CMR before pulmonary vein isolation and 20 control subjects (age, 68.3 ± 8.6 years; 55% male). The CMR-FT LA strain/phasic function and LV-ECV were compared between the PAF and control groups. The total and passive LA empty fraction (LAEF) and LA strain (corresponding to LA reservoir and conduit function) were decreased in the PAF group as compared to the control group. However, active LAEF (corresponding to the LA booster pump function) did not differ significantly between the PAF group (33.9 ± 10.9%) and control group (37.9 ± 13.3%, p = 0.15), while the active LA strain (corresponding to the LA booster pump function) was significantly decreased in the PAF group (11.4 ± 4.3 vs. 15.2 ± 5.6%, p = 0.002). The LV-ECV was significantly greater in the PAF group (28.7 ± 2.8%) than control group (26.6 ± 2.0%, p = 0.002). In the PAF group, the LV-ECV correlated significantly with the E/e′ and LA volume index. Regarding the LA strain, correlations were seen between the LV-ECV and both the reservoir function and conduit function. CMR-FT LA strain in combination with the LV-ECV in a single clinical study offers a potential imaging marker that identifies LA/LV remodeling including subtle LA booster pump dysfunction undetectable by the conventional booster pump LAEF in the PAF stage.
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44
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Hsiao CS, Hsiao SH, Ho YH. Correlation between left atrial expansion index and stroke subtype: A 10-Year Follow-Up Study. Echocardiography 2021; 38:861-870. [PMID: 33929760 DOI: 10.1111/echo.15064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Although left atrial (LA) expansion index predicts cardiovascular events, its efficacy for predicting cerebral events is unknown. METHODS This study enrolled 2205 patients who had sinus rhythm after echocardiography in their first visit. LA expansion index was calculated as (Volmax -Volmin ) x100%/Volmin , where Volmax was defined as maximal LA volume and Volmin as minimal LA volume. The study endpoint was ischemic stroke. Stroke subtype was classified as cardioembolic stroke (CE), noncardioembolic stroke with determined mechanism (NCE), or embolic stroke of undetermined source (ESUS). RESULTS Over a 10-year (mean 9.7 years) follow-up period, 128 (5.8%) participants reached endpoint, including 46 with CE, 33 with NCE, and 49 with ESUS. Regardless of stroke subtype, LA expansion index was lower in the event groups compared to the nonevent group. The lowest quartile of LA expansion index was associated with high CHA2 DS2 -VASc score at enrollment and more events, including CE, ESUS, atrial fibrillation (AF), heart failure, and all-cause mortality, relative to other quartiles. The LA expansion index was an independent predictor of CE (HR 0.82; 95% CI 0.723-0.912, per 10% increase in LA expansion index; P < .0001) and ESUS (HR 0.92; 95% CI 0.881-0.976, per 10% increase in LA expansion index; p 0.003). An LA expansion index <68% predicts the presence of AF after ESUS with 84% sensitivity and 70% specificity. CONCLUSION LA expansion index is useful for predicting CE and ESUS. It is also associated with AF, heart failure hospitalization, and all-cause mortality.
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Affiliation(s)
- Chao-Sheng Hsiao
- Department of Internal Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shih-Hung Hsiao
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan ROC
| | - Ying-Hao Ho
- Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan ROC
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45
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Van Laer SL, Verreyen S, Winkler KM, Miljoen H, Sarkozy A, Heuten H, Saenen J, Van Herck P, Van de Heyning CM, Heidbuchel H, Claeys MJ. Effect of Mitral Regurgitation on Thrombotic Risk in Patients With Nonrheumatic Atrial Fibrillation: A New CHA 2DS 2-VASc Score Risk Modifier? Am J Cardiol 2021; 145:69-76. [PMID: 33454347 DOI: 10.1016/j.amjcard.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
The current study assessed the effect of mitral regurgitation (MR) on thrombotic risk in nonrheumatic atrial fibrillation (AF). AF carries a thrombotic risk related to left atrial blood stasis. The prevalence of atrial thrombosis, defined as the presence of left atrial appendage thrombus and/or left atrial spontaneous echo contrast grade >2, was determined in 686 consecutive nonrheumatic AF patients without (adequate) anticoagulation scheduled for transesophageal echocardiography before electrical cardioversion and was related to the severity of MR adjusted for the CHA2DS2-VASc score. A total of 103 (15%) patients had severe MR, 210 (31%) had moderate MR, and 373 (54%) had no-mild MR; the median CHA2DS2-VASc score was 3.0 (interquartile range 2.0 to 4.0). Atrial thrombosis was observed in 118 patients (17%). The prevalence of atrial thrombosis decreased with increasing MR severity: 19.9% versus 15.2% versus 11.6% for no-mild, moderate, and severe MR, respectively (p value for trend = 0.03). Patients with moderate and severe MR had a lower risk of atrial thrombosis than patients with no-mild MR, with adjusted odds ratios of 0.51 (95% confidence interval 0.31 to 0.84) and 0.24 (95% confidence interval 0.11 to 0.49), respectively. The protective effect of MR was present across all levels of the CHA2DS2-VASc risk score and the presence of moderate-severe MR in patients with an intermediate CHA2DS2-VASc score (2 to 3) lowered the atrial thrombotic risk to the level of patients with a low CHA2DS2-VASc score (0 to 1). In conclusion, our data show that the presence of MR attenuated the atrial thrombotic risk by more than 50% in patients with nonrheumatic AF.
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46
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Demirkiran A, Amier RP, Hofman MBM, van der Geest RJ, Robbers LFHJ, Hopman LHGA, Mulder MJ, van de Ven P, Allaart CP, van Rossum AC, Götte MJW, Nijveldt R. Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling. Sci Rep 2021; 11:5965. [PMID: 33727587 PMCID: PMC7966746 DOI: 10.1038/s41598-021-85176-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/23/2021] [Indexed: 11/09/2022] Open
Abstract
The pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Raquel P Amier
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Mark B M Hofman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rob J van der Geest
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Lourens F H J Robbers
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Peter van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
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Influence of Chronic Obstructive Pulmonary Disease on Atrial Mechanics by Speckle Tracking Echocardiography in Patients With Atrial Fibrillation. Am J Cardiol 2021; 143:60-66. [PMID: 33359195 DOI: 10.1016/j.amjcard.2020.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 01/01/2023]
Abstract
The present study aimed to examine differences in left- and right atrial characteristics between atrial fibrillation (AF) patients with and without chronic obstructive pulmonary disease (COPD). For this, 420 patients (mean age 68 ± 10 years, 73% female) with first diagnosis of AF and baseline echocardiography were included. Of these, 143 COPD patients were compared with 277 patients without COPD matched by age, gender and body surface area. Additionally 38 healthy controls without cardiovascular risk factors, matched for age, were included. For all 3 groups, left atrial (LA) volumes and diameter, LA reservoir strain (LASr), left ventricular ejection fraction (LVEF), right atrial (RA) area and diameter, RA reservoir strain (RASr) and tricuspid annular plane systolic excursion were evaluated on transthoracic echocardiography. Baseline characteristics were similar in patients with and without COPD except for smoking and a history of heart failure (42% vs 11%, p < 0.001 and 48% vs 37%, p = 0.036 for COPD and non-COPD patients, respectively). Also, COPD patients less often used β-blockers (63% vs 75%, p = 0.017). There were no significant differences in LVEF, LA volume and RA area between COPD and non-COPD patients. Compared to the controls, AF patients had impaired LVEF, LASr and RASr. Only RASr was significantly worse in COPD patients as compared to non-COPD patients (15.3% [9.0 to 25.1] vs 19.6% [11.8 to 28.5], p = 0.013). Additionally, a trend towards worse RASr was observed with increasing COPD severity. In conclusion, AF patients with concomitant COPD have more impaired RA function compared to patients without COPD but with similar atrial size and LA function.
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Markus A, Valerie S, Mira K. Promising Biomarker Candidates for Cardioembolic Stroke Etiology. A Brief Narrative Review and Current Opinion. Front Neurol 2021; 12:624930. [PMID: 33716927 PMCID: PMC7947187 DOI: 10.3389/fneur.2021.624930] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/11/2021] [Indexed: 01/09/2023] Open
Abstract
Determining the cause of stroke is considered one of the main objectives in evaluating a stroke patient in clinical practice. However, ischemic stroke is a heterogeneous disorder and numerous underlying disorders are implicated in its pathogenesis. Although progress has been made in identifying individual stroke etiology, in many cases underlying mechanisms still remain elusive. Since secondary prevention strategies are tailored toward individual stroke mechanisms, patients whose stroke etiology is unknown may not receive optimal preventive treatment. Cardioembolic stroke is commonly defined as cerebral vessel occlusion by distant embolization arising from thrombus formation in the heart. It accounts for the main proportion of ischemic strokes, and its share to stroke etiology is likely to rise even further in future decades. However, it can be challenging to distinguish cardioembolism from other possible etiologies. As personalized medicine advances, stroke researchers' focus is increasingly drawn to etiology-associated biomarkers. They can provide deeper insight regarding specific stroke mechanisms and can help to unravel previously undetected pathologies. Furthermore, etiology-associated biomarkers could play an important role in guiding future stroke prevention strategies. To achieve this, broad validation of promising candidate biomarkers as well as their implementation in well-designed randomized clinical trials is necessary. This review focuses on the most-promising candidates for diagnosis of cardioembolic stroke. It discusses existing evidence for possible clinical applications of these biomarkers, addresses current challenges, and outlines future perspectives.
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Affiliation(s)
- Arnold Markus
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Schütz Valerie
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Katan Mira
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
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Darweesh RM, Baghdady YK, El Hossary H, Khaled M. Importance of left atrial mechanical function as a predictor of atrial fibrillation risk following cardiac surgery. Int J Cardiovasc Imaging 2021; 37:1863-1872. [PMID: 33591474 DOI: 10.1007/s10554-021-02163-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/10/2021] [Indexed: 11/27/2022]
Abstract
Postoperative atrial fibrillation (POAF) after cardiac surgery is a major health problem that is associated with a significant financial burden and increased early morbidity and mortality. We investigated the accuracy of new echocardiographic derived indices to predict patients at higher risk of developing POAF. 84 consecutive patients (age 57.9 ± 6.9, 32% female) hospitalized for isolated CABG underwent comprehensive echocardiographic evaluation before surgery. Left atrial (LA) function was quantified through the assessment of phasic LA volumes to calculate LATEF. Speckle tracking echocardiography STE was used to measure LA reservoir strain, conduit strain and booster strain. Patients who developed POAF had increased LA volumes and impaired LA functions assessed by both the volumetric phasic changes and STE. By univariable analysis, all LA function parameters significantly predicted POAF. Multivariate regression analysis showed that age (P = 0.03, OR 1.134, 95% CI 1.012-1.271) and LATEF (P = 0.001, OR 0.814, 95% CI 0.725-0.914) were strong independent factors for POAF with LATEF showing the highest predictive accuracy. After multivariable adjustment to include LA strain indices to the base model, LA contractile strain LACtS (23.93 ± 4.19 vs 37.0 ± 3.35, p < 0.001) was the best discriminated for the highest predictive accuracy (OR 0.429, 95% CI 0.26-0.708). The ROC Curve was calculated for the greatest performance for prediction of POAF (AUC LACtS: 0.992; LATEF: 0.899). Adding new left atrial mechanics parameters is a more sensitive, independent tool that provides an incremental predictive value to discriminate patients at more risk for POAF.
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Gokcal E, Horn MJ, Gurol ME. The role of biomarkers and neuroimaging in ischemic/hemorrhagic risk assessment for cardiovascular/cerebrovascular disease prevention. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:345-357. [PMID: 33632452 DOI: 10.1016/b978-0-12-819814-8.00021-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Stroke prevention in patients with atrial fibrillation is arguably one of the fastest developing areas in preventive medicine. The increasing use of direct oral anticoagulants and nonpharmacologic methods such as left atrial appendage closure for stroke prevention in these patients has increased clinicians' options for optimal care. Platelet antiaggregants are also commonly used in other ischemic cardiovascular and or cerebrovascular conditions. Long term use of oral anticoagulants for atrial fibrillation is associated with elevated risks of major bleeds including especially brain hemorrhages, which are known to have extremely poor outcomes. Neuroimaging and other biomarkers have been validated to stratify brain hemorrhage risk among older adults. A thorough understanding of these biomarkers is essential for selection of appropriate anticoagulant or left atrial appendage closure for stroke prevention in patients with atrial fibrillation. This article will address advances in the stratification of ischemic and hemorrhagic stroke risk among patients with atrial fibrillation and other conditions.
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Affiliation(s)
- Elif Gokcal
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Mitchell J Horn
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
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