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Solberg MG, Enger S, Berge T, Rønningen PS, Aagaard EN, Pervez MO, Orstad EB, Kvisvik B, Lyngbakken MN, Røsjø H, Steine K, Tveit A. Left atrial function in middle-aged men and women with and without paroxysmal atrial fibrillation: Data from the Akershus Cardiac Examination (ACE) 1950 study. Echocardiography 2024; 41:e15852. [PMID: 38837738 DOI: 10.1111/echo.15852] [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: 04/05/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
PURPOSE To assess left atrial (LA) function in individuals with known paroxysmal atrial fibrillation (AF) compared with healthy and nonhealthy individuals without atrial fibrillation. METHODS The Akershus Cardiac Examination 1950 Study included 3,706 individuals all born in 1950. LA strain assessment of reservoir (LASr), conduit (LAScd) and contractile (LASct) functions were performed in all participants by investigators blinded to clinical data. Participants with cardiovascular disease, obesity, diabetes, pulmonary or renal disease were defined as nonhealthy, and those without as healthy. Patients with paroxysmal AF were identified through medical history and ECG documentation. RESULTS LA strain assessment was feasible in 3,229 (87%) of the participants (50% women). The healthy group (n = 758) had significantly higher LASr and LAScd than the nonhealthy (n = 2,376), but LASct was similar between the groups. Participants with paroxysmal AF had significantly lower values of all strain parameters than the other groups. Multivariable logistic regression showed a significantly reduced probability of having AF per standard deviation increase in LASr and LASct. A nonlinear restricted cubic spline model fitted better with the association of LASr with paroxysmal AF than the linear model, and LA strain values below the population mean associated with an increased probability of having AF, but for values above the population mean no such association was present. CONCLUSION Compared to participants without AF, those with known paroxysmal AF had significantly lower values of all LA strain parameters during sinus rhythm. Lower values of LA strain were associated with a significantly increased probability of having AF.
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Affiliation(s)
- Magnar G Solberg
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Steve Enger
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Trygve Berge
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter S Rønningen
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Erika N Aagaard
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Mohammad Osman Pervez
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Eivind B Orstad
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Brede Kvisvik
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Magnus N Lyngbakken
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Helge Røsjø
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Kjetil Steine
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Arnljot Tveit
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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2
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Clark A, Ferkh A, Vandenberg J, Elhindi J, Thomas L. Altered left atrial metrics in patients with cryptogenic stroke: A systematic review and meta-analysis. Eur J Clin Invest 2024; 54:e14175. [PMID: 38308431 DOI: 10.1111/eci.14175] [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: 10/29/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND There is no defined cause for cryptogenic stroke/embolic stroke of undetermined source (CS-ESUS). As atrial fibrillation (AF) develops in a significant proportion of these patients, it has been suggested that left atrial (LA) myopathy may predispose to CS-ESUS. We investigated alterations in echocardiographic measures of LA size and function in patients with CS-ESUS. METHODS A systematic literature review and meta-analysis was performed. PubMed, EMBASE, Cochrane Library, Web of Science and SCOPUS were searched for articles published between 1 January 1990 and 10 February 2023. All observational studies of adult CS-ESUS patients with LA volume or function measurements performed by transthoracic echocardiogram were included. Individual random effects meta-analyses were performed on LA measurements in the CS-ESUS patients using subgroup analysis of comparator groups. RESULTS We included 29 articles with 3927 CS-ESUS patients. Analysis of weighted mean differences showed CS-ESUS patients had altered LA structure and function parameters, with a larger maximum indexed LA volume, reduced LA emptying fraction and/or LA reservoir strain, compared to healthy controls and noncardioembolic stroke patients. Conversely, CS-ESUS patients had a smaller left atrium with better function, compared to cardioembolic stroke patients and CS-ESUS patients who subsequently developed atrial fibrillation. CONCLUSIONS LA volume and function are altered in CS-ESUS patients compared to healthy controls and other stroke aetiologies. An underlying atrial myopathy in a subset of CS-ESUS patients may be involved in both thrombogenesis and dysrhythmia (specifically AF). While LA functional assessment is not currently recommended following stroke, it may offer an opportunity for recurrent stroke risk stratification.
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Affiliation(s)
- Amy Clark
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Aaisha Ferkh
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Jamie Vandenberg
- Mark Cowley Lidwill Research Program in Cardiac Electrophysiology, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - James Elhindi
- WSLHD Research and Education Network, Westmead Hospital, Westmead, New South Wales, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Camperdown, Sydney, New South Wales, Australia
- South West Clinical School, University of New South Wales, Kensington, New South Wales, Australia
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3
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Anwar AM. Incremental diagnostic and prognostic utility of left atrial deformation in heart failure using speckle tracking echocardiography. Heart Fail Rev 2024; 29:713-727. [PMID: 38466374 DOI: 10.1007/s10741-024-10392-z] [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] [Accepted: 01/31/2024] [Indexed: 03/13/2024]
Abstract
Left atrium (LA) is a very important component of cardiovascular performance. The assessment of LA function has gathered the interest with expanding research supporting the utility as a biomarker for outcomes in heart failure (HF). Echocardiography is the main imaging modality which helps in a qualitative and quantitative assessment of the LA size and function. Recent advances in probe technology and software analysis have provided a better understanding of LA anatomy, physiology, pathology, and function. A variety of parameters have been defined as markers of LA function but there is no single parameter that best defines LA function. Speckle tracking echocardiography-derived analysis of LA deformation provides a window on all phases of LA function (reservoir, conduit, and booster pump). There is accumulative published data that supported the diagnostic and prognostic values of LA deformation integration during echo assessment of LA in HF. This review article summarized the clinical utility of LA deformation that may help in prediction, diagnosis, categorization, risk stratification, and guiding the proper selection of therapy in HF patients in daily practice.
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Affiliation(s)
- Ashraf M Anwar
- Department of Cardiology, King Fahad Armed Forces Hospital, P.O. Box: 9862, Jeddah, 21159, Saudi Arabia.
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
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Stefani LD, Trivedi SJ, Ferkh A, Emerson P, Marschner S, Gan G, Altman M, Thomas L. Left atrial mechanics evaluated by two-dimensional strain analysis: alterations in essential hypertension. J Hypertens 2024; 42:274-282. [PMID: 37937486 DOI: 10.1097/hjh.0000000000003615] [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: 11/09/2023]
Abstract
BACKGROUND Hypertension is a cardiovascular risk factor that predisposes to cardiac structural alterations namely increased left ventricular (LV) wall thickness, reduced LV compliance and diastolic dysfunction, with consequent left atrial (LA) dilation and functional impairment. In this article, we evaluated differences in left atrial structure and function using two-dimensional speckle tracking echocardiography in patients with hypertension compared with controls. METHODS This was a retrospective cross-sectional study of 208 hypertensive patients and 157 controls who underwent a comprehensive transthoracic echocardiogram. Patients with hypertension were stratified by the presence of left ventricular hypertrophy (LVH). RESULTS Non-LVH hypertension patients had lower left atrial reservoir strain (LAS RES ) (34.78 ± 29.78 vs. 29.78 ± 6.08; P = 0.022) and conduit strain (LAS CD ) (19.66 ± 7.29 vs. 14.23 ± 4.59; P = 0.014) vs. controls despite similar left atrial volumes (LAV) . Left atrial contractile strain (LAS CT ) was not significantly different between non-LVH hypertension patients and controls (15.12 ± 3.77 vs. 15.56 ± 3.79; P = 0.601). Left atrial mechanical dispersion was significantly higher in the LVH group compared with the non-LVH hypertension group (42.26 ± 13.01 vs. 50.06 ± 14.95; P = 0.009). In multivariate regression analysis, LVH correlated with left atrial mechanical dispersion ( P = 0.016). An age-hypertension interaction independently correlated with LAS CT ( P < 0.001). CONCLUSION Hypertension results in functional left atrial changes even before development of LV hypertrophy and structural left atrial changes with increased left atrial volume. We demonstrate both a likely hypertension-associated left atrial myopathy that prevents age-related compensatory increase in left atrial contractile function, and impact of LVH in hypertension on left atrial dyssynchrony.
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Affiliation(s)
- Luke D Stefani
- Westmead Clinical School, University of Sydney
- Cardiology Department, Westmead Hospital
| | - Siddharth J Trivedi
- Westmead Clinical School, University of Sydney
- Cardiology Department, Westmead Hospital
| | - Aaisha Ferkh
- Westmead Clinical School, University of Sydney
- Cardiology Department, Westmead Hospital
| | - Peter Emerson
- Westmead Clinical School, University of Sydney
- Cardiology Department, Westmead Hospital
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead Hospital, Westmead
| | - Gary Gan
- Cardiology Department, Blacktown Hospital, Sydney
| | - Mikhail Altman
- Westmead Clinical School, University of Sydney
- Cardiology Department, Blacktown Hospital, Sydney
| | - Liza Thomas
- Westmead Clinical School, University of Sydney
- Cardiology Department, Blacktown Hospital, Sydney
- Southwestern Clinical School, University of New South Wales, Sydney, NSW, Australia
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5
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Ferkh A, Clark A, Thomas L. Left atrial phasic function: physiology, clinical assessment and prognostic value. Heart 2023; 109:1661-1669. [PMID: 36918267 DOI: 10.1136/heartjnl-2022-321609] [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: 01/18/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023] Open
Abstract
Left atrial (LA) phasic function provides significant insights into the pathophysiology of cardiovascular disease. LA function is described in three phases: reservoir (atrial filling, during systole), conduit (passive emptying, during early diastole) and contractile (active emptying, during late diastole). LA phasic function can be evaluated by different imaging modalities, and a variety of techniques including volumetric analysis, deformation (strain) and Doppler methods. LA phasic function (particularly LA reservoir strain) is more sensitive and provides earlier detection of LA dysfunction than alterations in LA volume. LA function parameters have also demonstrated significant diagnostic and prognostic value, particularly in heart failure, atrial fibrillation and stroke. However, there remain barriers to implementation of phasic function parameters in clinical practice and guidelines. This review outlines the physiology of LA phasic function, methods of assessment, and its diagnostic and prognostic utility in varying pathologies.
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Affiliation(s)
- Aaisha Ferkh
- Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Amy Clark
- Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Liza Thomas
- Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
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Kessler Iglesias C, Pouliopoulos J, Thomas L, Hayward CS, Jabbour A, Fatkin D. Atrial cardiomyopathy: Current and future imaging methods for assessment of atrial structure and function. Front Cardiovasc Med 2023; 10:1099625. [PMID: 37063965 PMCID: PMC10102662 DOI: 10.3389/fcvm.2023.1099625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
Changes in atrial size and function have historically been considered a surrogate marker of ventricular dysfunction. However, it is now recognized that atrial cardiomyopathy (ACM) may also occur as a primary myocardial disorder. Emerging evidence that ACM is a major risk factor for atrial fibrillation, heart failure, and thromboembolic stroke, has highlighted the significance of this disorder and the need for better assessment of atrial metrics in clinical practice. Key barriers in this regard include a lack of standardized criteria or hierarchy for the diagnosis of ACM and lack of consensus for the most accurate phenotyping methods. In this article we review existing literature on ACM, with a focus on current and future non-invasive imaging methods for detecting abnormalities of atrial structure and function. We discuss the relative advantages and disadvantages of transthoracic echocardiography and cardiac magnetic resonance imaging for assessing a range of parameters, including atrial size and contractile function, strain, tissue characteristics, and epicardial adipose tissue. We will also present the potential application of novel imaging methods such as sphericity index and four- or five-dimensional flow.
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Affiliation(s)
- Cassia Kessler Iglesias
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Jim Pouliopoulos
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Liza Thomas
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology Westmead Hospital, Sydney, NSW, Australia
- South West Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Christopher S. Hayward
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Andrew Jabbour
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Diane Fatkin
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Correspondence: Diane Fatkin
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7
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Sun P, Cen H, Chen S, Chen X, Jiang W, Zhu H, Liu Y, Liu H, Lu W. Left atrial dysfunction can independently predict exercise capacity in patients with chronic heart failure who use beta-blockers. BMC Cardiovasc Disord 2023; 23:128. [PMID: 36894879 PMCID: PMC9996944 DOI: 10.1186/s12872-023-03127-9] [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: 09/09/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Beta-blockers are first-line clinical drugs for the treatment of chronic heart failure (CHF). In the guidelines for cardiac rehabilitation, patients with heart failure who do or do not receive beta-blocker therapy have different reference thresholds for maximal oxygen uptake (VO2max). It has been reported that left atrial (LA) strain can be used to predict VO2max in patients with heart failure, which can be used to assess exercise capacity. However, most existing studies included patients who did not receive beta-blocker therapy, which could have a heterogeneous influence on the conclusions. For the vast majority of CHF patients receiving beta-blockers, the exact relationship between LA strain parameters and exercise capacity is unclear. METHODS This cross-sectional study enrolled 73 patients with CHF who received beta-blockers. All patients underwent a thorough resting echocardiogram and a cardiopulmonary exercise test to obtain VO2max, which was used to reflect exercise capacity. RESULTS LA reservoir strain, LA maximum volume index (LAVImax), LA minimum volume index (LAVImin) (P < 0.0001) and LA booster strain (P < 0.01) were all significantly correlated with VO2max, and LA conduit strain was significantly correlated with VO2max (P < 0.05) after adjusting for sex, age, and body mass index. LA reservoir strain, LAVImax, LAVImin (P < 0.001), and LA booster strain (P < 0.05) were significantly correlated with VO2max after adjusting for left ventricular ejection fraction, the ratio of transmitral E velocity to tissue Doppler mitral annulus e' velocity (E/e'), and tricuspid annular plane systolic excursion. LA reservoir strain with a cutoff value of 24.9% had a sensitivity of 74% and specificity of 63% for the identification of patients with VO2max < 16 mL/kg/min. CONCLUSION Among CHF patients receiving beta-blocker therapy, resting LA strain is linearly correlated with exercise capacity. LA reservoir strain is a robust independent predictor of reduced exercise capacity among all resting echocardiography parameters. CLINICAL TRIAL REGISTRATION This study is a part of the Baduanjin-Eight-Silken-Movement with Self-efficacy Building for Patients with Chronic Heart Failure (BESMILE-HF) trial NCT03180320 (ClinicalTrials.gov, registration date: 08/06/2017).
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Affiliation(s)
- Pengtao Sun
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, China.,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.,Department of Ultrasonography, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510000, China
| | - Huan Cen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.,Department of Ultrasonography, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510000, China
| | - Sinan Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.,Department of Ultrasonography, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510000, China
| | - Xiankun Chen
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.,Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510000, China.,Health Systems and Policy, Department of Global Public Health, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Wei Jiang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.,Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510000, China
| | - Huiying Zhu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.,Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510000, China
| | - Yuexia Liu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.,Department of Ultrasonography, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510000, China
| | - Hongmei Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, China. .,Department of Ultrasonography, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510000, China.
| | - Weihui Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China. .,Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510000, China.
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Sørensen EIVIND, Myrstad MARIUS, Solberg MAGNARGANGÅS, Øie ERIK, Tveit ARNLJOT, Aarønæs MARIT. Right heart structure and function in lifelong recreational endurance athletes with and without paroxysmal atrial fibrillation. J Am Soc Echocardiogr 2022; 35:1259-1268. [PMID: 35760278 DOI: 10.1016/j.echo.2022.06.008] [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: 02/03/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Healthy young athletes adapt to the increased demands of endurance exercise with symmetric cardiac remodeling. Male veteran endurance athletes have an increased risk of atrial fibrillation (AF), and some athletes seem susceptible to changes mimicking arrhythmogenic cardiomyopathy. Intense exercise puts a disproportionate hemodynamic load on the right-sided heart chambers. Despite this, data describing right heart structure and function in older veteran athletes are scarce. We aimed to investigate structural and functional characteristics of the right heart in veteran athletes with and without AF to contribute to the understanding of exercise-induced cardiac remodeling in this group. METHODS Three hundred and two male participants, of whom 151 were veteran skiers (62 with paroxysmal AF) and 151 were controls from the general population (62 with paroxysmal AF) underwent an echocardiographic examination in sinus rhythm to evaluate right atrial (RA) and right ventricular (RV) structure and function. While 87 of the participants had never exercised regularly, 50, 43, and 122 men had practiced regular endurance exercise for 1-20, 20-40, and >40 years, respectively. RESULTS RA volume and RV size increased with cumulative years of exercise (p<0.001), with a disproportionate increase in RV size compared with left ventricular (LV) size, regardless of AF status (p<0.001). RA and RV function assessed by strain remained similar despite lifelong exposure to endurance exercise. AF was associated with reduced RA strain irrespective of exposure to exercise (p<0.001). CONCLUSION RA and RV size and RV/LV ratio showed a dose-response relationship with cumulative years of endurance exercise, whereas RA and RV function did not. Indicating that increasing RV/LV ratio may represent a physiological adaptation to prolonged endurance exercise. AF was associated with reduced RA function, regardless of exposure to exercise, suggesting RA functional parameters are more closely linked to AF than RA size in veteran athletes.
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Affiliation(s)
- E I V I N D Sørensen
- Department of Internal Medicine, Diakonhjemmet Hospital, N-0370, Oslo, Norway; Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway; Institute of Clinical Medicine, University of Oslo, N-0316, Oslo, Norway.
| | - M A R I U S Myrstad
- Department of Internal Medicine, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway; Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway
| | - M A G N A R G A N G Å S Solberg
- Department of Internal Medicine, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway; Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway
| | - E R I K Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, N-0370, Oslo, Norway
| | - A R N L J O T Tveit
- Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway; Institute of Clinical Medicine, University of Oslo, N-0316, Oslo, Norway
| | - M A R I T Aarønæs
- Department of Internal Medicine, Diakonhjemmet Hospital, N-0370, Oslo, Norway
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9
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Sørensen E, Myrstad M, Solberg MG, Øie E, Tveit A, Aarønæs M. Left atrial function in male veteran endurance athletes with paroxysmal atrial fibrillation. Eur Heart J Cardiovasc Imaging 2021; 23:137-146. [PMID: 34849678 PMCID: PMC8685599 DOI: 10.1093/ehjci/jeab248] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/11/2021] [Indexed: 12/02/2022] Open
Abstract
Aims To assess left atrial (LA) function in sinus rhythm in veteran athletes with a history of paroxysmal atrial fibrillation (AF) exposed to prolonged endurance exercise compared with veteran athletes without AF and controls with and without paroxysmal AF from a non-athletic population. Methods and results Three hundred and two male participants from four groups, veteran recreational skiers with paroxysmal AF (n = 62), veteran skiers without AF (n = 89), and controls from a non-athletic population with (n = 62) and without paroxysmal AF (n = 89) underwent an echocardiographic examination in sinus rhythm to evaluate LA anatomy and function. The skiers (mean age 70.8±6.7 years) reported an average exposure to regular endurance exercise for 40–50 years. LA maximum and minimum volumes were larger in skiers (P < 0.001). LA volumes differed within the athletic and non-athletic groups with larger volumes in the AF groups ( P < 0.001). We observed a considerable overlap in LA volumes among non-athletes with AF and athletes without AF. LA reservoir strain (33.6% ± 4.8% vs. 28.3% ± 6.7% P < 0.001) and contractile strain (18.3% ± 4.0% vs. 15.0% ± 5.2% P < 0.001) were lower in both AF groups regardless of athletic status. LA reservoir strain was superior to volumetric measurements at identifying participants with AF (area under the curve 0.740 ±0.041). Conclusion Male veteran athletes had significantly larger LA volumes than non-athletes. In contrast, LA strain values were similar in athletes and non-athletes with paroxysmal AF, and significantly lower than in subjects without AF.
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Affiliation(s)
- Eivind Sørensen
- Department of Internal Medicine, Diakonhjemmet Hospital, N-0370 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, N-0316 Oslo, Norway
| | - Marius Myrstad
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, N-1346 Gjettum, Norway.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, N-1346 Gjettum, Norway
| | - Magnar Gangås Solberg
- Institute of Clinical Medicine, University of Oslo, N-0316 Oslo, Norway.,Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, N-1346 Gjettum, Norway.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, N-1346 Gjettum, Norway
| | - Erik Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, N-0370 Oslo, Norway
| | - Arnljot Tveit
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, N-1346 Gjettum, Norway.,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, N-1346 Gjettum, Norway
| | - Marit Aarønæs
- Department of Internal Medicine, Diakonhjemmet Hospital, N-0370 Oslo, Norway
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