1
|
Simon J, Smit JM, El Mahdiui M, Száraz L, van Rosendael AR, Zsarnóczay E, Nagy AI, Gellér L, van der Geest RJ, Bax JJ, Maurovich-Horvat P, Merkely B. Association of Left Atrial Appendage Morphology and Function With Stroke and Transient Ischemic Attack in Atrial Fibrillation Patients. Am J Cardiol 2024; 221:37-43. [PMID: 38552710 DOI: 10.1016/j.amjcard.2024.03.025] [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: 10/10/2023] [Revised: 03/03/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
We aimed to correlate left atrial appendage (LAA) structure and function with the history of stroke/transient ischemic attack (TIA) in patients with atrial fibrillation (AF). We analyzed the data of 649 patients with AF who were scheduled for catheter ablation. Patients underwent cardiac computed tomography and transesophageal echocardiography before ablation. The LAA morphologies depicted by cardiac computed tomography were categorized into 4 groups: cauliflower, chicken wing, swan, and windsock shapes. The mean age was 61.3 ± 10.5 years, 33.9% were women. The prevalence of stroke/TIA was 7.1%. After adjustment for the main risk factors, the LAA flow velocity ≤35.3 cm/s (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.09 to 4.61, p = 0.033) and the swan LAA shape (OR 2.69, 95% CI 0.96 to 6.86, p = 0.047) independently associated with a higher risk of stroke/TIA, whereas the windsock LAA morphology proved to be protective (OR 0.32, 95% CI 0.12 to 0.77, p = 0.017) compared with the cauliflower LAA shape. Comparing the differences between the LAA morphology groups, we measured a significantly smaller LAA orifice area (389.3 ± 137.7 mm2 in windsock vs 428.3 ± 158.9 ml in cauliflower, p = 0.021) and LAA volume (7.4 ± 3.0 mm2 in windsock vs 8.5 ± 4.8 mm2 in cauliflower, p = 0.012) in patients with windsock LAA morphology, whereas the LAA flow velocity did not differ significantly. Reduced LAA function and swan LAA morphology were independently associated with a higher prevalence of stroke/TIA, whereas the windsock LAA shape proved to be protective. Comparing the differences between the various LAA morphology types, significantly lower LAA volume and LAA orifice area were measured in the windsock LAA shape than in the cauliflower LAA shape.
Collapse
Affiliation(s)
- Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Budapest, Hungary
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center Leiden, The Netherlands
| | - Lili Száraz
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Budapest, Hungary
| | | | - Emese Zsarnóczay
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Budapest, Hungary
| | - Anikó Ilona Nagy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Lászlo Gellér
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Rob J van der Geest
- Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center Leiden, The Netherlands; Heart Center, Turku University Hospital Turku, Finland; University of Turku, Turku, Finland
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Budapest, Hungary.
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Fang R, Li Y, Wang J, Wang Z, Allen J, Ching CK, Zhong L, Li Z. Stroke risk evaluation for patients with atrial fibrillation: Insights from left atrial appendage. Front Cardiovasc Med 2022; 9:968630. [PMID: 36072865 PMCID: PMC9441763 DOI: 10.3389/fcvm.2022.968630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Left atrial appendage (LAA) is believed to be a common site of thrombus formation in patients with atrial fibrillation (AF). However, the commonly-applied stroke risk stratification model (such as. CHA2DS2-VASc score) does not include any structural or hemodynamic features of LAA. Recent studies have suggested that it is important to incorporate LAA geometrical and hemodynamic features to evaluate the risk of thrombus formation in LAA, which may better delineate the AF patients for anticoagulant administration and prevent strokes. This review focuses on the LAA-related factors that may be associated with thrombus formation and cardioembolic events.
Collapse
Affiliation(s)
- Runxin Fang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Yang Li
- Zhongda Hospital, The Affiliated Hospital of Southeast University, Nanjing, China
| | - Jun Wang
- First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zidun Wang
- First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - John Allen
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Chi Keong Ching
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - Liang Zhong
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - Zhiyong Li
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- *Correspondence: Zhiyong Li
| |
Collapse
|
4
|
Fang R, Wang Z, Zhao X, Wang J, Li Y, Zhang Y, Chen Q, Wang J, Liu Q, Chen M, Li Z. Stroke risk evaluation for patients with atrial fibrillation: Insights from left atrial appendage with fluid-structure interaction analysis. Comput Biol Med 2022; 148:105897. [DOI: 10.1016/j.compbiomed.2022.105897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 11/03/2022]
|
5
|
Miyauchi S, Tokuyama T, Uotani Y, Miyamoto S, Ikeuchi Y, Okamura S, Okubo Y, Katayama K, Takasaki T, Nakatani N, Matsudaira Y, Furusho H, Miyauchi M, Takahashi S, Nakano Y. Association between Left Atrial Appendage Fibrosis and Thrombus Formation: A Histological Approach. J Cardiovasc Electrophysiol 2022; 33:677-687. [DOI: 10.1111/jce.15384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Shunsuke Miyauchi
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
- Health Service CenterHiroshima University1‐7‐1 KagamiyamaHigashihiroshimaJapan
| | - Takehito Tokuyama
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yukimi Uotani
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Shogo Miyamoto
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yoshihiro Ikeuchi
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Sho Okamura
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yousaku Okubo
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Keijiro Katayama
- Department of Cardiovascular SurgeryHiroshima University Hospital1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Taiichi Takasaki
- Department of Cardiovascular SurgeryHiroshima University Hospital1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Nobuhiro Nakatani
- Medical Division, Technical CenterHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yorisato Matsudaira
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Hisako Furusho
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial Pathobiology, Graduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| | - Yukiko Nakano
- Department of Cardiovascular MedicineGraduate School of Biomedical and Health SciencesHiroshima University1‐2‐3, Kasumi, Minami‐kuHiroshimaJapan
| |
Collapse
|
6
|
Alinezhad L, Ghalichi F, Ahmadlouydarab M, Chenaghlou M. Left atrial appendage shape impacts on the left atrial flow hemodynamics: A numerical hypothesis generating study on two cases. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 213:106506. [PMID: 34752960 DOI: 10.1016/j.cmpb.2021.106506] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The left atrial appendage (LAA) is the most common region for thrombus formation in atrial fibrillation (AF). Morphological parameters such as shape, size, and LAA volume can cause insufficient effectiveness of available therapeutic options. This study aimed to examine blood flow inside LAA and its removal effects. Computational fluid dynamic (CFD) simulations were carried out on two patients with different morphologies. METHODS Two patients' CT was used to reconstruct the 3D geometries of the left atrium (LA) and left atrial appendage (LAA). Then, the geometries were refined in the mentioned software, and the LAA in some models was removed. Next, in generated 3D volume mesh, sinus rhythm (SR) and atrial fibrillation (AF) outflow velocity were imposed at the mitral valve as boundary conditions. Finally, CFD simulation was conducted to analyzing blood flow within LA with/without LA. RESULTS The results confirmed that velocity and vorticity decreased under AF conditions inside the LA domain for both patients. However, removing LAA may cause unpredictable consequences, due to different shape and volume of LAA. LAA removal had insignificant effects on velocity and vorticity within LA in SR-mitral outflow. However, removing LAA increased the blood flow rate by 9.15% and vorticity by 7.27% for patient one under AF rhythm (SR)-outflow. In contrast, for patient two, LAA removal in both AF and SR decreased velocity and vorticity within the LA domain. In SR-mitral outflow, velocity dropped by 18.8 %, and vorticity by 13.2%. Also, under AF velocity and vorticity decreased by 23.33% and 18.6% respectively. Meanwhile, the results indicated that the vorticity magnitude increased inside the LAA under AF associated with the risk of thrombus formation, particularly for patient one under AF. The distal part of LAA in both patients was the most common region for blood stasis because of the lowest velocity magnitude. CONCLUSION Overall, the morphology of LAA could be the critical parameter to determine the possibility of thrombosis formation, particularly under AF conditions. High volume, low blood flow velocity and two-lobe-appendage are more likely to have blood stasis. Furthermore, the morphology difference can affect the LAA removal result and make it more complicated. So, it could be challenging to generalize LAA removal as a therapeutic option for different patients. The implication of this CFD observation needs more investigation.
Collapse
Affiliation(s)
- Lida Alinezhad
- Department of Biomedical Engineering, Division of Biomechanics, Sahand University of Technology, Tabriz, Iran
| | - Farzan Ghalichi
- Department of Biomedical Engineering, Division of Biomechanics, Sahand University of Technology, Tabriz, Iran
| | - Majid Ahmadlouydarab
- Faculty of Chemical & Petroleum Engineering, University of Tabriz, Tabriz, Iran.
| | - Maryam Chenaghlou
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
7
|
Anselmino M, Frea S, Gili S, Rovera C, Morello M, Jorfida M, Teodori J, Perversi J, Salvetti I, Grosso Marra W, Faletti R, Righi D, Gaita F, DE Ferrari GM. Left atrial appendage morphology at transesophageal echocardiography: how to improve reproducibility? Minerva Cardiol Angiol 2020; 69:178-184. [PMID: 32657552 DOI: 10.23736/s2724-5683.20.05215-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Left atrial appendage (LAA) morphology, investigated by computed tomography and magnetic resonance imaging, has proved to relate to the risk of cerebrovascular events in patients with atrial fibrillation (AF). The aim of the present study was to assess reproducibility of transesophageal echocardiography (TEE) imaging in describing LAA morphology. METHODS Two-hundred consecutive patients referred for TEE were enrolled. In the first group of 47 (23.5%) patients LAA morphology was analyzed by conventional TEE and described as ChickenWing, Windsock, Cactus or Cauliflower. In the second group of 153 (76.5%) patients, instead, a 3D-Xplane diagnostic algorithm was performed to stratify LAA morphology as linear (ChickenWing) or complex (Windsock/Cactus and Cauliflower). Interobserver variability within three independent readers was assessed in both groups of patients and stratified by operator's experience and training. In a subgroup of 19 (12.4%) patients, the agreement of LAA morphology description by 3D-Xplane diagnostic algorithm was compared to cardiac magnetic resonance. RESULTS By conventional TEE the agreement among operators on LAA morphology classification was poor (ρ<0.13). The 3D-XPlane diagnostic algorithm, significantly increased interobserver agreement up to ρ=0.32 within all readers and up to ρ=0.82 among the experienced and specifically trained operators. LAA morphology description in this latter group provided strong agreement with cardiac magnetic resonance (up to ρ=0.77). CONCLUSIONS LAA morphology assessment is challenging by conventional TEE. To improve reproducibility, the use of the 3D-Xplane technique combined with a specific diagnostic algorithm and training of the operators is fundamental.
Collapse
Affiliation(s)
- Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Simone Frea
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Sebastiano Gili
- Interventional Cardiology Unit 3, IRCCS Monzino Cardiac Center, Milan, Italy
| | - Chiara Rovera
- Division of Cardiology, Hospital of Chivasso, Chivasso, Turin, Italy -
| | - Mara Morello
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Marcella Jorfida
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Julien Teodori
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Jacopo Perversi
- Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy
| | - Ilaria Salvetti
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | - Riccardo Faletti
- Division of Radiology, Department of Diagnostic Imaging and Radiotherapy, University of Turin, Turin, Italy
| | - Dorico Righi
- Division of Radiology, Department of Diagnostic Imaging and Radiotherapy, University of Turin, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Gaetano M DE Ferrari
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| |
Collapse
|
8
|
Anan AR, Fareed J, Suhaib J, Rafat R, Murad D, Isam B, Tariq M, Patricia E, Alexander E, Vaidya V, Peter A N, Abhishek D. Left Atrial Appendage Morphology as a Determinant for Stroke Risk Assessment in Atrial Fibrillation Patients: Systematic Review and Meta-Analysis. J Atr Fibrillation 2019; 12:2183. [PMID: 32002111 DOI: 10.4022/jafib.2183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/14/2019] [Accepted: 03/26/2019] [Indexed: 12/23/2022]
Abstract
Background Atrial fibrillation (AF) is a leading source of emboli that precipitate cerebrovascular accident (CVA) which is correlated with left atrial appendage (LAA) morphology. We aimed to elaborate the relationship between CVA and LAA morphology in AF patients. Methods Medline and EMBASE databases were thoroughly searched between 2010-2018 for studies that included atrial fibrillation patients and classified them into two groups based on CVA occurrence. Four different LAA morphologies (Chicken wing CW, Cauliflower, cactus and windsock) were determined in each group by 3D TEE, MDCT or CMRI. New Castle Ottawa Scale was used to appraise the quality of included studies. The risk of CVA before cardiac ablation and/or LAA intervention in CW patients was compared to each type of non-CW morphologies. The extracted data was statistically analyzed in the form of forest plot by measuring the risk ratio (RR) using REVMAN software. P value and I square were used to assess the heterogeneity between studies. Results PRISMA diagram was illustrated showing 789 imported studies for screening. Three duplicates were removed, and the rest were arbitrated by 2 reviewers yielding 12 included studies with 3486 patients including 1551 with CW, 442 with cauliflower, 732 with cactus 765 with windsock. The risk of CVA in CW patients was reduced by 41% relative to non-CW patients (Total RR=0.59 (0.52-0.68)). Likewise, the risk of CVA in CW patients was less by 46%, 35% and 31% compared to cauliflower (Total RR =0.54(0.46-0.64)), cactus (Total RR =0.65(0.55-0.77)) and windsock (Total RR =0.69(0.58-0.83)) patients respectively. Low levels of heterogeneity were achieved in all comparisons (I square <35% and p value > 0.1). Conclusions Patients with non-CW morphologies (cauliflower, cactus and windsock) show a higher incidence of CVA than CW patients. For that reason, LAA appendage morphology could be useful for risk stratification of CVA in AF patients.
Collapse
Affiliation(s)
- Abu Rmilah Anan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Jumah Fareed
- Rutgers-Robert Wood Johnson Universty Hospital, New Brunswick, NJ, USA
| | | | | | | | - Bsisu Isam
- Jordan University Hospital, Amman, Jordan
| | | | - Erwin Patricia
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Egbe Alexander
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Vaibha Vaidya
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Deshmukh Abhishek
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
9
|
Miao Y, Wang R, Wu H, Yang S, Qiu Y. CPCGI confers neuroprotection by enhancing blood circulation and neurological function in cerebral ischemia/reperfusion rats. Mol Med Rep 2019; 20:2365-2372. [PMID: 31322214 DOI: 10.3892/mmr.2019.10472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 05/09/2019] [Indexed: 11/06/2022] Open
Abstract
The current study used a rat middle cerebral artery occlusion (MCAO) model with the aim to explore the effects of compound porcine cerebroside and ganglioside injection (CPCGI) on brain ischemia/reperfusion injury in rats. Improvement in the infarct‑side microcirculation and the overall recovery of neurological function were detected by triphenyltetrazolium chloride staining, laser speckle blood flow monitoring, latex perfusion, immunofluorescence and immunoblotting. The results revealed that administration of CPCGI for 7 consecutive days following ischemic stroke contributed to the recovery of neurological function and the reduction of cerebral infarct volume in rats. Blood flow monitoring results demonstrated that the administration of CPCGI effectively promoted cerebral blood flow following stroke, and contributed to the protection of the ischemic side blood vessels. In addition, CPCGI treatment increased the numbers of new blood vessels in the peripheral ischemic region, and upregulated the expression levels of vascular endothelial growth factor, angiopoietin 1 and its receptor TEK receptor tyrosine kinase, fibroblast growth factor and Wnt signaling pathway‑associated proteins. Taken together, the present results indicated that CPCGI improved the blood circulation and neurological function following cerebral ischemia/reperfusion in rats.
Collapse
Affiliation(s)
- Yifeng Miao
- Department of Neurosurgery, Renji Hospital, South Campus, Shanghai Jiaotong University School of Medicine, Shanghai 201112, P.R. China
| | - Ran Wang
- Department of Neurosurgery, Renji Hospital, South Campus, Shanghai Jiaotong University School of Medicine, Shanghai 201112, P.R. China
| | - Hui Wu
- Department of Neurosurgery, Renji Hospital, South Campus, Shanghai Jiaotong University School of Medicine, Shanghai 201112, P.R. China
| | - Shaofeng Yang
- Department of Neurosurgery, Renji Hospital, South Campus, Shanghai Jiaotong University School of Medicine, Shanghai 201112, P.R. China
| | - Yongming Qiu
- Department of Neurosurgery, Renji Hospital, South Campus, Shanghai Jiaotong University School of Medicine, Shanghai 201112, P.R. China
| |
Collapse
|
10
|
Wang F, Zhu M, Wang X, Zhang W, Su Y, Lu Y, Pan X, Gao D, Zhang X, Chen W, Xu Y, Sun Y, Xu D. Predictive value of left atrial appendage lobes on left atrial thrombus or spontaneous echo contrast in patients with non-valvular atrial fibrillation. BMC Cardiovasc Disord 2018; 18:153. [PMID: 30064363 PMCID: PMC6069846 DOI: 10.1186/s12872-018-0889-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 07/16/2018] [Indexed: 01/26/2023] Open
Abstract
Background Left atrial appendage morphology has been proved to be an important predictor of left atrial thrombus (LAT) and left atrial spontaneous echo contrast (LASEC) and stroke in patients with non-valvular atrial fibrillation (NVAF). However, the relation between left atrial appendage (LAA) lobes and LAT or LASEC is still unknown. The aim of this study is to investigate the correlation between the number of left atrial appendage lobes and LAT/LASEC in patients with NVAF. Methods This monocentric cross-sectional study enrolled 472 consecutive patients with non-valvular atrial fibrillation, who had transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) prior to cardioversion or left atrial appendage closure (LAAC) from July 2009 to August 2015 in department of cardiology of Shanghai Tenth People’s Hospital. Patients who had significant mitral or aortic valve disease, previous cardiac valvular surgery and other complicated cardiac diseases were excluded. Individuals were divided into two groups:the LAT/LASEC group (16.95%), which comprised patients with LAT or LASEC, as confirmed by TEE; and a negative control group (83.05%).Baseline overall group characterization with demographic, clinical, laboratory data and echocardiographic parameters, alongside with information on medication was obtained for all patients. Subgroup analysis with line chart was applied for exploring the association between LAA lobes and LAT/LAESC. Receptor-operating curves (ROC) were used to test the value of LA anteroposterior diameter detected by different echocardiography methods predicting LAT or LASEC. Multivariable logistic regression analysis was used to investigate independent predictors of LAT/LASEC. Results Among 472 patients, 23 (4.87%) had LA/LAA thrombus and 57 (12.1%) had LA spontaneous echo contrast. Compared to the negative group, patients in LAT/LASEC group had higher CHA2DS2-VASc score (3.79 ± 1.75 vs 2.65 ± 1.76, p < 0.001), larger LAD (measured by TTE, 48.1 ± 7.7 vs 44.6 ± 6.5, P < 0.001; measured by TEE, 52.2 ± 6.2 vs 46.7 ± 7.1, P < 0.001), lower left upper pulmonary venous flow velocity (LUPVFV) (0.54 ± 0.17 m/s vs 0.67 ± 0.26 m/s, CI 95% 0.05–0.22, P = 0.003), more left atrial appendage lobes (1.67 ± 0.77 vs 1.25 ± 0.50, p < 0.001). There was a good discriminative capacity for LAD detected by TTE (area under the curve (AUC), 0.67, CI 95% 0.61–0.73, p < 0.001) and LAD detected by TEE (AUC, 0.73, CI 95% 0.67–0.79, p < 0.001). The subgroup analysis based on gender and different LAA lobes yielded similar results (male group: p < 0.001;female group: p = 0.004) that the number of LAA lobes were significantly associated with LA thrombus or SEC. In multivariable logistic regression analysis, both the number of LAA lobes (odds ratio: 2.37; CI 95% 1.37–4.09; p = 0.002) and the persistent AF (odds ratio: 3.57; CI 95% 1.68–7.57; p = 0.001) provided independent and incremental predictive value beyond CHA2DS2-VASc score. Conclusion The number of LAA lobes is an independent risk factor and has a moderate predictive value for LAT/LASEC among NVAF patients in China.
Collapse
Affiliation(s)
- Fan Wang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Mengyun Zhu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Xiaoyu Wang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Wei Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Yang Su
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Yuyan Lu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Xin Pan
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Di Gao
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Xianling Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Wei Chen
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Yuxi Sun
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO. 301 Middle Yanchang Road, Shanghai, 200072, China.
| | - Dachun Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, NO. 301 Middle Yanchang Road, Shanghai, 200072, China.
| |
Collapse
|