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Yoon JH, Moon J, Chung HM, Choi EY, Kim JY, Min PK, Yoon YW, Lee BK, Hong BK, Kwon HM, Rim SJ. Left atrial function assessed by Doppler echocardiography rather than left atrial volume predicts recurrence in patients with paroxysmal atrial fibrillation. Clin Cardiol 2013; 36:235-40. [PMID: 23495006 DOI: 10.1002/clc.22105] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/30/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Paroxysmal atrial fibrillation (PaAF) may present as a single self-terminating episode of atrial fibrillation (AF) or a more persistent form after sinus conversion. We investigated predictors of recurrence in patients with PaAF. HYPOTHESIS Left atrial function would be an useful parameter for predicting PaAF recurrence. METHODS The study population included 228 PaAF patients (131 males, age 64±14 years) who underwent transthoracic echocardiography immediately after spontaneous sinus conversion at initial AF diagnosis. We followed the study patients for AF recurrence. RESULTS AF recurrence was demonstrated in 45 patients (20%, age 68±13 years) after spontaneous sinus conversion. Patients with recurrence had larger left atrial volume index (32±12 vs 25±10 mL/m2, P<0.001), left ventricle mass index (107±34 vs 93±25 g/m2, P=0.012), and left ventricle filling pressure (E/e'') (14±7 vs 12±5, P=0.012), whereas early diastolic mitral annular velocity (e') (5±2 vs 6±3 cm/s, P=0.021), late diastolic mitral annular velocity (A') (7±3 vs 9±2 cm/s, P<0.001), and peak systolic mitral annular velocity (7±2 vs 8±2 cm/s, P=0.045) were significantly lower. In multivariate Cox regression analysis detecting independent predictors of PaAF recurrence, lower A' (hazard ratio: 0.623, 95% confidence interval: 0.476-0.815, P=0.001) was a significant predictor of AF recurrence. CONCLUSIONS A', which indicates left atrial (LA) contractile function after sinus conversion, was the independent predictor of PaAF recurrence, whereas LA volume was not. LA function may be more important than LA volume in predicting recurrence particularly in patients with PaAF.
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Affiliation(s)
- Ji Hyun Yoon
- Cardiology Division, Heart Center, Gangnam Severance Hospital, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim SM, Cho KI, Kwon JH, Lee HG, Kim TI. Impact of obstructive sleep apnea on left atrial functional and structural remodeling beyond obesity. J Cardiol 2012; 60:475-83. [PMID: 22890070 DOI: 10.1016/j.jjcc.2012.07.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 06/18/2012] [Accepted: 06/21/2012] [Indexed: 01/08/2023]
Abstract
BACKGROUND To evaluate the left atrial (LA) volume and function of obese patients with/without obstructive sleep apnea (OSA) and its association with left ventricular (LV) diastolic function independent of obesity. METHODS LA volumetric and functional parameters were measured by 2-dimensional and strain echocardiography in 49 obese (body mass index ≥ 25 kg/m(2)) subjects (24 non-OSA and 25 OSA). RESULTS OSA group showed larger maximal LA volume indexed for body surface area, larger volume before atrial contraction, a reduction in the LA passive emptying fraction, and an increase in the LA active emptying fraction with no significant change in LA total emptying fraction. Mitral annular early diastolic velocity (Ea) was significantly reduced, whereas the ratio of mitral valve early diastolic velocity (E) to Ea (E/Ea) and late diastolic velocity (Aa) were significantly increased in OSA group. Although the mean peak late diastolic strain rate had not shown any differences, the LA mean peak systolic strain/strain rate, and mean peak early diastolic strain rate were significantly lower in the OSA group. Apnea-hypopnea index (AHI) of the OSA patients was significantly correlated with E/Ea (r=0.67, p<0.001). There is a significant correlation between LA active emptying volume index and E/Ea (r=0.77, p<0.001), and between LA passive emptying volume index and E/Ea (r=-0.51, p=0.009). CONCLUSION LA structural and functional remodeling was significantly correlated with the severity of OSA and LV diastolic filling pressure. OSA impaired LA wall compliance and passive contraction independent of obesity.
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Affiliation(s)
- Seong-Man Kim
- Division of Cardiology, Internal Medicine, Maryknoll Medical Center, Busan, Republic of Korea
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Choi BJ, Cho KI, Kim SM, Song YJ, Lee HG, Kim TI. Impact of right ventricular apical pacing and its frequency on left atrial function. J Cardiovasc Ultrasound 2012; 20:42-8. [PMID: 22509438 PMCID: PMC3324727 DOI: 10.4250/jcu.2012.20.1.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 02/14/2012] [Accepted: 02/16/2012] [Indexed: 12/29/2022] Open
Abstract
Background Right ventricular apical (RVA) pacing induces left ventricular (LV) dyssynchrony, increases the risk of persistent atrial fibrillation in the long term. The aim was to investigate the effects of RVA pacing on left atrial (LA) function, which are unknown. Methods Echocardiographic evaluation including LV dyssynchrony based on conventional Doppler, tissue Doppler imaging and speckle tracking strain echocardiography was done before and after (12 months) single-chamber ventricular pacemaker implantation in 40 patients with sick sinus syndrome. Patients were divided to 2 groups, according to the RVA pacing frequency (group I had higher pacing rate of more than 50% and group II, less than 50%). Results There was no significant difference in LV ejection fraction, however, mean global LV strain, myocardial performance index, and parameters of LV dyssynchrony had shown significant changes after 12 months of RVA pacing. There were also significant increase in the LA volume index and the reduction of peak systolic LA strain and strain rate (SR), peak early and late diastolic SR after RVA pacing. Moreover, there was significant deterioration of LV dyssynchrony and both LA and LV longitudinal function in even group II. LA functional deterioration and LA volume was significantly correlated with the frequency of RVA pacing. Conclusion LV dyssynchrony, induced by RVA pacing, significantly impaired active LA contraction and passive stretching, and these findings were shown in the patients with even less than 50% of RVA pacing. Impairment of LA strain/SR was significantly correlated with the frequency of RVA pacing.
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Affiliation(s)
- Byung-Joo Choi
- Division of Cardiology, Department of Internal Medicine, Ulsan Hospital, Ulsan, Korea
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Shin MS, Kim BR, Oh KJ, Bong JM, Chung WJ, Kang WC, Han SH, Moon CI, Ahn TH, Choi IS, Shin EK. Echocardiographic assessments of left atrial strain and volume in healthy patients and patients with mitral valvular heart disease by tissue Doppler imaging and 3-dimensional echocardiography. Korean Circ J 2009; 39:280-7. [PMID: 19949613 PMCID: PMC2771819 DOI: 10.4070/kcj.2009.39.7.280] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 02/24/2009] [Accepted: 03/10/2009] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives The purpose of the current study was to assess left atrial (LA) physiology in relation to associations between LA volume change and regional tissue velocities and strains, and to extend this information to patients with mitral stenosis (MS) or mitral regurgitation (MR). Subjects and Methods Twenty-two healthy persons, 22 patients with moderate-to-severe MS, and 22 patients with moderate-to-severe MR were studied. Tissue velocities, strains, and time-volume curves of the LA were acquired using tissue Doppler imaging and 3-dimensional echocardiography. Results In healthy controls, the maximal LA volume was negatively correlated with the posterior wall longitudinal systolic strain (r=-0.45, p=0.03). The time-to-maximal LA volume was positively correlated with the time-to-posterior wall longitudinal peak strain (r=0.46, p=0.03) and the time-to-circumferential peak strain (r=0.59, p=0.004). The LA active emptying fraction (LAactEF) was positively correlated with the posterior wall longitudinal peak systolic and late diastolic tissue velocities. In patients with MS, the maximal LA volume was negatively correlated with the posterior wall radial peak systolic velocity and the longitudinal late diastolic velocity. In patients with MS, the LAactEF had an additional positive correlation with the anterior wall longitudinal and circumferential systolic velocities, whereas the patients with MR had an additional positive correlation between the LAactEF and the lateral wall longitudinal peak strain as compared with the healthy cantrols. Conclusion LA longitudinal and circumferential deformations are more related than radial deformation to determining LA volume and function. The LA of patients with MS revealed a greater pathologic physiology than those of patients with MR.
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Affiliation(s)
- Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea
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Cho KI, Lee SH, Jang SH, Lee DW, Lee HG, Kim TI. Assessment of Left Atrial Function and Remodeling in Patients With Atrial Fibrillation by Performing Strain Echocardiography: A Prospective Study to Assess the Influence of Renin-Angiotensin System Inhibitors on Atrial Fibrillation. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.6.305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kyoung Im Cho
- Division of Cardiology, Maryknoll Medical Center, Busan, Korea
| | - Sang Hee Lee
- Division of Cardiology, Maryknoll Medical Center, Busan, Korea
| | - Sun Hee Jang
- Division of Cardiology, Maryknoll Medical Center, Busan, Korea
| | - Dong Won Lee
- Division of Cardiology, Maryknoll Medical Center, Busan, Korea
| | - Hyeon Gook Lee
- Division of Cardiology, Maryknoll Medical Center, Busan, Korea
| | - Tae Ik Kim
- Division of Cardiology, Maryknoll Medical Center, Busan, Korea
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Kim HJ, On YK, Sung J, Kim JH, Song YB, Lee WS, Choi JO, Shin DH, Cho SW, Choi JH, Hahn JY, Kim JS. Risk Factors for Predicting New-Onset Atrial Fibrillation in Persons Who Received Health Screening Tests. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.12.609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hak Jin Kim
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Keun On
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Hyung Kim
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wang-Soo Lee
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae-Hee Shin
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Won Cho
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyuck Choi
- Division of Cardiology, Department of Medicine, Dongsuwon Hospital, Suwon, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Soo Kim
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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