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Wedin JO, Rodin S, Flachskampf FA, Simonson OE, Pallin J, Hörsne Malmborg J, James SK, Ståhle E, Grinnemo KH. Left atrial dysfunction in bicuspid aortic valve patients with severe aortic stenosis is associated with post-operative atrial fibrillation following aortic valve replacement. Eur Heart J Open 2024; 4:oeae020. [PMID: 38590529 PMCID: PMC11000824 DOI: 10.1093/ehjopen/oeae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/10/2024] [Accepted: 03/11/2024] [Indexed: 04/10/2024]
Abstract
Aims To investigate (i) the association between pre-operative left atrial (LA) reservoir strain and post-operative atrial fibrillation (AF) and (ii) the incidence of post-operative ischaemic stroke events separately in bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients after surgical aortic valve replacement for isolated severe aortic stenosis (AS). Methods and results We prospectively enrolled 227 patients (n = 133 BAV and n = 94 TAV) with isolated severe AS scheduled for aortic valve replacement. A comprehensive intra- and inter-observer validated pre-operative echocardiogram with an analysis of LA reservoir strain was performed. Post-operative AF was defined as a sustained (>30 s) episode of AF or atrial flutter. The timing of neurological events was defined in accordance with the Valve Academic Research Consortium-3 criteria for stroke. Post-operative AF occurred in 114 of 227 patients (50.2%), with no difference between BAV and TAV patients (48.1 vs. 53.1%, P = 0.452). Persisting post-operative AF at discharge was more frequent in BAV patients (29.7 vs. 8.0%, P = 0.005). Pre-operative LA reservoir strain was independently associated with post-operative AF (odds ratio = 1.064, 95% confidence interval 1.032-1.095, P < 0.001), with a significant interaction between LA reservoir strain and aortic valve morphology (Pinteraction = 0.002). The cumulative transient ischemic attack (TIA)/stroke incidence during follow-up was significantly higher in BAV patients (19.1 vs. 5.8% at 5 years). Conclusion Pre-operative LA function was associated with post-operative AF after aortic valve replacement in BAV AS patients, while post-operative AF in TAV AS patients likely depends on transient post-operative alterations and traditional cardiovascular risk factors. TIA/stroke during follow-up was more common in BAV AS patients.
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Affiliation(s)
- Johan O Wedin
- Department of Surgical Sciences, Uppsala University Hospital, entrance 70, 1st floor, SE-751 85 Uppsala, Sweden
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
| | - Sergey Rodin
- Department of Surgical Sciences, Uppsala University Hospital, entrance 70, 1st floor, SE-751 85 Uppsala, Sweden
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
| | - Frank A Flachskampf
- Department of Medical Sciences, Uppsala University Hospital, entrance 40, 5th floor, SE-751 85 Uppsala, Sweden
- Department of Clinical Physiology, Uppsala University Hospital, entrance 40, 5th floor, SE-751 85 Uppsala, Sweden
| | - Oscar E Simonson
- Department of Surgical Sciences, Uppsala University Hospital, entrance 70, 1st floor, SE-751 85 Uppsala, Sweden
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
| | - Johan Pallin
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
| | - Jonathan Hörsne Malmborg
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
| | - Stefan K James
- Department of Medical Sciences, Uppsala University Hospital, entrance 40, 5th floor, SE-751 85 Uppsala, Sweden
- Department of Cardiology, Uppsala University Hospital, entrance 40, 5th floor, SE-751 85 Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala Science Park, Hubben, Dag Hammarskjölds väg 38, SE-751 85 Uppsala, Sweden
| | - Elisabeth Ståhle
- Department of Surgical Sciences, Uppsala University Hospital, entrance 70, 1st floor, SE-751 85 Uppsala, Sweden
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
| | - Karl-Henrik Grinnemo
- Department of Surgical Sciences, Uppsala University Hospital, entrance 70, 1st floor, SE-751 85 Uppsala, Sweden
- Department of Cardiothoracic Surgery, Uppsala University Hospital, entrance 50, 4th floor, SE-751 85 Uppsala, Sweden
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2
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Pastore MC, Degiovanni A, Grisafi L, Renda G, Sozzani M, Giordano A, Salvatici C, Lorenz V, Pierfelice F, Cappelli C, De Donno F, Focardi M, Ricci F, Benedetto U, Gallina S, Cameli M, Patti G. Left Atrial Strain to Predict Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting. Circ Cardiovasc Imaging 2024; 17:e015969. [PMID: 38227692 DOI: 10.1161/circimaging.123.015969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/06/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery being associated with poorer outcomes. Revealing before the operation of left atrial subtle structural/functional abnormalities may help to identify patients at increased risk of POAF. We investigated the role of left atrial strain parameters by preoperative speckle tracking echocardiography as independent predictors of POAF in patients undergoing coronary artery bypass graft. METHODS Consecutive patients undergoing isolated coronary artery bypass graft were prospectively enrolled at three Italian centers. All patients underwent transthoracic echocardiography before the operation. The occurrence of POAF up to discharge was monitored. RESULTS Overall, a total of 310 patients were included. POAF was demonstrated in 103 patients (33%). At receiver operating characteristic curve analysis, lower global peak atrial longitudinal strain (PALS) values significantly predicted the risk of POAF (area under the curve, 0.74; P<0.001). The optimal cutoff value for the arrhythmia prediction was a global PALS value <28%, with a specificity of 86% and a sensitivity of 36%. The incidence of POAF was 51% in patients with global PALS <28% versus 14% in those with PALS ≥28% (P<0.001), with a POAF-free survival at Kaplan-Meier analysis of 45.4% and 85.7%, respectively (P<0.001). At multivariate analysis, a global PALS <28% carried a 3.6-fold higher risk of POAF (hazard ratio, 3.6 [95% CI, 2.2-5.9]; P<0.001). The risk increase was even higher when PALS <28% was associated with age ≥70 years (adjusted hazard ratio, 11.2 [4.7-26.6], P<0.001). CONCLUSIONS A presurgery global PALS <28% is a specific parameter to stratify patients at increased risk of POAF after coronary artery bypass graft. This assessment can be useful to identify patients at higher arrhythmic risk in whom perioperative preventive strategies and stricter monitoring aimed at early diagnosing and treating POAF may be applied.
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Affiliation(s)
- Maria Concetta Pastore
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena (M.C.P., C.S., M.F., M.C.)
| | - Anna Degiovanni
- Department of Cardio-Thoracic and Vascular Diseases, Maggiore della Carità Hospital, Novara (A.D., L.G., G.P.)
| | - Leonardo Grisafi
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
- Department of Cardio-Thoracic and Vascular Diseases, Maggiore della Carità Hospital, Novara (A.D., L.G., G.P.)
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Martina Sozzani
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
| | - Andrea Giordano
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
| | - Cosimo Salvatici
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena (M.C.P., C.S., M.F., M.C.)
| | - Veronica Lorenz
- Division of Cardio-Thoracic Surgery, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, Siena (V.L.)
| | - Francesca Pierfelice
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Clelia Cappelli
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Federica De Donno
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena (M.C.P., C.S., M.F., M.C.)
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Umberto Benedetto
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiac Surgery, SS. Annunziata Hospital, Chieti; Italy (U.B.)
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena (M.C.P., C.S., M.F., M.C.)
| | - Giuseppe Patti
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
- Department of Cardio-Thoracic and Vascular Diseases, Maggiore della Carità Hospital, Novara (A.D., L.G., G.P.)
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Drăgan A, Mateescu AD. Novel Biomarkers and Advanced Cardiac Imaging in Aortic Stenosis: Old and New. Biomolecules 2023; 13:1661. [PMID: 38002343 PMCID: PMC10669288 DOI: 10.3390/biom13111661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Currently, the symptomatic status and left ventricular ejection fraction (LVEF) play a crucial role in aortic stenosis (AS) assessment. However, the symptoms are often subjective, and LVEF is not a sensitive marker of left ventricle (LV) decompensation. Over the past years, the cardiac structure and function research on AS has increased due to advanced imaging modalities and potential therapies. New imaging parameters emerged as predictors of disease progression in AS. LV global longitudinal strain has proved useful for risk stratification in asymptomatic severe AS patients with preserved LVEF. The assessment of myocardial fibrosis by cardiac magnetic resonance is the most studied application and offers prognostic information on AS. Moreover, the usage of biomarkers in AS as objective measures of LV decompensation has recently gained more interest. The present review focuses on the transition from compensatory LV hypertrophy (H) to LV dysfunction and the biomarkers associated with myocardial wall stress, fibrosis, and myocyte death. Moreover, we discuss the potential impact of non-invasive imaging parameters for optimizing the timing of aortic valve replacement and provide insight into novel biomarkers for possible prognostic use in AS. However, data from randomized clinical trials are necessary to define their utility in daily practice.
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Affiliation(s)
- Anca Drăgan
- Department of Cardiovascular Anaesthesiology and Intensive Care, Emergency Institute for Cardiovascular Diseases “Prof Dr C C Iliescu”, 258 Fundeni Road, 022328 Bucharest, Romania
| | - Anca Doina Mateescu
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases “Prof Dr C C Iliescu”, 258 Fundeni Road, 022328 Bucharest, Romania;
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4
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Madsen CL, Park-Hansen J, Irmukhamedov A, Carranza CL, Rafiq S, Rodriguez-Lecoq R, Palmer-Camino N, Modrau IS, Hansson EC, Jeppsson A, Hadad R, Moya-Mitjans A, Greve AM, Christensen R, Carstensen HG, Høst NB, Dixen U, Torp-Pedersen C, Køber L, Gögenur I, Truelsen TC, Kruuse C, Sajadieh A, Domínguez H. The left atrial appendage closure by surgery-2 (LAACS-2) trial protocol rationale and design of a randomized multicenter trial investigating if left atrial appendage closure prevents stroke in patients undergoing open-heart surgery irrespective of preoperative atrial fibrillation status and stroke risk. Am Heart J 2023; 264:133-142. [PMID: 37302738 DOI: 10.1016/j.ahj.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/20/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Current recommendations regarding the use of surgical left atrial appendage (LAA) closure to prevent thromboembolisms lack high-level evidence. Patients undergoing open-heart surgery often have several cardiovascular risk factors and a high occurrence of postoperative atrial fibrillation (AF)-with a high recurrence rate-and are thus at a high risk of stroke. Therefore, we hypothesized that concomitant LAA closure during open-heart surgery will reduce mid-term risk of stroke independently of preoperative AF status and CHA2DS2-VASc score. METHODS This protocol describes a randomized multicenter trial. Consecutive participants ≥18 years scheduled for first-time planned open-heart surgery from cardiac surgery centers in Denmark, Spain, and Sweden are included. Both patients with a previous diagnosis of paroxysmal or chronic AF, as well as those without AF, are eligible to participate, irrespective of their CHA2DS2-VASc score. Patients already planned for ablation or LAA closure during surgery, with current endocarditis, or where follow-up is not possible are considered noneligible. Patients are stratified by site, surgery type, and preoperative or planned oral anticoagulation treatment. Subsequently, patients are randomized 1:1 to either concomitant LAA closure or standard care (ie, open LAA). The primary outcome is stroke, including transient ischemic attack, as assigned by 2 independent neurologists blinded to the treatment allocation. To recognize a 60% relative risk reduction of the primary outcome with LAA closure, 1,500 patients are randomized and followed for 2 years (significance level of 0.05 and power of 90%). CONCLUSIONS The LAACS-2 trial is likely to impact the LAA closure approach in most patients undergoing open-heart surgery. TRIAL REGISTRATION NCT03724318.
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Affiliation(s)
- Christoffer Læssøe Madsen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Park-Hansen
- Department of Cardiology, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Akhmadjon Irmukhamedov
- Department of Heart, Lung, and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Christian Lildal Carranza
- Department of Cardio-Thoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sulman Rafiq
- Department of Cardio-Thoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Ivy Susanne Modrau
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Emma C Hansson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rakin Hadad
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Anders Møller Greve
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Research, Research Unit of Rheumatology, University of Southern Denmark, Odense University Hospital, Denmark
| | - Helle Gervig Carstensen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Nis Baun Høst
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ulrik Dixen
- Department of Cardiology, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | | | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - Thomas Clement Truelsen
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Helena Domínguez
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark.
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Lisi M, Pastore MC, Fiorio A, Cameli M, Mandoli GE, Righini FM, Cavigli L, D'Ascenzi F, Focardi M, Rubboli A, Campo G, Mondillo S, Henein MY. Left Atrial Remodeling in Response to Aortic Valve Replacement: Pathophysiology and Myocardial Strain Analysis. Life (Basel) 2022; 12. [PMID: 36556439 DOI: 10.3390/life12122074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Severe aortic stenosis (AS) is the most common valve disease in the elderly and is associated with poor prognosis if treated only medically. AS causes chronic pressure overload, concentric left ventricular (LV) hypertrophy, myocardial stiffness, and diastolic dysfunction. This adverse remodeling also affects the left atrium (LA), which dilates and develops myocardial fibrosis, with a reduction in intrinsic function and a consequent high risk of the development of atrial fibrillation. Speckle-tracking echocardiography is able to detect myocardial dysfunction before other conventional parameters, such as LV ejection fraction, and also predict clinical outcomes. This review aims at describing LV and LA remodeling in AS and before and after aortic valve replacement and the usefulness of myocardial strain analysis in this clinical setting.
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6
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Benfari G, Mandoli GE, Magne J, Miglioranza MH, Ancona R, Luksic VR, Pastore MC, Santoro C, Michalski B, Malagoli A, Muraru D, Donal E, Cosyns B, Edvardsen T, Popescu BA, Cameli M; MASCOT investigators. Left atrial strain determinants and clinical features according to the heart failure stages. New insight from EACVI MASCOT registry. Int J Cardiovasc Imaging. [DOI: 10.1007/s10554-022-02669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/30/2022] [Indexed: 11/05/2022]
Abstract
AbstractFew studies analyzed left atrial (LA) peak atrial longitudinal strain (PALS) determinants, particularly across heart failure (HF) stages. We aimed to analyze the pathophysiological and clinical PALS correlates in a large multicentric prospective study. This is a multicenter prospective observational study enrolling 745 patients with HF stages. Data included PALS and left ventricular global longitudinal strain (LV-GLS). Exclusion criteria were: valvular prosthesis; atrial fibrillation; cardiac transplantation; poor acoustic window. Median global PALS was 17% [24–32]. 29% of patients were in HF-stage 0/A, 35% in stage-B, and 36% in stage-C. Together with age, the echocardiographic determinants of PALS were LA volume and LV-GLS (overall model R2 = 0.50, p < 0.0001). LV-GLS had the strongest association with PALS at multivariable analysis (beta: −3.60 ± 0.20, p < 0.0001). Among HF stages, LV-GLS remained the most important PALS predictor (p < 0.0001) whereas age was only associated with PALS in lower HF-stage 0/A or B (R = − 0.26 p < 0.0001, R = − 0.23 p = 0.0001). LA volume increased its association to PALS moving from stage 0/A (R = − 0.11; P = 0.1) to C (R = − 0.42; P < 0.0001). PALS was the single most potent echocardiographic parameter in predicting the HF stage (AUC for B vs. 0/A 0.81, and AUC vs. 0/A for C 0.76). PALS remained independently associated with HF stages after adjusting for ejection fraction, E/e′ ratio, and mitral regurgitation grade (p < 0.0001). Although influenced by LV-GLS and LA size across HF stages, PALS is incrementally and independently associated with clinical status. LA function may reflect a substantial part of the hemodynamic consequences of ventricular dysfunction.
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7
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Madsen CV, Park-Hansen J, Holme SJV, Irmukhamedov A, Carranza CL, Greve AM, Al-Farra G, Riis RGC, Nilsson B, Clausen JSR, Nørskov AS, Kruuse C, Truelsen TC, Dominguez H. Randomized Trial of Surgical Left Atrial Appendage Closure: Protection Against Cerebrovascular Events. Semin Thorac Cardiovasc Surg 2022; 35:664-672. [PMID: 35777693 DOI: 10.1053/j.semtcvs.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 01/31/2023]
Abstract
Following open-heart surgery, atrial fibrillation and stroke occur frequently. Left atrial appendage closure added to elective open-heart surgery could reduce the risk of ischemic stroke. We aim to examine if routine closure of the left atrial appendage in patients undergoing open-heart surgery provides long-term protection against cerebrovascular events independently of atrial fibrillation history, stroke risk, and oral anticoagulation use. Long-term follow-up of patients enrolled in the prospective, randomized, open-label, blinded evaluation trial entitled left atrial appendage closure by surgery (NCT02378116). Patients were stratified by oral anticoagulation status and randomized (1:1) to left atrial appendage closure in addition to elective open-heart surgery vs standard care. The primary composite endpoint was ischemic stroke events, transient ischemic attacks, and imaging findings of silent cerebral ischemic lesions. Two neurologists blinded for treatment assignment adjudicated cerebrovascular events. In total, 186 patients (82% males) were reviewed. At baseline, mean (standard deviation (SD)) age was68 (9) years and 13.4% (n = 25/186) had been diagnosed with atrial fibrillation. Median [interquartile range (IQR)] CHA2DS2-VASc was 3 [2,4] and 25.9% (n = 48/186) were receiving oral anticoagulants. Mean follow-up was 6.2 (2.5) years. The left atrial appendage closure group experienced fewer cerebrovascular events; intention-to-treat 11 vs 19 (P = 0.033, n = 186) and per-protocol 9 vs 17 (P = 0.186, n = 141). Left atrial appendage closure as an add-on open-heart surgery, regardless of pre-surgery atrial fibrillation and oral anticoagulation status, seems safe and may reduce cerebrovascular events in long-term follow-up. More extensive randomized clinical trials investigating left atrial appendage closure in patients without atrial fibrillation and high stroke risk are warranted.
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Affiliation(s)
- Christoffer V Madsen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark.
| | - Jesper Park-Hansen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Susanne J V Holme
- Department of Cardio-Thoracic Surgery, Copenhagen University Hospital - Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Akhmadjon Irmukhamedov
- Department of Heart, Lung, and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Christian L Carranza
- Department of Cardio-Thoracic Surgery, Copenhagen University Hospital - Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Anders M Greve
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Gina Al-Farra
- Department of Radiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Robert G C Riis
- Department of Radiology, Copenhagen University Hospital - Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
| | - Brian Nilsson
- Department of Cardiology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Johan S R Clausen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark
| | - Anne S Nørskov
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Thomas C Truelsen
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Helena Dominguez
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark
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8
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Dalos D, Haaser SS, Hofer F, Kazem N, Koller L, Hammer A, Steinlechner B, Laufer G, Hengstenberg C, Niessner A, Sulzgruber P. The Impact of Left Atrial Mechanics on Adverse Events and Clinical Outcome After Cardiac Surgery. Eur J Cardiothorac Surg 2022; 62:6583179. [PMID: 35536199 DOI: 10.1093/ejcts/ezac275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/12/2022] [Accepted: 05/06/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Post-operative atrial fibrillation (POAF) represents a common complication after cardiac surgery that is associated with unfavorable clinical outcome. Identifying patients at risk for POAF is crucial but challenging. This study aimed to investigate the prognostic potential of speckle tracking echocardiography (STE) on POAF and fatal adverse events from a long-term perspective. METHODS A total of 124 patients undergoing elective cardiac surgery were prospectively enrolled and underwent pre-operative STE. Patients were followed prospectively for the occurrence of POAF within the entire hospitalization and reaching the secondary end-points cardiovascular (CV) and all-cause mortality. RESULTS Within the study population 43.5% (n = 53) of enrolled individuals developed POAF. After a median follow-up of 3.9 years, 25 (20.2%) patients died. We observed that patients presenting with POAF had lower global peak atrial longitudinal strain (PALS) values compared to the non-POAF arm (POAF: 14.8% [95% CI : 10.9-17.8] vs non-POAF: 19.4% [95% CI : 14.8-23.5], p < 0.001). Moreover, global PALS was a strong and independent predictor for POAF (adjusted Odds Ratio per 1-SD: 0.37 [95% CI : 0.22-0.65], p < 0.001), and independently associated with mortality (adjusted Hazard Ratio per 1-SD: 0.63 [95% CI : 0.40-0.99], p = 0.048). CART analysis revealed a cut-off value of < 17% global PALS as high-risk for both POAF and mortality. CONCLUSION Global PALS is associated with the development of POAF following surgery in an unselected patient population undergoing CABG and/or valve surgery. Since patients with global PALS <17% face a poor long-term prognosis, routine assessment of global PALS needs to be considered in terms of proper secondary prevention in the era of personalized medicine.
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Affiliation(s)
- Daniel Dalos
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Sophie Selina Haaser
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Felix Hofer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Niema Kazem
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Lorenz Koller
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Andreas Hammer
- Department of Anesthesiology, Medical University of Vienna, Austria
| | - Barbara Steinlechner
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Austria
| | - Günther Laufer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
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9
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Sánchez FJ, Pueyo E, Diez ER. Strain Echocardiography to Predict Postoperative Atrial Fibrillation. Int J Mol Sci 2022; 23:ijms23031355. [PMID: 35163278 PMCID: PMC8836170 DOI: 10.3390/ijms23031355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/23/2022] [Accepted: 01/23/2022] [Indexed: 11/16/2022] Open
Abstract
Postoperative atrial fibrillation (POAF) complicates 15% to 40% of cardiovascular surgeries. Its incidence progressively increases with aging, reaching 50% in octogenarians. This arrhythmia is usually transient but it increases the risk of embolic stroke, prolonged hospital stay, and cardiovascular mortality. Though many pathophysiological mechanisms are known, POAF prediction is still a hot topic of discussion. Doppler echocardiogram and, lately, strain echocardiography have shown significant capacity to predict POAF. Alterations in oxidative stress, calcium handling, mitochondrial dysfunction, inflammation, fibrosis, and tissue aging are among the mechanisms that predispose patients to the perfect “atrial storm”. Manifestations of these mechanisms have been related to enlarged atria and impaired function, which can be detected prior to surgery. Specific alterations in the atrial reservoir and pump function, as well as atrial dyssynchrony determined by echocardiographic atrial strain, can predict POAF and help to shed light on which patients could benefit from preventive therapy.
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Affiliation(s)
| | - Esther Pueyo
- BSICOS Group, I3A, IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain;
- CIBER-BBN, 28029 Madrid, Spain
| | - Emiliano Raúl Diez
- Faculty of Medical Sciences, National University of Cuyo, Mendoza 5500, Argentina;
- Institute of Medical and Experimental Biology of Cuyo, IMBECU-UNCuyo-CONICET, Mendoza 5500, Argentina
- Correspondence: ; Tel.: +54-9-261-558-7632
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10
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Błażejowska E, Urbanowicz T, Gąsecka A, Olasińska-Wiśniewska A, Jaguszewski MJ, Targoński R, Szarpak Ł, Filipiak KJ, Perek B, Jemielity M. Diagnostic and Prognostic Value of miRNAs after Coronary Artery Bypass Grafting: A Review. Biology (Basel) 2021; 10:1350. [PMID: 34943265 PMCID: PMC8698870 DOI: 10.3390/biology10121350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 12/23/2022]
Abstract
MiRNAs are noncoding, 21-24 nucleotide-long RNA particles that control over 60% of genes. MiRNAs affect gene expression through binding to the 3'-untranslated region of messenger RNA (mRNA), thus inhibiting mRNA translation or inducing mRNA degradation. MiRNAs have been associated with various cardiovascular diseases, including heart failure, hypertension, left ventricular hypertrophy, or ischemic heart disease. In addition, miRNA expression alters during coronary artery bypass grafting (CABG) surgery, which could be used to predict perioperative outcomes. CABG is an operation in which complex coronary arteries stenosis is treated by bypassing atherosclerotic lesions with venous or arterial grafts. Despite a very low perioperative mortality rate and excellent long-term survival, CABG is associated with postoperative complications, including reperfusion injury, graft failure, atrial fibrillation and perioperative myocardial infarction. So far, no reliable diagnostic and prognostic tools to predict prognosis after CABG have been developed. Changes in the perioperative miRNA expression levels could improve the diagnosis of post-CABG myocardial infarction and atrial fibrillation and could be used to stratify risk after CABG. Herein, we describe the expression changes of different subtypes of miRNAs during CABG and review the diagnostic and prognostic utility of miRNAs in patients undergoing CABG.
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Affiliation(s)
- Ewelina Błażejowska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Tomasz Urbanowicz
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (T.U.); (A.O.-W.); (B.P.); (M.J.)
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Anna Olasińska-Wiśniewska
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (T.U.); (A.O.-W.); (B.P.); (M.J.)
| | - Miłosz J. Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, 80-211 Gdansk, Poland; (M.J.J.); (R.T.)
| | - Radosław Targoński
- 1st Department of Cardiology, Medical University of Gdansk, 80-211 Gdansk, Poland; (M.J.J.); (R.T.)
| | - Łukasz Szarpak
- Department of Clinical Sciences, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland; (Ł.S.); (K.J.F.)
| | - Krzysztof J. Filipiak
- Department of Clinical Sciences, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland; (Ł.S.); (K.J.F.)
| | - Bartłomiej Perek
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (T.U.); (A.O.-W.); (B.P.); (M.J.)
| | - Marek Jemielity
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (T.U.); (A.O.-W.); (B.P.); (M.J.)
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11
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Rossi A, Carluccio E, Cameli M, Inciardi RM, Mandoli GE, D'Agostino A, Biagioli P, Maffeis C, Pugliese NR, Pastore MC, Mengoni A, Pedrinelli R, Henein M, Dini FL. Left atrial structural and mechanical remodelling in heart failure with reduced ejection fraction. ESC Heart Fail 2021; 8:4751-4759. [PMID: 34726345 PMCID: PMC8712899 DOI: 10.1002/ehf2.13654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/13/2021] [Accepted: 10/01/2021] [Indexed: 01/20/2023] Open
Abstract
Aims In patients with heart failure with reduced ejection fraction (HFrEF), an association between left atrial (LA) dilatation and dysfunction is expected, but the degree of coexistence of the two abnormalities and their relative prognostic role is not known. Methods and results A total of 626 HFrEF patients formed the study population. All of them underwent a comprehensive echocardiographic evaluation. LA maximal volume was indexed to body surface area (LAVi); LA function was assessed using strain analysis during the reservoir phase: peak atrial longitudinal strain (PALS) analysis. Study primary endpoint was overall mortality or hospitalization for worsening heart failure. Four groups of patients were included in this study according to LAVi (≤34 or >34 mL/m2) and PALS (≤23% or >23%); 61 (10%) patients had normal LA volume and function (Group 1), 58 (9%) had LA dilatation but normal function (Group 2), 100 (16%) had normal volume but abnormal function (Group 3), and 407 (65%) had enlarged left atrium and abnormal function (Group 4). PALS was associated with primary endpoint in patients with both normal‐size [Groups 1 and 3: hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.88–0.96; P = 0.0006] and dilated left atria (Groups 2 and 4: HR 0.93, 95% CI 0.91–0.96; P < 0.0001). In contrast, LAVi was associated with the primary endpoint in patients with abnormal LA function (Groups 3 and 4: HR 1.018, 95% CI 1.011–1.024; P < 0.00001) but not in those with normal PALS (Groups 1 and 2: HR 1.023, 95% CI 0.99–1.057; P = 0.1). Conclusions Left atrial dilatation and dysfunction frequently but not invariably coexist. PALS emerged as a significant prognostic parameter in HFrEF even in the absence of LA dilation.
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Affiliation(s)
- Andrea Rossi
- Division of Cardiology, Azienda Ospedaliero Universitaria Verona, P.le Stefani 1, Verona, 37126, Italy
| | - Erberto Carluccio
- Cardiologia e Fisiopatologia Cardiovascolare, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Perugia, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Riccardo M Inciardi
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Paolo Biagioli
- Cardiologia e Fisiopatologia Cardiovascolare, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Perugia, Italy
| | - Caterina Maffeis
- Division of Cardiology, Azienda Ospedaliero Universitaria Verona, P.le Stefani 1, Verona, 37126, Italy
| | - Nicola R Pugliese
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Anna Mengoni
- Cardiologia e Fisiopatologia Cardiovascolare, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Perugia, Italy
| | - Roberto Pedrinelli
- Departmento di Patologia Chirurgica, Medica, Molecolare e dell' Area Critica University of Pisa, Pisa, Italy
| | - Michael Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Frank L Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
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12
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Maffeis C, Inciardi RM, Khan MS, Tafciu E, Bergamini C, Benfari G, Setti M, Ribichini FL, Cicoira M, Butler J, Rossi A. Determinants of exercise intolerance symptoms considered non-specific for heart failure in patients with stage A and B: role of the left atrium in the transition phase to overt heart failure. Int J Cardiovasc Imaging 2021; 38:103-112. [PMID: 34460024 PMCID: PMC8818638 DOI: 10.1007/s10554-021-02375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/04/2021] [Indexed: 11/08/2022]
Abstract
To assess to what extent left atrial (LA) structure and function are associated with non-specific heart failure symptoms, so that patients were classified as HF stage A and B. Mechanisms underlying the transition to overt HF in patients with stage A and B HF are unclear. Consecutive outpatients undergoing echocardiography and clinical evaluation and classified as HF stage A and B with preserved left ventricular ejection fraction (LVEF) were included. The association between LA measures [volume (LAVi), peak longitudinal-(PALS), contraction-(PACS) and conduit-strain] and non-specific HF symptoms was assessed using adjusted logistic regression analyses. The incremental value of atrial myopathy in symptoms prediction on top of clinical or echocardiographic confounders was assessed through ROC curves analyses. The cohort comprehended 185 patients (63 ± 16 years, 47% women) of whom 133 (72%) were asymptomatic, and 52 (28%) reported non-specific HF symptoms. After adjustment for clinical and echocardiographic confounders for HF symptoms, LAVi, PALS and PACS were associated with symptoms (p < 0.05). Among echocardiographic variables, only LA parameters were significantly associated with symptoms on top of clinical confounders (for LAVi OR [95% CI] 1.56 [1.21–2.00], p < 0.0001; for PALS 1.45 (1.10–1.91), p = 0.0009; for PACS 2.10 [1.33–3.30], p = 0.002). After adjustment for age, hypertension and COPD or E/E′, LV mass-i and mitral ERO, atrial myopathy added predictive value for symptoms presence compared to the clinical variables or echocardiographic parameters described (AUC increase 0.80 to 0.88, p = 0.004, and 0.79 to 0.84, p = 0.06, respectively). In patients with HF stages A–B and preserved LVEF, measures of LA structure and function were associated with non-specific HF symptoms. A comprehensive LA remodeling evaluation may help clinicians in the appropriate identification of overt HF.
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Affiliation(s)
- Caterina Maffeis
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Riccardo M Inciardi
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | | | - Elvin Tafciu
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Corinna Bergamini
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Martina Setti
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Mariantonietta Cicoira
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy.
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13
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Semeraro GC, Meroni CA, Cipolla CM, Cardinale DM. Atrial Fibrillation after Lung Cancer Surgery: Prediction, Prevention and Anticoagulation Management. Cancers (Basel) 2021; 13:cancers13164012. [PMID: 34439166 PMCID: PMC8394120 DOI: 10.3390/cancers13164012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Atrial fibrillation that occurs after surgery raises further questions with respect to spontaneous atrial fibrillation, being an event unquestionably related to the surgical act itself and always quite self-limiting. The purpose of this review is to present the knowledge gained so far, including the most recent findings, regarding this peculiar form of arrhythmia. Its prognostic impact and the possibility of predicting and preventing it were the subject of our analysis, as well as the similarities and differences with spontaneous atrial fibrillation in relation to anticoagulation. Where possible, the search for evidence has focused on studies involving lung cancer patients undergoing thoracic surgery, highlighting any differences with cardiac surgery. Abstract Atrial fibrillation (AF) is a common complication of the early postoperative period of various types of surgery, including that for lung cancer. Although induced by the homeostatic alterations related to surgery, there is evidence that it is not a mere stand-alone transitory event, but it represents a relevant complication of surgery, bearing considerable prognostic consequences. Different methods have therefore been explored to predict the occurrence of postoperative atrial fibrillation (POAF) and prevent it. In particular, the age among clinical factors, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), as a marker, have proven to be good predictors, and the use of beta-blockers or amiodarone in primary prevention seems to reduce its incidence significantly. There is growing evidence that POAF significantly increases the risk of stroke and global mortality in the long term; therefore, it should be managed in the same way as spontaneous atrial fibrillation. In this review, we will present the strongest evidence found so far and the most recent findings regarding the management of POAF, with a special focus on patients undergoing thoracic surgery for lung cancer.
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Affiliation(s)
| | - Carlo Ambrogio Meroni
- Cardiology Department, European Institute of Oncology, IRCCS, 20145 Milan, MI, Italy
| | - Carlo Maria Cipolla
- Cardiology Department, European Institute of Oncology, IRCCS, 20145 Milan, MI, Italy
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14
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Shahim B, Malaisrie SC, George I, Thourani VH, Biviano AB, Russo M, Brown DL, Babaliaros V, Guyton RA, Kodali SK, Nazif TM, Kapadia S, Pibarot P, McCabe JM, Williams M, Genereux P, Lu M, Yu X, Alu M, Webb JG, Mack MJ, Leon MB, Kosmidou I. Postoperative Atrial Fibrillation or Flutter Following Transcatheter or Surgical Aortic Valve Replacement: PARTNER 3 Trial. JACC Cardiovasc Interv 2021; 14:1565-1574. [PMID: 34294398 DOI: 10.1016/j.jcin.2021.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to assess the incidence and prognostic impact of early and late postoperative atrial fibrillation or flutter (POAF) in patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). BACKGROUND There is an ongoing controversy regarding the incidence, recurrence rate, and prognostic impact of early (in-hospital) POAF and late (postdischarge) POAF in patients with AS undergoing TAVR or SAVR. METHODS In the PARTNER (Placement of Aortic Transcatheter Valve) 3 trial, patients with severe AS at low surgical risk were randomized to TAVR or SAVR. Analyses were performed in the as-treated population excluding patients with preexistent atrial fibrillation or flutter. RESULTS Among 781 patients included in the analysis, early POAF occurred in 152 (19.5%) (18 of 415 [4.3%] and 134 of 366 [36.6%] following TAVR and SAVR, respectively). Following discharge, 58 new or recurrent late POAF events occurred within 1 year following the index procedure in 55 of 781 patients (7.0%). Early POAF was not an independent predictor of late POAF following discharge (odds ratio: 1.04; 95% CI: 0.52-2.08; P = 0.90). Following adjustment, early POAF was not an independent predictor of the composite outcome of death, stroke, or rehospitalization (hazard ratio: 1.10; 95% CI: 0.64-1.92; P = 0.72), whereas late POAF was associated with an increased adjusted risk for the composite outcome (hazard ratio: 8.90; 95% CI: 5.02-15.74; P < 0.0001), irrespective of treatment modality. CONCLUSIONS In the PARTNER 3 trial, early POAF was more frequent following SAVR compared with TAVR. Late POAF, but not early POAF, was significantly associated with worse outcomes at 2 years, irrespective of treatment modality.
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Affiliation(s)
- Bahira Shahim
- Cardiovascular Research Foundation, New York, New York, USA
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA
| | - Isaac George
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Vinod H Thourani
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Angelo B Biviano
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Mark Russo
- Division of Cardiac Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | | | | | | | - Susheel K Kodali
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Tamim M Nazif
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | | | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | | | | | - Philippe Genereux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Michael Lu
- Edwards Lifesciences, Irvine, California, USA
| | - Xiao Yu
- Edwards Lifesciences, Irvine, California, USA
| | - Maria Alu
- Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Ioanna Kosmidou
- Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA.
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15
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Kawczynski MJ, Gilbers M, Van De Walle S, Schalla S, Crijns HJ, Maessen JG, Schotten U, Maesen B, Bidar E. Role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation after cardiac surgery: a systematic review of the literature and meta-analysis. Europace 2021; 23:1731-1743. [PMID: 34000038 DOI: 10.1093/europace/euab095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/30/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS This systematic review and meta-analysis aims to evaluate the role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation (POAF) after cardiac surgery. METHODS AND RESULTS Electronic databases were searched for studies reporting on pre-operative echocardiographic predictors of POAF in PubMed, Cochrane library, and Embase. A meta-analysis of echocardiographic predictors of POAF that were identified by at least five different publications was performed. Forty-three publications were included in this systematic review. Echocardiographic predictors for POAF included surrogate parameters for total atrial conduction time (TACT), structural cardiac changes, and functional disturbances. Meta-analysis showed that prolonged pre-operative PA-TDI interval [5 studies, Cohen's d = 1.4, 95% confidence interval (CI) 0.9-1.9], increased left atrial volume indexed for body surface area (LAVI) (23 studies, Cohen's d = 0.8, 95% CI 0.6-1.0), and reduced peak atrial longitudinal strain (PALS) (5 studies, Cohen's d = 1.4, 95% CI 1.0-1.8), were associated with POAF incidence. Left atrial volume indexed for body surface was the most important predicting factor in patients without a history of AF. These parameters remained important predictors of POAF in heterogeneous populations with variable age and comorbidities such as coronary artery disease and valvular disease. CONCLUSION This meta-analysis shows that increased TACT, increased LAVI, and reduced PALS are valuable parameters for predicting POAF in the early post-operative phase in a large variety of patients.
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Affiliation(s)
- Michal J Kawczynski
- Department of Cardiothoracic Surgery, Heart and Vascular Centre Maastricht University Medical Centre, Professor Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Martijn Gilbers
- Department of Cardiothoracic Surgery, Heart and Vascular Centre Maastricht University Medical Centre, Professor Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Sophie Van De Walle
- Department of Cardiothoracic Surgery, Heart and Vascular Centre Maastricht University Medical Centre, Professor Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Simon Schalla
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Department of Cardiology, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Harry J Crijns
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Department of Cardiology, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Heart and Vascular Centre Maastricht University Medical Centre, Professor Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Ulrich Schotten
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Heart and Vascular Centre Maastricht University Medical Centre, Professor Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Heart and Vascular Centre Maastricht University Medical Centre, Professor Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Department of Physiology, Maastricht University, Maastricht, The Netherlands
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Weber J, Bond K, Flanagan J, Passick M, Petillo F, Pollack S, Robinson N, Petrossian G, Cao JJ, Barasch E. The Prognostic Value of Left Atrial Global Longitudinal Strain and Left Atrial Phasic Volumes in Patients Undergoing Transcatheter Valve Implantation for Severe Aortic Stenosis. Cardiology 2021; 146:489-500. [PMID: 33752215 DOI: 10.1159/000514665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The changes and the prognostic implications of left atrial (LA) volumes (LAV), LA function, and vascular load in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) are less known. METHODS We enrolled 150 symptomatic patients (mean age 82 ± 8 years, 58% female, and pre-TAVI aortic valve area 0.40 ± 0.19 cm/m2) with severe AS who underwent 2D transthoracic echocardiography and 2D speckle tracking echocardiography at average 21 ± 35 days before and 171 ± 217 days after TAVI. The end point was a composite of new onset of atrial fibrillation, hospitalization for heart failure and all-cause death (major adverse cardiac events [MACE]). RESULTS After TAVI, indexed maximal LA volume and minimum volume of the LA decreased by 2.1 ± 10 mL/m2 and 1.6 ± 7 mL/m2 (p = 0.032 and p = 0.011, respectively), LA function index increased by 6.8 ± 11 units (p < 0.001), and LA stiffness decreased by 0.38 ± 2.0 (p = 0.05). No other changes in the LA phasic volumes, emptying fractions, and vascular load were noted. Post-TAVI, both left atrial and ventricular global peak longitudinal strain improved by about 6% (p = 0.01 and 0.02, respectively). MACE was reached by 37 (25%) patients after a median follow-up period of 172 days (interquartile range, 20-727). In multivariable models, MACE was associated with both pre- and post-TAVI LA global peak longitudinal strain (hazard ratio [HR] 0.75, CI 0.59-0.97; and HR 0.77, CI 0.60-1.00, per 5 percentage point units, respectively), pre-TAVI LV global endocardial longitudinal strain (HR 1.37, CI 1.02-1.83 per 5 percentage point units), and with most of the LA phasic volumes. CONCLUSION Within 6 months after TAVI, there is reverse LA remodeling and an improvement in LA reservoir function. Pre- and post-TAVI indices of LA function and volume remain independently associated with MACE. Larger studies enrolling a greater diversity of patients may provide sufficient evidence for the utilization of these imaging biomarkers in clinical practice.
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Affiliation(s)
- Jonathan Weber
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Kristine Bond
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Joseph Flanagan
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Michael Passick
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Florentina Petillo
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Simcha Pollack
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Newell Robinson
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - George Petrossian
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - J Jane Cao
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA.,Health Sciences Center, Stony Brook University, Stony Brook, New York, USA
| | - Eddy Barasch
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA, .,Health Sciences Center, Stony Brook University, Stony Brook, New York, USA,
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Malagoli A, Rossi L, Zanni A, Sticozzi C, Piepoli MF, Benfari G. Refining the Role of Left Atrial Strain in Heart Failure with Reduced Ejection Fraction. J Am Soc Echocardiogr 2021; 34:804-805. [PMID: 33713782 DOI: 10.1016/j.echo.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Rossi
- Division of Cardiology, Department of Cardiology, ''Guglielmo da Saliceto'' Hospital, Piacenza, Italy
| | - Alessia Zanni
- Division of Cardiology, Department of Cardiology, ''Guglielmo da Saliceto'' Hospital, Piacenza, Italy
| | - Concetta Sticozzi
- Division of Cardiology, Department of Cardiology, ''Guglielmo da Saliceto'' Hospital, Piacenza, Italy
| | - Massimo Francesco Piepoli
- Division of Cardiology, Department of Cardiology, ''Guglielmo da Saliceto'' Hospital, Piacenza, Italy
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Sánchez FJ, Gonzalez VA, Farrando M, Baigorria Jayat AO, Segovia-Roldan M, García-Mendívil L, Ordovás L, Prado NJ, Pueyo E, Diez ER. Atrial Dyssynchrony Measured by Strain Echocardiography as a Marker of Proarrhythmic Remodeling and Oxidative Stress in Cardiac Surgery Patients. Oxid Med Cell Longev 2020; 2020:8895078. [PMID: 33456678 DOI: 10.1155/2020/8895078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 12/14/2022]
Abstract
Aging leads to structural and electrophysiological changes that increase the risk of postoperative atrial arrhythmias; however, noninvasive preoperative markers of atrial proarrhythmic conditions are still needed. This study is aimed at assessing whether interatrial dyssynchrony determined using two-dimensional speckle tracking echocardiography relates to proarrhythmic structural and functional remodeling. A cohort of 45 patients in sinus rhythm referred for cardiac surgery was evaluated by echocardiography and surface electrocardiogram the day before the intervention. Transmembrane potential, connexin, and potassium channel distribution, inflammatory, and nitrooxidative markers were measured from right atrial tissue obtained from patients. A difference greater than 40 milliseconds between right and left atrial free wall contraction confirmed the presence of interatrial dyssynchrony in 21 patients. No difference in relation with age, previous diseases, and 2-dimensional echocardiographic findings as well as average values of global longitudinal right and left atrial strain were found between synchronic and dyssynchronic patients. Postoperative atrial fibrillation incidence increased from 8.3% in the synchronic group to 33.3% in the dyssynchronic ones. P wave duration showed no difference between groups. Action potentials from dyssynchronous patients decreased in amplitude, maximal rate of depolarization, and hyperpolarized. Duration at 30% of repolarization increased, being markedly shorter at 90% of repolarization. Only the dyssynchronous group showed early and delayed afterdepolarizations. Atrial tissue of dyssynchronous patients displayed lateralization of connexin 40 and increased connexin 43 expression and accumulation of tumor necrosis factor-α in the intercalated disc. Tumor necrosis factor-α did not colocalize, however, with lateralized connexin 40. Nitroxidative marks and KATP channels increased perivascularly and in myocytes. Our results demonstrate that, as compared to a traditional surface electrocardiogram, the novel noninvasive echocardiographic evaluation of interatrial dyssynchrony provides a better identification of nonaged-related proarrhythmic atrial remodeling with increased susceptibility to postoperative atrial fibrillation.
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Cameli M, Miglioranza MH, Magne J, Mandoli GE, Benfari G, Ancona R, Sibilio G, Reskovic Luksic V, Dejan D, Griseli L, Van De Heyning CM, Mortelmans P, Michalski B, Kupczynska K, Di Giannuario G, Devito F, Dulgheru R, Ilardi F, Salustri A, Abushahba G, Morrone D, Fabiani I, Penicka M, Katbeh A, Sammarco G, Esposito R, Santoro C, Pastore MC, Comenale Pinto S, Kalinin A, Pičkure Ž, Ažman Juvan K, Zupan Mežnar A, Coisne A, Coppin A, Opris MM, Nistor DO, Paakkanen R, Biering-Sørensen T, Olsen FJ, Lapinskas T, Vaškelyté JJ, Galian-Gay L, Casas G, Motoc AI, Papadopoulos CH, Loizos S, Ágoston G, Szabó I, Hristova K, Tsonev SN, Galli E, Vinereanu D, Mihaila Baldea S, Muraru D, Mondillo S, Donal E, Galderisi M, Cosyns B, Edvardsen T, Popescu BA. Multicentric Atrial Strain COmparison between Two Different Modalities: MASCOT HIT Study. Diagnostics (Basel) 2020; 10:diagnostics10110946. [PMID: 33202837 PMCID: PMC7696899 DOI: 10.3390/diagnostics10110946] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 12/18/2022] Open
Abstract
Two methods are currently available for left atrial (LA) strain measurement by speckle tracking echocardiography, with two different reference timings for starting the analysis: QRS (QRS-LASr) and P wave (P-LASr). The aim of MASCOT HIT study was to define which of the two was more reproducible, more feasible, and less time consuming. In 26 expert centers, LA strain was analyzed by two different echocardiographers (young vs senior) in a blinded fashion. The study population included: healthy subjects, patients with arterial hypertension or aortic stenosis (LA pressure overload, group 2) and patients with mitral regurgitation or heart failure (LA volume–pressure overload, group 3). Difference between the inter-correlation coefficient (ICC) by the two echocardiographers using the two techniques, feasibility and analysis time of both methods were analyzed. A total of 938 subjects were included: 309 controls, 333 patients in group 2, and 296 patients in group 3. The ICC was comparable between QRS-LASr (0.93) and P-LASr (0.90). The young echocardiographers calculated QRS-LASr in 90% of cases, the expert ones in 95%. The feasibility of P-LASr was 85% by young echocardiographers and 88% by senior ones. QRS-LASr young median time was 110 s (interquartile range, IR, 78-149) vs senior 110 s (IR 78-155); for P-LASr, 120 s (IR 80-165) and 120 s (IR 90-161), respectively. LA strain was feasible in the majority of patients with similar reproducibility for both methods. QRS complex guaranteed a slightly higher feasibility and a lower time wasting compared to the use of P wave as the reference.
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Affiliation(s)
- Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (S.M.)
- Correspondence: ; Tel.: +39-0577585377
| | - Marcelo Haertel Miglioranza
- Institute of Cardiology, University Foundation of Cardiology, Porto Alegre 90620-000, Brazil; (M.H.M.); (L.G.)
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, F-87042, 87042 Limoges, France;
- Cardiology Department, INSERM U1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (S.M.)
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy;
| | - Roberta Ancona
- UOC Cardiologia/UTIC—“Santa Maria delle Grazie” Hospital Pozzuoli, 80078 Pozzuoli, Italy; (R.A.); @gmail.it (G.S.); (S.C.P.)
| | - Gerolamo Sibilio
- UOC Cardiologia/UTIC—“Santa Maria delle Grazie” Hospital Pozzuoli, 80078 Pozzuoli, Italy; (R.A.); @gmail.it (G.S.); (S.C.P.)
| | - Vlatka Reskovic Luksic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (V.R.L.); (D.D.)
| | - Dosen Dejan
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (V.R.L.); (D.D.)
| | - Leonardo Griseli
- Institute of Cardiology, University Foundation of Cardiology, Porto Alegre 90620-000, Brazil; (M.H.M.); (L.G.)
| | | | - Philippe Mortelmans
- Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium; (C.M.V.D.H.); (P.M.)
| | - Blazej Michalski
- Department of Cardiology, Medical University of Lodz, 91347 Lodz, Poland; (B.M.); (K.K.)
| | - Karolina Kupczynska
- Department of Cardiology, Medical University of Lodz, 91347 Lodz, Poland; (B.M.); (K.K.)
| | | | | | - Raluca Dulgheru
- Cardiology Department—Heart Valve Clinic—University Hospital Liege, B-4000 Liege, Belgium; (R.D.); (F.I.)
| | - Federica Ilardi
- Cardiology Department—Heart Valve Clinic—University Hospital Liege, B-4000 Liege, Belgium; (R.D.); (F.I.)
- Department of Advanced Biomedical Sciences, Federico II, University Hospital, 80131 Naples, Italy; (R.E.); (C.S.); (M.G.)
| | - Alessandro Salustri
- Non-Invasive Department, Heart Hospital—Hamad Medical Corporation, Doha 3050, Qatar; (A.S.); (G.A.)
| | - Galal Abushahba
- Non-Invasive Department, Heart Hospital—Hamad Medical Corporation, Doha 3050, Qatar; (A.S.); (G.A.)
| | - Doralisa Morrone
- Cardiothoracic and Vascular Department, Pisa University, 56126 Pisa, Italy; (D.M.); (I.F.)
| | - Iacopo Fabiani
- Cardiothoracic and Vascular Department, Pisa University, 56126 Pisa, Italy; (D.M.); (I.F.)
- Cardiologia e Medicina Cardiovascolare—Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Martin Penicka
- Cardiovascular Research Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (M.P.); (A.K.)
| | - Asim Katbeh
- Cardiovascular Research Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (M.P.); (A.K.)
| | - Giuseppe Sammarco
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35122 Padua, Italy; (G.S.); (D.M.)
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II, University Hospital, 80131 Naples, Italy; (R.E.); (C.S.); (M.G.)
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II, University Hospital, 80131 Naples, Italy; (R.E.); (C.S.); (M.G.)
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (S.M.)
| | - Salvatore Comenale Pinto
- UOC Cardiologia/UTIC—“Santa Maria delle Grazie” Hospital Pozzuoli, 80078 Pozzuoli, Italy; (R.A.); @gmail.it (G.S.); (S.C.P.)
| | - Artem Kalinin
- Department “Gailezers”, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (A.K.); (Z.P.)
| | - Žanna Pičkure
- Department “Gailezers”, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (A.K.); (Z.P.)
| | - Katja Ažman Juvan
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Anja Zupan Mežnar
- Cardiology Department, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Augustine Coisne
- Department of Clinical Physiology and Echocardiography—Heart Valve Clinic, Lille University Hospital, 59800 Lille, France; (A.C.); (A.C.)
| | - Amandine Coppin
- Department of Clinical Physiology and Echocardiography—Heart Valve Clinic, Lille University Hospital, 59800 Lille, France; (A.C.); (A.C.)
| | - Mihaela Maria Opris
- Institute for Emergency Cardiovascular Diseases and Transplant of Targu Mures, 540136 Targu Mures, Romania; (M.M.O.); (D.O.N.)
| | - Dan Octavian Nistor
- Institute for Emergency Cardiovascular Diseases and Transplant of Targu Mures, 540136 Targu Mures, Romania; (M.M.O.); (D.O.N.)
| | - Riitta Paakkanen
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, 00100 Helsinki, Finland;
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Copenhagen, Denmark; (T.B.-S.); (F.J.O.)
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Copenhagen, Denmark; (T.B.-S.); (F.J.O.)
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (T.L.); (J.J.V.)
| | - Jolanta Justina Vaškelyté
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (T.L.); (J.J.V.)
| | - Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.-G.); (G.C.)
| | - Guillem Casas
- Department of Cardiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.-G.); (G.C.)
| | - Andreea Iulia Motoc
- Centre for Cardiovascular Diseases, University Hospital of Brussels, B-1090 Brussels, Belgium; (A.I.M.); (B.C.)
| | | | - Savvas Loizos
- Korgialenio Benakio—Red Cross Hospital, 115 26 Athens, Greece; (C.H.P.); (S.L.)
| | - Gergely Ágoston
- Department of Family Medicine, University of Szeged, H-6725 Szeged, Hungary; (G.A.); (I.S.)
| | - Istvan Szabó
- Department of Family Medicine, University of Szeged, H-6725 Szeged, Hungary; (G.A.); (I.S.)
| | - Krasimira Hristova
- Department of Noninvasive Functional Diagnostic and Imaging, National Heart Hospital, 1309 Sofia, Bulgaria; (K.H.); (S.N.T.)
| | - Svetlin Netkov Tsonev
- Department of Noninvasive Functional Diagnostic and Imaging, National Heart Hospital, 1309 Sofia, Bulgaria; (K.H.); (S.N.T.)
| | - Elena Galli
- Centre Hospitalier Universitaire de Rennes, Inserm, University of Rennes, LTSI—UMR 1099, F-35000 Rennes, France; (E.G.); (E.D.)
| | - Dragos Vinereanu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila—Emergency and University Hospital, 050474 Bucharest, Romania; (D.V.); (S.M.B.)
| | - Sorina Mihaila Baldea
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila—Emergency and University Hospital, 050474 Bucharest, Romania; (D.V.); (S.M.B.)
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35122 Padua, Italy; (G.S.); (D.M.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (S.M.)
| | - Erwan Donal
- Centre Hospitalier Universitaire de Rennes, Inserm, University of Rennes, LTSI—UMR 1099, F-35000 Rennes, France; (E.G.); (E.D.)
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II, University Hospital, 80131 Naples, Italy; (R.E.); (C.S.); (M.G.)
| | - Bernard Cosyns
- Centre for Cardiovascular Diseases, University Hospital of Brussels, B-1090 Brussels, Belgium; (A.I.M.); (B.C.)
| | - Thor Edvardsen
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway;
- Faculty of Medicine, University of Oslo, 0315 Oslo, Norway
| | - Bogdan A. Popescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”—Euroecolab, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Sos. Fundeni 258, 022328 Bucharest, Romania;
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Öztürk C, Fasell T, Sinning JM, Werner N, Nickenig G, Hammerstingl C, Schueler R. Left atrial global function in chronic heart failure patients with functional mitral regurgitation after MitraClip. Catheter Cardiovasc Interv 2020; 96:678-684. [PMID: 32065722 DOI: 10.1002/ccd.28775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/07/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Left atrial (LA) volumes and function are believed to improve following interventional reduction of mitral regurgitation (MR) with MitraClip. However, exact LA alterations after MitraClip in patients with functional MR and functional mitral regurgitation (FMR) are unknown. OBJECTIVES We aimed to evaluate the effect of MitraClip on LA volumes and global function in patients with FMR and its importance for patients' prognosis. METHODS All patients underwent three-dimensionally transthoracic echocardiography with an offline evaluation of LA geometry and strain analysis at baseline and follow-up (FU). FU examinations were planned for 6 and 12 months after MitraClip. RESULTS We prospectively included 50 consecutive surgical high-risk (logistic EuroSCORE: 17.2 ± 13.9%) patients (77 ± 9 years, 22% female) with symptomatic moderate-to-severe to severe functional MR without atrial fibrillation. Echocardiographic evaluation showed that the E/E' ratio was significantly higher at FU (15.6 ± 7.3, 24.1 ± 13.2, p = .05) without relevant changes in systolic left ventricle (LV) function (p = .5). LA volumes (end-diastolic volume [LA-EDV] and end-systolic volume [LA-ESV]) (LA-EDV: 83.1 ± 39.5 ml, 115.1 ± 55.3 ml, p = .012; LA-ESV: 58.4 ± 33.4 ml, 80.1 ± 43.9 ml, p = .031), muscular mass (105.1 ± 49.3 g, 145.4 ± 70.6 g, p = .013), as well as LA stroke volume (24.6 ± 12.5 ml, 34.9 ± 19.1 ml, p = .016) significantly increased after the procedure. LA ejection fraction (LA-EF: 31.7 ± 12.8%, 31.1 ± 12.3%, p = .8) and atrial global strain (aGS: -10.8 ± 5.4%, -9.7 ± 4.45%, p = .4) showed no significant changes at FU. Despite no relevant changes during FU, the baseline aGS was found to be the strongest predictor for mortality and adverse interventional outcome. CONCLUSION MitraClip increases atrial stroke volume, atrial volumes, and muscular mass in patients with FMR. We found that the baseline aGS the strongest predictor for mortality, rehospitalization, and higher residual MR at FU.
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Affiliation(s)
- Can Öztürk
- Heart Center Bonn, Department of Cardiology, University of Bonn, Bonn, Germany
| | - Tamana Fasell
- Heart Center Bonn, Department of Cardiology, University of Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Heart Center Bonn, Department of Cardiology, University of Bonn, Bonn, Germany
| | - Nikos Werner
- Heart Center Bonn, Department of Cardiology, University of Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Cardiology, University of Bonn, Bonn, Germany
| | | | - Robert Schueler
- Contilia Heart and Vascular Center, Elisabeth Hospital, Essen, Germany
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Indja B, Woldendorp K, Vallely MP, Grieve SM. New Onset Atrial Fibrillation Following Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Heart Lung Circ 2020; 29:1542-1553. [PMID: 32327310 DOI: 10.1016/j.hlc.2020.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/20/2020] [Accepted: 03/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND New-onset atrial fibrillation (NOAF) is a well-recognised, although variably reported complication following surgical aortic valve replacement (SAVR). Rates of NOAF following transcatheter aortic valve implantation (TAVI) seem to be notably less than SAVR, even though this population is typically older and of higher risk. The aim of this study was to determine the prevalence of NOAF in both these populations and associated postoperative outcomes. METHODS We conducted a systematic review and meta-analysis of studies reporting rates of NOAF post SAVR or TAVI, along with early postoperative outcomes. Twenty-five (25) studies with a total of 13,010 patients were included in the final analysis. RESULTS The prevalence of NOAF post SAVR was 0.4 (95% CI 0.36-0.44) and post TAVI 0.15 (95% CI 0.11-0.18). NOAF was associated with an increased risk of postoperative cerebrovascular accident (CVA) for SAVR and TAVI (RR 1.44 95% CI 1.01-2.06 and RR 2.24 95% CI 1.46-3.45 respectively). NOAF was associated with increased mortality in the TAVI group (RR 3.02 95% CI 1.55-5.9) but not the SAVR group (RR 1.00, 95% CI 0.54-1.84). Hospital length of stay was increased for both TAVI and SAVR patients with NOAF (MD 2.54 days, 95% CI 2.0-3.00) and (MD 1.64 days, 95% CI 0.04-3.24 respectively). CONCLUSIONS The prevalence of NOAF is significantly less following TAVI, as compared to SAVR. While NOAF is associated with increased risk of postoperative stroke for both groups, for TAVI alone NOAF confers increased risk of early mortality.
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Affiliation(s)
- Ben Indja
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kei Woldendorp
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Michael P Vallely
- Division of Cardiac Surgery, The Ohio State University, Columbus, OH, USA
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Rizvi F, Mirza M, Olet S, Albrecht M, Edwards S, Emelyanova L, Kress D, Ross GR, Holmuhamedov E, Tajik AJ, Khandheria BK, Jahangir A. Noninvasive biomarker-based risk stratification for development of new onset atrial fibrillation after coronary artery bypass surgery. Int J Cardiol 2020; 307:55-62. [PMID: 31952855 DOI: 10.1016/j.ijcard.2019.12.067] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/02/2019] [Accepted: 12/30/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation (PoAF) is a common complication after cardiac surgery. A pre-existing atrial substrate appears to be important in postoperative development of dysrhythmia, but its preoperative estimation is challenging. We tested the hypothesis that a combination of clinical predictors, noninvasive surrogate markers for atrial fibrosis defining abnormal left atrial (LA) mechanics, and biomarkers of collagen turnover is superior to clinical predictors alone in identifying patients at-risk for PoAF. METHODS In patients without prior AF undergoing coronary artery bypass grafting, concentrations of biomarkers reflecting collagen synthesis and degradation, extracellular matrix, and regulatory microRNA-29s were determined in serum from preoperative blood samples and correlated to atrial fibrosis extent, alteration in atrial deformation properties determined by 3D speckle-tracking echocardiography, and AF development. RESULTS Of 90 patients without prior AF, 34 who developed PoAF were older than non-PoAF patients (72.04 ± 10.7 y; P = 0.043) with no significant difference in baseline comorbidities, LA size, or ventricular function. Global (P = 0.007) and regional longitudinal LA strain and ejection fraction (P = 0.01) were reduced in PoAF vs. non-PoAF patients. Preoperative amino-terminal-procollagen-III-peptide (PIIINP) (103.1 ± 39.7 vs. 35.1 ± 19.3; P = 0.041) and carboxy-terminal-procollagen-I-peptide levels were elevated in PoAF vs. non-PoAF patients with a reduction in miR-29 levels and correlated with atrial fibrosis extent. Combining age as the only significant clinical predictor with PIIINP and miR-29a provided a model that identified PoAF patients with higher predictive accuracy. CONCLUSIONS In patients without a previous history of AF, using age and biomarkers of collagen synthesis and regulation, a noninvasive tool was developed to identify those at risk for new-onset PoAF.
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Affiliation(s)
- Farhan Rizvi
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA.
| | - Mahek Mirza
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA
| | - Susan Olet
- Patient Centered Research, Advocate Aurora Research Institute, 960 N. 12th Street, Suite 4120, Milwaukee, WI 53233, USA
| | - Melissa Albrecht
- Aurora St. Luke's Medical Center School of Diagnostic Sonography, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Stacie Edwards
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA
| | - Larisa Emelyanova
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA
| | - David Kress
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA; and
| | - Gracious R Ross
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA
| | - Ekhson Holmuhamedov
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA; and
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA; and
| | - Arshad Jahangir
- Center for Integrative Research on Cardiovascular Aging (CIRCA), Advocate Aurora Research Institute, 960 N. 12th Street, Milwaukee, WI 53233, USA; Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA; and; Center for Advanced Atrial Fibrillation Therapies, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Suite 777, Milwaukee, WI 53215, USA.
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23
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Inciardi RM, Rossi A, Bergamini C, Benfari G, Maffeis C, Greco C, Drago A, Guazzi M, Ribichini FL, Cicoira M. Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics. Eur J Heart Fail 2019; 22:499-506. [PMID: 31793154 DOI: 10.1002/ejhf.1677] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 11/08/2022] Open
Abstract
AIMS To assess the association between mitral regurgitation (MR) and left atrial (LA) structural and functional remodelling and their effect on pulmonary haemodynamics. METHODS AND RESULTS Consecutive unselected patients undergoing comprehensive echocardiography were enrolled. Parameters of cardiac structure and function were obtained as well as mitral effective regurgitant orifice area (ERO) and estimation of pulmonary artery systolic pressure (PASP). Measures of LA structure [LA volume (LAV)] and function [peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS) and conduit strain (CS)] were also calculated. The study population included 102 patients (mean age 70 ± 14 years, 42% women), with a mean ejection fraction of 52 ± 13%. MR was classified as organic due to mitral valve prolapse in 14 patients (14%) and functional in 88 patients (86%). Mean ERO was 0.12 ± 0.12 cm2 and 86 patients (84%) had an ERO ≤0.2 cm2 . ERO was significantly associated with worse measures of LA structure and function. Despite the low burden of MR, the association remained significant after adjusting for clinical and echocardiographic confounders (β: 3.7, P = 0.022 for LAV; β: -3.0, P = 0.003 for PALS; β: -1.8, P = 0.027 for PACS) and was significantly related with functional MR (P for interaction <0.001). ERO was also significantly associated with PASP, and measures of LA function (PALS and PACS) significantly modified this relationship (P for interaction <0.001). CONCLUSIONS Even a mild degree of MR contributes to LA remodelling and this relationship plays an active role in pulmonary circulation, suggesting a potential mechanism by which these parameters contribute to the development of heart failure.
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Affiliation(s)
- Riccardo M Inciardi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Corinna Bergamini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Caterina Maffeis
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Carmen Greco
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Drago
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Marco Guazzi
- Cardiology Department, University of Milano School of Medicine, IRCCS Policlinico San Donato, Milan, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
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25
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Marques-Alves P, Marinho AV, Teixeira R, Baptista R, Castro G, Martins R, Gonçalves L. Going beyond classic echo in aortic stenosis: left atrial mechanics, a new marker of severity. BMC Cardiovasc Disord 2019; 19:215. [PMID: 31601185 PMCID: PMC6785856 DOI: 10.1186/s12872-019-1204-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/24/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is limited information regarding left atrial (LA) mechanics in aortic valve stenosis (AS). We assessed LA mechanics in AS through speckle-tracking echocardiography (STE) according to severity and prognosis. METHODS We included 102 patients diagnosed with severe AS (sAS) and 80 patients with moderate AS (mAS), all with preserved ejection fraction and no coronary artery disease. LA mechanics and left ventricular global longitudinal strain (LV-GLS) were assessed by STE. The cohort was followed-up for a median of 30 (IQR 12.6-50) months, and outcomes were determined (combined outcome of HF, death, and aortic valve replacement). RESULTS In our sample set, values of LV-GLS (- 18.5% vs - 17.1, p = 0.025), E/e' ratio (15.8 vs 18.4, p = 0.03), and global LA mechanics (LA ɛsys, 23% vs 13.8%, p < 0.001) were worse for sAS compared to those for mAS. However, LA ɛsys (AUC 0.85, 95% CI 0.78-0.90, p < 0.001), ɛe (AUC 0.83, 95% CI 0.75-0.88, p < 0.001), and ɛa (AUC 0.80, 95% CI 0.70-0.84, p < 0.001) were the best discriminators of sAS, with sensitivities higher than 85%. LA ɛsys showed a stronger correlation with both aortic valve area (r2 = 0.6, p < 0.001) and mean LV/aortic gradient (r2 = 0.55, p < 0.001) than LV-GLS (r2 = 0.3 and r2 = 0.25, p = 0.01). Either LV-GLS or LA ɛsys, but not the E/e' ratio, TAPSE, or RV/RA gradient, were a significant predictors of the combined outcome. CONCLUSIONS LA global strain was the best discriminator of severity, surpassing E/e' ratio and LV-GLS, and a significant predictor of prognosis in AS.
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Affiliation(s)
- Patrícia Marques-Alves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal. .,Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal.
| | - Ana Vera Marinho
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
| | - Rogério Teixeira
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal.,iCBR, Coimbra Institute for Clinical and Biomedical Research, Universidade de Coimbra, Coimbra, Portugal.,Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | - Rui Baptista
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal.,iCBR, Coimbra Institute for Clinical and Biomedical Research, Universidade de Coimbra, Coimbra, Portugal.,Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | - Graça Castro
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
| | - Rui Martins
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
| | - Lino Gonçalves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal.,iCBR, Coimbra Institute for Clinical and Biomedical Research, Universidade de Coimbra, Coimbra, Portugal.,Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
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Benfari G, Noni M, Onorati F, Cerrito L, Pernigo M, Vinco G, Cameli M, Mandoli G, Borio G, Geremia G, Zivelonghi C, Abbasciano R, Mazzali G, Zamboni M, Faggian G, Rossi A, Ribichini F. Effects of Aortic Valve Replacement on Left Ventricular Diastolic Function in Patients With Aortic Valve Stenosis. Am J Cardiol 2019; 124:409-415. [PMID: 31186115 DOI: 10.1016/j.amjcard.2019.04.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/13/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
The afterload increase imposed by severe aortic valve stenosis (AS) creates concentric left ventricular (LV) remodeling and diastolic dysfunction (DD), which are both markers of poor clinical outcome. Ideally, a correctly timed surgery for isolated AS can reverse the LV remodeling. However, data on LV DD after aortic valve replacement (AVR) are sparse and contrasting. Aims of the study are to define the markers of a favorable evolution of the DD at follow-up. Patients with severe isolated AS, scheduled for AVR were prospectively enrolled. Transthoracic echocardiography with DD assessment was performed before surgery, and at 12 months after surgery. Global LV longitudinal and circumferential strain, peak atrial longitudinal and contraction strain (PALS, PACS) were obtained at baseline. LV septal biopsy to assess fibrosis was performed at the time of AVR. Sixty-seven patients were enrolled, age 72 ± 8 years, 66% female, ejection fraction 61 ± 8%, E/e' 13 ± 6, PALS 23 ± 7%. Normal estimated left atrial pressure was detected in 19/67 (28%) versus 43/67 (64%) at follow-up (p <0.0001). In the 37 patients with biopsy available, fibrosis was 24 ± 12%. PALS and AS severity were correlated with LV fibrosis (R2 = 0.19; p = 0.006, and R2 = 0.15; p = 0.02, respectively). PALS (odds ratio: 1.19 [1.05 to 1.41], p = 0.02) and PACS (odds ratio: 1.24 [1.06 to 1.50], p = 0.006) were the only baseline noninvasive parameters independently associated with normal left atrial pressure at follow-up. Mean follow-up time was 791 ± 245 days, and 8 (12%) patients had cardiovascular events (death, hospital admission due to heart failure or ischemic disease, and onset of atrial fibrillation). Myocardial fibrosis (p = 0.05), baseline PALS (p = 0.004), and PACS (p = 0.03) were associated with cardiovascular events. In conclusion, LV diastolic function generally improves after AVR for severe AS. Baseline PALS, PACS, and LV fibrosis were related to the DD and clinical outcome at follow-up; these parameters might cue a better diastolic response to the afterload correction.
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Cameli M, Sciaccaluga C, Mandoli GE, D'Ascenzi F, Tsioulpas C, Mondillo S. The role of the left atrial function in the surgical management of aortic and mitral valve disease. Echocardiography 2019; 36:1559-1565. [PMID: 31260141 DOI: 10.1111/echo.14426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/06/2019] [Accepted: 06/07/2019] [Indexed: 01/21/2023] Open
Abstract
The right management of both mitral and aortic disease can be challenging, especially in asymptomatic patients. The current guidelines recommend valve repair or replacement when symptoms arise or when there is an evident left ventricular dysfunction. However, deciding the optimal surgical timing can be very difficult, since the line between the absence of symptoms and being minimally symptomatic, especially in the elderly, is blurred. Another relevant issue regards the second surgical criterion: operating on a patient with a reduced left ventricular ejection fraction or with a dilated left ventricle might jeopardize the possibility of a fully reverse remodeling of the heart after surgery. In this scenario, the left atrium might play an important role. In particular, left atrial deformation might be a very useful tool to detect early ultrastructural alterations, and help or support guiding a patient-tailored treatment at an early stage, optimizing the outcome in the long term.
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Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular Disease, University of Siena, Siena, Italy
| | | | - Giulia E Mandoli
- Department of Cardiovascular Disease, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Cardiovascular Disease, University of Siena, Siena, Italy
| | | | - Sergio Mondillo
- Department of Cardiovascular Disease, University of Siena, Siena, Italy
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Tadic M, Cuspidi C, Pencic B, Grassi G, Kocijancic V, Celic V. Left atrial phasic function in hypertensive patients with significant aortic stenosis and preserved ejection fraction. Hypertens Res 2019; 42:1200-8. [PMID: 30944414 DOI: 10.1038/s41440-019-0256-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/12/2019] [Accepted: 03/05/2019] [Indexed: 11/08/2022]
Abstract
The purpose of this investigation was to evaluate the influence of hypertension on left atrial (LA) function in patients with moderate and severe AS. This cross-sectional study included 121 patients with moderate and severe AS and preserved left ventricular (LV) ejection fraction ( > 50%) and 79 age-matched controls who underwent a comprehensive echocardiographic examination. LA phasic function was determined by both volumetric and strain methods. Our findings showed that the LV ejection fraction was similar between hypertensive and normotensive AS patients. Maximal, minimal, and pre-A LA volume indexes gradually increased from controls to moderate-to-severe AS patients. The total, passive and active LA emptying fraction (EF) gradually decreased in the same direction. LA phasic function estimated with strain analysis showed that reservoir, conduit, and pump LA phasic functions were lower in all AS patients than in normotensive controls. However, there was no significant difference between moderate and severe AS except in LA pump function, which was lower in severe AS. Differences in LA phasic function were more prominent in volumetric than in strain analyses. Blood pressure, LV mass index, and AS severity were independent of other clinical and echocardiographic parameters associated with LA phasic function in patients with AS. In conclusion, hypertension has an additive impact on LA phasic function in patients with moderate and severe AS. Blood pressure and AS severity were independently associated with LA phasic function parameters in AS patients. Volumetric assessment of LA phasic function should not be completely replaced with strain analysis.
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Mateescu AD, Călin A, Beladan CC, Roşca M, Enache R, Băicuş C, Botezatu S, Ginghină C, Popescu BA. Left Atrial Dysfunction as an Independent Correlate of Heart Failure Symptoms in Patients With Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction. J Am Soc Echocardiogr 2019; 32:257-66. [DOI: 10.1016/j.echo.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Indexed: 11/17/2022]
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Sener Y, Okşul M, Hekimsoy V. Risk factors for postoperative atrial fibrillation. Indian J Anaesth 2019; 63:511. [PMID: 31263312 PMCID: PMC6573055 DOI: 10.4103/ija.ija_858_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Abstract
PURPOSE OF REVIEW We provide an updated review on the incidence of postoperative atrial fibrillation (POAF) after cardiac surgery as determined by enhanced cardiac rhythm monitoring technology and provide a rationale for why a more aggressive detection approach for POAF may be clinically useful. RECENT FINDINGS Most of the published literature had focused on the in-hospital incidence of POAF after cardiac surgery. However, recent studies using continuous cardiac rhythm technologies revealed that the incidence of POAF during the postdischarge, subacute (<1 month) phase could be as high as 28%. This is a clinically relevant finding since that POAF is linked with occurrence of future, 'late' atrial fibrillation, and adverse clinical outcomes even beyond 1 year after cardiac surgery. Furthermore, the role of oral anticoagulation is still not well established for cardiac surgical patients with POAF because of lack of randomized trials specifically designed for this patient population. SUMMARY Emerging data suggest that POAF after cardiac surgery is not a transient, self-resolving phenomenon. Rather, its occurrence is associated with future risk of atrial fibrillation and long-term adverse outcomes such as stroke and death. This highlights the potential importance of enhanced cardiac rhythm monitoring to refine prognostic stratification in this high-risk patient population.
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