Atrial Dysfunction in Patients With Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation

Reddy, Yogesh N.V.; Obokata, Masaru; Verbrugge, Frederik H.; Lin, Grace; Borlaug, Barry A.

doi:10.1016/j.jacc.2020.07.009

Cited by 212 publications

(200 citation statements)

References 36 publications

Supporting

Mentioning

190

Contrasting

Unclassified

Order By: Relevance

“…Few studies are related to the subject of atrial dysfunction in circumstances of AF in patients with HFpEF. For example, our study may seem complementary to the work of Reddy et al [ 22 ] which demonstrated the mechanical decline of LA function, resulting in AF, in patients with HFpEF. While the above mentioned study aimed to determine the consequence of LA dysfunction to emphasize the AF burden in HFpEF patients, the goal of our study was to find common LV/LA myocardial mechanics parameters, to demonstrate DD in patients with AF and associate these parameters with symptomatic HFpEF.…”

Section: Discussionsupporting

confidence: 79%

Left atrial minimal volume: association with diastolic dysfunction and heart failure in patients in sinus rhythm or atrial fibrillation with preserved ejection fraction

et al. 2021

View full text Add to dashboard Cite

Background Evidence of diastolic dysfunction (DD) required for the diagnosis of heart failure with preserved ejection fraction (HFpEF) is elusive in atrial fibrillation (AF). Left ventricular (LV) and left atrial (LA) speckle-tracking echocardiography (STE) may provide rhythm independent indications of DD. We aimed to find common LV/LA myocardial mechanics parameters to demonstrate DD, using STE in patients with AF. Methods 176 echocardiographic assessments of patients were studied retrospectively by STE. 109 patients with history of AF were divided in three groups: sinus with normal diastolic function (n = 32, ND), sinus with DD (n = 35, DD) and patients with AF during echocardiography (n = 42). These assessments were compared to 67 normal controls. Demographic, clinical, echocardiographic and myocardial mechanic characteristics were obtained. Results The patients with DD in sinus rhythm and patients with AF were similar in age, mostly women, and had cardiovascular risk factors as well as higher dyspnea prevalence compared to either controls or patients with ND. In the AF group, LV ejection fraction (LVEF) (p = 0.008), global longitudinal strain and LA emptying were lower (p < 0.001), whereas LA volumes were larger (p < 0.001) compared to the other groups. In a multivariable analysis of patients in sinus rhythm, LA minimal volume indexed to body surface area (Vmin-I) was found to be the single significant factor associated with DD (AUC 83%). In all study patients, Vmin-I correlated with dyspnea (AUC 80%) and pulmonary hypertension (AUC 90%). Conclusions Vmin-I may be used to identify DD and assist in the diagnosis of HFpEF in patients with AF.

show abstract

Section: Discussionsupporting

confidence: 79%

Left atrial minimal volume: association with diastolic dysfunction and heart failure in patients in sinus rhythm or atrial fibrillation with preserved ejection fraction

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Resulting From Age-Related Arial Fibrillation Is Associated With Increased Fibrosis Burden: Insights From a Clinical Study Combining With an in vivo Experiment Kai-bin Lin 1 † , Kan-kai Chen 1 † , Shuai Li 1 † , Ming-qi Cai 1 , Min-jie Yuan 1 , Yan-peng Wang 1 , Xue Zhang 1 , Meng Wei 1 , Mei-Ling Yan 2 , Xin-Xin Ma 3 , Dong-Yan Zheng 3 , Qi-han Wu 4 , Jing-bo Li 1 * and Dong Huang 1 * Background: Atrial fibrillation (AF) is increasingly considered an age-related degenerative disease, whose process is associated with the development of impaired left atrial (LA) performance. However, the subtle dynamic changes of LA performance in AF during aging have yet to be fully elucidated.…”

Section: Impaired Left Atrial Performancementioning

confidence: 99%

“…It was predicted that more than 8.3 million patients over the age of 60 will suffer from AF by the year 2030 in China ( 2 ). When AF is refractory and sustains with age, afflicted patients tend to develop severe left atrial (LA) dysfunction and heart failure with preserved ejection fraction ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Impaired Left Atrial Performance Resulting From Age-Related Arial Fibrillation Is Associated With Increased Fibrosis Burden: Insights From a Clinical Study Combining With an in vivo Experiment

Lin¹,

Chen²,

Li³

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Background: Atrial fibrillation (AF) is increasingly considered an age-related degenerative disease, whose process is associated with the development of impaired left atrial (LA) performance. However, the subtle dynamic changes of LA performance in AF during aging have yet to be fully elucidated. Atrial fibrosis is a key substrate for the development of AF, but the progression of fibrosis during aging and its relationship with LA dysfunction need to be further explored.Methods: A total of 132 control individuals and 117 persistent AF patients were prospectively studied. Subjects were further stratified into three age groups (age group 1: younger than 65 years, age group 2: between 65 and 79 years old, and age group 3: older than 80 years). The two-dimensional speckle tracking imaging was carried out for analyzing the alterations in LA function underlying LA remodeling, whereas electroanatomic mapping was performed to investigate LA fibrosis burden. In animal study, aged mice and young mice served as research subjects. Echocardiography and histological staining were used to assess LA performance and fibrosis burden, respectively.Results: Echocardiography showed progressive increases in LA dimension and LA stiffness index, and progressive decreases in LA global longitudinal strain and LA strain rates with advancing age in both AF and control cohorts, which was more prominent in AF cohort. Electroanatomic mapping showed progressive decrease in mean LA voltage and progressive increases in LA surface area, low-voltage area %, and LA volume with advancing age, whereas more significant alterations were observed in AF patients. Moreover, left atrial global longitudinal strain was positively correlated with mean LA voltage, whereas LA stiffness index was negatively related to mean LA voltage. In animal experiment, increased LA size and pulmonary artery dimension as well as longer P-wave duration and more prominent LA fibrosis were found in aged mice.Conclusions: This study provides new evidence of subtle changes in structure and performance of left atrium and their association with atrial fibrosis in both AF and non-AF subjects during physiological aging. In addition, our study also provides normal values for LA structure and performance in both AF and non-AF conditions during aging. These measurements may provide an early marker for onset of AF and LA adverse remodeling.

show abstract

“…ACM as a disease is not only related to the development and persistency of AF but also seems to play an important role in many cardiovascular pathologies such as heart failure with preserved ejection fraction (HFpEF) [29] and ischemic stroke [6]. Previous studies investigating LAS demonstrated not only an association between reduced LAS values and new-onset AF [12][13][14] and higher arrhythmia recurrence rates after PVI [15][16][17], but also an increased risk for HFpEF [38] and stroke [39]. These findings may also be explained by presence of ACM in the investigated patients, resulting in reduced LAS values, and may, therefore, extend the pathophysiological understanding of the above-mentioned cardiovascular diseases.…”

Section: Clinical Relevance Of Acm Diagnosismentioning

confidence: 99%

“…Recently, echocardiographic markers of left atrial (LA) function were reported to be associated with new-onset AF and arrhythmia recurrence following PVI [12][13][14][15][16][17] and may be useful for the diagnosis of ACM [18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Echocardiographic diagnosis of atrial cardiomyopathy allows outcome prediction following pulmonary vein isolation

et al. 2021

View full text Add to dashboard Cite

Background Relevant atrial cardiomyopathy (ACM), defined as a left atrial (LA) low-voltage area ≥ 2 cm2 at 0.5 mV threshold on endocardial contact mapping, is associated with new-onset atrial fibrillation (AF), higher arrhythmia recurrence rates after pulmonary vein isolation (PVI), and an increased risk of stroke. The current study aimed to assess two non-invasive echocardiographic parameters, LA emptying fraction (EF) and LA longitudinal strain (LAS, during reservoir (LASr), conduit (LAScd) and contraction phase (LASct)) for the diagnosis of ACM and prediction of arrhythmia outcome after PVI. Methods We prospectively enrolled 60 consecutive, ablation-naive patients (age 66 ± 9 years, 80% males) with persistent AF. In 30 patients (derivation cohort), LA-EF and LAS cut-off values for the presence of relevant ACM (high-density endocardial contact mapping in sinus rhythm prior to PVI at 3000 ± 1249 sites) were established in sinus rhythm and tested in a validation cohort (n = 30). Arrhythmia recurrence within 12 months was documented using 72-h Holter electrocardiograms. Results An LA-EF of < 34% predicted ACM with an area under the curve (AUC) of 0.846 (sensitivity 69.2%, specificity 76.5%) similar to a LASr < 23.5% (AUC 0.878, sensitivity 92.3%, specificity 82.4%). In the validation cohort, these cut-offs established the correct diagnosis of ACM in 76% of patients (positive predictive values 87%/93% and negative predictive values 73%/75%, respectively). Arrhythmia recurrence in the entire cohort was significantly more frequent in patients with LA-EF < 34% and LASr < 23.5% (56% vs. 29% and 55% vs. 26%, both p < 0.05). Conclusion The echocardiographic parameters LA-EF and LAS allow accurate, non-invasive diagnosis of ACM and prediction of arrhythmia recurrence after PVI. Graphic abstract

show abstract

Atrial Dysfunction in Patients With Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation

Cited by 212 publications

References 36 publications

Left atrial minimal volume: association with diastolic dysfunction and heart failure in patients in sinus rhythm or atrial fibrillation with preserved ejection fraction

Left atrial minimal volume: association with diastolic dysfunction and heart failure in patients in sinus rhythm or atrial fibrillation with preserved ejection fraction

Impaired Left Atrial Performance Resulting From Age-Related Arial Fibrillation Is Associated With Increased Fibrosis Burden: Insights From a Clinical Study Combining With an in vivo Experiment

Echocardiographic diagnosis of atrial cardiomyopathy allows outcome prediction following pulmonary vein isolation

Contact Info

Product

Resources

About