Hypertension and atrial fibrillation: Evidence of progressive atrial remodeling with electrostructural correlate in a conscious chronically instrumented ovine model

Lau, Dennis H.; Mackenzie, Lorraine; Kelly, Darren J.; Psaltis, Peter J.; Brooks, A.; Worthington, Michael; Rajendram, Arumuga; Kelly, Douglas; Zhang, Yuan; Kuklik, Paweł; Nelson, Adam; Wong, Christopher X.; Worthley, Stephen G.; Rao, M. Mohan; Faull, Randall J.; Edwards, James; Saint, David A.; Sanders, Prashanthan

doi:10.1016/j.hrthm.2010.05.010

Cited by 160 publications

(106 citation statements)

References 30 publications

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“…3 The above is of no surprise because both large and small animal studies have clearly demonstrated the adverse effects of hypertension on abnormal atrial remodeling that include slow and heterogenous atrial conduction, increased interstitial fibrosis, and inflammation that result in increased atrial arrhythmogenicity. 4,5 Similar findings were seen from electroanatomical right atria mapping in chronically treated hypertensive patients with conduction slowing, areas of low-voltage and increased AF vulnerability. 6 It is important to note that these abnormal atrial changes have been shown to be reversible with blood pressure (BP) lowering therapy in a rat study.…”

supporting

confidence: 60%

Blood Pressure Control in Atrial Fibrillation

et al. 2017

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supporting

confidence: 60%

Blood Pressure Control in Atrial Fibrillation

et al. 2017

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“…Decreased LA strain implies the deterioration of LA compliance, which might be related to LA interstitial fibrosis and is a hallmark of structural remodeling of HT, 4) which induces AF. In models of AF, LA tissue contains fibrillar collagen, an expanded extracellular matrix, and a disorganized myocyte architecture.…”

Section: Discussionmentioning

confidence: 99%

“…Some large animal model studies have provided insights into atrial histological remodeling in HT. 3,4) An enlargement of LA is a common finding in patients with HT, indicating hypertensive heart disease. 5,6) Furthermore, many studies have reported that LA enlargement is strongly associated with the incidence of cardiovascular outcomes including the incidence of AF, heart failure, or stroke.…”

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confidence: 99%

Three-Dimensional Speckle Tracking Imaging for Assessing Left Atrial Function in Hypertensive Patients With Paroxysmal Atrial Fibrillation

et al. 2016

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SummaryHypertension (HT) is known to be the most prevalent risk factor for paroxysmal atrial fibrillation (PAF), however, its mechanisms have not been fully clarified. Our aim was to investigate the differences in left atrial (LA) function between healthy subjects, and hypertensive patients without PAF (HT-PAF(-)) and with PAF (HT-PAF(+)) using 3-dimensional (3D) speckle tracking imaging (STI). A total of 144 subjects were enrolled: 44 HT-PAF(+) (27 males; mean age 69 ± 10 years), 50 HT-PAF(-) (31 males; mean age 63 ± 11 years), and 50 controls (31 males; mean age 51 ± 14 years). All subjects were in sinus rhythm during the examination. LA volume, LA emptying fraction (LAEF), and LA wall strain were analyzed by 3D area tracking imaging. The maximal value of the global strain curve was defined as the peak global strain. The standard deviation of the time from the R-wave on the electrocardiogram to peak positive values of the segmental strain curves corrected by the R-R' interval in 6 mid LA segments (TP-SD) was calculated to assess LA dyssynchrony. LAEF and peak global strain were lower in HT-PAF(+) than in HT-PAF(-) (P < 0.01) and in the control (P < 0.01). Moreover, TP-SD was higher in HT-PAF(+) than in HT-PAF(-) (P < 0.05) and in the control (P < 0.01). Multivariate analysis revealed LA volume index, peak global strain, and TP-SD were independent determinants of HT-PAF(+). The presence of PAF is associated with diminished LA compliance and advanced mechanical dyssynchrony, as well as LA geometric deformation. (Int Heart J 2016; 57: 705-711) Key words: Three-dimensional echocardiography, Strain, Hypertension, Left atrium A trial fibrillation (AF) is the most common arrhythmia, and its frequency is increasing with the aging of populations. 1,2) Alterations in left atrial (LA) geometry and function, known as LA remodeling, often develop in AF. It is widely known that hypertension (HT) is a risk factor for developing AF and is often synergistically associated with it. Some large animal model studies have provided insights into atrial histological remodeling in HT.3,4) An enlargement of LA is a common finding in patients with HT, indicating hypertensive heart disease. 5,6) Furthermore, many studies have reported that LA enlargement is strongly associated with the incidence of cardiovascular outcomes including the incidence of AF, heart failure, or stroke. 7-9) A better understanding of atrial structure and function in patients with HT is crucial for predicting risk factors for and incidence of AF, as well as complications accompanying the disease.Speckle tracking imaging (STI) is a non-Doppler-based method for the objective quantification of regional myocardial function, independent of ultrasound beam direction. The feasibility of two-dimensional (2D-) STI for measuring LA deformation in patients with paroxysmal or persistent AF has been documented. [10][11][12] Three-dimensional (3D-) STI is thought to be preferable to 2D-STI because the ability of 3D-STI to track echo patterns in 3D-space would eliminate the prob...

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“…Although body mass index and blood lipids were modestly improved, the primary mechanism(s) driving the benefit of exercise may not be apparent from these measures alone and instead may come from the direct effects on autonomic factors and intrinsic electrophysiological measures that require invasive procedures for assessment. In animal and human studies, AF risk factors such as hypertension 16 and obesity 17 are associated with atrial remodeling, characterized by conduction slowing, low atrial voltages, and increased interstitial fibrosis. A key question that remains to be answered is whether exercise training can independently reverse atrial remodeling or whether its effects are mediated via other pathways.…”

Section: Circulationmentioning

confidence: 99%