Left Atrial Strain Has Superior Prognostic Value to Ventricular Function and Delayed-Enhancement in Dilated Cardiomyopathy

Raafs, Anne; Vos, J. H.; Henkens, Michiel T.H.M.; Slurink, Bram O.; Verdonschot, Job A.J.; Bossers, Daan; Roes, Kit C. B.; Kundu, Chanakya Nath; Hazebroek, Mark; Nijveldt, Robin; Heymans, Stéphane

doi:10.1016/j.jcmg.2022.01.016

Cited by 53 publications

(26 citation statements)

References 32 publications

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“…In addition, the radiation dose delivered to the atrium may have caused structural changes in the atrium, such as fibrosis, and facilitate AF. Atrial fibrosis, remodeling, and myopathy can be visualized with cardiac magnetic resonance imaging . Prospective studies that use cardiac magnetic resonance imaging following thoracic RT may uncover the role of RT-induced structural changes in the development of AF.…”

Section: Discussionmentioning

confidence: 99%

Association of Sinoatrial Node Radiation Dose With Atrial Fibrillation and Mortality in Patients With Lung Cancer

Kim

Yang

et al. 2022

JAMA Oncol

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ImportanceAtrial fibrillation (AF) can develop following thoracic irradiation. However, the critical cardiac substructure responsible for AF has not been properly studied.ObjectiveTo describe the incidence of AF in patients with lung cancer and determine predictive cardiac dosimetric parameters.Design, Setting, and ParticipantsThis retrospective cohort study was performed at a single referral center and included 239 patients diagnosed with limited-stage small cell lung cancer (SCLC) and 321 patients diagnosed with locally advanced non–small cell lung cancer (NSCLC) between August 2008 and December 2019 who were treated with definitive chemoradiotherapy.ExposuresRadiation dose exposure to cardiac substructures, including the chambers, coronary arteries, and cardiac conduction nodes, were calculated for each patient.Main Outcomes and MeasuresMain outcomes were AF and overall survival.ResultsOf the 239 and 321 patients with SCLC and NSCLC, the median (IQR) age was 68 (60-73) years and 67 (61-75) years, and 207 (86.6%) and 261 (81.3%) were men, respectively. At a median (IQR) follow-up time of 32.7 (22.1-56.6) months, 9 and 17 patients experienced new-onset AF in the SCLC and NSCLC cohorts, respectively. The maximum dose delivered to the sinoatrial node (SAN Dmax) exhibited the highest predictive value for prediction of AF. A higher SAN Dmax significantly predicted an increased risk of AF in patients with SCLC (adjusted hazard ratio [aHR], 14.91; 95% CI, 4.00-55.56; P < .001) and NSCLC (aHR, 15.67; 95% CI, 2.08-118.20; P = .008). However, SAN Dmax was not associated with non-AF cardiac events. Increased SAN Dmax was significantly associated with poor overall survival in patients with SCLC (aHR, 2.68; 95% CI, 1.53-4.71; P < .001) and NSCLC (aHR, 1.97; 95% CI, 1.45-2.68; P < .001).Conclusions and RelevanceIn this cohort study, results suggest that incidental irradiation of the SAN during chemoradiotherapy may be associated with the development of AF and increased mortality. This supports the need to minimize radiation dose exposure to the SAN during radiotherapy planning and to consider close follow-up for the early detection of AF in patients receiving thoracic irradiation.

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Section: Discussionmentioning

confidence: 99%

Association of Sinoatrial Node Radiation Dose With Atrial Fibrillation and Mortality in Patients With Lung Cancer

Kim

Yang

et al. 2022

JAMA Oncol

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“…[ 6 , 43 ] In a prior study on patients with dilated cardiomyopathy, the LA conduit function was a predictor of a composite of sudden or cardiac death, heart failure hospitalization, and life-threatening arrhythmias. [ 44 ] In another investigation, the LA conduit function was a predictor of all-cause mortality and heart transplantation, and a composite of all-cause mortality, heart transplantation, heart failure readmission, and aborted sudden cardiac death. [ 45 ] In older adult subjects, the LA conduit function can augment accuracy in the prediction of death and heart failure with reduced or preserved EFs.…”

Section: Discussionmentioning

confidence: 99%

Correlation between Heart rate recovery and Left Atrial phasic functions evaluated by 2D speckle-tracking Echocardiography after Acute Myocardial infarction

Mashayekhi

Mohseni-Badalabadi

Hosseinsabet

et al. 2023

BMC Cardiovasc Disord

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Background Heart rate recovery (HRR) in the exercise test is the index of cardiac autonomic system function and sympathovagal balance impaired in patients with myocardial infarction (MI). An instance is left atrial (LA) phasic function, which is impaired in such patients. In this study, we investigated the role of HRR in predicting LA phasic functions in patients with MI. Methods The present study recruited 144 consecutive patients with ST-elevation MI. A symptom-limited exercise test was performed about 5 weeks after MI, with echocardiography conducted just before the exercise test. The patients were divided into abnormal and normal HRR at 60 s (HRR60) and again into abnormal and normal HRR at 120 s (HRR120) after the exercise test. LA phasic functions, evaluated by 2D speckle-tracking echocardiography, were compared between the 2 groups. Results Patients with abnormal HRR120 had lower LA strain values and strain rates during the reservoir, conduit, and contraction phases, while those with abnormal HRR60 had lower LA strain values and strain rates during the reservoir and conduit phases. The differences were lost after adjustments for possible confounders, except for LA strain and strain rate during the conduit phase, in patients with abnormal HRR120. Conclusions Abnormal HRR120 in the exercise test can independently predict decreased LA conduit function in patients with ST-elevation MI.

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“…Diastolic dysfunction has been independently associated with ventricular arrhythmias and mortality in other diseases, such as chronic renal failure, sickle cell anemia, and postcoronary bypass surgery. The majority of previous studies on LA strain analysis have focused on LAS (reservoir function), which provides incremental prognostic information in general and referral populations ( 32 , 33 ). Recently combined echocardiographic parameters, including LA compliance and LA stifness, were proposed for the evaluation of LV diastolic function and filling pressure ( 12 , 34 ) LA compliance refers to the ability of the LA to stretch and expand in response to an increase in blood volume.…”

Section: Discussionmentioning

confidence: 99%

Abnormal left atrial compliance is associated with a history of life-threatening arrhythmia in corrected Tetralogy of Fallot

Vautier

Mulet

Macquaire

et al. 2023

Front. Cardiovasc. Med.

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ObjectivesThe objectives of this study were to examine left atrial (LA) function and compliance using two-dimensional (2D) strain analysis in adult patients with corrected Tetralogy of Fallot (c-ToF) and to investigate the relationships between LA function and patient characteristics, especially history of life-threatening arrhythmia (h-LTA).MethodsFifty-one c-ToF patients (34 males; age, 39 ± 15 years; h-LTA, n = 13) were included in this retrospective monocenter study. In addition to a 2D standard echocardiography examination, 2D strain analysis was performed to assess left ventricular (LV) and LA functions, including peak-positive LA strain (LAS—reservoir function) and LA compliance [defined as the ratio LAS/(E/Ea)].ResultsPatients with h-LTA were older and exhibited a longer QRS duration. LV ejection fraction, LAS and LA compliance were significantly lower in the group of patients with h-LTA. Indexed LA and RA volumes, RV end-diastolic area was significantly higher and RV fractional area change significantly lower in the h-LTA group. LA compliance was the best echocardiographic predictor for h-LTA (AUC: 0.839; p < 0.001). Moderate inverted correlations were found between LA compliance and age and QRS duration. Among the echocardiographic parameters, LA compliance was moderately inversely correlated with RV end-diastolic area (r = −0.40, p = 0.01).ConclusionWe documented abnormal LAS and LA compliance values in adult c-ToF patients. Further study is needed to determine how best to incorporate LA strain, particularly LA compliance, into multiparametric predictive models for LTA in c-ToF patients.

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Left Atrial Strain Has Superior Prognostic Value to Ventricular Function and Delayed-Enhancement in Dilated Cardiomyopathy

Cited by 53 publications

References 32 publications

Association of Sinoatrial Node Radiation Dose With Atrial Fibrillation and Mortality in Patients With Lung Cancer

Association of Sinoatrial Node Radiation Dose With Atrial Fibrillation and Mortality in Patients With Lung Cancer

Correlation between Heart rate recovery and Left Atrial phasic functions evaluated by 2D speckle-tracking Echocardiography after Acute Myocardial infarction

Abnormal left atrial compliance is associated with a history of life-threatening arrhythmia in corrected Tetralogy of Fallot

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