Left Atrial Volume Combined With Atrial Pump Function Identifies Hypertensive Patients With a History of Paroxysmal Atrial Fibrillation

Abstract

Abstract-Identifying patients at high risk for the occurrence of atrial fibrillation is one means by which subsequent thromboembolic complications may be prevented. Left atrial enlargement is associated with progression of atrial remodeling, which is a substrate for atrial fibrillation, but impaired atrial pump function is also another aspect of the remodeling. Our objective was to differentiate patients with a history of paroxysmal atrial fibrillation using echocardiography. We studied 280 hypertensive patients (age: 66Ϯ7 years; left ventricular ejection fraction: 65Ϯ8%), including 140 consecutive patients with paroxysmal atrial fibrillation and 140 age-and sex-matched control subjects. Left atrial volume was measured using the modified Simpson method at both left ventricular end systole and preatrial contraction and was indexed to body surface area. Peak late-diastolic mitral annular velocity was measured during atrial contraction using pulsed tissue Doppler imaging as an atrial pump function. Left atrial volume index measured at left ventricular end systole had a 74% diagnostic accuracy and a 71% positive predictive value for identifying patients with paroxysmal atrial fibrillation; these values for the ratio of left atrial volume index at left ventricular end systole to the peak late-diastolic mitral annular velocity were 82% and 81%, respectively, and those for the ratio of left atrial volume index at preatrial contraction to the peak late-diastolic mitral annular velocity were 86% and 90%, respectively. In conclusion, left atrial size combined with atrial pump function enabled a more accurate diagnosis of a history of paroxysmal atrial fibrillation than conventional parameters. (Hypertension. 2010;55:1150-1156.)Key Words: hypertension Ⅲ echocardiography Ⅲ atrial fibrillation Ⅲ left atrium Ⅲ remodeling A trial fibrillation (AF) is not generally life threatening but is considered to be the most common cause of ischemic stroke, which often yields serious complications because of acute occlusion of intracranial arteries without collateral circulation. The incidence of stroke is increased by Ϸ5-fold in the presence of nonvalvular AF. [1][2][3][4][5] Moreover, recent studies have demonstrated that stroke risk is no less in patients with paroxysmal AF (PAF) than in those with persistent AF. 6 Therefore, it is crucial to identify patients who have PAF in order to prevent subsequent thromboembolic complications, especially in patients with hypertension, which is a major etiologic factor associated with both AF and stroke. [7][8][9] Left atrial (LA) enlargement associated with the progression of atrial structural remodeling plays a key role in the initiation and maintenance of AF. 10,11 The most recent recommendations for echocardiographic chamber quantification indicate that LA volume (LAV) provides an accurate measurement of asymmetrical remodeling of the LA chamber. 12 LAV is increased in patients with PAF 13 and is also an important predictor of cardiovascular outcome, including the occurrence of AF, 14 supporti...

The significance of the left atrial volume index in cardioversion success and its relationship with recurrence in patients with non-valvular atrial fibrillation subjected to electrical cardioversion: a study on diagnostic accuracy

“…Various clinical and echocardiographic studies have suggested that any diastolic dysfunction accompanying these parameters may affect the LA structure and function in a way to lead to atrial fibrillation and the recurrence of AF after the cardioversion (12)(13)(14). The echocardiographically determined LA size is known to be closely associated with the development of AF, and the LA size has been reported to be an independent predictor of the sinus rhythm restoration after the cardioversion (15,16). The moderate correlation observed between the LAVI and the energy level required for a successful ECV in our study, as well as the higher risk for the recurrence of the AF during the follow-up of the patients in which higher energy levels were needed in order to achieve the sinus rhythm, point to a relationship between the LAVI and the electrical instability.…”

Hypertension and atrial fibrillation: epidemiology, pathophysiology and therapeutic implications

“…In Framingham Heart Study, the duration of elevated BP as well as the level of systolic BP were associated with the development of left atrial dilatation. 24 Moreover, diastolic dysfunction, 25,26 left atrial enlargement and mechanical function, 27 and LVH 28 are all important predictors for the development of AF in patients with hypertension. On the other hand, the development of AF in hypertensive patients with left ventricular diastolic and/or systolic dysfunction can further worsen the left atrial enlargement, and thus increased the risk of AF recurrence.…”

Adjusted Left Atrial Emptying Fraction as a Predictor of Procedural Outcome after Catheter Ablation for Atrial Fibrillation

“…4 Furthermore, investigators have shown that evaluating LA pump function combined with LAV enables a more accurate diag nosis of paroxysmal AF (PAF) than do conventional values. 5,6 However, data are sparse concerning the role of functional LA remodeling in predicting procedural outcomes.Identifying the arrhythmic substrates and evaluating the structural and functional changes in the atria by means of noninvasive methods can be useful in selecting patients for rhythmcontrol therapy, including CA, early in the disease process.7 Mul tislice computed tomography (MSCT) is an accurate method for evaluating LAV, with low interobserver variability. In this study, we used MSCT to quantify LA pump function and structural changes before CA.…”

“…4 Furthermore, investigators have shown that evaluating LA pump function combined with LAV enables a more accurate diag nosis of paroxysmal AF (PAF) than do conventional values. 5,6 However, data are sparse concerning the role of functional LA remodeling in predicting procedural outcomes.…”