Pulmonary hypertension in stiff left atrial syndrome: pathogenesis and treatment in one

Maeder, Micha T.; Nägele, Reto; Rohner, Philipp; Weilenmann, Daniel

doi:10.1002/ehf2.12234

Cited by 7 publications

(7 citation statements)

References 10 publications

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“…One such change, the appearance of a prominent v‐wave, has routinely been ascribed to mitral valve insufficiency. As noted above, however, the LA pressure waveform arises from the interaction between LA and mitral valve function and can display a prominent v‐wave in response to not only mitral valve insufficiency, but also, as demonstrated previously, worsening of LA compliance . Through examination of a given LA waveform, including through the identification of a sharper v‐wave upstroke, relatively prominent a‐wave, and less drastic x‐ and y‐descents, an operator might distinguish an LA waveform with prominent v‐wave reflecting reduced LA compliance from another waveform similar in morphology but arising instead from severe mitral regurgitation alone (Figure ).…”

Section: Introductionmentioning

confidence: 86%

Hemodynamics rounds: Hemodynamics of mitral valve interventions

Lloyd

Rihal

Eleid

2020

Cathet Cardio Intervent

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Mitral valvulopathy presents as regurgitation, stenosis, or mixed disease and can occur in both native and prosthetic valves. Such disease develops in conjunction with pathophysiologic changes in the left atrium (LA) and drives changes in LA compliance, pressure, and thus clinical syndromes. With advances in the understanding and treatment of structural heart disease and in the setting of higher‐risk patient populations, less‐invasive transcatheter approaches have become increasingly commonplace in the treatment of mitral valve disease. Over time, transcatheter mitral valve interventions have evolved to include paravalvular leak closure, mitral valve repair, and mitral valve replacement. Parallel to this evolution, advances in invasive intracardiac pressure monitoring, particularly at the level of the LA, have also occurred. These advances emphasize the unique interplay between mitral valve disease and LA function; account for limitations of noninvasive assessment; and guide beneficial outcomes in each area of transcatheter mitral valve intervention. As a result, continuous transseptal LA pressure monitoring has developed into an indispensable instrument in successful percutaneous mitral valve intervention, complementing traditional noninvasive assessment.

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Section: Introductionmentioning

confidence: 86%

Hemodynamics rounds: Hemodynamics of mitral valve interventions

Lloyd

Rihal

Eleid

2020

Cathet Cardio Intervent

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“…Since this condition is relatively new, that data is largely limited to case reports and retrospective experiences. It has been associated with postcapillary pulmonary hypertension 76–79 …”

Section: Acm Catheter Ablation and Af Ablation Surgerymentioning

confidence: 99%

Atrial fibrillation and atrial cardiomyopathies

Baman

Cox

McCarthy

et al. 2021

Cardiovasc electrophysiol

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Atrial fibrillation (AF) is the most common arrhythmia among adults. While there have been incredible advances in the management of AF and its clinical sequelae, investigation of atrial cardiomyopathies (ACMs) is becoming increasingly more prominent. ACM refers to the electromechanical changes—appreciated subclinically and/or clinically—that underlie atrial dysfunction and create an environment ripe for the development of clinically apparent AF. There are several subtypes of ACM, distinguished by histologic features. Recent progress in cardiovascular imaging, including echocardiography with speckle‐tracking (e.g., strain analysis), cardiovascular magnetic resonance imaging (CMR), and atrial 4‐D flow CMR, has enabled increased recognition of ACM. Identification of ACM and its features carry clinical implications, including elevating a patient's risk for development of AF, as well as associations with outcomes related to catheter‐based and surgical AF ablation. In this review, we explore the definition and classifications of ACM, its complex relationship with clinical AF, imaging modalities, and clinical implications. We propose next steps for a more unified approach to ACM recognition that can direct further research into this complex field.

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“…Interestingly, a novel interventional strategy aimed at LA and LV depressurization in advanced diastolic heart failure by creating a controlled atrial septal defect [ 23 ] (“neo-ASD”) was recently applied, for the first time, to a patient with the stiff LA syndrome after 3 ablation procedures within the preceding 9 years, presenting as severe dyspnea and signs of right-sided congestion, refractory to diuretics [ 24 ]. This approach resulted in a significant clinical improvement [ 24 ], which was discussed by Maeder et al [ 25 ], who argued that a persistent post-puncture atrial septal defect was a likely explanation of only minor symptoms in their patient with the LA stiff syndrome after multiple ablations, in spite of a mean pulmonary wedge pressure of 24 mm Hg with large V-waves of 40 mm Hg.…”

Section: Stiff Left Atrial Syndrome – a Rare Complication Of Radiofrementioning

confidence: 99%

Left atrial compliance: an overlooked predictor of clinical outcome in patients with mitral stenosis or atrial fibrillation undergoing invasive management

Hrabia

Pogue

Zayachkowski

et al. 2018

pwki

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In the assessment of cardiovascular disease, the clinical significance of left atrial (LA) pressure-volume relations has largely been overlooked in contrast to left ventricular (LV) compliance. However, LA compliance has recently gained more attention. Net atrioventricular compliance (Cn), a joint measure of LA and LV compliance, can be calculated non-invasively by a previously validated method using parameters from standard echocardiography. Compliance measurement may be of relevance in selected clinical settings. First, subjects with low Cn are more likely to have their mitral valve area overestimated by the traditional mitral pressure half-time method. Consequently, low Cn in mitral stenosis, usually resulting from reduced LA compliance, can be mistaken for mild mitral stenosis. Second, low Cn independently predicted pulmonary hypertension and disease progression in medically treated mitral stenosis, and late cardiovascular complications after successful percutaneous mitral valvuloplasty. Decreased LA compliance also accounts for stiff LA syndrome, a rare complication of radiofrequency catheter ablation for atrial fibrillation, manifesting as otherwise unexplained heart failure with elevated LA pressure and pulmonary hypertension. Finally, depressed pre-ablation LA stiffness index, i.e. the ratio of the change in LA pressure to the corresponding change in LA volume during passive LA filling, was an independent predictor of arrhythmia recurrence. Thus, LA stiffening translates into adverse clinical outcomes in patients with mitral stenosis or atrial fibrillation undergoing interventional procedures. Whether reduced LA compliance after LA appendage occlusion can result in the LA stiff syndrome, has not been reported so far.

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Pulmonary hypertension in stiff left atrial syndrome: pathogenesis and treatment in one

Cited by 7 publications

References 10 publications

Hemodynamics rounds: Hemodynamics of mitral valve interventions

Hemodynamics rounds: Hemodynamics of mitral valve interventions

Atrial fibrillation and atrial cardiomyopathies

Left atrial compliance: an overlooked predictor of clinical outcome in patients with mitral stenosis or atrial fibrillation undergoing invasive management

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