Pulmonary Vein Enlargement as an Independent Predictor for New-Onset Atrial Fibrillation

Abstract

Pulmonary vein (PV) enlargement is associated with atrial fibrillation (AF). However, the predictive value of PV volume for new-onset AF has not been determined. We retrospectively assessed and enrolled non-AF subjects who underwent echocardiography and cardiac CT angiography (CCTA) around the same time and evaluated the development of AF longitudinally. PV volume was assessed by estimating the three-dimensional CCTA-derived mid-diastolic PV volume from the ostium to tertiary branches. Overall, 1105 subjects were enrolled. Among them, 29 developed AF during a mean follow-up of 4.28 ± 3.08 years after baseline CCTA and echocardiography. The AF group had a higher proportion of older aged subjects, a higher ratio of early mitral flow velocity (E) to early mitral annular tissue velocity (Em), higher Em, and larger left atrial (LAVI) and PV (PVVI) volume indices. PVVI was independently associated with male sex, left ventricular dimension, E/Em and LAVI. AF incidence increased markedly across each baseline PVVI tertile (2.2%, 5.1%, and 10.8%). In the multivariate Cox model, increased PVVI was independently associated with new-onset AF (hazard ratio (HR) = 5.401, 4.931–6.193, p = 0.007). Based on the analysis of multimodal cardiac imaging, our results provide mechanistic insights into PV remodeling and its potential role as a link between diastolic dysfunction and developing AF.

Role of pulmonary circulation assessment in CT imaging in evaluating the severity and tendency of severe and critical COVID-19 pneumonia

“…We proposed that the dilation of PV was a predictor of poor clinical outcomes. The dilation of PV is seen in pulmonary congestion caused by increased pulmonary venous return and left heart insu ciency [18,19]. Pulmonary in ammation leads to congestion of the lung tissue, which has been reported in the early studies.…”

Large Right Pulmonary Vein Is a Predictor of Atrial Fibrillation Recurrence after Pulmonary Vein Isolation in Patients with Persistent Atrial Fibrillation

“…In persistent AF, RPAV was signi cantly larger in the group with recurrent AF after PVI. Previous studies have reported the relationship between AF and PV volume [22][23][24][25] . However, this is the rst to report a relationship between large RPAV and recurrent AF after PVI.…”

Putative protective effects of sodium-glucose cotransporter 2 inhibitors on atrial fibrillation through risk factor modulation and off-target actions: potential mechanisms and future directions

“…Significant dilation of both superior pulmonary veins and the left atrium reportedly occurs in patients with atrial fibrillation [ 109 ]. Accordingly, the incidence of AF is related to pulmonary vein volume index [ 110 ]. Thus, the structure and function of the left atrium are directly impacted by left ventricular filling pressure.…”