The left atrium: A reservoir and a witness for risk of symptoms and cardiovascular complications

Donal, Erwan; Galli, Elena; L'official, Guillaume

doi:10.1177/2047487319839542

Cited by 2 publications

(2 citation statements)

References 20 publications

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“…According to the recent guidelines, 18 the evaluation of RV performance plays a pivotal role in risk assessment in TR 10 , 19 ; however, the prognostic thresholds for RV functional parameters have not been clearly established. In practice, a comprehensive workup, including the atria, 20 , 21 , 22 , 23 ventricles, and pulmonary pressure, is needed. However, the multitude of indices describing right heart chambers and pulmonary circulation may pose some interpretational problems, thus affecting the final conclusions.…”

Section: Introductionmentioning

confidence: 99%

Isolated functional tricuspid regurgitation: how to define patients at risk for event?

et al. 2023

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Aims Functional tricuspid regurgitation (TR) is a turning point in cardiac diseases. Symptoms typically appear late. The optimal timing for proposing a valve repair remains a challenge. We sought to analyse the characteristics of right heart remodelling in patients with significant functional TR to identify the parameters that could be used in a simple prognostic model predicting clinical events. Methods and resultsWe designed a prospective observational French multicentre study including 160 patients with significant functional TR (effective regurgitant orifice area > 30 mm 2 ) and left ventricular ejection fraction > 40%. Clinical, echocardiographic, and electrocardiogram data were collected at baseline and at the 1 and 2 year follow-up. The primary outcome was all-cause death or hospitalization for heart failure. At 2 years, 56 patients (35%) achieved the primary outcome. The subset with events showed more advanced right heart remodelling at baseline, but similar TR severity. Right atrial volume index (RAVI) and the tricuspid annular plane systolic excursion to systolic pulmonary arterial pressure (TAPSE/sPAP) ratio, reflecting right ventricular-pulmonary arterial coupling, were 73 mL/m 2 and 0.40 vs. 64.7 mL/m 2 and 0.50 in the event vs. event-free groups, respectively (both P < 0.05). None among all the clinical and imaging parameters tested had a significant group × time interaction. The multivariable analysis leads to a model including TAPSE/sPAP ratio > 0.4 (odds ratio = 0.41, 95% confidence limit 0.2 to 0.82) and RAVI > 60 mL/m 2 (odds ratio = 2.13, 95% confidence limit 0.96 to 4.75), providing a clinically valid prognostic evaluation. Conclusions RAVI and TAPSE/sPAP are relevant for predicting the risk for event at 2 year follow-up in patients with an isolated functional TR.

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Section: Introductionmentioning

confidence: 99%

Isolated functional tricuspid regurgitation: how to define patients at risk for event?

et al. 2023

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“…This issue is at the moment largely unanswered, however the attempt to travel this very fascinating research pathway seems reasonable to us. The reservoir phase has been shown to be systematically impaired on the occasion of an episode of AF [4]. Moreover, after cardioversion of an episode of AF, the patients mostly prone to develop AF recurrences are just those with the most deteriorated reservoir atrial phase, identificated by means of speckle tracking echocardiography (STE) [5].…”

Section: Introductionmentioning

confidence: 99%

Favorable Effects of Sacubitril/Valsartan on the Peak Atrial Longitudinal Strain in Patients With Chronic Heart Failure and a History of One or More Episodes of Atrial Fibrillation: A Retrospective Cohort Study

Vecchis¹,

Paccone

Maio

2020

J Clin Med Res

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Background: The peak atrial longitudinal strain (PALS) is primarily an index of the reservoir function of atrial chambers. The conceptual basis exists to hypothesize that sacubitril/valsartan improves the expandability of atrial chambers in the reservoir phase of the atrial mechanical cycle, as a consequence of its effect of prolonging the half-life of natriuretic peptides. Therefore in this retrospective study we evaluated the repercussions of the administration of sacubitril/valsartan maintained for at least 12 months on the PALS. Methods: In our retrospective study a cohort of 40 patients treated with sacubitril/valsartan has been compared with a second cohort subjected to the conventional treatment with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker. A general criterion to be satisfied was the presence of at least one episode of atrial fibrillation (AF) in the history of the enrolled patients. The study population was composed of New York Heart Association (NYHA) class II/III chronic heart failure (CHF) patients, due to the fact that the treating physicians of the patients whose clinical records were used as source of data, complied with the international guidelines that have so far validated sacubitril/valsartan exclusively for the CHF therapy. The aims were to verify whether the 1-year administration of sacubitril/valsartan is effective in improving the PALS, and also ascertain whether the drug is associated with a decreased risk of AF relapses over a mean retrospective observation period of 12 months. Results: Sacubitril/valsartan cohort was proven to benefit from a significant increase in average values of PALS (median: 26.5%; in-terquartile range (IQR): 22%-30%), opposed to the much less pronounced increase in PALS found in the conventional therapy cohort (median: 22.5%; IQR: 18%-25.5%). Additionally, the comparison made by means of one-way analysis of variance regarding the mean changes of PALS values, outlined clearly that the sacubitril/valsartan users had an increase in PALS after 1 year of therapy significantly greater (P < 0.001) compared to the patients taking the conventional drugs. Moreover, a risk significantly higher of AF recurrences (P = 0.001) was identified in the conventional therapy group compared to the sacubitril/valsartan group during a 12-month retrospective observation period. Conclusions: In the present retrospective cohort study a higher increase of PALS has been shown in the cohort treated with sacubitril/valsartan. Moreover, a reduced risk of AF recurrences has been shown in the sacubitril/valsartan users compared to the patients with CHF subjected to conventional treatment.

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The left atrium: A reservoir and a witness for risk of symptoms and cardiovascular complications

Cited by 2 publications

References 20 publications

Isolated functional tricuspid regurgitation: how to define patients at risk for event?

Isolated functional tricuspid regurgitation: how to define patients at risk for event?

Favorable Effects of Sacubitril/Valsartan on the Peak Atrial Longitudinal Strain in Patients With Chronic Heart Failure and a History of One or More Episodes of Atrial Fibrillation: A Retrospective Cohort Study

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