The Prognostic Value of Left Atrial Peak Reservoir Strain in Acute Myocardial Infarction Is Dependent on Left Ventricular Longitudinal Function and Left Atrial Size

Ersbøll, Mads; Andersen, Mads J.; Valeur, Nana; Mogensen, Ulrik M.; Waziri, Homa; Møller, Jacob Eifer; Hassager, Christian; Søgaard, Peter; Køber, Lars

doi:10.1161/circimaging.112.978296

Cited by 136 publications

(46 citation statements)

References 30 publications

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“…[311][312][313][314][315][316] In the absence of MVD, an increase in LA size most commonly reflects increased wall tension as a result of increased LA pressure, [317][318][319][320] as well as impairment in LA function secondary to atrial myopathy. 321,322 A clear relationship exists between an enlarged LA and the incidence of atrial fibrillation and stroke, [323][324][325][326][327][328][329][330][331][332] risk for overall mortality after myocardial infarction, 321,322,333,334 risk for death and hospitalization in patients with dilated cardiomyopathy, [335][336][337][338][339][340][341][342][343][344] and major cardiac events or death in patients with diabetes mellitus. 345 left atrium enlargement is a marker of both the severity and chronicity of diastolic dysfunction and magnitude of LA pressure elevation.…”

Section: Imaging Techniques To Detect Atrial Cardiomyopathies Mappingmentioning

confidence: 99%

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

et al. 2016

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Section: Imaging Techniques To Detect Atrial Cardiomyopathies Mappingmentioning

confidence: 99%

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

et al. 2016

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“…Another multivariate model with the addition of GLS was designed because GLS is closely associated with albuminuria and LA longitudinal extension. 16, 24 The inter-and intra-observer variabilities for GLS and LA assessments were determined by intra-class correlation coefficient from 20 randomly selected patients.…”

Section: Echocardiographymentioning

confidence: 99%

Impaired Mechanics of Left Ventriculo-Atrial Coupling in Patients With Diabetic Nephropathy

Mochizuki

Tanaka

Matsumoto

et al. 2016

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp nephropathy has been identified as independently associated with LVSD in asymptomatic DM patients with preserved LVEF. 13- 15 We recently focused our research especially on the interaction of albuminuria and LVSD in such patients, 16 and as a result consider albuminuria to be the primary mediator of myocardial fibrosis by suppression of collagen turnover via impaired crosslinking of collagen. However, the effect of albuminuria on LA function in asymptomatic DM patients with preserved LVEF remains unknown.Accordingly, the aim of this study was to investigate the effect of diabetic nephropathy on LA function, as assessed by 2D speckle-tracking strain echocardiography in asymptomatic DM patients with preserved LVEF. We also evaluated the relationship between LVSD and LA function in these patients.iabetes mellitus (DM) is considered to be one of the most significant causes of left atrial (LA) remodeling as well as left ventricle (LV) longitudinal systolic myocardial dysfunction (LVSD), which can increase risk of development of heart failure with preserved ejection fraction (EF) or atrial fibrillation (AF) even in asymptomatic DM patients with preserved LVEF. 1,2 In fact, it has been reported by several epidemiological researchers that DM duration and poor glycemic control contribute to the morbidity of AF, 3-5 and this relationship has been further substantiated by pathological evidence of LA fibrosis and remodeling in diabetic rats. 6,7 The recent use of speckle-tracking strain imaging has made it possible to quantify detailed aspects of LA function such as reservoir, conduit and contractile function even before structural remodeling occurs. 8 In addition, DM-related complications have been found to play an important role in the development of diabetic cardiomyopathy, 9-12 and diabetic Background: Diabetic nephropathy is independently associated with longitudinal systolic dysfunction of the left ventricle (LV) in asymptomatic diabetes mellitus (DM) patients with preserved LV ejection fraction (LVEF). However, the effect of diabetic nephropathy on left atrial (LA) function remains unknown.

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“…The sheer number of measures of LA function (.20) generates confusion and hinders comparability of published studies. The reproducibility of these measures may also be an issue that threatens the robustness of these B (Asymptomatic structural heart disease) † LA peak reservoir strain measured within 48 h of admission for acute myocardial infarction is associated with the composite outcome of death and HF 13 † LA function independently predicts HF hospitalization among patients with coronary artery disease and preserved LVEF 14 † LA pump function is the strongest predictor of major adverse cardiac events and all-cause mortality in patients with chronic hypertension 15 † LAEF is associated with risk of new-onset AF independent of clinical risk factors, LV systolic/diastolic function, and LA volume in elderly persons referred for echocardiography 16 † LA ejection force is associated with risk of cardiovascular events independent of age, risk factors, LV geometry, and LV diastolic function in a population with pre-clinical risk factors such as hypertension and diabetes 17 † LA strain occurs in hypertensive and diabetic patients even prior to development of overt LA dilatation 18 C (Symptomatic HF) HFpEF † LA kinetic energy predicts cardiovascular death and HF hospitalization in chronic HF regardless of EF, and has an incremental prognostic value over LA size 19 † Blunted increase in mitral annular A' velocity during exercise distinguishes HFpEF from asymptomatic hypertensive patients 20 † LAEF at rest and blunted LA systolic reserve with isometric handgrip distinguish HFpEF from asymptomatic hypertensive LV hypertrophy 21 † LA dysfunction relates to symptom onset in HFpEF 22 and occurs even in the absence of overt LA enlargement 23 † LA strain is independently associated with exercise capacity in HFpEF 24 † LA pump function is an independent correlate of HF symptoms in hypertrophic cardiomyopathy 5 …”

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confidence: 99%

Function over form? Assessing the left atrium in heart failure

Shah

Lam

2014

European Heart Journal

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This editorial refers to 'Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value' † , by P. Pellicori et al., on page 733.The understanding of heart failure (HF) haemodynamics has traditionally focused on left ventricular (LV) structure and function, with the left atrium being viewed simply as a passive transport chamber that empties into the left ventricle. Over the last decade, there has been increasing recognition of the importance of left atrial (LA) structure and function in the pathophysiology of HF. LA volume was first to be established as a biomarker integrating the magnitude and duration of LV diastolic function, and a predictor of cardiovascular outcomes in HF. More recently, LA function has emerged as a novel determinant of clinical status and outcomes in HF, and perhaps an even more robust prognostic marker than LA volume ( Table 1). Pellicori et al. have now explored the prognostic relevance of one summary measure of LA function-LA emptying fraction (LAEF)-by magnetic resonance imaging (MRI) in HF.1 In this single-centre study of 759 patients with suspected HF and in sinus rhythm undergoing cardiac MRI, LAEF was lower on average among 664 patients with the confirmed diagnosis of HF. Lower LAEF correlated with larger LA maximal and conduit volumes, smaller LA reservoir volume, lower LV and right ventricular (RV) ejection fraction, greater LV and RV remodelling, and higher circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Over a median follow-up of 3-4 years, LAEF, but not LA volume, was independently associated with incident HF hospitalization, cardiovascular mortality, all-cause mortality, and atrial fibrillation in multivariable models that included clinical predictors and NT-proBNP level. Importantly, LAEF provided incremental value in predicting these outcomes, beyond clinical variables alone but not in addition to NT-proBNP levels. The left atrium modulates LV filling and cardiovascular performance by three distinct functions: (i) as a reservoir for pulmonary venous return during LV systole; (ii) as a conduit for passive flow of blood from the pulmonary veins into the ventricle during early LV diastole and diastasis, and (iii) as a pump during late LV diastole that augments LV stroke volume (by 15-30% in healthy individuals and more in the presence of abnormal LV relaxation) (Figure 1). LA reservoir function is influenced by LA compliance as well as LV contraction via descent of the LV base during systole, and RV systolic pressure transmitted via the pulmonary circulation. LA conduit function is inversely related to reservoir function and strongly modulated by LV relaxation and compliance. LA pump function reflects LA contractility and is also dependent on both LA preload (venous return) and LA afterload (LV end-diastolic pressure). Of note, the Frank -Starling mechanism applies to LA mechanics (as with LV mechanics), wherein LA ejection volume increases as LA filling volume increases, ...

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The Prognostic Value of Left Atrial Peak Reservoir Strain in Acute Myocardial Infarction Is Dependent on Left Ventricular Longitudinal Function and Left Atrial Size

Cited by 136 publications

References 30 publications

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

Impaired Mechanics of Left Ventriculo-Atrial Coupling in Patients With Diabetic Nephropathy

Function over form? Assessing the left atrium in heart failure

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