Left atrial volume index and pulmonary arterial pressure predicted MACE among patients with STEMI during 8-year follow-up: experience from a tertiary center

Abstract Background Atrial fibrillation (AF) increased the risk of development of kidney disease. The elimination of AF by catheter ablation is associated with improvement in renal function. However, the mechanism of cardio-renal interaction in AF has not been fully elucidated. Purpose We tested the hypothesis that left atrial volume index (LAVI), which is a marker of left atrial mechanical reserve, predicts improvement in renal function after restoring sinus rhythm with catheter ablation of AF. Methods We analyzed consecutive patients who underwent catheter ablation of AF from January 2012 to October 2018 and had completed follow-up more than 3 months after catheter ablation. Exclusion criteria were need for hemodialysis and acute hospitalization. Estimated glomerular filtration rate (eGFR) was assessed on admission and at the end of follow-up periods after catheter ablation and the difference was defined as ΔeGFR. Left atrial volume index was derived using the biplane area-length method. Results A total of 159 AF patients (paroxysmal 112 [70%], persistent 47 [30%]) were included in this study. The mean age was 65±11 years and 74% were male. During the mean follow-up period of 7.9±3.2 months, 105 patients (66%) were free from atrial tachyarrhythmias and 54 (34%) experienced the recurrence. Baseline eGFR and LAVI were not significantly different between the non-recurrence group and the recurrence group (71.0±17.4 and 75.1±22.8 mL/min/1.73m2; p=0.24, 35.7±12.5 and 37.9±15.0 ml/m2; p=0.34). ΔeGFR in the non-recurrence group was significantly greater compared with the recurrence group (+1.5±1.0 versus −4.3±1.4 mL/min/1.73m2; p=0.001). Baseline LAVI was negatively correlated with ΔeGFR in the non-recurrence group (r=−0.3; p=0.002; Figure), but not in the recurrence group (p=0.1). Multiple regression analysis in the non-recurrence group identified baseline LAVI (β=−0.35, p<0.001), baseline age (β=−0.31, p<0.001) and baseline eGFR (β=−0.59, p<0.001) as independent predictors for eGFR improvement after catheter ablation. In the patients with LAVI <34 ml/m2, age <70 years and eGFR <90 mL/min/1.73m2, the mean ΔeGFR was +6.3±1.9 mL/min/1.73m2. Figure 1 Conclusions LAVI, a marker of left atrial mechanical reserve, was an independent predictor of improvement in renal function after restoring sinus rhythm with catheter ablation of AF. This observation suggests that AF-related deterioration of renal function is due at least in part to impaired atrial mechanical function.

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P1261DIAGNOSTIC VALUE OF TEMPORARY OCCLUSION OF ARTERIO-VENOUS HIGH FLOW FISTULA DURING RIGHT HEART CATHETERISATION IN PATIENTS WITH PULMONARY HYPERTENSION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1261 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Eugene Zeltyn-Abramov ◽

RUSTAM ISKHAKOV ◽

NATALYA BELAVINA ◽

NATALIYA KLOCHKOVA ◽

NADIA FROLOVA

Keyword(s):

Arterial Pressure ◽

Pulmonary Arterial Pressure ◽

High Flow ◽

Right Atrial ◽

Volume Index ◽

Atrial Volume ◽

Right Heart ◽

Systolic Pulmonary Arterial Pressure ◽

Pulmonary Arterial

Abstract Background and Aims Pulmonary hypertension (PH) is prevalent in patients with functioning high-flow arterio-venous fistula (HFAVF) and associated with congestive heart failure (CHF). The real incidence and possible causes of this phenomenon is a matter of debate. Hemodynamic effects of HFAVF is considering as one of the reasons for PH formation. The subject of study was the impact of HFAVF on selected parameters of central hemodynamics. In particular, the diagnostic relevance of test of temporary HFAVF occlusion (TTO) was evaluated during right heart catheterization (RHC). Method A total of 13 patients were enrolled: 8 - after kidney transplantation (KT) with preserved allograft function and 5 - on maintenance hemodialysis (HD). All of them demonstrated clinical presentation of CHF III-IV class (NYHA). Severe PH and diastolic disfunction (DD) were observed at a baseline: echocardiographic systolic pulmonary arterial pressure sPAP (mmHg): M=59 (SD 13), ratio of mitral early diastolic inflow velocity (E) (pulsed wave Doppler) to average of septal and lateral mitral annular early-diastolic peak velocity (e′) (tissue Doppler imaging) E/e′ M=18 (SD 5). The ones who have comorbid conditions that cause PH were excluded. All patients bore an upper arm HFAVF, flow of the AVF (Qa) measured by Doppler ultrasonography was markedly high (Qa): M = 3,8 l/min (SD 1,2), the cardio-pulmonary recirculation (Qa/CO): M = 51% (SD 13). All patients underwent RHC and TTO AVF. Echocardiography (Echo) was performed initially and on the follow up (8 weeks after AVF closure/flow reduction). Statistical analysis was performed using the STATISTICA 13 software (Wilcoxon, T-test). Results The results of RHC and Echo data are presented in tables 1, 2. As can be seen from the table data, all cases demonstrated instrumental features of high output CHF (HO CHF) in accordance with patient’s clinical status. TTO of HFAVF resulted in statistically significant decrease in CO and CI values, but no changes in PAP parameters were observed. Taking into account clinical and instrumental features of advanced CHF, HF AVF was closed in 8 patients after KT and in 2 patients on HD. 3 patients on HD underwent AVF flow reduction up to Qa not exceeding 1,1 l/min. Follow-up demonstrated complete resolution of CHF and dramatic improvement of DD, reduction in CO, CI, sPAP, volume parameters. CO, cardiac output; CI, cardiac index; sPAP, systolic pulmonary arterial pressure; meanPAP, mean pulmonary arterial pressure; RAP, mean right atrial pressure; PCWP, pulmonary capillary wedge pressure; LV EDVi, left ventricular end-diastolic volume index; LAVi, left atrial volume index; RAVi, right atrial volume index; Conclusion PH is a component of AVF-induced HO CHF and could be classified as postcapillary one. TTO confirms significant HFAVF contribution to specific changes of parameters of central hemodynamics due to HO CHF. TTO does not impact on PAP values and therefore is not valid to clarify PH genesis per se.

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Abstract 11212: Left Atrial Volume Index Predicts Recurrence of Stroke in Patients With Non-Sustained Atrial Tachycardia

Circulation ◽

10.1161/circ.130.suppl_2.11212 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Hyemoon Chung ◽

Pil-Ki Min ◽

Young Won Yoon ◽

Byoung-Kwon Lee ◽

Bum-Kee Hong ◽

...

Keyword(s):

Left Atrial ◽

Atrial Tachycardia ◽

Left Atrial Volume ◽

Holter Monitoring ◽

Volume Index ◽

Stroke Recurrence ◽

Stroke Patients ◽

Atrial Volume ◽

Left Atrial Volume Index

Introduction: NSAT is known to appear more frequently in patients with paroxysmal AF. Additionally enlarged LA is considered to be an independent risk factor for newly diagnosed AF. We investigated the relationship between non-sustained atrial tachycardia (NSAT) and stroke recurrence and the risk factors that may predict stroke recurrence in stroke patients where 24-hour Holter monitoring documented NSAT without paroxysmal AF. Hypothesis: We hypothesized that those patients who presented with NSAT and enlarged LA would have a higher incidence of stroke recurrence. Methods: 214 patients (102 males, mean 70±11 years) with acute ischemic stroke and NSAT were subject to 24-hour Holter monitoring. During follow-up patients were assessed for stroke recurrence and echocardiographic parameters. Results: During a mean follow-up period of 36±34 months, the recurrence rate of stroke was 11.8% (25 of 214). Those patients with recurrence had a larger LA diameter (34.73±5.04 vs. 40.64±3.45mm, p<0.001), LA volume index (LAVI, 22.56±5.86vs. 33.81±7.80 ml/m 2 , p<0.001and increased E/E’ (12.27±4.86 vs. 14.49±4.38, p=0.032) compared to patients without recurrence (n=189). A Kaplan-Meier survival rate was significantly lower in patients with enlarged LA size (LAVI>28 mm 3 /m 2 ) compared with patients without enlarged LA size (LAVI≤28 mm 3 /m 2 ) (p<0.001 by log-rank test). Cox regression analysis revealed that left atrial volume index hazard ratio (HR: 1.148, 95% CI: 1.092-1.206, p<0.001) was an independent predictor for stroke recurrence in patients with NSAT. Areas under the Receiver Operating Characteristics (ROC) curve of LAVI for recurrence of stroke was 0.876 (95% CI: 0.791-0.960, p<0.001). Conclusions: In patients with acute ischemic stroke and NSAT, increased LAVI predicts an increased risk of stroke recurrence. This study supports the potential use of anticoagulants in stroke patients with NSAT and increased LAVI without documented AF to reduce recurrent stroke.

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Postoperative atrial fibrillation after aortic valve replacement is a risk factor for long-term atrial fibrillation

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz094 ◽

2019 ◽

Vol 29 (3) ◽

pp. 378-385 ◽

Cited By ~ 2

Author(s):

Rasmus Carter-Storch ◽

Jordi S Dahl ◽

Nicolaj L Christensen ◽

Redi Pecini ◽

Eva V Søndergård ◽

...

Keyword(s):

Atrial Fibrillation ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Atrial ◽

Left Atrial Volume ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index

AbstractOBJECTIVESPostoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. However, knowledge on the rate of long-term atrial fibrillation (LTAF) after POAF remains unclear. We investigated predictors of POAF in patients with aortic stenosis undergoing surgical aortic valve replacement, and assessed the rate of LTAF during follow-up.METHODSWe prospectively included 96 adult patients with severe aortic stenosis undergoing surgical aortic valve replacement. Patients with previous atrial fibrillation (AF) were excluded. Patients underwent echocardiography, cardiac computed tomography and magnetic resonance imaging immediately prior to surgery. Surgical aortic clamp time and postoperative C-reactive protein (CRP) were documented. POAF was defined as AF recorded within 7 days of surgery. Through chart review, patients were followed up for documented episodes of LTAF occurring more than 7 days after surgery.RESULTSPOAF occurred in 51 patients (53%). It was associated with larger preoperative echocardiographic left atrial volume index (44 ± 12 vs 37 ± 8 ml/m2, P = 0.004), longer aortic clamp time [80 (70–102) vs 72 (62–65) min, P = 0.04] and higher CRP on first postoperative day [80 (64–87) vs 65 (44–83) mg/l, P = 0.001]. Multivariable logistic regression revealed that left atrial volume index [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02–1.13; P = 0.005] and postoperative CRP (OR 1.03, 95% CI 1.01–1.05; P = 0.006) were the only independent predictors of POAF. During 695 days (25th–75th percentile: 498–859 days) of follow-up, LTAF occurred in 11 patients of whom 10 were in the POAF group (hazard ratio 9.4, 95% CI 1.2–74; P = 0.03).CONCLUSIONSPOAF is predicted by left atrial volume index and postoperative CRP. Patients with POAF have a 9-fold increase risk of developing symptomatic LTAF during follow-up.Clinical trial registration numberClinicalTrials.gov (NCT02316587).

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P1017Thoracoscopic AF ablation is a successful treatment for patients with a giant left atrium

European Heart Journal ◽

10.1093/eurheartj/ehz747.0608 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Neefs ◽

R Wesselink ◽

M M Terpstra ◽

N W E Van Den Berg ◽

W R Berger ◽

...

Keyword(s):

Left Atrium ◽

Left Atrial ◽

Atrial Tachycardia ◽

Left Atrial Volume ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

Af Ablation ◽

Kaplan Meier

Abstract Background Severely enlarged left atrial (LA) volume is associated with a considerable ineffective outcome of ablation for atrial fibrillation (AF). Therefore, in patients with AF and a giant atrial volume catheter ablation is not recommended. However, thoracoscopic AF ablation is being performed in patients with AF and giant LA, but with unknown efficacy. Purpose To determine efficacy of thoracoscopic AF ablation in patients with AF and a giant LA. Methods Patients underwent thoracoscopic AF ablation (paroxysmal AF) plus additional left atrial ablations (persistent AF) and were prospectively followed. Giant LA was defined as left atrial volume index (LAVI)≥50 ml/m2, outcome was also assessed for LAVI≥55 ml/m2. Follow-up was performed with ECGs and 24-hour Holters every three months. After a 3-month blanking period, all AADs were discontinued. Primary outcome was recurrence of any atrial tachycardia ≥30 sec during one year of follow-up. Results Between 2008–2017, 357 patients underwent thoracoscopic AF ablation. At baseline, giant LA was diagnosed in 72 (20.2%) patients (mean LAVI: 59.5±9.6 ml/m2), while 285 (79.8%) had a smaller left atrium (mean LAVI: 36.3±7.8 ml/m2), p<0.001. Giant LA patients were older (mean: 61.7±6.9 vs 59.3±9.0 years, p=0.03) and more often diagnosed with persistent AF (n=60, 83.3%) compared to control (n=164, 57.5%), p<0.001. Sex (female: n=19, 26.4% vs n=79, 27.7%, p=0.82) and history of AF (median: 4.0 [IQR: 2.0–6.0] vs 4.0 [IQR: 2.0–8.0] years, p=0.10) were equally distributed. Freedom of any atrial tachycardia did not differ significantly between both groups (n=43, 59.7% vs n=195, 68.4%, log rank p=0.91), figure. This was similar for the cut-off of LAVI≥55 ml/m2: n=24/43 (55.8%) vs n=214/314 (68.2%), p=0.15). AF recurred in 16 (22.2%) patients with giant LA compared to 55 (19.3%) patients, while atrial tachycardia recurred in 21 (29.2%) vs 56 (19.6%) patients, respectively, p=0.06. Kaplan-Meier analysis of AF recurrence i Conclusion Thoracoscopic AF ablation is an effective therapy in patients with a giant LA. Thoracoscopic AF ablation may therefore be a feasible treatment for patients with a giant LA.

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P0252TROPONIN T AND LEFT ATRIAL VOLUME INDEX ARE ASSOCIATED WITH THE OCCURRENCE OF NEW-ONSET ATRIAL FIBRILLATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 4-5

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0252 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Markus Hakamäki ◽

Tapio Hellman ◽

Roosa Lankinen ◽

Niina Koivuviita ◽

Jussi Pärkkä ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Volume ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

Stage 4 ◽

Ckd Stage ◽

New Onset

Abstract Background and Aims Atrial fibrillation (AF) and chronic kidney disease (CKD) are common and often co-existing conditions. However, little is known on the prevalence and incidence of AF in patients with CKD stage 4-5. Method We prospectively recruited 210 consecutive non-dialysis patients with CKD stage 4-5 between 2013 and 2017. Follow-up data on AF occurrence as well as baseline medical history, laboratory tests and echocardiography were collected. Results At baseline, mean age was 62 years, 73/210 (34.8%) of the participants were female, mean estimated glomerular filtration rate was 12.8ml/min and 41/210 (19.5%) patients had a prior diagnosis of AF. After median follow-up of 46 [IQR 27] months, new-onset AF was detected in 33/169 (19.5%) patients (69.9 events/1000 person-years). Overall, 22/33 (66.7%) of patients with new-onset AF were identified with a triggering condition, most commonly severe infection or surgery, and 21/33 (63.6%) were receiving renal replacement therapy (dialysis or acquired kidney transplant) at the time of AF detection, respectively. In Cox proportional hazard model age >60 years (HR 4.27, CI95% 1.57-11.64, p<0.01), elevated troponin T (TnT) >50ng/l (HR 3.61, CI95% 1.55-8.37, p<0.01) and left atrial volume index (LAVI) >30ml/m2 (HR 4.82, CI95% 1.11-21.00, p=0.04) independently predicted the occurrence of new-onset AF. Furthermore, the predictive effect of the covariates was cumulative (Figure 1). Conclusion The incidence rate of AF was remarkably high in this prospective study on patients with CKD stage 4-5. Elevated TnT and increased LAVI are associated with the occurrence of new-onset AF in patients with severe CKD.

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Morphofunctional Cardiac Changes in Singleton and Twin Pregnancies

10.21203/rs.3.rs-61689/v1 ◽

2020 ◽

Author(s):

Takeshi Umazume ◽

Takahiro Yamada ◽

Itsuko Furuta ◽

Hiroyuki Iwano ◽

Mamoru Morikawa ◽

...

Keyword(s):

Left Atrial ◽

Vena Cava ◽

Left Atrial Volume ◽

Volume Index ◽

Atrial Volume ◽

Mixed Effect ◽

Left Atrial Volume Index ◽

Tertiary Center ◽

Twin Pregnancies ◽

Singleton Pregnancies

Abstract Objectives To compare heart echocardiographic changes between women with singleton and twin pregnanciesMethods We enrolled pregnant and postpartum women for this longitudinal cohort study in a tertiary center from 2014 through 2016. We analyzed 166 and 83 prospectively collected longitudinal data on simultaneously determined echocardiography parameters and blood variables in 44 and 22 normotensive women with either singleton or twin pregnancies, respectively. We tested mixed effect models for echocardiographic parameters and cardiac biomarkers.Results The mean left atrial volume index and brain natriuretic peptide (BNP) level were significantly higher in women with twin pregnancies than in those with singleton pregnancies during the 3rd trimester and immediately postpartum (within 1 week after childbirth). The 2nd trimester inferior vena cava diameters were significantly smaller and the 3rd trimester creatinine levels were significantly higher in women with twin pregnancies than in those with singleton pregnancies. BNP was positively correlated with left atrial volume index (β=0.49, p<0.01) and with the ratio of early diastolic transmitral to mitral annular velocity (E/e') (β=0.41, p<0.01). BNP and N-terminal precursor protein BNP (NT-proBNP) fragments immediately postpartum were negatively correlated with the later E/e', at 1 month postpartum in women with singleton pregnancies (r=−0.33, p=0.02 and r=−0.36, p<0.01, respectively).Conclusions The intravascular cardiac load at postpartum within 1 week after childbirth was greater in women with twin pregnancies than in those with singleton pregnancies. BNP/NT-proBNP was significantly positively correlated with LA volume index and E/e', BNP may be secreted to reduce the volume and pressure overload on the myocardial wall by diuretic action and may have improved the diastolic functions 1 month after childbirth. Our results provide evidence to deepen the understanding of the pathophysiological hemodynamic changes after delivery.

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