Acute change in left atrial performance in patients with atrial fibrillation undergoing catheter ablation using AutoStrain

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): International PhD Program in Cardiovascular Pathophysiology and Therapeutics CardioPaTh Background Radio-frequency catheter ablation (CA) is associated with changes of left atrial (LA) structure and function. However, the data on the accuracy of automated analysis of LA strain (LAS) are unavailable. Therefore, the aim of the present study was to compare automated with manual LAS analysis in patients with atrial fibrillation (AF) undergoing CA during sinus rhythm. Methods We prospectively enrolled 36 consecutive patients (age: 62 ± 22 years, 33% female) with symptomatic AF and preserved left ventricular (LV) ejection fraction (≥50%) undergoing the CA during sinus rhythm. All patients underwent comprehensive echocardiography at 1-day pre-CA and at 1-day post-CA. Reservoir and contractile LAS were assessed using both the automated and the manual technique as average of segmental values in apical four-chamber (4CH) view using the onset of QRS as a reference point. Results Radio-frequency CA was associated with significant decrease in magnitude of reservoir and contractile LAS in all patients, and increase in LA end-systolic (max) and end-diastolic (min) volume index (all p < 0.001) (figure 1). The correlation between (semi-) automated and manual LAS assessment was excellent in all measurements (figure 2). The manual correction was needed in 7 out of 36 patients (19%). Despite this, the time needed to perform AutoStrain-derived analysis was significantly lower than the time needed for the manual LAS analysis (12 ± 3 ms vs. 40 ± 5 ms, p < 0.01). Moreover, in 10 randomly selected patients, the AutoStrain showed significantly lower interobserver variability than the manual LAS analysis (3.1% vs. 6.7%, p < 0.01). Conclusion The AutoStrain-derived LAS analysis showed a high correlation with manual LAS analysis. Moreover, the AutoStrain technique was associated with significantly shorter analysis time and lower interobserver variability compared with the manual technique. Abstract Figure.

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Echocardiography markers of myocardial deformation as independent predictors of sinus rhythm maintenance after catheter ablation for paroxysmal atrial fibrillation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.175 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A Katbeh ◽

T De Potter ◽

P Geelen ◽

K Iliodromitis ◽

Z Balogh ◽

...

Keyword(s):

Catheter Ablation ◽

Ejection Fraction ◽

Sinus Rhythm ◽

Radio Frequency ◽

Left Atrial ◽

Area Under The Curve ◽

Left Ventricular ◽

Volume Index ◽

Term Maintenance

Abstract Funding Acknowledgements Type of funding sources: None. Background Speckle Tracking Echocardiography (STE) provides a comprehensive and quantitative assessment of myocardial function. However, the accuracy of STE-derived indices to predict maintenance of sinus rhythm (SR) following radio-frequency catheter ablation (CA) is still under debate. Therefore, the aim of the present study is to define the accuracy of STE-derived parameters to predict long-term maintenance of SR in patients with paroxysmal AF undergoing CA. Methods We prospectively enrolled 218 consecutive patients (age: 62 ± 10 years, 30% females) with paroxysmal AF undergoing first-CA. All patients with preserved ejection fraction (EF ≥ 50%) underwent comprehensive transthoracic echocardiography at baseline, including assessment of left ventricular (LV) global longitudinal strain (GLS), left atrial (LA) reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) using two-dimensional STE in apical views. Results At 12 months follow up, a total of 39 (18%) patients had a documented recurrence of AF. Among imaging parameters, LASr > 23% showed the largest area under the curve (0.80) to predict long-term maintenance of SR with sensitivity of 79% and specificity of 72%. Other parameters of LA function, LA diameter, maximum or minimum LA volume index, LV GLS or ejection fraction, and indices of LV diastolic function had lower area under the curve (Figure 1). Using multi-variable logistic regression, LASr (OR 1.19, 95% CI 1.10-1.23, p < 0.001) and LASct (OR 1.21, 95% CI 1.07-1.37, p = 0.002) were independently associated with long-term SR while maximum or minimum LA volume index was not. Conclusion In patients with paroxysmal AF undergoing radio-frequency CA, preserved LA reservoir and contractile strain is independently associated with long-term maintenance of SR, whereas LA diameter or volumes were not. LA strain may therefore be useful in management of patients with paroxysmal AF. Figure 1: Receiver-operating characteristic curves of left atrial reservoir strain (LASr), LA conduit strain (LAScd), LA contractile strain (LASct), LA emptying fraction (LAEF), LA expansion index (LAEI), LA end-systolic (LAES) and end-diastolic (LAED) volume index (VI) to predict long-term maintenance of sinus rhythm. Abstract Figure.

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Abstract 3068: Intra-left Ventricular Contractile Dyssynchrony As An Independent Determinant Of Left Atrial Remodeling In Patients With Atrial Fibrillation Managed by Catheter-based Circumferential Pulmonary Venous Isolation

Circulation ◽

10.1161/circ.116.suppl_16.ii_688 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

FU-CHUN CHIU ◽

Yi-Chih Wang ◽

Chih-Chieh Yu ◽

Ling-Ping Lai ◽

Juey-Jen Hwang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Catheter Ablation ◽

Sinus Rhythm ◽

Left Atrial ◽

Left Ventricular ◽

Filling Pressure ◽

Doppler Imaging ◽

Atrial Remodeling ◽

Independent Determinant

BACKGROUND. Enlarged left atrial volume (LAV), resulting from multifactorial pathogenesis, carries a poorer prognosis to patients with atrial fibrillation (AF) even under well rhythm control. We hypothesized that the preexistence of intra-left ventricular (LV) contractile dyssynchrony impaired diastolic filling, which contribute to atrial remodeling in AF patients. METHODS. We investigated 40 patients (34 men and 6 women, mean age 60 ± 10 years) with paroxysmal or persistent AF who were converted mainly by catheter ablation-based circumferential pulmonary venous isolation and then pharmacologically maintained in sinus rhythm. Exclusion criteria included significant (>moderate) valvular heart disease, LV ejection fraction <55 %, or ischemic heart disease confirmed by positive stress tests or coronary angiography. The LAV was measured by 2D echocardiography [π×D1×D2×D3/6 from parasternal long-axis view (D1) and apical four-chamber view (D2 & D3)]. The peak myocardial systolic velocity (S M ) and the time to peak S M (T S ) of the 6-basal and 6-mid LV segments were measured by tissue Doppler imaging (TDI). RESULTS. With similar AF duration before conversion, patients with LAV >40ml (n = 16) had similar baseline characteristics, cardiovascular medications, QRS width, and LV chamber sizes as those with LAV <40ml (n = 24). However, TDI showed the mean S M was borderline lower (6.3 ± 1.2 vs. 7.1 ± 1.2 cm/s, p < 0.05), and the maximal intersegmental difference in T S (77 ± 43 vs. 40 ± 22 ms, p < 0.003) was greater in patients with larger LAV. The intersegmental difference in T S correlated positively with LAV (r = 0.41, p < 0.009), and LV filling pressure estimated by early transmitral flow velocity/annular diastolic velocity was significantly higher (12.3 ± 7.8 vs. 8.7 ± 2.2, p < 0.045) in patients with intersegmental difference in T S >65 ms. After adjusting for age, gender, and the diastolic parameters, intersegmental difference in T S >65ms emerged as an independent determinant of larger LAV in multivariate logistic analysis (OR=17; 95% CI=2–166, p < 0.016). CONCLUSIONS. Intraventricular dyssynchrony, which accompanied with elevated LV filling pressure, contributed independently to LA remodeling in AF patients converted into sinus rhythm by catheter ablation.

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Left Atrial Appendage Remodeling after Atrial Fibrillation Ablation

10.22541/au.164146068.81734500/v1 ◽

2022 ◽

Author(s):

Yichi Zhang ◽

Abdel Hadi El Hajjar ◽

Chao Huang ◽

Aneesh Dhore-Patil ◽

Mario Mekhael ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Ejection Fraction ◽

Left Atrial ◽

Left Atrial Appendage ◽

Left Ventricular ◽

Wilcoxon Test ◽

Atrial Appendage ◽

Volume Index ◽

Af Ablation

Introduction: Larger left atrial appendage (LAA) ostium area and greater left atrial (LA) volume have been associated with an increased risk of ischemic stroke. Catheter ablation (CA) of atrial fibrillation (AF) leads to morphological and functional changes within the LA and LAA, some of which are not well studied. Here, we present findings regarding post-ablation changes of the LAA ostia and correlate them with various LA, LAA and left ventricular (LV) functional and morphological metrics. Methods: This retrospective analysis included patients scheduled to undergo first-time radiofrequency CA for AF. Catheter ablation techniques included PVI with or without additional ablations. Cardiac magnetic resonance imaging (CMR) was used to assess LA, LAA and LV morphology and function, including LAA ostium area, LA/LAA volume and volume index, LA ejection fraction, LA strain, and LV ejection fraction. A Kruskal-Wallis test was used for correlating LAA ostial dimensions with other LA morphological and functional metrics. The t-test or two-sample Wilcoxon test were used to compare LA and LAA morphological parameters. Results: A total of 101 patients with AF were included in this study. The mean age was 60.1 ± 11.1 years, 69% were male, the average BMI was 29.22 ± 5.08. The LAA ostial area reduced significantly from 3.84 ± 1.15 cm before ablation to 3.42 ± 0.96 cm after ablation (p=0.0004). This reduction was asymmetrical, as the minor axis length decreased from 1.92 cm to 1.77 cm without significant changes in the major axis. LVEF increased from a pre-ablation average of 48.26% to a post-ablation average of 53.62% (p=0.015). Correlation of pre-ablation LVEF and LAA ostium area showed a near-significant negative trend (r=-0.21, p=0.083). LAEF correlated negatively with LAA ostial area (r=-0.289, p=0.0057), total LA strain (r=-0.248, p=0.0185), and passive LA strain (r=-0.208, p=0.049). Conclusion: There is a significant asymmetrical reduction of the LAA ostial area after AF ablation that is independent of LVEF changes. Larger LAA ostial area was associated with lower LAEF and LA strain. Remodeling of the LAA after AF ablation may help account for reduced risk of stroke and increased cardiac function.

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P2451Patterns of left atrial structural and functional remodeling after catheter ablation in paroxysmal and long-standing persistent atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz748.0783 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Katbeh ◽

T De Potter ◽

P Geelen ◽

Z Balogh ◽

E Stefanidis ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrial ◽

Contractile Function ◽

Left Ventricular ◽

Volume Index ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Functional Remodeling

Abstract Background Both atrial fibrillation (AF) and catheter ablation (CA) may be associated with changes in left atrial (LA) structure and function. However, the data describing acute and short-term effects of CA on LA contractile function in different sub-types of AF are scarce. Purpose First, to describe patterns of LA structural and functional remodeling in patients with paroxysmal AF (PAF) or long-standing persistent AF (LSPAF) undergoing first or redo CA. Second, to assess clinical feasibility of LA strain and strain rate (SR) to monitor effect of AF and CA on LA contractile function. Methods We prospectively enrolled 138 consecutive patients (age: 63±21 years, 32% females) with PAF undergoing first (81%) or redo (19%) CA during sinus rhythm, and 20 individuals (age: 66±23 years, 20% females) with LSPAF undergoing first CA during AF. All patients were symptomatic and preserved (≥50%) left ventricular ejection fraction. Control group consisted of 23 healthy controls. All patients underwent comprehensive echocardiography one day pre-CA and post-CA, and at 3 month follow-up. The LA reservoir, conduit and contractile longitudinal strain (LAS) and LASR were assessed using 2D speckle tracking echocardiography as average of segmental values in apical views. Results A total of 14 (9%) patients had insufficient image quality for LA assessment and were excluded (feasibility: 91%). Pre-CA, patients with LSPAF showed the largest left atrial volume index (LAVI) (45±14 ml/m2), followed by PAF (35±8 ml/m2) and controls (24±10 ml/m2) (p<0.001). The lowest reservoir and contractile LAS was observed in patients with LSPAF (12±5% and 0%), followed by PAF undergoing redo CA (22±7% and 9±4%), versus first CA (27±8% and 13±4%) and controls (37±7% and 16±4%) (p<0.001). LASR followed similar trend. Post-CA, we observed acute increase of LAVI in all groups (figure 1). Reservoir and contractile LAS and LASR decreased only in patients with PAF who underwent first CA. In contrast, it remained unchanged in individuals with PAF who had redo CA or even increased in subjects with LSPAF (figure 2). At 3 month follow-up, LAVI was significantly reduced compared with baseline in all groups of patients with AF (p<0.01). In contrast, LAS and LASR did not show uniform improvement in all AF groups and on average they remained significantly lower compared with controls (p<0.01). The lowest LAS and LASR values were observed in patients with PAF who underwent redo CA (no improvement from baseline) and in patients with LSPAF (significant improvement versus baseline) (figure 2). Patients with PAF who had the first CA showed higher LAS and LASR compared with other two AF groups (p<0.01) but still significantly lower than controls (p<0.01). Conclusion Different sub-types of AF show different patterns of LA structural and functional remodeling after CA. Both reservoir and contractile LAS appear highly feasible and reproducible to monitor LA contractile function in this clinical setting.

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Early assessment of left atrial function after cardioversion predicts recurrence of atrial fibrillation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.173 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

K Kupczynska ◽

BW Michalski ◽

E Trzos ◽

D Miskowiec ◽

L Szyda ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Left Atrial ◽

Left Ventricular ◽

Volume Index ◽

Left Ventricular Ejection ◽

Early Assessment ◽

Ventricular Ejection Fraction ◽

Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Background The restoration of sinus rhythm (SR) improves the mechanical function of the heart. Purpose To assess left atrial (LA) function before and within 24 hours after successful electrical cardioversion (EC) and its prognostic value for atrial fibrillation (AF) recurrence during 24 months follow-up. Methods Prospective study involved 71 patients with non-valvular AF (mean age 64 ± 13 years, 61% male). All patients underwent echocardiography before and after EC. We analysed standard parameters in two-dimensional echo, pulse-wave Doppler and tissue Doppler echocardiography. Using speckle-tracking method we assessed peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS). Results During follow-up we noticed AF recurrence in 48 (68%) patients. Median time to AF recurrence was 2.4 (IQR 1 to 6.9) months. Left ventricular ejection fraction as well as E/E’ and PALS assessed during AF were statistically insignificant as potential predictors in univariate regression model. Receiver operating characteristic curve analysis revealed that left atrial volume index >37 ml/m² (AUC = 0.811, p < 0.0001), E/A ratio >2.1 (AUC = 0.828, p < 0.0001), A wave ≤0.4 m/s (AUC = 0.662, p = 0.01), mean E/E’ ratio during sinus rhythm >8.5 (AUC = 0.815, p < 0.0001), mean A’ wave of ≤5.5 cm/s (AUC = 0.848, p < 0.0001), PALS-SR ≤14.1% (AUC = 0.767, p < 0.0001), PACS ≤4.3% (AUC = 0.883, p < 0.0001) were the optimal cut-off values for predicting AF recurrence. Conclusions The assessment of LA and diastolic function conducted within 24 hours after successful cardioversion predicts long-term maintenance of sinus rhythm.

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Consideration of non-valvular atrial fibrillation with left atrial appendage thrombus formation despite under appropriate oral anticoagulation therapy

European Heart Journal ◽

10.1093/ehjci/ehaa946.0071 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Shiraki ◽

H Tanaka ◽

K Yamashita ◽

Y Tanaka ◽

K Sumimoto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Regression Analysis ◽

Oral Anticoagulation ◽

Left Atrial ◽

Thrombus Formation ◽

Anticoagulation Therapy ◽

Left Ventricular ◽

Volume Index ◽

Oral Anticoagulation Therapy

Abstract Background Atrial fibrillation (AF) is the most frequently sustained cardiac arrhythmia, with a prevalence of about 2–3% in the general population. In accordance with CHADS2 or CHA2DS2-VASc score, appropriate oral anticoagulation therapy such as warfarin or direct oral anticoagulants (DOAC) significantly reduced the risk of thromboembolic events. However, left atrial (LA) thrombus can be detected in the LA appendage (LAA) in AF patients despite appropriate oral anticoagulation therapy. Purpose Our purpose was to investigate the associated factors of LAA thrombus formation in non-valvular atrial fibrillation (NVAF) patients despite under appropriate oral anticoagulation therapy. Methods We retrospectively studied consecutive 286 NVAF patients for scheduled catheter ablation or electrical cardioversion for AF in our institution between February 2017 and September 2019. Mean age was 67.1±9.4 years, 79 patients (29.5%) were female, and 140 (52.2%) were paroxysmal AF. All patients underwent transthoracic and transesophageal echocardiography before catheter ablation or electrical cardioversion. All patients received appropriate oral anticoagulation therapy including warfarin or DOAC for at least 3 weeks prior to transesophageal echocardiography based on the current guidelines. LAA thrombus was defined as an echodense intracavitary mass distinct from the underlying endocardium and not caused by pectinate muscles by at least three senior echocardiologists. Results Of 286 NVAF patients with under appropriate oral anticoagulation therapy, LAA thrombus was observed in 9 patients (3.3%). Univariate logistic regression analysis showed that age, paroxysmal AF, CHADS2 score ≥3, left ventricular end-diastolic volume index (LVEDVI), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), LA volume index (LAVI), mitral inflow E and mitral e' annular velocities ratio (E/e'), and LAA flow were associated with LAA thrombus formation. It was noteworthy that multivariate logistic regression analysis showed that LAA flow was independent predictor of LAA thrombus (OR: 0.72, 95% CI: 0.59–0.89, p<0.005) as well as LVEF. Furthermore, receiver operating characteristic (ROC) curve analysis identified the optimal cutoff value of LAA flow for predicting LAA thrombus as ≤15cm/s, with a sensitivity of 88%, specificity of 93%, and area under the curve (AUC) of 0.95. Conclusions LAA flow was strongly associated with LAA thrombus formation even in NVAF patients with appropriate oral anticoagulation therapy. According to our findings, further strengthen of oral anticoagulation therapy or percutaneous transcatheter closure of the LAA may be considered in NVAF patients with appropriate oral anticoagulation therapy but low LAA flow, especially <15cm/s. Funding Acknowledgement Type of funding source: None

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Incidence and predictors of left atrial thrombus development in patients scheduled for repeat catheter ablation for atrial fibrillation: Is transesophageal echocardiography always mandatory?

10.22541/au.161495869.95334184/v1 ◽

2021 ◽

Author(s):

Satoshi Yanagisawa ◽

Yasuya Inden ◽

Shuro Riku ◽

Kazumasa Suga ◽

Koichi Furui ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Transesophageal Echocardiography ◽

Left Atrial ◽

Thrombus Formation ◽

Imaging Modality ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Imaging Evaluation ◽

Ventricular Ejection Fraction

Introduction: The risk of developing left atrial (LA) thrombi after initial catheter ablation for atrial fibrillation (AF) and requirements for imaging evaluation for thrombi screening at repeat ablation is unclear. This study aimed to assess the occurrence of thrombus development and frequency of any imaging study evaluating thrombus formation during repeat ablation for AF. Methods: Of 2,066 patients undergoing initial catheter ablation for AF with uninterrupted oral anticoagulation, 615 patients underwent repeat ablation after 258.0 (105.0-882.0) days. We investigated which factors were associated with safety outcomes and requirements for thrombi screening. Results: All patients underwent at least one imaging examination to screen for thrombi in the first session, but the examination rate decreased to 476 patients (77%) before the repeat procedure. The frequency of imaging evaluations was 5.0%, 11%, 21%, 84%, and 91% for transesophageal echocardiography and 18%, 33%, 49%, 98%, and 99% for any imaging modality at repeat ablation performed ≤60 days, ≤90 days, ≤180 days, >180 days, and >1 year after the initial procedure, respectively. Three patients (0.5%) developed LA thrombi at repeat ablation due to identifiable causes, and no patients had thromboembolic events when no imaging evaluation was performed. Multivariate analysis revealed that repeat ablation >180 days, non-paroxysmal atrial arrhythmias, and lower left ventricular ejection fraction were predictors of the risk of thrombus development. Conclusions: The risk development of thrombus at repeat ablation for AF was low. There needs to be a risk stratification for the requirement of imaging screening for thrombi at repeat ablation for AF.

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Abstract 15257: Epicardial and Peri-atrial Fat Attenuation Predict Recurrence in Patients Undergoing Repeat Catheter Ablation for Refractory Atrial Fibrillation

Circulation ◽

10.1161/circ.142.suppl_3.15257 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mark S Brahier ◽

Fengwei Zou ◽

Frank Migliarese ◽

Milos Tomovic ◽

Alexandra Taylor ◽

...

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Adipose Tissue ◽

Catheter Ablation ◽

Left Atrial ◽

Left Atrial Volume ◽

Epicardial Fat ◽

Volume Index ◽

Atrial Volume ◽

Af Recurrence

Background: Identifying factors predictive of atrial fibrillation (AF) recurrence after catheter ablation (CA) can improve patient selection. It has been hypothesized that inflammatory paracrine signaling by metabolically active adipose tissue induces pathologic changes in surrounding cardiovascular tissue. In fact, fat attenuation on CT has been previously associated with AF recurrence after de novo CA. The purpose of this study was to investigate the predictive qualities of epicardial and peri-atrial adipose tissue in a population undergoing repeat CA. We hypothesized that higher epicardial and left peri-atrial fat attenuation would predict recurrence as markers of increased localized inflammation. Methods: The study population consisted of 84 patients with symptomatic, drug and ablation-refractory AF undergoing repeat CA. All patients had a pre-ablation, contrast-enhanced cardiac CT, which was analyzed for mean fat attenuation in Hounsfield units (HU) and left atrial volume using the post-processing program 3D Slicer. Patients were followed for recurrence of atrial tachyarrhythmias after a 3-month blanking period. We performed logistic regression to adjust for age, sex, BMI, hypertension, smoking history, diabetes, obstructive sleep apnea, and left atrial volume index. Results: Repeat CA patients with recurrence (n=52) had a higher epicardial fat attenuation (-84.8 ±5.6 vs -88.1 ±5.2 HU; p=0.009) and peri-atrial fat attenuation (-81.0 ±4.7 vs -83.2 ±4.3 HU; p=0.036) than those without recurrence (n=32) at a mean follow-up period of 26 ±18 months. Logistic regression analysis showed that epicardial fat attenuation (OR 1.21; p=0.005) and peri-atrial fat attenuation (OR 1.27; p=0.007) are predictive of AF recurrence independent of traditional risk factors. Conclusions: Epicardial and left peri-atrial adipose attenuation are predictive of recurrence in patients undergoing repeat CA for AF.

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P3764Morphological mechanisms of atrial functional mitral regurgitation in patients with atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz745.0615 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Nagaoka ◽

Y Mukai ◽

S Kawai ◽

S Takase ◽

K Sakamoto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Ventricular Ejection Fraction ◽

Mitral Regurgitation ◽

Left Atrial ◽

Left Ventricular ◽

Volume Index ◽

Left Ventricular Ejection ◽

Functional Mitral Regurgitation ◽

Mitral Leaflet ◽

Ventricular Ejection Fraction

Abstract Background Atrial functional mitral regurgitation (AFMR) occurs in patients with atrial fibrillation. However, morphological mechanisms of AFMR are poorly understood. Purpose The purpose of this study was to examine the morphological characteristics in patients with AFMR. Methods Among consecutive 795 patients undergoing initial radiofrequency catheter ablation (RFCA) at our hospital, twenty-five patients with persistent AF accompanied by AFMR (≥ moderate) before RFCA (AFMR group) were studied. Age-matched 25 patients with persistent AF without MR were defined as a control group. Results Left ventricular ejection fraction (LVEF) was lower and left atrium volume index was larger in the AFMR group (Table). Mitral valve annulus diameter and length of anterior mitral leaflet (AML) were similar between groups, whereas length of posterior mitral leaflet (PML) was significantly shorter in the AFMR group. Smaller tethering angle of AML (γ in the figure) and shorter tethering height were significantly associated with the occurrence of AFMR, which were different from morphology of functional mitral regurgitation in patients with dilated LV. Multiple regression analysis revealed that less tenting height (p<0.05) and LA dilatation toward the posterior (p<0.01) were significantly related to AFMR. Echocardiographic parameters AFMR (n=25) Control (n=25) P value Age, y 69±8 66±10 NS Male, n (%) 9 (36) 20 (80) P=0.001 LVEF,% 60±9 67±6 P=0.004 LAD, mm 44±5 41±7 NS LAVI, ml/m2 56±17 41±13 P<0.001 MV diameter, mm 3.9±0.4 3.8±0.5 NS α angle, ° 34±9 35±7 NS β angle, ° 48±9 50±8 NS γ angle, ° 32±5 37±5 P=0.0005 AML length, mm 3.0±0.5 3.0±0.5 NS PML length, mm 2.1±0.1 2.4±0.1 P=0.03 Tenting height, mm 1.5±0.1 1.8±0.1 P=0.02 D, mm 0.8±0.3 0.5±0.3 P=0.001 LVEF: left ventricular ejection fraction; LAD: left atrial diameter; LAVI: left atrial volume index; AML: anterior mitral leaflet; PML: posterior mitral leaftlet. Conclusions AFMR occurs in patients with unique morphological features, such as less tethering height and LA dilatation toward the posterior.

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2140Association of arterial stiffness with left atrial structure and phasic function: a community-based cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz748.0087 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y Yoshida ◽

K Nakanishi ◽

M Daimon ◽

J Ishiwata ◽

N Sawada ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Arterial Stiffness ◽

Left Atrial ◽

Global Longitudinal Strain ◽

Multivariable Analysis ◽

Significant Risk ◽

Left Ventricular ◽

Volume Index ◽

Community Based

Abstract Background Increased arterial stiffness is recognized as an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. Cardio-ankle vascular index (CAVI) is emerging as an important tool to assess arterial stiffness noninvasively which is derived from the concept of stiffness β index and is less dependent on blood pressure at the time of measurement than pulse wave velocity. Purpose This study aimed to investigate the association of arterial stiffness with left atrial (LA) volume and phasic function in a community-based cohort. Methods We included 1,156 participants without overt cardiovascular disease who underwent extensive cardiovascular examination. Arterial stiffness was evaluated by CAVI. Speckle-tracking echocardiography was employed to evaluate LA phasic function including reservoir, conduit and pump strain as well as left ventricular global longitudinal strain (LVGLS). Results CAVI was negatively correlated with reservoir and conduit strain (r=−0.37 and −0.45, both p<0.001; Figure), whereas weakly, but positively correlated with LA volume index and pump strain (r=0.12 and 0.09, both p<0.01). In multivariable analysis, CAVI was significantly associated with reservoir and conduit strain independent of traditional cardiovascular risk factors, pertinent laboratory parameters and LV morphology and function including LVGLS (standardized β=−0.22 and −0.26, respectively, both p<0.001), whereas there was no independent association with LA volume index and pump strain. In the categorical analysis, the abnormal CAVI (≥9.0) carried the significant risk of impaired reservoir (<31.4%) and conduit (<12.4%) strain (adjusted odds ratio = 2.63 and 3.71 vs. normal CAVI, both p<0.01) in a fully-adjusted model including laboratory and echocardiographic parameters. Figure 1 Conclusion Arterial stiffness was independently associated with LA reservoir and conduit function, even in the absence of overt cardiovascular disease. This association may explain the higher incidence of atrial fibrillation in individuals with increased arterial stiffness.

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