Impact of chronic mitral regurgitation on 3D atrial size and mechanics. Insights from the prospective 3D-PRIME study

Abstract Background Chronic mitral regurgitation (MR) leads to progressive left atrial (LA) dilation. Its relative contribution to 3-dimensional (3D) LA structural and functional remodelling and the impact of concomitant clinical and hemodynamic factors, has been less explored. Aims To assess 3D LA size and mechanics, as well as mean LA pressure estimated from the pulmonary vein flow, in relation to chronic MR severity. Methods In the prospective 3D-PRIME (3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation) study, 46 patients with chronic MR (69±13 years, body mass index (BMI) 26.2±4.3kg/m2, 50% women, 26% with atrial fibrillation, 30% with severe MR) recruited at one heart valve center were investigated with 2D and 3D transthoracic and transesophageal echocardiography. MR severity was quantified by the regurgitant volume (RV) and MR classified as organic, atrial functional or ventricular functional, as by current recommendations. LA size was measured by 3D maximum volume (LAV) indexed for body surface area (LAVI), LA mechanics by 3D peak relative increase in longitudinal volume in the reservoir phase (Sr), and mitral size by 3D annulus area and total leaflet area. Pulmonary vein Doppler flow profile was recorded in both right and left upper veins, and mean LA pressure was estimated from the average pulmonary vein systolic/diastolic velocity time integral ratio. Results Average mitral RV was 38±26ml, LAVI 53ml/m2, and Sr 17±11%. Increased mitral RV correlated with higher LAV and mean LA pressure (Figure 1), larger mitral annulus area (r=0.42) and total leaflet area (r=0.38) (all p<0.01), but not with Sr. In backward stepwise multivariate linear regression analyses, increased LAVI was independently predicted by larger mitral RV, higher age and atrial fibrillation (R2=0.62), higher mean LAP by larger mitral RV, body mass index and atrial fibrillation (R2=0.55), while lower Sr was associated with higher age and atrial fibrillation (R2=0.62) (all p<0.001). Patients with atrial functional MR (30% of the total group) had the largest LAVs and lowest Sr despite slightly lower mitral RV (Figure 2). Conclusion Chronic MR is associated with progressive increase in LA volume, mean LA pressure, and mitral annulus and total leaflet area. While MR is accompanied by low 3D LA longitudinal deformation, impaired LA mechanics is multifactorial and related closely to age and history of atrial arrythmias. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Haukeland University Hospital Figure 1 Figure 2

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Impact of body mass index on atrial fibrillation ablation using cryoballoon: procedural data and clinical outcomes

European Heart Journal ◽

10.1093/ehjci/ehaa946.0420 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Urbanek ◽

S Chen ◽

S Bordignon ◽

N Tsianakas ◽

F Bologna ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Pulmonary Vein ◽

Body Mass ◽

Pulmonary Vein Isolation ◽

Clinical Success ◽

Cryoballoon Ablation ◽

Group 3 ◽

The Impact

Abstract Background The impact of body mass index (BMI) on atrial fibrillation (AF) ablation using cryoballoon (CB) has been seldom reported. Purpose To evaluate the impact of BMI on procedural data as well as the clinical efficacy and safety character of using CB. Methods Symptomatic AF patients (paroxysmal / persistent AF) with BMI ≥25 who underwent CB based pulmonary vein isolation (PVI) were enrolled. CB PVI was performed using the second generation CB (CB 2, 28mm), with 4min based freeze protocol and bonus freeze delivery in case of time-to-isolation (TTI) >75 sec. All procedures were performed under conscious sedation. Procedural endpoint was electrical pulmonary vein isolation. Clinical success was defined as no recurrence of AF/atrial tachycardia (AT). Results Data from 600 consecutive patients were collected. Three groups defined: BMI 25–29 (Group 1, G1 n=337); BMI 30–34 (Group 2, G2 n=149); BMI ≥35 (Group 3, G3 n=114). Patients in Group 3 were younger (G1: 67±11 y; G2: 68±10y G3 62±11y; p<0,001) and presented bigger LA (G1 39,5±4,9 mm; G2: 41,6±5,5; G3 42,4±5,1; p<0,001). Most of the patients presented with PAF (G1: 59,3% G2: 57,7% G3: 54,4%). Among 2342 Targeted PVs, 2332 (99,6%) were isolated using solely the CB (G2: one procedure was abolished due to failed aortic puncture during transseptal access; G3: one PVI was not completed due to PNP; 6 touch up RF ablation in G1 and 2 in G3). Procedure time (G1:58,45 min; G2: 60,44 min; G3 63,19 min) and fluoroscopy time (G1: 9,3 min; G2: 9,5 G3: 10,6 min) were comparable among the groups. PN Injury was the main recorded complication: 20/600 (2,6%) patients with a transient PN palsy (PNP) and 6/600 (1%) with a persistent PNP. No sedation related complication was recorded. Follow up survival curve analysis after one year revealed a favorable follow up in G1 (78,4%) and G2 (82,5%) compared to G3 (66,5%) (G1 Vs G3 p: 0,002 G2 vs G3 p=0,008, G1 vs G2 p=0,47). The influence of BMI on the follow up was confirmed in the subgroup of patients with paroxysmal AF but not in patients presenting persistent AF. Conclusions Cryoballoon ablation in obese patients is feasible and associated with a relatively low complication rate. BMI plays a role in predicting recurrences especially in patients presenting with paroxysmal AF. Funding Acknowledgement Type of funding source: None

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Nonalcoholic fatty liver disease and the risk of atrial fibrillation stratified by body mass index: a nationwide population-based study

Scientific Reports ◽

10.1038/s41598-021-83367-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

So-Ryoung Lee ◽

Kyung-Do Han ◽

Eue-Keun Choi ◽

Seil Oh ◽

Gregory Y. H. Lip

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Liver Disease ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Body Mass ◽

Fatty Liver Disease ◽

Nonalcoholic Fatty Liver ◽

Increased Risk ◽

The Impact

AbstractWe evaluated the association between nonalcoholic fatty liver disease (NAFLD) and incident atrial fibrillation (AF) and analyzed the impact of NAFLD on AF risk in relation to body mass index (BMI). A total of 8,048,055 subjects without significant liver disease who were available fatty liver index (FLI) values were included. Subjects were categorized into 3 groups based on FLI: < 30, 30 to < 60, and ≥ 60. During a median 8-year of follow-up, 534,442 subjects were newly diagnosed as AF (8.27 per 1000 person-years). Higher FLI was associated with an increased risk of AF (hazard ratio [HR] 1.053, 95% confidence interval [CI] 1.046–1.060 in 30 ≤ FLI < 60, and HR 1.115, 95% CI 1.106–1.125 in FLI ≥ 60). In underweight subjects (BMI < 18.5 kg/m2), higher FLI raised the risk of AF (by 1.6-fold in 30 ≤ FLI < 60 and by twofold in FLI ≥ 60). In normal- and overweight subjects, higher FLI was associated with an increased risk of AF, but the HRs were attenuated. In obese subjects, higher FLI was not associated with higher risk of AF. NAFLD as assessed by FLI was independently associated with an increased risk of AF in nonobese subjects with BMI < 25 kg/m2. The impact of NAFLD on AF risk was accentuated in lean subjects with underweight.

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Sex Differences in the Impact of Body Mass Index on the Risk of Future Atrial Fibrillation: Insights From the Longitudinal Population‐Based Tromsø Study

Journal of the American Heart Association ◽

10.1161/jaha.117.008414 ◽

2018 ◽

Vol 7 (9) ◽

Cited By ~ 7

Author(s):

Jocasta Ball ◽

Maja‐Lisa Løchen ◽

Tom Wilsgaard ◽

Henrik Schirmer ◽

Laila A. Hopstock ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Sex Differences ◽

Body Mass ◽

Population Based ◽

The Impact

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The impact of substrate and trigger ablation for reduction of functional mitral regurgitation in patients with persistent atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehab724.0477 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

T Watanabe ◽

T Yamada ◽

S Tamaki ◽

M Yano ◽

T Hayashi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Mitral Regurgitation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Independent Predictor ◽

Persistent Atrial Fibrillation ◽

Left Ventricular ◽

Functional Mitral Regurgitation ◽

The Impact

Abstract Background Functional mitral regurgitation (FMR) is not uncommon in atrial fibrillation (AF) patients. Left atrial (LA) substrate remodeling and corresponding mitral valve annulus dilation has been reported as the most possible cause of FMR. Percutaneous catheter ablation (CA) is an effective treatment for AF. Although significant FMR could be improved by sinus restoration, patients with mitral regurgitation were more likely to experience recurrent AF post ablation, especially those with significant mitral regurgitation. There is no information available on the efficacy of CA for persistent AF in patients with FMR. Purpose The purpose of this study is to investigate the predictors of FMR improvement by CA and to determine the efficacy of substrate and trigger CA for persistent AF in patients with FMR. Methods We prospectively studied 512 consecutive patients admitted for persistent AF ablation from the EARNEST-PVI (Prospective Multicenter Randomized Study of Effect of Extensive Ablation on Recurrence in Patients with Persistent Atrial Fibrillation Treated with Pulmonary Vein Isolation) trial. On admission, enrolled patients were randomly assigned in a 1:1 ratio to pulmonary vein isolation (PVI) or PVI-plus additional ablation (linear ablation or/and CFAE ablation). Of the 512 patients, we studied 94 patients with preoperative echocardiography showing moderate or greater baseline FMR. FMR grades were classified into 5 grades (0/1/2/3/4). The FMR improvement group (FMRI(+)) was defined as a case in which the FMR was improved by two or more grades compared the preoperative echocardiography and the one year follow-up examination. Results Of the 94 patients, 42 were in the PVI group and 52 were in the PVI-plus additional ablation group. There were 30 cases in the FMRI(+) group and 64 cases in the FMRI(−) group. There were no significant baseline differences in age, sinus rhythm maintenance, plasma B-type natriuretic peptide (BNP) level, left ventricular diastolic dimension, or left atrium dimension between the FMRI(+) and FMRI(−) groups. AF duration was significantly shorter in the FMRI(+) group than FMRI(−) groups (5.8±9.4 months vs 12.4±15.4 months, p<0.0001). In addition, significantly more additional ablation cases were observed in the FMRI(+) group than in the FMRI(−) group (73.3% vs 46.8%, p=0.016). In multivariate analyses, only additional ablation was an independent predictor of FMRI (odds ratio 0.226 95% CI 0.081–0.626; p=0.004). Conclusions Catheter ablation is a valid option for the treatment of AF in patients with functional MR and additional substrate and trigger ablation were the only independent predictor of FMR improvement. FUNDunding Acknowledgement Type of funding sources: None.

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Impact of body mass index on outcomes in European patients with atrial fibrillation: the ESC EHRA EORP Atrial Fibrillation General Long-Term registry (AFGen LT)

European Heart Journal ◽

10.1093/ehjci/ehaa946.3022 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G Boriani ◽

M Proietti ◽

C Laroche ◽

L Fauchier ◽

F Marin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Body Mass ◽

Large Cohort ◽

Funding Source ◽

Increased Risk ◽

Underweight Patients ◽

The Impact

Abstract Introduction The impact of body mass index (BMI) on outcomes in patients with atrial fibrillation (AF) has been largely debated. Aims To describe the relationship between BMI categories and clinical outcomes in a large cohort of European AF patients. Methods We included all AF patients with available baseline BMI and creatinine clearance and 1-year follow-up data enrolled in the EORP-AF General Long-Term Registry. Outcomes considered were: i) a composite of any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death; ii) CV death; iii) all-cause death. Results A total of 7,759 patients were included in this analysis. Of these, 55 (0.7%) were underweight, 2,074 (26.7%) were normal weight, 3,170 (40.9%) were overweight, 1,703 (21.9%) were obese and 757 (9.8%) were severe obese. Mean age was progressively lower across the categories (p<0.0001), with proportion of patients aged≥75 years also progressively lower (52.7% in underweight to 19.4% in severe obese patients; p<0.001). Both underweight (41.8%) and severe obese (25.0%) patients were more likely symptomatic (p<0.001). Mean CHA2DS2-VASc score was higher in underweight patients (p=0.0325). Use of any oral anticoagulant therapy was progressively higher across the BMI categories (p<0.001). At 1-year follow-up the rate of all outcomes considered were highest for underweight patients and lowest in severe obese [Figure 1]. On univariate Cox regression analysis, being underweight was consistently associated to a higher risk for all outcomes, while increasing of weight categories was associated with progressively lower risk for adverse outcomes. After full adjustment with clinical and pharmacological characteristics, no effect of higher BMI classes was found for any outcome, but an independent association with an increased risk of CV death and all-cause death was seen for underweight patients (Table 1). Conclusions In a large cohort of European AF patients a progressively lower rate of outcomes was found across increasing BMI classes. After full adjustments, no significant association was found between the higher BMI classes and outcomes. Underweight was associated with an increased risk for CV death and all-cause death. Figure 1. Outcomes at 1-year Follow-up Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies have supported it with unrestricted grants

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Impact of body mass index on the outcome of catheter ablation of atrial fibrillation

Heart ◽

10.1136/heartjnl-2018-313490 ◽

2018 ◽

Vol 105 (3) ◽

pp. 244-250 ◽

Cited By ~ 23

Author(s):

Benedict M Glover ◽

Kathryn L Hong ◽

Nikolaos Dagres ◽

Elena Arbelo ◽

Cécile Laroche ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Catheter Ablation ◽

Body Mass ◽

Lifestyle Modification ◽

Weighted Analysis ◽

The Impact ◽

Baseline Bmi ◽

Af Recurrence

ObjectivesThe association between obesity and atrial fibrillation (AF) is well-established. We aimed to evaluate the impact of index body mass index (BMI) on AF recurrence at 12 months following catheter ablation using propensity-weighted analysis. In addition, periprocedural complications and fluoroscopy details were examined to assess overall safety in relationship to increasing BMI ranges.MethodsBaseline, periprocedural and follow-up data were collected on consecutive patients scheduled for AF ablation. There were no specific exclusion criteria. Patients were categorised according to baseline BMI in order to assess the outcomes for each category.ResultsAmong 3333 patients, 728 (21.8%) were classified as normal (BMI <25.0 kg/m2), 1537 (46.1%) as overweight (BMI 25.5–29.0 kg/m2) and 1068 (32.0%) as obese (BMI ≥30.0 kg/m2). Procedural duration and radiation dose were higher for overweight and obese patients compared with those with a normal BMI (p=0.002 and p<0.001, respectively). An index BMI ≥30 kg/m2 led to a 1.2-fold increased likelihood of experiencing recurrent AF at 12-months follow-up as compared with overweight patients (HR 1.223; 95% CI 1.047 to 1.429; p=0.011), while no significant correlation was found between overweight and normal BMI groups (HR 0.954; 95% CI 0.798 to 1.140; p=0.605) and obese versus normal BMI (HR 1.16; 95% CI 0.965 to 1.412; p=0.112).ConclusionsPatients with a baseline BMI ≥30 kg/m2 have a higher recurrence rate of AF following catheter ablation and therefore lifestyle modification to target obesity preprocedure should be considered in these patients.

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