Cardiac Imaging to Assess Left Ventricular Systolic Function in Atrial Fibrillation

Bunting, Karina V; O’Connor, Kieran; Steeds, Richard P.; Kotecha, Dipak

doi:10.1016/j.amjcard.2020.10.012

Cited by 7 publications

(4 citation statements)

References 39 publications

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“…Restoration of atrial transport function to improve hemodynamics is another important goal of the Maze procedure. Poor left atrial contractility can cause a decrease in cardiac output of as much as 30% [ 30 ].Atrial transport function can be restored in 70% to 100% of patients after the Maze procedure. In this systematic review, we investigated the comparison of mid‐term clinical outcomes between MV + Cox-Maze versus MV alone.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of Cox‐Maze procedure for atrial fibrillation during mitral valve surgery: a meta-analysis of randomized controlled trials

Gao,

Luo,

Yang

et al. 2024

J Cardiothorac Surg

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Background Cox‐Maze procedure is currently the gold standard treatment for atrial fibrillation (AF). However, data on the effectiveness of the Cox‐Maze procedure after concomitant mitral valve surgery (MVS) are not well established. The aim of this study was to assess the safety and efficacy of Cox-Maze procedure versus no-maze procedure n in AF patients undergoing mitral valve surgery through a systematic review of the literature and meta‐analysis. Methods A systematic search on PubMed/MEDLINE, EMBASE, and Cochrane Central Register of Clinical Trials (Cochrane Library, Issue 02, 2017) databases were performed using three databases from their inception to March 2023, identifying all relevant randomized controlled trials (RCTs) comparing Cox-Maze procedure versus no procedure in AF patients undergoing mitral valve surgery. Data were extracted and analyzed according to predefined clinical endpoints. Results Nine RCTs meeting the inclusion criteria were included in this systematic review with 663 patients in total (341 concomitant Cox‐Maze with MVS and 322 MVS alone). Across all studies with included AF patients undergoing MV surgery, the concomitant Cox‐Maze procedure was associated with significantly higher sinus rhythm rate at discharge, 6 months, and 12 months follow‐up when compared with the no-Maze group. Results indicated that there was no significant difference between the Cox‐Maze and no-Maze groups in terms of 1 year all-cause mortality, pacemaker implantation, stroke, and thromboembolism. Conclusions Our systematic review suggested that RCTs have demonstrated the addition of the Cox‐Maze procedure for AF leads to a significantly higher rate of sinus rhythm in mitral valve surgical patients, with no increase in the rates of mortality, pacemaker implantation, stroke, and thromboembolism.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of Cox‐Maze procedure for atrial fibrillation during mitral valve surgery: a meta-analysis of randomized controlled trials

Gao,

Luo,

Yang

et al. 2024

J Cardiothorac Surg

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“…41 Documenting diastolic dysfunction using cardiac imaging is also challenging when AF is present, and there is limited information about what measurement and what value should be used in these patients. 42 The current guideline-suggested practice of averaging multiple sequential beats in AF to obtain a reasonable mean is not based on scientific principle. Variation between beats for the measurement of E/e′ filling pressures is over 40% in AF, meaning that reproducibility is so low that we should question the value of such measurements.…”

Section: Diagnostic Challenges For Heart Failure With Preserved Eject...mentioning

confidence: 99%

Breaking the Cycle of Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation

2022

Self Cite

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Heart failure with preserved ejection fraction (HFpEF) and AF are two common cardiovascular conditions that are inextricably linked to each other’s development and progression, often in multimorbid patients. Current management is often directed to specific components of each disease without considering their joint impact on diagnosis, treatment and prognosis. The result for patients is suboptimal on all three levels, restricting clinicians from preventing major adverse events, including death, which occurs in 20% of patients at 2 years and in 45% at 4 years. New trial evidence and reanalysis of prior trials are providing a glimmer of hope that adverse outcomes can be reduced in those with concurrent HFpEF and AF. This will require a restructuring of care to integrate heart failure and AF teams, alongside those that manage comorbidities. Parallel commencement and non-sequential uptitration of therapeutics across different domains will be vital to ensure that all patients benefit at a personal level, based on their own needs and priorities.

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“…A recent study found that patients with PerAF had significantly reduced LV ejection fraction (LVEF) than that in patients with PAF ( 8 ). Although global longitudinal strain (GLS) is a widely used LV strain parameter that provides prognostic information ( 14 ), a few studies have externally validated GLS in AF patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of left atrial and ventricular remodeling in atrial fibrillation subtype by using speckle tracking echocardiography

Lu,

Liu,

Sun

et al. 2023

Front. Cardiovasc. Med.

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BackgroundAtrial fibrillation (AF) is associated with cardiac structural and functional remodeling. We investigated the left atrial (LA) and left ventricular (LV) changes in AF subtypes by using two-dimensional echocardiography strain techniques.MethodsThe study population consisted of 102 subjects with sinus rhythm (control group) and 463 patients with AF, among which 284 patients had paroxysmal AF (PAF) and 179 patients had persistent AF (PerAF). A speckle tracking automatic functional imaging software was used to perform the strain analysis.ResultsPatients with AF had dilated LA maximum and minimum volume, decreased LA reservoir strain, lower LV ejection fraction (LVEF), and impaired global longitudinal strain (GLS) compared to those of the sinus rhythm control group. In patients with PerAF, the LA maximum and minimum volumes were larger, and the LA reservoir strain [PAF vs. PerAF, 28% (21,33) vs. 19% (14, 28), P < 0.05], LVEF, and absolute GLS value (PAF vs. PerAF, −16.9 ± 3.3 vs. −14.1 ± 3.5%) were lower than those in patients with PAF. Patients with AF regardless of LA enlargement had decreased LA reservoir strain and lower LVEF and absolute GLS value than those in the sinus rhythm control group.ConclusionCompared with those with normal sinus rhythm, patients with AF had dilated LA volume and impaired LA function, which were further worsened in patients with PerAF than those in patients with PAF. LA functional impairment occurred before LA enlargement. Left atrioventricular remodeling happened across different stages of AF development.

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Cardiac Imaging to Assess Left Ventricular Systolic Function in Atrial Fibrillation

Cited by 7 publications

References 39 publications

Safety and efficacy of Cox‐Maze procedure for atrial fibrillation during mitral valve surgery: a meta-analysis of randomized controlled trials

Safety and efficacy of Cox‐Maze procedure for atrial fibrillation during mitral valve surgery: a meta-analysis of randomized controlled trials

Breaking the Cycle of Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation

Evaluation of left atrial and ventricular remodeling in atrial fibrillation subtype by using speckle tracking echocardiography

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