Comprehensive assessment of left atrial and ventricular remodeling in paroxysmal atrial fibrillation by the cardiovascular magnetic resonance myocardial extracellular volume fraction and feature tracking strain

Yamada, A.; Hashimoto, Naoki; Fujito, Hidesato; Hatta, Takumi; Saito, Yuki; Otsuka, Naoto; Wakamatsu, Yuji; Arai, M.; Watanabe, Ryuta; Kurokawa, Syuhei; Kitano, Daisuke; Nagashima, Koichi; Yoda, Shunichi; Okumura, Yasuo

doi:10.1038/s41598-021-90117-6

Cited by 8 publications

(6 citation statements)

References 45 publications

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“…Our study may support the usage of LAEF and LAS r the concept of HFpEF staging by integration of LV and LA mechanics [ 6 ], and consistent with the knowledge of previously described HFpEF phenogroup 2 of TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial, of which pathophysiology is characterized by older age, marked LA enlargement, and high burden of diastolic dysfunction [ 36 ]. Moreover, LA strain assessment also predicts AF progression in HFpEF [ 34 ] and correlates with increased myocardial extracellular volume [ 37 ] which indicates accumulation of extracellular matrix in HFpEF [ 38 ]. Treatments that target cardiac fibrosis [ 39 ] and LA reverse remodeling [ 40 ] may have benefit in such population.…”

Section: Discussionmentioning

confidence: 99%

Impact of different degrees of left ventricular strain on left atrial mechanics in heart failure with preserved ejection fraction

Songsangjinda

Krittayaphong

2022

BMC Cardiovasc Disord

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Background Impairment of left atrial (LA) function is linked to left ventricle (LV) mechanics in patients with heart failure with preserved ejection fraction (HFpEF). In this study, we set forth to determine the difference in LA mechanics compared between HFpEF patients with different degrees of LV strains using the cardiac magnetic resonance feature tracking technique. Methods This retrospective study enrolled 79 patients with prior heart failure event and LV ejection fraction (LVEF) ≥ 50% (HFpEF group) together with 2:1 matched controls. LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS); LA emptying fraction (LAEF); and, LA strains consisting of reservoir phase strain (LASr), conduit phase strain (LAScd), and contraction phase strain (LASct) were derived from cine images. All LA parameters were compared between HFpEF subgroups (lower and higher LV strain stratified by the median of each LV strain value) and controls. Results A total of 237 subjects were included. HFpEF had a lower LAEF and LA strain values compared with controls. The mean GLS value was significantly different between HFpEF and controls (− 13.3 ± 3.4% vs. − 15.4 ± 2.2%, p < 0.001). HFpEF with lower GLS (value ≥ − 13.1%) had significantly impaired LA mechanical parameters compared with both HFpEF with higher GLS and controls independent of potential confounders, as follows: LAEF (38.8 ± 16.6% vs. 48.6 ± 15.7% and 54.2 ± 12.2%), LASr (14.6 ± 7.1% vs. 24.3 ± 9.6% and 26.7 ± 8.8%), and LAScd (− 6.6 ± 3.9% vs. − 12.9 ± 6.0% and − 14.7 ± 7.4%) (post hoc analysis of variance p < 0.05 for all comparisons). Similarly, HFpEF with lower GCS (value ≥ − 16.6%) or lower GRS (value < 27.9%) also had significant impairment of LASr and LAScd compared with the higher strain group and controls. Abnormal LAEF (< 50%) and abnormal LASr (< 23%) are independently associated with NYHA class ≥ II (Odds ratio [OR] 3.894 [95% CI 2.202–6.885] p < 0.001, adjusted OR 3.382 [1.791–6.389] p < 0.001 for abnormal LAEF; and OR 2.613 [1.497–4.562] p = 0.001, adjusted OR 2.064 [1.118–2.110] p = 0.021 for abnormal LASr). Conclusions Patients with HFpEF were found to have impaired LV and LA mechanics. Abnormal LA mechanics was highly prevalent in HFpEF patients with lower LV strain and significantly associated with the symptomatic status of the patients.

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Section: Discussionmentioning

confidence: 99%

Impact of different degrees of left ventricular strain on left atrial mechanics in heart failure with preserved ejection fraction

Songsangjinda

Krittayaphong

2022

BMC Cardiovasc Disord

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“…We found that impaired LA booster function could be considered to ascertain subjects harboring ALDH2 polymorphism with modest alcohol consumption and could be used to independently identify AF in these subjects. As an active and key modulator against the presence of impaired LV diastolic kinetics, the LA booster pump function emerged as a strong marker that can be used for identifying AF incidence [ 43 , 44 ]; however, the exact mechanisms and clinical significance of our findings warrant further research.…”

Section: Discussionmentioning

confidence: 99%

Variant Aldehyde Dehydrogenase 2 (ALDH2*2) as a Risk Factor for Mechanical LA Substrate Formation and Atrial Fibrillation with Modest Alcohol Consumption in Ethnic Asians

et al. 2021

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Aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphism is a common genetic variant in Asians that is responsible for defective toxic aldehyde and lipid peroxidation metabolism after alcohol consumption. The extent to which low alcohol consumption may cause atrial substrates to trigger atrial fibrillation (AF) development in users with ALDH2 variants remains to be determined. We prospectively enrolled 249 ethnic Asians, including 56 non-drinkers and 193 habitual drinkers (135 (70%) as ALDH2 wild-type: GG, rs671; 58 (30%) as ALDH2 variants: G/A or A/A, rs671). Novel left atrial (LA) mechanical substrates with dynamic characteristics were assessed using a speckle-tracking algorithm and correlated to daily alcohol consumption and ALDH2 genotypes. Despite modest and comparable alcohol consumption by the habitual alcohol users (14.3 [8.3~28.6] and 12.3 [6.3~30.7] g/day for those without and with ALDH2 polymorphism, p = 0.31), there was a substantial and graded increase in the 4-HNE adduct and prolonged PR, and a reduction in novel LA mechanical parameters (including peak atrial longitudinal strain (PALS) and phasic strain rates (reservoir, conduit, and booster pump functions), p < 0.05), rather than an LA emptying fraction (LAEF) or LA volume index across non-drinkers, and in habitual drinkers without and with ALDH2 polymorphism (all p < 0.05). The presence of ALDH2 polymorphism worsened the association between increasing daily alcohol dose and LAEF, PALS, and phasic reservoir and booster functions (all Pinteraction: <0.05). Binge drinking superimposed on regular alcohol use exclusively further worsened LA booster pump function compared to regular drinking without binge use (1.66 ± 0.57 vs. 1.97 ± 0.56 1/s, p = 0.001). Impaired LA booster function further independently helped to predict AF after consideration of the CHARGE-AF score (adjusted 1.68 (95% CI: 1.06–2.67), p = 0.028, per 1 z-score increment). Habitual modest alcohol consumption led to mechanical LA substrate formation in an ethnic Asian population, which was more pronounced in subjects harboring ALDH2 variants. Impaired LA booster functions may serve as a useful predictor of AF in such populations.

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“…The CMR data acquisition and post processing have been described in a previous study at our hospital (17). MR images were acquired using a 1.5-T scanner (Ingenia; Philips Healthcare, Eindhoven, Netherlands) with retrospective electrocardiographic gating.…”

Section: Cardiac Magnetic Resonance and Lung Perfusion Single-photon ...mentioning

confidence: 99%

Cardiovascular manifestations identified by multi-modality imaging in patients with long COVID

Murata

Yamada

Fujito

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe possibility of permanent cardiovascular damage causing cardiovascular long COVID has been suggested; however, data are insufficient. This study investigated the prevalence of cardiovascular disorders, particularly in patients with cardiovascular long COVID using multi-modality imaging.MethodsA total of 584 patients admitted to the hospital due to COVID-19 between January 2020 and September 2021 were initially considered. Upon outpatient follow-up, 52 (9%) were suspected to have cardiovascular long COVID, had complaints of chest pain, dyspnea, or palpitations, and were finally enrolled in this study. This study is registered with the Japanese University Hospital Medical Information Network (UMIN 000047978).ResultsOf 52 patients with long COVID who were followed up in the outpatient clinic for cardiovascular symptoms, cardiovascular disorders were present in 27% (14/52). Among them, 15% (8/52) had myocardial injury, 8% (4/52) pulmonary embolisms, and 4% (2/52) both. The incidence of a severe condition (36% [5/14] vs. 8% [3/38], p = 0.014) and in-hospital cardiac events (71% [10/14] vs. 24% [9/38], p = 0.002) was significantly higher in patients with cardiovascular disorders than in those without. A multivariate logistic regression analysis revealed that a severe condition (OR, 5.789; 95% CI 1.442–45.220; p = 0.017) and in-hospital cardiac events (OR, 8.079; 95% CI 1.306–25.657; p = 0.021) were independent risk factors of cardiovascular disorders in cardiovascular long COVID patients.ConclusionsSuspicion of cardiovascular involvement in patients with cardiovascular long COVID in this study was approximately 30%. A severe condition during hospitalization and in-hospital cardiac events were risk factors of a cardiovascular sequalae in CV long COVID patients.

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Comprehensive assessment of left atrial and ventricular remodeling in paroxysmal atrial fibrillation by the cardiovascular magnetic resonance myocardial extracellular volume fraction and feature tracking strain

Cited by 8 publications

References 45 publications

Impact of different degrees of left ventricular strain on left atrial mechanics in heart failure with preserved ejection fraction

Impact of different degrees of left ventricular strain on left atrial mechanics in heart failure with preserved ejection fraction

Variant Aldehyde Dehydrogenase 2 (ALDH2*2) as a Risk Factor for Mechanical LA Substrate Formation and Atrial Fibrillation with Modest Alcohol Consumption in Ethnic Asians

Cardiovascular manifestations identified by multi-modality imaging in patients with long COVID

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