Echocardiographic Assessment of Atrial Function: From Basic Mechanics to Specific Cardiac Diseases

Inoue, Kentaro; Kawakami, Hiroshi; Akazawa, Yusuke; Higashi, Haruhiko; Hatori, Takashi; Yamaguchi, Osamu

doi:10.3390/jcdd9030068

Cited by 7 publications

(5 citation statements)

References 100 publications

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“…Most studies of LA MD have defined the parameter as SD-TPS corrected by the R-R interval (%) instead of the crude SD-TPS value in ms. 14,17,28,30 Endurance athletes experience exercise-induced bradycardia and as expected, the athletes in the present study had a lower resting heart rate than the non-athletic group. 31 Hence, we introduced an association between athletic status and LA MD when correcting SD-TPS by the R-R interval.…”

Section: Discussionsupporting

confidence: 84%

“…It is reported to be a novel predictor of AF in the general population, linked to the recurrence of AF after catheter ablation, and associated with stroke among AF patients. [14][15][16][17] Watanabe et al found an association between increased LA MD and low voltage zones recognized by voltage mapping in paroxysmal AF patients indicating regional fibrosis in the LA wall. 18 There has also been a report of increased atrial fibrosis assessed by magnetic resonance imaging (MRI) in a group of healthy veteran endurance athletes, linking long-term endurance exercise to increased atrial fibrosis.…”

Section: Introductionmentioning

confidence: 99%

“…LA mechanical dispersion (LA MD), defined by the standard deviation of time‐to‐peak strain (SD‐TPS), is a marker of electromechanical atrial function. It is reported to be a novel predictor of AF in the general population, linked to the recurrence of AF after catheter ablation, and associated with stroke among AF patients 14–17 . Watanabe et al.…”

Section: Introductionmentioning

confidence: 99%

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Left atrial dyssynchrony in veteran endurance athletes with and without paroxysmal atrial fibrillation

et al. 2023

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Background Prolonged endurance exercise increase the risk of atrial fibrillation (AF) in men. Functional parameters may help separate physiological from pathological atrial remodeling in athletes. LA mechanical dispersion (LA MD) is associated with AF in the general population, but the associations between prolonged exercise, LA MD and AF are not known. Purpose To describe LA MD in veteran athletes with and without paroxysmal AF (pAF) and to investigate LA MD's ability to identify veteran athletes with pAF. Methods Two hundred and ninety‐three men, skiers with (n = 57) and without (n = 87) pAF, and controls with (n = 61) and without pAF (n = 88) underwent an echocardiographic exam in sinus rhythm. LA reservoir strain (LASr) was measured, and LA MD defined as the standard deviation of time‐to‐peak strain (SD‐TPS). Results Skiers (mean age 70.7 ± 6.7 years) reported an average of 40–50 years of endurance exercise. LA volumes were associated with pAF and athletic status (p < .001). SD‐TPS was associated with pAF (p < .001) but not athletic status (p = .173). We found no significant trend between years of exercise and SD‐TPS in individuals without AF (p = .893). SD‐TPS did not add incremental value in identifying athletes with pAF in addition to clinical markers, QRS width, LA volume, and LASr (p = .056). Conclusion LA MD was associated with pAF regardless of athletic status but not related to years of endurance exercise, suggesting LA MD could be a promising marker of pathological atrial remodeling in athletes. However, we found no incremental value of LA MD identifying athletes with pAF when LASr was included in the model.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Left atrial dyssynchrony in veteran endurance athletes with and without paroxysmal atrial fibrillation

et al. 2023

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“…In Cardiac Amyloidosis, the left atrium is impaired like the left ventricle due to amyloid infiltration, leading to increased size, reduced ejection force, and strain. While LA dimension or volume can suggest chronic elevation of LA pressure, they are insufficient parameters to obtain detailed information about LA function [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Strain Imaging by Speckle Tracking Echocardiography: The Supportive Diagnostic Value in Cardiac Amyloidosis and Hypertrophic Cardiomyopathy

Monte

Faro

Trimarchi

et al. 2023

JCDD

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Background: Left atrial (LA) function is crucial for assessing left ventricular filling in various cardiovascular conditions. Cardiac Amyloidosis (CA) is characterized by atrial myopathy and LA function impairment, with diastolic dysfunction up to restrictive filling pattern, leading to progressive heart failure and arrhythmias. This study evaluates LA function and deformation using speckle tracking echocardiography (STE) in patients with CA compared to a cohort of patients with sarcomeric Hypertrophic Cardiomyopathy (HCM) and a control group. Methods: We conducted a retrospective, observational study (from January 2019 to December 2022) including a total of 100 patients: 33 with ATTR-CA, 34 with HCMs, and 33 controls. Clinical evaluation, electrocardiograms, and transthoracic echocardiography were performed. Echocardiogram images were analyzed in post-processing using EchoPac software for LA strain quantification, including LA-reservoir, LA-conduit, and LA-contraction strain. Results: The CA group exhibited significantly impaired LA function compared to HCMs and control groups, with LA-reservoir median values of −9%, LA-conduit −6.7%, and LA-contraction −3%; this impairment was consistent even in the CA subgroup with preserved ejection fraction. LA strain parameters correlated with LV mass index, LA volume index, E/e’, and LV-global longitudinal strain and were found to be associated with atrial fibrillation and exertional dyspnea. Conclusions: LA function assessed by STE is significantly impaired in CA patients compared to HCMs patients and healthy controls. These findings highlight the potential supportive role of STE in the early detection and management of the disease.

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“…LA strain was measured using specific software (2D Cardiac Performance Analysis; Tomtec Arena 2.42) and end diastole as the zero-strain reference point. 9 LA reservoir function was assessed by the reservoir strain (LASr) and additionally estimated from the product LASr (as a surrogate of LA pressure change [10][11][12] )×LA reservoir volume [13][14][15] -a simplified index of LA reservoir work (LAWr).…”

Section: La Size and Functionmentioning

confidence: 99%

Atrial Dysfunction in Significant Atrial Functional Mitral Regurgitation: Phenotypes and Prognostic Implications

Cramariuc

Alfraidi

Nagata

et al. 2023

Circ: Cardiovascular Imaging

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BACKGROUND: Atrial functional mitral regurgitation (AFMR) is associated with increased morbidity and mortality. Left atrial (LA) size and function in AFMR are poorly characterized. We aimed to assess LA function by reservoir strain (LASr) and estimated reservoir work (LAWr) and their impact on outcome in AFMR. METHODS: Consecutive patients at our institution between 2001 and 2019 and with significant (moderate or greater) AFMR were examined. LAWr was estimated as LASr×LA reservoir volume, and patients were grouped by median LASr and LAWr. Outcomes were all-cause death or heart failure hospitalizations. RESULTS: Five hundred fifteen AFMR patients were followed up for 5 (1–17) years. Patients had previously documented atrial fibrillation (AF; 37%), heart failure with preserved ejection fraction (HFpEF) without AF (24%), or both (HFpEF+AF, 39%). LA volume was largest in AF, while LA function parameters were most impaired in the combined HFpEF+AF group. During follow-up, patients with low LASr or LAWr had higher risk of death ( P <0.001) and heart failure hospitalization ( P <0.05). In Cox regression analyses, low LASr and LAWr, but not LA volume or left ventricular function, were associated with a higher risk of death (LASr: hazard ratio, 2.3 [95% CI, 1.6–3.5]; LAWr: hazard ratio, 3.4 [95% CI, 2.4–4.9]; both P <0.001) after adjustment for clinical and echocardiographic confounders. Low LASr and LAWr were strongest associated with death in HFpEF and HFpEF+AF. CONCLUSIONS: LA reservoir function but not LA size is a robust predictor of outcome in significant AFMR. This provides mechanistic insights into the interplay of functional versus geometric LA changes in AFMR.

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Echocardiographic Assessment of Atrial Function: From Basic Mechanics to Specific Cardiac Diseases

Cited by 7 publications

References 100 publications

Left atrial dyssynchrony in veteran endurance athletes with and without paroxysmal atrial fibrillation

Left atrial dyssynchrony in veteran endurance athletes with and without paroxysmal atrial fibrillation

Left Atrial Strain Imaging by Speckle Tracking Echocardiography: The Supportive Diagnostic Value in Cardiac Amyloidosis and Hypertrophic Cardiomyopathy

Atrial Dysfunction in Significant Atrial Functional Mitral Regurgitation: Phenotypes and Prognostic Implications

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