Is left atrium the best kept secret of the heart? Left atrial dilatation and cardiovascular outcomes

Polovina, Marija; Coats, Andrew J.S.; Seferović, Petar

doi:10.1136/heartjnl-2019-315695

Cited by 7 publications

(5 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The LA is widely recognized for being extremely sensitive to LV hemodynamic changes [17,18]. Alterations in LA structure and function may occur before observable LV dysfunction, making them potentially more useful for subclinical disease discrimination than LV measures [19].…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Automated, Machine-Learning-Based Left Heart Chamber Metrics: Associations with Prevalent Vascular Risk Factors and Cardiovascular Diseases

Barbieri

Albini

Chiusolo

et al. 2022

JCM

View full text Add to dashboard Cite

Background. Three-dimensional transthoracic echocardiography (3DE) powered by artificial intelligence provides accurate left chamber quantification in good accordance with cardiac magnetic resonance and has the potential to revolutionize our clinical practice. Aims. To evaluate the association and the independent value of dynamic heart model (DHM)-derived left atrial (LA) and left ventricular (LV) metrics with prevalent vascular risk factors (VRFs) and cardiovascular diseases (CVDs) in a large, unselected population. Materials and Methods. We estimated the association of DHM metrics with VRFs (hypertension, diabetes) and CVDs (atrial fibrillation, stroke, ischemic heart disease, cardiomyopathies, >moderate valvular heart disease/prosthesis), stratified by prevalent disease status: participants without VRFs or CVDs (healthy), with at least one VRFs but without CVDs, and with at least one CVDs. Results. We retrospectively included 1069 subjects (median age 62 [IQR 49–74]; 50.6% women). When comparing VRFs with the healthy, significant difference in maximum and minimum indexed atrial volume (LAVi max and LAVi min), left atrial ejection fraction (LAEF), left ventricular mass/left ventricular end-diastolic volume ratio, and left ventricular global function index (LVGFI) were recorded (p < 0.05). In the adjusted logistic regression, LAVi min, LAEF, LV ejection fraction, and LVGFI showed the most robust association (OR 3.03 [95% CI 2.48–3.70], 0.45 [95% CI 0.39–0.51], 0.28 [95% CI 0.22–0.35], and 0.22 [95% CI 0.16–0.28], respectively, with CVDs. Conclusions. The present data suggested that novel 3DE left heart chamber metrics by DHM such as LAEF, LAVi min, and LVGFI can refine our echocardiographic disease discrimination capacity.

show abstract

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Automated, Machine-Learning-Based Left Heart Chamber Metrics: Associations with Prevalent Vascular Risk Factors and Cardiovascular Diseases

Barbieri

Albini

Chiusolo

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…This may be because the ETH patients in this study were all old and the level of angiotensin-converting enzyme in the atrial tissue was significantly increased to trigger atrial remodeling. The increasing residual blood volume in the left atrium caused it to relax and expand, leading to a decrease in the function of 'storage' (29). At the same time, the left atrial passive emptying volume of the left atrium is reduced, causing 'transport' dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…At the same time, the left atrial passive emptying volume of the left atrium is reduced, causing 'transport' dysfunction. When PAF occurs in patients with ETH, the atrial muscle loses its normal contractile function due to uncoordinated atrial electrophysiological activities, which leads to the disappearance of left atrial auxiliary pump function and reduction of left atrial blood output, further leading to an increase in left atrial volume load and reduction in its storage function (29,30). Changes to these three functions affect each other and further cause left atrial dysfunction in patients with ETH combined with PAF.…”

Section: Discussionmentioning

confidence: 99%

Left heart function evaluation of patients with essential hypertension and paroxysmal atrial fibrillation by two-dimensional speckle tracking imaging combined with real-time three-dimensional ultrasound imaging

et al. 2021

View full text Add to dashboard Cite

Background: This study aims to assess the value of two-dimensional speckle tracking imaging (2D-STI) combined with real-time 3-dimensional echocardiography (RT-3DE) in evaluating left heart function in patients with combined ETH and PAF. Methods: A prospective study was designed, and the research period was from January 2017 to January 2020. A PAF observation group comprised of patients with ETH and PAF, a PAF control group of patients with ETH but without PAF, and a healthy volunteer group referred to as the healthy group, each comprised of 50 patients was established. All patients underwent routine ultrasound imaging examination using 2D-STI and RT-3DE. The interventricular septum thickness (IVST), left and right atrioventricular diameter (LAD), left ventricular posterior wall thickness (PWT), left ventricular ejection fraction (LVEF), the mean left atrium peak strain (mSs, mSe, mSa), strain rate (mSRs, mSRe, mSRa), the left ventricular mass (LVM), left ventricular mass index (LVMI), and left atrial total emptying volume (LATEV), the left atrial volume index (LAVI), left atrial total emptying fraction (LATEF), left atrium expansion index (LAEI), left atrium passive ejection fraction (LAPEF), and left atrial active ejection fraction (LAAEF) were calculated. Patients in the PAF observation group received telmisartan combined with rosuvastatin after diagnosis and 12-and 24-month-follow up visits were conducted. During these visits, 2D-STI combined with RT-3DE was used to evaluate cardiac function and each patient's blood pressure was monitored. Results: Patients in the PAF observation group had a significantly longer course of ETH than patients in the PAF control group (13.5±4.4 vs. 10.32±5.6, P=0.002). The comparison of routine 2D-STI and RT-3DE ultrasound indexes among the three groups also showed significant differences (P<0.01). During the 2-year follow-up period, the IVST, LAD, PWT, and LVEF of remaining patients significantly improved as treatment progressed (P<0.05). The LAVI, LATEF, and LAEI also improved significantly as the treatment progressed (P<0.05). After 12 months of treatment, the recurrence rate of atrial fibrillation was 16.33% (8/45) and after 24 months this was 34.21% (13/38).Conclusions: Cardiac function could be evaluated comprehensively by 2D-STI combined with RT-3DE in patients with ETH combined with PAF at initial diagnosis and follow-up. Ethical approvalAll procedures performed in this study involving human participants were in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Clinical Ethics Committee of The Central Hospital of

show abstract

“…Echocardiographic alterations describe various CR findings as previously described changes in size, mass, geometry, and function of the heart [5]. As dysfunction may not be present at early stages, we evaluated cardiac remodeling through morphological parameters, ventricular geometry, and LA dimension [5,21]. Regarding the geometry pattern, 4 types were defined based on LVMI and RWT.…”

Section: Echocardiographic Evaluationmentioning

confidence: 99%

Serum Vitamin D Levels, Disease Activity Score-28 for Rheumatoid Arthritis with C-Reactive Protein (DAS28-CRP), and Cardiac Remodeling Determined by Ventricular Dimensions and Left Atrium Diameter in Patients with Rheumatoid Arthritis: A Prospective Observational Study

et al. 2022

View full text Add to dashboard Cite

the Technological and Scientific Development (CNPq), and the Coordination for the Improvement of Higher Education Personnel (CAPES -code 001) Conflict of interest: None declared Background:Rheumatoid arthritis (RA) can cause extra-articular manifestations, and the myocardium can be a target. This study aimed to describe structural and functional cardiac echocardiographic variables in RA patients and to evaluate whether vitamin D (VD) levels and inflammation markers, evaluated by Disease Activity Score-28 for Rheumatoid Arthritis with C-reactive protein (DAS28-CRP), are associated with cardiac remodeling (CR) in this population. Material/Methods:This prospective observational study evaluated 90 patients with RA in Botucatu University Hospital wards from 2014 to 2017. Clinical data were recorded, including demographic information, comorbidities, length of disease, and treatment type. Serum VD and C-reactive protein levels were measured, and the DAS28-CRP was calculated. A transthoracic echocardiography study was performed. The outcome evaluated was CR. This parameter was assessed by left ventricular geometric patterns and left atrium diameter. Results:We evaluated 90 RA patients. The mean age was 52.9±10.8 years, and 17.8% were male. The length of the disease was 96 (60-180) months. Serum VD levels were 30.7±10.4 ng/mL and the DAS28 was 2.7±0.9. Regarding the CR parameters, 56.7% had altered left ventricular geometric patterns and 25.8% had enlargement of left atrium diameter. Even in multivariate analysis, the left ventricular geometric patterns were not associated with the VD levels and the inflammation marker used. However, sufficient VD levels protect from left atrium enlargement (OR: 0.905; IC 95%: 0.843-0.973; P=0.007). Conclusions:Low serum vitamin D values, but not inflammation, are associated with CR in patients with RA.

show abstract

Is left atrium the best kept secret of the heart? Left atrial dilatation and cardiovascular outcomes

Cited by 7 publications

References 10 publications

Three-Dimensional Automated, Machine-Learning-Based Left Heart Chamber Metrics: Associations with Prevalent Vascular Risk Factors and Cardiovascular Diseases

Three-Dimensional Automated, Machine-Learning-Based Left Heart Chamber Metrics: Associations with Prevalent Vascular Risk Factors and Cardiovascular Diseases

Left heart function evaluation of patients with essential hypertension and paroxysmal atrial fibrillation by two-dimensional speckle tracking imaging combined with real-time three-dimensional ultrasound imaging

Serum Vitamin D Levels, Disease Activity Score-28 for Rheumatoid Arthritis with C-Reactive Protein (DAS28-CRP), and Cardiac Remodeling Determined by Ventricular Dimensions and Left Atrium Diameter in Patients with Rheumatoid Arthritis: A Prospective Observational Study

Contact Info

Product

Resources

About