Left atrial function in obese and non-obese patients undergoing percutaneous pulmonary vein isolation

Abstract

Obesity constitutes a risk factor for atrial fibrillation (AF) and modifies the efficacy of invasive AF treatment. Left atrial (LA) global longitudinal strain (GLS), which is measured using speckle-tracking echocardiography (STE), is one of the new methods that are helpful in evaluating the function of LA. The aim of the study was to evaluate LA function in obese and non-obese patients that were undergoing percutaneous pulmonary vein isolation (PVI) before and 6 months after the procedure. 89 patients (F/M: 31/58; mean age: 55.8 ± 9.8 years) with paroxysmal or persistent symptomatic AF that had been qualified for percutaneous PVI were prospectively enrolled in the study. Body mass index (BMI) constituted as a discriminating factor for the study groups: obese group: BMI ≥ 30 kg/m (29 patients, F/M: 13/16, mean age: 55.13 ± 10.1 years) and non-obese group BMI < 30 kg/m (60 patients, F/M: 18/42, mean age: 57.17 ± 9.0 years). Transthoracic echocardiography (TTE) with LA GLS and segmental longitudinal strain were analysed 1 day before and 6 months after PVI. PVI efficacy was evaluated 6 months after PVI via a seven-day Holter monitoring. Baseline analysis revealed significantly lower two-chamber (2-Ch) LA GLS in the obese patients compared to the non-obese subjects (- 10.55 ± 3.7 vs - 13.11 ± 5.1, p = 0.004). Segmental strain analysis showed no significant differences between the groups. The data that was obtained 6 months after PVI showed a significantly lower 4-Ch LA GLS in the obese patients compared to the non-obese subjects (- 11.04 ± 5.0 vs - 13.91 ± 4.2, p = 0.02), which was accompanied by a significantly lower segmental 4-Ch LA function in the obese patients (med-sept: - 11.66 ± 11.2 vs - 15.97 ± 5.3, p = 0.04; api-sept: - 9.04 ± 6.3 vs - 13.62 ± 6.5, p < 0.001; api-lat: - 7.62 ± 4.0 vs - 13.62 ± 6.5, p < 0.001; med-lat: -9.31 + - 7.9 vs - 15.04 + - 6.3, p = 0.003, global: - 11.04 + - 5.0 vs - 13.91 + - 4.2, p = 0.02). PVI efficacy was confirmed in 52 (58.4%) patients and was similar in both groups. Comparison of the baseline and 6-month strain revealed no differences in LA GLS in either group. Differences in LA GLS before and after the procedure (delta LA GLS) were not obesity dependent. Apical-septal and apical-lateral strain in the obese group, which were measured in 4-Ch view, were significantly lower after the procedure compared to the baseline (p < 0.001). Obese patients with paroxysmal AF were characterised by impaired LA GLS, which is persistent and was accompanied by segmental dysfunction after PVI at the 6-month follow-up. PVI efficacy was comparable between the obese and non-obese patients.

Cardiorespiratory fitness, obesity and left atrial function in patients with atrial fibrillation

“…This finding is in line with the results of Gulel et al [32] who found no significant differences in LA mechanical function assessed by LAS. More recently, Cichón et al [33] , reported no significant differences in LASr in the 4-chamber view with a significant yet clinically minimal difference in the 2-chamber view. In contrast, Chirinos et al [34] showed a reduced LASr and LASc with a higher LASb function among overweight and obese middle-age adults.…”

Evaluating the pure effect of weight on cardiac function in patients with cardiac syndrome X

“…It seems that there is a strong association between reduction in LV filling pressure and improvement in LA function as indicated by the enhancement in LA strain. 20 Decreased LA strain has been found to be related to the LV diastolic dysfunction. 21 Moreover, it has been reported that LA strain has depressed in comorbid conditions associated with diastolic dysfunction, such as diabetes 22 and obesity.…”

Impaired Relaxation and Reduced Lusitropic Reserve in Atrial Myocardium in the Obese Patients

“…FABP3 may be used as an indicator of the early atrial functional injury caused by higher BMI. Clinically, increased BMI has been associated with LA enlargement and impaired LA global longitudinal strain (5,6). We have previously shown that in a rat heart failure model with metabolic syndrome, the LA remodeling and loss of atrial function in vivo are direct consequences of the adipose phenotype (21).…”

“…Since many recent studies have shown a significant correlation between BMI and atrial remodeling in recent years (4)(5)(6), underlying the overweight-and obesity-related molecular biology mechanisms are yet poorly understood.…”

“…Prior reports have described that BMI and increasing age were associated with the left atrium (LA) enlargement and LA volumes that were independent of the effects of hypertension and diabetes mellitus type 2 (DM2) (5). Obese patients with paroxysmal atrial fibrillation (AF) were characterized by the impaired LA global longitudinal strain, which is persistent and was accompanied by the segmental dysfunction after the percutaneous pulmonary vein isolation at the 6-month follow-up (6). Recent studies have demonstrated that the right atrium (RA) volumes have been identified as an independent predictor of the adverse events in the patients with heart failure (HF) with reduced ejection fraction (HFrEF) assessed on both the MRI and echocardiography (7,8).…”