Left Atrial Phasic Function by Cardiac Magnetic Resonance Feature Tracking Is a Strong Predictor of Incident Cardiovascular Events

Chirinos, Julio A.; Sardana, Mayank; Ansari, Bilal; Satija, Vaibhav; Kuriakose, Daniel; Edelstein, Ilaina; Oldland, Garrett; Miller, Rachana; Gaddam, Swetha; Lee, Jonathan J.; Suri, Arpita; Akers, Scott

doi:10.1161/circimaging.117.007512

Cited by 95 publications

(80 citation statements)

References 32 publications

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“…The authors who reported these findings did not provide explanations for their results . The reduced LA reservoir function is strong predictor of incident cardiovascular events, atrial fibrillation occurrence and recurrence, and worse outcome in patients with heart failure with preserved ejection fraction . Our present findings showed that athletes had reduced LA pump function.…”

Section: Discussioncontrasting

confidence: 64%

Left atrial function in elite athletes: A meta‐analysis of two‐dimensional speckle tracking echocardiographic studies

Cuspidi

Tadić²,

Sala

et al. 2019

Clinical Cardiology

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Background: We sought to investigate left atrial (LA) volume, function, and strain in elite athletes by a meta-analysis including echocardiographic studies that provided volumetric and strain analysis of LA phasic function. Methods:The OVID-MEDLINE, PubMed, and Cochrane CENTRAL databases were searched for English-language articles without time restriction up to February 2018 through focused and high sensitive search strategies. Studies were identified by crossing the following search terms:Results: Meta-analysis included 403 athletes and 314 active but not trained healthy controls from 9 studies. Pooled data showed that average LA volume index was higher in athletes than in healthy controls (28.0 ± 1.0 vs 20.7 ± 0.8 mL/m 2 , P < 0.001). Global LA longitudinal strain, showing LA reservoir function, was lower in the athletes than in healthy controls with borderline significance (37.0 ± 1.2 vs 38.3 ± 1.5%, P = 0.044). Late diastolic LA strain rate, resembling LA contractile function, was also lower in elite athletes than in control group (−1.56 ± 0.08 vs −1.74 ± 0.09 seconds −1, P = 0.007). Conclusions:Our meta-analysis shows that LA volume is higher, while LA reservoir and contractile functions are impaired in elite athletes during active training compared to untrained controls. Whether these changes persist during deconditioning periods remains to be determined. These alterations may be related to the higher risk of arrhythmias, in particular atrial fibrillation, reported among middle/old aged athletes. K E Y W O R D Sleft atrium, meta-analysis, phasic function, strain, volume

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Section: Discussioncontrasting

confidence: 64%

Left atrial function in elite athletes: A meta‐analysis of two‐dimensional speckle tracking echocardiographic studies

Cuspidi

Tadić²,

Sala

et al. 2019

Clinical Cardiology

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“…Clinical importance of the left atrial functional analysis has been emphasized in many echocardiography studies particularly the prognostic value of left atrial measurements for patients with heart failure with preserved ejection fraction (Morris et al, 2011;Santos et al, 2014Santos et al, , 2016Cameli et al, 2017;Liu et al, 2018). Clinical studies that used MRI sequences for cardiac functional measurements also led to similar findings and demonstrated the prognostic values of the left atrial functional parameters in heart failure patients (Von Roeder et al, 2017;Chirinos et al, 2018). One of the significant advantages of the proposed method is that it is fully automated and, therefore, will allow for analyzing a large number of MRI images which otherwise tedious and time-consuming.…”

Section: Discussionmentioning

confidence: 84%

Fully Automated Left Atrial Segmentation from MR Image Sequences Using Deep Convolutional Neural Network and Unscented Kalman Filter

Zhang

Martin

Noga

et al. 2018

2018 IEEE International Conference on Bioinformatics and Biomedicine (BIBM)

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This study proposes a fully automated approach for the left atrial segmentation from routine cine longaxis cardiac magnetic resonance image sequences using deep convolutional neural networks and Bayesian filtering. The proposed approach consists of a classification network that automatically detects the type of long-axis sequence and three different convolutional neural network models followed by unscented Kalman filtering (UKF) that delineates the left atrium. Instead of training and predicting all long-axis sequence types together, the proposed approach first identifies the image sequence type as to 2, 3 and 4 chamber views, and then performs prediction based on neural nets trained for that particular sequence type. The datasets were acquired retrospectively and ground truth manual segmentation was provided by an expert radiologist. In addition to neural net based classification and segmentation, another neural net is trained and utilized to select image sequences for further processing using UKF to impose temporal consistency over cardiac cycle. A cyclic dynamic model with time-varying angular frequency is introduced in UKF to characterize the variations in cardiac motion during image scanning. The proposed approach was trained and evaluated separately with varying amount of training data with images acquired from 20, 40, 60 and 80 patients. Evaluations over 1515 images with equal number of images from each chamber group acquired from an additional 20 patients demonstrated that the proposed model outperformed state-of-the-art and yielded a mean Dice coefficient value of 94.1%, 93.7% and 90.1% for 2, 3 and 4-chamber sequences, respectively, when trained with datasets from 80 patients.

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“…Importance of LA phasic function evaluation is increasingly recognized for its incremental value in terms of prognosis and risk stratification in various disease states [1, 23–28]. We studied the clinical relevance and prognostic utility of disturbed LA phasic function in heterogeneous population associated with hypertension or AF.…”

Section: Discussionmentioning

confidence: 99%

“…LA enlargement in the patients with hypertension or AF is a common clinical phenomenon. However, the prognostic importance of LA phasic functions has more recently been recognized [1]. The LA modulates left ventricular (LV) filling through three components: reservoir, conduit and booster pump phase.…”

Section: Introductionmentioning

confidence: 99%

Clinical implication of disturbed left atrial phasic functions in the heterogeneous population associated with hypertension or atrial fibrillation

Zhu

Chen

Liu

et al. 2019

Cardiovasc Ultrasound

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Background: To evaluate left atrial (LA) phasic functions in patients with hypertension and/or paroxysmal atrial fibrillation (PAF) and its clinical significance. Methods: LA strain was studied in 77 patients (25 hypertension, 24 lone AF, and 28 with both hypertension and PAF) and 28 controls using two-dimensional speckle-tracking echocardiography (2D STE). The following indexes during atrial reservoir, conduit and pump phase were analyzed respectively: (1) peak atrial longitudinal strain (PALS) and strain rate (PALSR), (2) the standard deviation of time to PALS and PALSR of all LA segments (TpS-SD% and TpSR-SD%). Results: Compared with controls, PALS res , PALS cond and PALSR cond were significantly reduced in patients with isolated hypertension (all P < 0.01) but no significant differences were observed in PALS pump , PALSR pump and TpS pump -SD% between them (all P > 0.05). PALS pump , PALSR pump and PALSR res were significantly lower in patients with both hypertension and PAF than in those with isolated hypertension (all P < 0.05). PALS and PALSR were significantly decreased, and TpS-SD% was significantly increased during each phase in lone AF patients than in controls (all P < 0.05), and PALSR pump was further depressed in patients with both hypertension and PAF (P = 0.029). PALSR cond ≤ 1.475 s − 1 combined with TpS pump -SD% ≥ 3.25% (sensitivity, 85%; specificity, 71%; AUC = 0.845, P < 0.001) could distinguish lone AF from healthy subjects effectively, while in hypertensive patients, PALS pump ≤ 14.2% was found to be an independent differentiator for occurrence of AF or not with sensitivity of 81% and specificity of 84% (AUC = 0.838, P < 0.001). LAVI≥29.3 mL/m 2 was an independent characteristic for reflecting different LA remodeling in lone AF or hypertension with AF. Conclusions:The impairment of LA phasic functions was varied in patients with hypertension and/or AF. The disturbed LA phasic functions were proved to have independent abilities of differential diagnosis in this heterogeneous population associated with hypertension or AF.

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Left Atrial Phasic Function by Cardiac Magnetic Resonance Feature Tracking Is a Strong Predictor of Incident Cardiovascular Events

Cited by 95 publications

References 32 publications

Left atrial function in elite athletes: A meta‐analysis of two‐dimensional speckle tracking echocardiographic studies

Left atrial function in elite athletes: A meta‐analysis of two‐dimensional speckle tracking echocardiographic studies

Fully Automated Left Atrial Segmentation from MR Image Sequences Using Deep Convolutional Neural Network and Unscented Kalman Filter

Clinical implication of disturbed left atrial phasic functions in the heterogeneous population associated with hypertension or atrial fibrillation

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