Low voltage areas, atrial natriuretic peptides and fibrosis: Challenges and controversies

Floria, Mariana; Radu, Smaranda; Moraru, Aurelian Corneliu

doi:10.1002/clc.23497

Cited by 3 publications

(5 citation statements)

References 5 publications

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“…Previously reported that late-gadolinium enhancement cardiac magnetic resonance imaging (LGE-MRI) examination of structural remodeling of the left atrium, structural remodeling of the left atrium was more common in the group with reduced LVEF [19]. AF patients with a high degree of LA structural remodeling may have low baseline LVEF and have LA fibrosis [20].…”

Section: Discussionmentioning

confidence: 99%

“…The large number of patients who maintained sinus rhythm may have contributed to the low incidence of thromboembolism during the 12-month follow-up period. However, in patients with a high risk of stroke and systemic embolism, regular D-dimer, prothrombin fragment F1 + 2, and LVEF check should be performed to determine the presence or absence of hypercoagulability [19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

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Difference in left atrial D-dimer level in patients with atrial fibrillation treated with direct oral anticoagulant

Watanabe

Tachibana²,

Shinoda³

et al. 2021

BMC Cardiovasc Disord

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Background Atrial fibrillation (AF) may cause cerebral and systemic embolism. An increased D-dimer level indicates hyperactivation of secondary fibrinolysis, resulting in predilection for thrombosis. To clarify the differential effects of anticoagulation therapy, we compared the D-dimer levels in peripheral and left atrial (LA) blood of atrial fibrillation patients scheduled for ablation. Methods We analyzed 141 patients with non-valvular AF (dabigatran, n = 30; apixaban, n = 47; edoxaban, n = 64; mean age: 68 years, male: 60%). Peripheral venous blood and LA blood was collected before pulmonary vein isolation. We examined the laboratory and echocardiographic parameters. Results After adjusting for baseline characteristics, D-dimer level in the LA was significantly higher in patients treated with edoxaban than that in those on apixaban (0.77 ± 0.05 vs. 0.60 ± 0.05 μg/mL, P = 0.047), although there were no significant differences in peripheral D-dimer levels. We classified the D-dimer value of the LA into a normal group (< 0.9) and a high value group (≥ 1.0); the peripheral prothrombin fragment F1 + 2 level (odds ratio [OR] 1.012; 95% confidence interval [CI]: 1.003–1.022; P = 0.008) and left ventricular ejection fraction (LVEF) (OR, 0.947; 95% CI, 0.910–0.986; P = 0.008) were potential predictors of high LA D-dimer levels. Conclusions In apixaban-treated patients, the D-dimer level in the left atrium was lower than in edoxaban-treated patients on the day of ablation, suggesting that the anticoagulant effect of apixaban on the left atrium is better than that of edoxaban in patients with AF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Difference in left atrial D-dimer level in patients with atrial fibrillation treated with direct oral anticoagulant

Watanabe

Tachibana²,

Shinoda³

et al. 2021

BMC Cardiovasc Disord

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“…Atrial cardiomyopathy, a new entity best studied in atrial fibrillation, is currently a pathophysiological concept, with the possibility of clinically significant manifestation resulting from complex changes in the function, structure, tissue architecture, contractility, or electrophysiological characteristics of the LA. Left atrial dysfunction assessed by STE, LA size best assessed by LA volume, biomarkers as an atrial natriuretic peptide, spontaneous echo contrast (by transesophageal echocardiography), delayed enhancement areas (by magnetic resonance imaging known as the best marker of fibrosis), or low voltage areas (assessed during the electrophysiological study) are the main parameters related to atrial cardiomyopathy and atrial failure 10‐12 . Left atrial volume is a tardive phenotypic manifestation of atrial cardiomyopathy, inconstantly correlating with NT‐proANP levels and fibrosis levels (at least, in atrial fibrillation) 11 .…”

Section: Figurementioning

confidence: 99%

“…Left atrial dysfunction assessed by STE, LA size best assessed by LA volume, biomarkers as an atrial natriuretic peptide, spontaneous echo contrast (by transesophageal echocardiography), delayed enhancement areas (by magnetic resonance imaging known as the best marker of fibrosis), or low voltage areas (assessed during the electrophysiological study) are the main parameters related to atrial cardiomyopathy and atrial failure. [10][11][12] Left atrial volume is a tardive phenotypic manifestation of atrial cardiomyopathy, inconstantly correlating with NT-proANP levels and fibrosis levels (at least, in atrial fibrillation). 11 Larger LA volume and lower LA ejection fraction are associated with the presence of spontaneous echo contrast, an echocardiographic marker of thrombosis.…”

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confidence: 99%

Left atrial functional changes as emerging diagnostic and prognostic marker

Floria

Burlacu

2022

J of Clinical Ultrasound

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“…Surprisingly, LVAs do not consistently correlate with atrial volume, since there could be patients with intensely fibrotic LA but with normal volume. In a chronic setting, the presence of LVAs does not correlate with NT-proANP, because the more the LA cardiomyopathy progresses, the more the fibrotic tissue, and the less LA myocardium there is to secret ANP [ 22 ].…”

Section: Combining Multimodality Imaging Improves the La Assessmentmentioning

confidence: 99%

The Role of the Left Atrium: From Multimodality Imaging to Clinical Practice: A Review

Beltrami

Dei

Milli

2022

Life

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In recent years, new interest is growing in the left atrium (LA). LA functional analysis and measurement have an essential role in cardiac function evaluation. Left atrial size and function are key elements during the noninvasive analysis of diastolic function in several heart diseases. The LA represents a “neuroendocrine organ” with high sensitivity to the nervous, endocrine, and immune systems. New insights highlight the importance of left atrial structural, contractile, and/or electrophysiological changes, introducing the concept of “atrial cardiomyopathy”, which is closely linked to underlying heart disease, arrhythmias, and conditions such as aging. The diagnostic algorithm for atrial cardiomyopathy should follow a stepwise approach, combining risk factors, clinical characteristics, and imaging. Constant advances in imaging techniques offer superb opportunities for a comprehensive evaluation of LA function, underlying specific mechanisms, and patterns of progression. In this literature review, we aim to suggest a practical, stepwise algorithm with integrative multimodality imaging and a clinical approach for LA geometry and functional analysis. This integrates diastolic flow analysis with LA remodelling by the application of traditional and new diagnostic imaging techniques in several clinical settings such as heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), and mitral regurgitation (MR).

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Low voltage areas, atrial natriuretic peptides and fibrosis: Challenges and controversies

Cited by 3 publications

References 5 publications

Difference in left atrial D-dimer level in patients with atrial fibrillation treated with direct oral anticoagulant

Difference in left atrial D-dimer level in patients with atrial fibrillation treated with direct oral anticoagulant

Left atrial functional changes as emerging diagnostic and prognostic marker

The Role of the Left Atrium: From Multimodality Imaging to Clinical Practice: A Review

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