Measurement of Left Atrial Pressure is a Good Predictor of Freedom From Atrial Fibrillation

Bergau, Leonard; Vollmann, Dirk; Lüthje, Lars; Sohns, Jan M; Seegers, Joachim; Sohns, Christian; Zabel, Markus

doi:10.1016/s0972-6292(16)30774-4

“…Although the greatest clinical utility concerns LASr in the case of echocardiography and LAPmean in the case of hemodynamic measurements, the importance of other LAS and LAP values is also increased. A study revealed that both LAPmax and LAPmean were significantly higher in patients with AF recurrence after catheter ablation [30]. In that study, in multivariate analysis, an LAPmax >18 mm Hg was significantly associated with an elevated risk for AF recurrence (hazard ratio [HR], 3.8).…”

Section: Discussionmentioning

confidence: 94%

Correlations between left atrial strain and left atrial pressures values in patients undergoing atrial fibrillation ablation

Uziębło‐Życzkowska

¹

,

Krzesiński

²

,

Jurek

³

et al. 2021

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Background:We aimed to investigate the correlations between left atrial strain (LAS) assessed by speckle tracking echocardiography and directly measured left atrial pressures (LAP) values and to estimate the features of patients with lower LAS values. Methods:A prospective, observational study was performed on patients with atrial fibrillation (AF) undergoing ablation. Detailed transthoracic echocardiography with the speckle tracking method was used to estimate the LAS reservoir (LASr) and direct measurements of LAP during ablation in all patients.Results: A total of 172 patients were included (98 with sinus rhythm [SR] and 74 with AF). The patients with lower LASr (first tercile) compared to those with higher (third tercile), were older, more often female, presented with a larger left atrium (LA) (per the LA area and volume index), and had more impaired left ventricular (LV) diastolic function parameters (e' , E/e'). The correlation analysis of the echocardiographic parameters with the LAP revealed the most significant correlations in the SR group, where the E/e' ratio, LASr, and LAS contraction (LASct) values were all associated with LAP. The cut-off value of LASr estimating high elevated mean LAP (≥15 mm Hg) was 21.88 (Area Under Curve [AUC], 0.81; 95% confidence interval [CI], 0.72-0.90; P <0.0001) for the SR group and 11.25 (AUC, 0.66; 95% CI, 0.53-0.80; P = 0.016) for the AF group.Conclusions: AF patients with lower LASr are older, more often female, have a larger LA, and have more impaired LV diastolic function. Low LASr and LASct and high E/e' ratio values are associated with higher LAP in AF patients with SR.

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“…The elevation of LAP also shortens the effective refractory period of cardiomyocytes and increases the chances of developing AF [25]. LAP was related to left atrial structural remodeling [26]. Some studies found that plasma CTRP3 levels were associated with hypertension, coronary heart disease, and heart failure, and CTRP3 inhibited myocardial fibrosis in myocardial infarction rats.…”

Section: Discussionmentioning

confidence: 99%

Association of Plasma C1q/TNF-Related Protein 3 (CTRP3) in Patients with Atrial Fibrillation

Chen

¹

,

Liu

²

,

Xu

³

et al. 2020

Mediators of Inflammation

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Atrial fibrillation (AF) is a highly prevalent cardiac arrhythmia characterized by atrial remodeling. Complement C1q tumor necrosis factor-related protein 3 (CTRP3) is one of the adipokines associated with obesity, diabetes, and coronary heart disease. The association between plasma CTRP3 levels and AF is uncertain. The aim of this study was to investigate whether plasma CTRP3 concentrations were correlated with AF. Our study included 75 AF patients who underwent catheter ablation at our hospital and 47 sinus rhythm patients to determine the difference in plasma CTRP3 concentrations. Blood samples before the ablation were collected, and ELISA was used to measure the concentrations of CTRP3. Plasma CTRP3 concentrations were significantly lower in AF patients compared with control group ( 366.9 ± 105.2 ng / ml vs. 429.1 ± 100.1 ng / ml , p = 0.002 ). In subgroup studies, patients with persistent AF had lower plasma CTRP3 concentrations than those with paroxysmal AF ( 328.3 ± 83.3 ng / ml vs. 380.0 ± 109.2 ng / ml , p = 0.037 ). The concentrations of plasma CTRP3 in the recurrence group after radiofrequency catheter ablation of AF were lower than those in the nonrecurrence group ( 337.9 ± 77.3 ng / ml vs. 386.6 ± 108.1 ng / ml , p = 0.045 ). Multivariate regression analysis revealed the independent correlation between plasma CTRP3 level and AF. Plasma CTRP3 concentrations were correlated with the presence of AF and AF recurrence.

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“…Transseptal LAP was measured as described previously [13, 14]. For the ablation procedure, access was achieved from the femoral veins.…”

Section: Methodsmentioning

confidence: 99%

Validation of E/e′ Using the Index-Beat Method as an Estimate of Left Atrial Pressure in Patients with Atrial Fibrillation

Ma¹,

Fang²,

Xue³

et al. 2023

Cardiology

0

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Introduction: Echocardiographic assessment of diastolic function during atrial fibrillation (AF) remains challenging due to the irregular cardiac cycle length. We sought to assess whether the index-beat method, the beat following two preceding cardiac cycles of equal duration, could provide a more reliable measurement of E/e′ (mitral E wave/diastolic tissue Doppler velocity) than the conventional averaging of consecutive beats and hence facilitate the non-invasive estimation of elevated left atrial pressure (LAP) in patients with AF. Methods: We prospectively studied 35 patients with persistent AF who had preserved left ventricular ejection fraction and underwent radiofrequency ablation. LAP was measured in conjunction with trans-septal puncture during catheter ablation. Echocardiography was performed 24 h before ablation and E/e′ was determined using the recommended averaging of 10 beats and the index-beat method, with the observers blinded to the clinical details and LAP measurements. Results: Correlation analysis showed a strong positive correlation between two methods in terms of both septal E/e′ (r = 0.841, p < 0.001) and lateral E/e′ (r = 0.930, p < 0.001). Bland-Altman analysis also showed a good agreement between the two measurement methods in terms of E/e′. E/e′ determined using both conventional averaging and the index-beat method was significantly correlated with LAP (p < 0.05). After Fisher Z transformation, we found that the index-beat septal E/e′ had a better correlation with LAP than did the conventional averaging E/e′ (r = 0.736 vs. r = 0.392, Zr = -2.110, p = 0.035). Furthermore, the index-beat method took significantly less time to measure E/e′ (mean 33.6 s; 95% confidence intervals (CI): 32.1s to 36.2s), than did conventional averaging method (mean 96.2 s; 95% CI: 90.2s to 102.3s; p < 0.001). Receiver operating characteristic curve analysis revealed that the optimal cut-off for predicting mean LAP > 12mmHg was 11 (sensitivity 100%; specificity 77.3%) for index-beat septal E/e′ and 16 (sensitivity 61.5%; specificity 95.5%) for index-beat lateral E/e′. Conclusions: Good correlations were found between E/e′ and LAP in patients with AF, particularly with the index-beat method. Moreover, the index-beat method can easily measure E/e′ at an accuracy similar to that for the conventional averaging of consecutive beats, which can therefore be applied to assess the diastolic dysfunction and potentially improve the diagnosis of heart failure in patients with AF.

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Measurement of Left Atrial Pressure is a Good Predictor of Freedom From Atrial Fibrillation

Cited by 14 publications

References 36 publications

Correlations between left atrial strain and left atrial pressures values in patients undergoing atrial fibrillation ablation

Correlations between left atrial strain and left atrial pressures values in patients undergoing atrial fibrillation ablation

Association of Plasma C1q/TNF-Related Protein 3 (CTRP3) in Patients with Atrial Fibrillation

Validation of E/e′ Using the Index-Beat Method as an Estimate of Left Atrial Pressure in Patients with Atrial Fibrillation

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