Relation between echocardiographically determined left atrial size and atrial fibrillation.

Henry, Walter L.; Morganroth, Joel; Pearlman, A S; Clark, Chester E.; Redwood, David R.; Itscoitz, S B; Epstein, Stephen E.

doi:10.1161/01.cir.53.2.273

Cited by 582 publications

(217 citation statements)

References 25 publications

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“…Additionally, although the interaction between LV mass index and hypertension was not statistically significant, stratified results suggest that LV mass index was associated with diminished white matter microstructure among hypertensive, but not normotensive, participants. This association, which should be interpreted with caution, is consistent with prior work showing the associations among hypertension, LV mass index,17 and white matter disease 18. Those with longstanding hypertension may have some underlying structural brain changes present,27 making the white matter more vulnerable to small changes in LV structure.…”

Section: Discussionsupporting

confidence: 89%

“…First, increased LV mass index and compromised white matter microstructure may be explained by a common etiology, such as hypertension. As the left ventricle pumps against a high‐pressure arterial system over time, the myocardium hypertrophies17 to provide enough force for adequate perfusion. Thus, hypertension directly contributes to LV remodeling and has been shown to directly lead to changes in the cerebral vasculature, damaging the white matter 18.…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, the increase in LV mass index could directly contribute to diminished white matter microstructure by reducing cardiac functional efficiency. For example, when the left ventricle hypertrophies, the electrical tracts in the myocardium lengthen, increasing the risk for cardiac arrhythmias 17. As the synchronized conduction of the heart becomes compromised, risk for blood stasis increases,19 potentially leading to thrombus formation 17.…”

Section: Discussionmentioning

confidence: 99%

“…For example, when the left ventricle hypertrophies, the electrical tracts in the myocardium lengthen, increasing the risk for cardiac arrhythmias 17. As the synchronized conduction of the heart becomes compromised, risk for blood stasis increases,19 potentially leading to thrombus formation 17. Therefore, those older adults with increased LV mass index could experience silent cardioembolic ischemia, leading to subclinical brain microvascular changes.…”

Section: Discussionmentioning

confidence: 99%

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Increased Left Ventricular Mass Index Is Associated With Compromised White Matter Microstructure Among Older Adults

Moore

Liu

Pechman

et al. 2018

JAHA

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BackgroundLeft ventricular (LV) hypertrophy is associated with cerebrovascular disease and cognitive decline. Increased LV mass index is a subclinical imaging marker that precedes overt LV hypertrophy. This study relates LV mass index to white matter microstructure and cognition among older adults with normal cognition and mild cognitive impairment.Methods and ResultsVanderbilt Memory & Aging Project participants free of clinical stroke, dementia, and heart failure (n=318, 73±7 years, 58% male, 39% mild cognitive impairment) underwent brain magnetic resonance imaging, cardiac magnetic resonance, and neuropsychological assessment. Voxelwise analyses related LV mass index (g/m2) to diffusion tensor imaging metrics. Models adjusted for age, sex, education, race/ethnicity, Framingham Stroke Risk Profile, cognitive diagnosis, and apolipoprotein E–ε4 status. Secondary analyses included a LV mass index×diagnosis interaction term with follow‐up models stratified by diagnosis. With identical covariates, linear regression models related LV mass index to neuropsychological performances. Increased LV mass index related to altered white matter microstructure (P<0.05). In models stratified by diagnosis, associations between LV mass index and diffusion tensor imaging were present among mild cognitive impairment participants only (P<0.05). LV mass index was related only to worse visuospatial memory performance (β=−0.003, P=0.036), an observation that would not withstand correction for multiple testing.ConclusionsIn the absence of prevalent heart failure and clinical stroke, increased LV mass index corresponds to altered white matter microstructure, particularly among older adults with clinical symptoms of prodromal dementia. Findings highlight the potential link between subclinical LV remodeling and cerebral white matter microstructure vulnerability.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Increased Left Ventricular Mass Index Is Associated With Compromised White Matter Microstructure Among Older Adults

Moore

Liu

Pechman

et al. 2018

JAHA

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“…[15] and [21] However, the power of the present study is not sufficient to reject the widespread notion that a greater left atrial diameter is associated with AF relapse.…”

Section: Study Population and Traditional Factors Predicting Sr Maintcontrasting

confidence: 74%

Noninvasive estimation of organization in atrial fibrillation as a predictor of sinus rhythm maintenance

Petersson

Sandberg

Platonov

et al. 2011

Journal of Electrocardiology

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Previous studies indicate that the predictive value of atrial fibrillatory rate in patients undergoing cardioversion of atrial fibrillation (AF) of long duration is limited. The present study investigates signal entropy in this setting. Standard 12-lead electrocardiograms (ECGs) were recorded from 66 consecutive patients with AF undergoing cardioversion and sample entropy estimated. Patients were followed for 4 weeks. At follow-up, 59% of the patients had relapsed to AF. The AF signal entropy of these patients before cardioversion was 0.099 ± 0.015, whereas it was 0.093 ± 0.012 among the 41% maintaining sinus rhythm (P = .02). As hypothesized, signal entropy was lower in patients who maintained sinus rhythm 4 weeks after cardioversion than in those who did not. However, the overlap was large, making its clinical value limited.

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Atrial fibrillation and flutter. Immediate control and conversion with intravenously administered verapamil

Tommaso¹,

McDonough²,

Parker³

et al. 1983

Archives of Internal Medicine

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The safety and efficacy of the intravenous (IV) calcium channel blocker, verapamil, in controlling the ventricular response or converting to sinus rhythm patients with atrial flutter or atrial fibrillation were assessed. Seventeen patients (nine with atrial flutter and eight with atrial fibrillation) with these arrhythmias that were difficult to control pharmacologically were chosen for the study. All patients at the time of study were receiving digoxin. Either verapamil or placebo was chosen randomly and a bolus of 0.075 mg/kg (up to 5 mg) was administered. Twelve patients had a marked reduction in their ventricular response after IV administration of verapamil (seven with atrial flutter and five with atrial fibrillation). None of these 12 patients converted (nonconverters). The average reduction in heart rate was from 120 +/- 6 beats per minute to a minimum of 83 +/- 13 beats per minute within 20 minutes after drug administration. Verapamil was found to convert five patients with atrial arrhythmias to sinus rhythm (two with atrial flutter and three with atrial fibrillation) (converters). In addition, three patients with atrial arrhythmias of less than one month who did not convert with parenteral drug therapy converted within 24 hours while receiving the oral drug. Converters had their supraventricular arrhythmias of significantly shorter duration (median, three hours v 30 days) and tended to have smaller left atrial size (3.8 +/- 0.7 cm v 4.3 +/- 1.3 cm) compared with the nonconverters. We conclude that verapamil is safe and effective when administered IV to patients with atrial flutter and fibrillation for control of ventricular response. In short duration atrial arrhythmias, conversion to sinus rhythm is likely once the ventricular response is controlled.

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Relation between echocardiographically determined left atrial size and atrial fibrillation.

Cited by 582 publications

References 25 publications

Increased Left Ventricular Mass Index Is Associated With Compromised White Matter Microstructure Among Older Adults

Increased Left Ventricular Mass Index Is Associated With Compromised White Matter Microstructure Among Older Adults

Noninvasive estimation of organization in atrial fibrillation as a predictor of sinus rhythm maintenance

Atrial fibrillation and flutter. Immediate control and conversion with intravenously administered verapamil

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