Left Atrial Expansion Index Research Articles

Assessment of left atrial function in patients with hypertrophic cardiomyopathy using two-dimensional strain: a comparison with volume-derived values.

Hypertrophic cardiomyopathy (HCM) is a common heart disease. Left atrial (LA) function plays an important role in the diastolic function in patients with HCM. In this study, two-dimensional speckle tracking imaging (2D-STI) was used to assess left atrial (LA) function in patients with HCM. Thirty-four patients with HCM and thirty-four age- and gender-matched normal subjects were studied. The LA Volume-Derived Index was measured using 2D ultrasonic images. The LA strain (S-reservoir, S-conduit, S-booster pump) and the strain rate (SR-reservoir, SR-conduit, SR-booster pump), representing the reservoir, conduit and booster pump functions, respectively, were measured. The LA reservoir, conduit and booster pump functions were significantly different between patients with HCM and normal subjects. The values in patients with HCM were less than those in normal subjects. In patients with HCM, S-reservoir and SR-reservoir were significantly correlated with the total LA ejection fraction (LAEF), LA Expansion Index and left ventricular (LV) global longitudinal strain. S-conduit and SR-conduit were significantly correlated with e' and LV global longitudinal strain. S-booster pump and SR-booster pump were significantly correlated with the A, a', active LAEF and LA Expansion Index. S-booster pump was significantly correlated with the LV global longitudinal strain. 2D-STI conveniently demonstrated the LA dysfunction in patients with HCM by detecting the LA strain and strain rate. The accurate assessment of LA function could have potential clinical value for the treatment of patients with HCM.

11 - Is left atrial expansion index a reliable predictor of increased left ventricular filling pressures?

11 - Is left atrial expansion index a reliable predictor of increased left ventricular filling pressures?

Renal function decline predicted by left atrial expansion index in non-diabetic cohort with preserved systolic heart function.

Since natriuretic peptide and troponin are associated with renal prognosis and left atrial (LA) parameters are indicators of subclinical cardiovascular abnormalities, this study investigated whether LA expansion index can predict renal decline. This study analysed 733 (69% male) non-diabetic patients with sinus rhythm, preserved systolic function, and estimated glomerular filtration rate (eGFR) higher than 60 mL/min/1.73 m2. In all patients, echocardiograms were performed and LA expansion index was calculated. Renal function was evaluated annually. The endpoint was a downhill trend in renal function with a final eGFR of <60 mL/min/1.73 m2. Rapid renal decline was defined as an annual decline in eGFR >3 mL/min/1.73 m2. The median follow-up time was 5.2 years, and 57 patients (7.8%) had renal function declines (19 had rapid renal declines, and 38 had incidental renal dysfunction). Events were associated with left ventricular mass index, LA expansion index, and heart failure during the follow-up period. The hazard ratio was 1.426 (95% confidence interval, 1.276-1.671; P < 0.0001) per 10% decrease in LA expansion index and was independently associated with an increased event rate. Compared with the highest quartile for the LA expansion index, the lowest quartile had a 9.7-fold risk of renal function decline in the unadjusted model and a 6.9-fold risk after adjusting for left ventricular mass index and heart failure during the follow-up period. Left atrial expansion index is a useful early indicator of renal function decline and may enable the possibility of early intervention to prevent renal function from worsening. NCT01171040.

Left atrial volume and function in dogs with naturally occurring myxomatous mitral valve disease

ObjectiveMyxomatous mitral valve disease (MMVD) induces progressive left atrial (LA) enlargement. The LA modulates left ventricular filling and performance through its reservoir, conduit, and contractile function. Assessment of LA size and function may provide valuable information on the level of cardiac compensation. Left atrial function in dogs with naturally occurring MMVD remains largely unexplored. The objective of this study was to evaluate LA volume and function in dogs with naturally occurring MMVD. AnimalsThis prospective study included 205 client-owned dogs of different breeds, 114 healthy dogs, and 91 dogs with MMVD of different disease severities. MethodsUsing two-dimensional echocardiography, the biplane area-length method was applied to assess LA volume and calculate volumetric indices of LA reservoir, conduit, and contractile function. ResultsLeft atrial volume and LA stroke volume increased, whereas LA reservoir and contractile function decreased with increasing disease severity. A maximal LA volume <2.25mL/kg was the optimal cut off identified for excluding congestive heart failure in dogs with chronic MMVD with a sensitivity of 96% and a specificity of 100%. An active LA emptying fraction <24% and/or a LA expansion index <126% were suggestive of congestive heart failure in dogs with chronic MMVD with a sensitivity of 77% and a specificity of 89% and a sensitivity of 82% and a specificity of 82%, respectively. ConclusionDogs with MMVD appear to have larger LA volumes with poorer LA function. Deteriorating LA function, characterized by a decreasing reservoir and active contractile function, was evident in dogs with MMVD with increasing disease severity.

ASSESSMENT OF LEFT ATRIAL FUNCTION IN PATIENTS WITHMITRAL VALVE DISEASES

ABSTRACTObjective:To observe and assess left atrial (LA) function by observing the differences in conventional Doppler echo parameters of left ventricular inflow, Left atrial appendage, among patients with mitral valve disease.Methods: Forty three mitral valve disease subjects appearing consecutively for echocardiogram (ECHO) test at the cardiology department in a tertiary care hospital were recruited into the study as per the pre-set inclusion and exclusion criteria. The data from the ECHO was pooled using Microsoft excel and analyzed using SPSS software by application of appropriate statistical tests.Results:Of the 43 objects, 39 had MS, 3 had MR and 2 of them were found to have both MS and MR. The major presenting symptom as observed in 33 subjects, was dyspnea. LA maximum volume was found to be 91±59 ml and minimum was 66±51 ml. Left atrial expansion index was 128±91. Left atrial active emptying fraction was 29±13 and passive emptying fraction was 31±15. No significant change in LA global strain among groups with MR and without MR was observed. Further, no significant difference was observed in left atrial indices like left atrial emptying fraction, left atrial passive emptying fraction, atrial fraction, Left atrial expansion index among groups having MR and no MR.Conclusion:LA contractile, reservoir and conduit function was significantly reduced in mitral valve diseases due to increased hemodynamic load. No significant difference was noted in global LA strain irrespective of MS or MR.Key Words: Valvular disease; Left atria; Strain; Contractile function

Diastolic Heart Failure Predicted by Left Atrial Expansion Index in Patients with Severe Diastolic Dysfunction.

BackgroundLeft atrial (LA) echocardiographic parameters are increasingly used to predict clinically relevant cardiovascular events. The study aims to evaluate the LA expansion index (LAEI) for predicting diastolic heart failure (HF) in patients with severe left ventricular (LV) diastolic dysfunction.MethodsThis prospective study enrolled 162 patients (65% male) with preserved LV systolic function and severe diastolic dysfunction (132 grade 2 patients, 30 grade 3 patients). All patients had sinus rhythm at enrollment. The LAEI was calculated as (Volmax - Volmin) x 100% / Volmin, where Volmax was defined as maximal LA volume and Volmin was defined as minimal volume. The endpoint was hospitalization for HF withp reserved LV ejection fraction (HFpEF).ResultsThe median follow-up duration was 2.9 years. Fifty-four patients had cardiovascular events, including 41 diastolic and 8 systolic HF hospitalizations. In these 54 patients, 13 in-hospital deaths and 5 sudden out-of-hospital deaths occurred. Multivariate analyses revealed that HFpEF was associated with LAEI.and atrial fibrillation during follow-up. For predicting HFpEF, the LAEI had a hazard ratio of 1.197per 10% decrease. In patients who had HFpEF events, the LAEI significantly (P< 0.0001) decreased from 69±18% to 39±11% during hospitalization. Although the LAEI improved during follow-up (53±13%), it did not return to baseline.ConclusionsThe LAEI predicts HFpEF in patients with severe diastolic dysfunction; it worsens during HFpEF events and partially recovers during followup.

Quantitative evaluation of left atrial volume and function by one-dimensional, two-dimensional, and three-dimensional echocardiography in a population of normal dogs

ObjectivesThe primary goal of this study was to compare left atrial (LA) volume and functional indices in a population of normal dogs using transthoracic one-dimensional M-mode, two-dimensional (2D), and three-dimensional (3D) echocardiography. AnimalsForty clinically normal dogs of various breeds were stratified into four groups based on weight. MethodsLeft atrial volume (LAV) was estimated by converting single linear measurements derived from M-mode and 2D images into volumes via the cube and sphere formulas. 2D echocardiography was employed to estimate LAV using linear measures and rectangular and ellipsoid formulas, as well as area-length and the monoplane method of disks. LAV was estimated using the biplane area-length method on 4- and 2-chamber 2D images. LAV was directly measured using 3D volume data obtained over four consecutive cardiac cycles. LAV estimates were compared amongst methods, correlated to body size, and evaluated for reproducibility. Functional indices derived from these various echocardiographic methods were compared to identify any systematic differences based on imaging modality. LA functional indices included LA ejection fraction (LAEF), total LA emptying volume, passive LA emptying volume/fraction, active LA emptying volume/fraction, and LA expansion index. ResultsThe M-mode derived estimates of LAV were significantly smaller than all 2D- and 3D-derived LAV (p<0.0001). The left-sided 3D LAV had the highest correlation with body weight (r2 = 0.8806) for all phases of the LA cycle with acceptable interobserver variability (CV 11%). Conclusions3D echocardiography is a feasible, non-invasive method to measure LAV in a population of normal dogs.

Epinephrine and left atrial and left ventricular diastolic function decrease in normal subjects

BackgroundWe assessed the effect of epinephrine over left atrial and left ventricular diastolic function in subjects without structural heart disease. MethodsTwenty-seven, 34.6±17.2year-old patients without structural heart disease were included. Intravenous epinephrine (50 to 100ng/kg/min) was infused. Left atrial and ventricular functions were evaluated by means of echocardiography before and during the epinephrine infusion. ResultsNo complications were observed. Significant increases in heart rate and systolic blood pressure were recorded. Both left atrial (minimal and maximal) volumes increased but increase in the minimal volume was more pronounced, and the ejection fraction diminished. Left atrial expansion index decreased and the fraction of left ventricular inflow volume resulting from atrial contraction increased. Two patients displayed abnormal left ventricular diastolic function. During epinephrine infusion, E/A and e′ decreased, and isovolumetric relaxation time increased. ConclusionsIn this group of young adults without structural heart disease, epinephrine infusion was safe, did not produce any complications, and induced a small but significant decrease in left atrial function and left ventricular diastolic function.

The differences in left atrial function between ischemic and idiopathic dilated cardiomyopathy patients: A two-dimensional speckle tracking imaging study.

To evaluate left atrial (LA) function in patients with ischemic (ICM) or idiopathic dilated (DCM) cardiomyopathy via two-dimensional speckle-tracking imaging. We measured the LA maximum volume, minimum volume, and volume before the atrial systole, and calculated total emptying volume, expansion index, active emptying volume, and fraction. We measured strain and strain rate during systole and late diastole using two-dimensional speckle-tracking imaging, and analyzed correlations between variables. We found no significant differences in LA size, left ventricle (LV) end-diastole diameter, LV ejection fraction (EF), E/A, E/e', deceleration time of the E wave, and effective mitral regurgitant orifice area between the DCM and the ICM group. However, the LA expansion index, active EF, systolic and late diastolic strain, and strain rate were lower in the ICM group (p < 0.05). The expansion index and active EF were positively correlated with the systolic strain rate and the absolute value of the late diastolic strain rate, respectively. LA basic echocardiographic variables did not reflect the differences between ICM and DCM patients, but the systolic and late diastolic strain, as well as the strain rate, were lower in DCM patients. Two-dimensional speckle-tracking imaging is a promising method to differentiate these patients. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:437-445, 2016.

Left Atrial Expansion Index Predicts Left Ventricular Filling Pressure and Adverse Events in Acute Heart Failure With Severe Left Ventricular Dysfunction

BackgroundThe power of left atrial (LA) parameters for predicting left ventricular (LV) filling pressure and adverse events in acute heart failure (HF) with severe LV dysfunction, either sinus rhythm or atrial fibrillation (AF), is not fully understood. Methods and ResultsEchocardiography was performed in 141 patients with acute decompensated congestive HF and LV ejection fraction <35%, including 42 with permanent AF. The LA expansion index was calculated as (Volmax − Volmin) × 100%/Volmin, where Volmax was defined as maximal and Volmin as minimal LA volume. Of 141 patients, invasive LV filling pressures within 12 hours of LA expansion index measurement were available in 109. The end points were 3-year frequencies of HF hospitalization and all-cause mortality. Over a median follow-up of 3.1 years, 74 participants (52.5%) reached the end points (sinus vs AF group: 48.5% vs 61.9%, respectively; P = .047). Multivariate analysis revealed that adverse events of both groups were only independently associated with age and LA expansion index. Rates of adverse events were proportional to LA expansion index. There was a good logarithmic relationship between LA expansion index and LV filling pressure, regardless of presence or absence of AF. ConclusionsLV filling pressure can be estimated well by LA expansion index, with or without AF. The LA expansion index predicts adverse events in HF patients with severe systolic dysfunction. (ClinicalTrials.gov number: NCT01307722).

Atrial fibrillation ablation by single ring isolation versus wide antral isolation: Effects on left atrial size and function

BackgroundPulmonary vein isolation (PVI) by single ring isolation (SRI) has been demonstrated to reduce recurrence of atrial fibrillation (AF) compared to the standard technique of wide antral isolation (WAI). In this study, we examine the differential effect of these techniques on left atrial size and function. MethodsWe examined left atrial (LA) size (LA maximum and LA minimum volumes) and function (LA emptying fraction and LA expansion index) over a period of 6months following PVI as measured by transthoracic echocardiography in 187 patients that were enrolled in a randomised controlled trial of SRI vs WAI. ResultsCompared to pre-ablation, at 6months post-PVI, there was a small decrease in the LA maximum volume in the WAI group (67.3 vs 62.7mL, p=0.02). The LA size did not change significantly over 6months in the SRI group. Patients who underwent SRI had a small reduction in the LA expansion index at 6months post-PVI compared to baseline (80.6 vs 66.6%, p=0.02). LA function did not change significantly over 6months in the WAI group. However, at 6months, there was no difference in any measure of LA size or function between the SRI and WAI groups. ConclusionsSRI, whilst previously demonstrated to be more effective than WAI in preventing AF recurrence, is associated with minimal adverse effects on left atrial function at medium term follow-up despite the isolation of a larger region of LA myocardium.

13. Immediate Effect of percutaneous transvenous mitral commissurotomy on atrial electromechanical delay and left atrial mechanical functions in patients with rheumatic mitral stenosis

Rheumatic mitral stenosis (MS) is associated with prolonged inter and intra-atrial electromechanical delays and impaired left atrial (LA) mechanical functions, which are considered to be markers of atrial fibrillation (AF) risk. This study was conducted to assess the immediate effect of successful percutaneous transvenous mitral commissurotomy (PTMC) on these parameters. This observational study included 25 patients with symptomatic, severe MS (aged 34.1 ± 7.1 years, with mean mitral valve area (MVA) of 0.74 ± 0.13 cm2), in normal sinus rhythm, who underwent successful PTMC at our hospital. Inter-atrial (AEMD), left intra-atrial (L-IAEMD) and right intra-atrial (R-IAEMD) electromechanical delays were measured on tissue Doppler imaging. Phasic LA volumes (Vmax: maximal LA volume, Vmin: minimal LA volume and Vp: LA volume at P-wave onset) were measured by modified Simpson’s method. Parameters of LA reservoir function i.e. LA total emptying fraction (LATEF) and LA expansion index (LAEI); conduit function i.e. LA passive emptying fraction (LAPEF); and pump function i.e. LA active emptying fraction (LAAEF) were calculated from the phasic LA volumes. PTMC was performed using the standard Inoue Balloon technique. All these parameters were evaluated and compared before and 24–48 h after PTMC. Successful PTMC led to significant reduction in AEMD (p < 0.001), L-IAEMD (p < 0.001), R-IAEMD (p < 0.001), Vmax (p < 0.001), Vmin (p < 0.001) and Vp (p < 0.001). There were significant increments in LATEF (p = 0.001), LAEI (p = 0.002) and LAPEF (p = 0.05), while there was no significant change in LAAEF (p = 0.127) after PTMC. Successful PTMC has a favorable early impact on left atrial mechanical functions and other novel parameters of atrial electromechanical remodeling in MS patients. Large scale prospective studies are required to confirm whether improvement in these markers translates into reduced long term AF risk in these patients.

Assessment of left atrial volume and function in patients with psoriasis by using real time three-dimensional echocardiography.

Left atrial (LA) volume has been identified as a predictor of adverse cardiovascular outcomes, both in the general population and in selected clinical conditions. The aim of this study was to evaluate the effect of psoriasis on LA volume and mechanical function. A total of 40 consecutive normotensive psoriasis patients free of any cardiovascular disease and 39 healthy volunteers were included. All participants underwent comprehensive transthoracic echocardiographic examination. LA volume and mechanical function were evaluated using real-time three-dimensional echocardiography (RT3DE). There were no significant differences between psoriasis and control groups with regard to conventional echocardiographic parameters. Individuals with psoriasis had a higher incidence of left ventricular diastolic dysfunction (LVDD) than the controls; nine people with psoriasis (23%) and three control individuals (8%) had LVDD (p = 0.06). With regard to the parameters obtained from RT3DE, LA maximum, LA minimum, passive stroke volume, and passive emptying fraction were significantly higher; whereas LA active emptying fraction, LA total emptying fraction, LA expansion index, and active stroke volume values were significantly lower in individuals with psoriasis compared with controls. Disease duration and Psoriasis Area of Severity Index (PASI) score correlated with the majority of volume parameters. Individuals with psoriasis had higher LA phasic volumes and impaired LA mechanical function compared with healthy controls. LA volume and functional analysis with RT3DE may facilitate recognition of subtle LA dysfunction in patients with psoriasis.

Evaluation of left atrial volume and function in systemic sclerosis patients using speckle tracking and real-time three-dimensional echocardiography.

Objective:The aim of the present study was to evaluate left atrial (LA) volume and functions using real-time three-dimensional echocardiography (RT3DE) and speckle tracking in systemic sclerosis (SSc) patients.Methods:The study was designed as a cross-sectional observational study. We studied 41 consecutive SSc patients (38 females, mean age: 49.5±11.6 years) and 38 healthy controls (35 females, mean age: 48.5±10.8 years). Patients with evidence or history of cardiovascular disease and patients with risk factors as hypertension, diabetes and chronic renal failure were excluded from the study. All study subjects underwent standard echocardiography; LA speckle tracking and RT3DE was performed to assess LA volume and phasic functions. Differences between numeric variables were tested using the independent sample Student’s t-test or Mann-Whitney U test, where appropriate.Results:There were no significant differences between SSC patients and controls regarding left ventricular (LV) systolic functions and two-dimensional (2-D) atrial diameters. Presence of LV diastolic dysfunction (LVDD) was evaluated and graded according to recommendations of the American Society of Echocardiography. Accordingly, LVDD was observed to be significantly more frequent in SSc patients; 16 SSc patients (39%) and 5 controls (12.8%) were observed to have LVDD (p=0.007). With regard to results obtained from RT3DE, LA maximum, minimum, and before atrial contraction volumes were significantly higher (40.5±14.6 vs. 32.6±8.9, 15.5±8.4 vs. 9.9±3.5 and 28.7±11.7 vs. 21.4±7.0 mL respectively, p<0.05 for all), whereas LA active emptying fraction, LA total emptying fraction, LA expansion index, and passive emptying fraction values were significantly (47.1±12.0 vs. 52.9±10.1%, 62.8±10.5 vs. 69.5±6.7%, 187.5±76.0 vs. 246.6±96.0, 29.6±9.3 vs. 34.4±11.0% respectively, p<0.05 for all) in SSc patients than in controls. In addition, regarding results obtained from speckle tracking echocardiography, atrial peak-systolic longitudinal strain (e), early negative strain rate (SR), late negative SR, and peak positive SR values were observed to be significantly lower in SSc patients.Conclusion:LA volumes were significantly increased, and LA reservoir, conduit, and contractile functions were significantly impaired in SSc patients compared with controls. LA volume and functional analyses with RT3DE and speckle tracking may facilitate the recognition of subtle LA dysfunction in SSc patients.

PP.36.23

Objective: Arterial hypertension (AH) leads to left atrial (LA) dilation, that could be a substrate for the occurrence of atrial fibrillation (AF) and associated with the LA remodeling. Aim of the study was to determine if the short-standing paroxysmal AF influences on structural and functional disorders of LA in patients (pts) with AH. Design and method: 74 hypertensive pts (age 63,0 ± 9,5 years; 40% male) were divided into 2 comparable groups: 44 pts with paroxysmal AF of less than 1 year arrhythmic anamnesis and paroxysms frequency 1 per 3 months (G1), 30 pts without AF (G2). Echocardiography with Doppler technique and ABPM were performed. LA enlargement was defined as LA volume index (LAVI) > 29 mL/m2. LA empting fraction (LAEF) < 45% and LA expansion index (LA exp inx) < 90% were categorized as LA phasic dysfunction. Results: LAVI was significantly higher in G1 vs G2 group [32,1 (28,3; 35,7) vs 24,7 (23,2; 27,2) mL/m2, p < 0.0001]. 23 (52%) pts in G1 and 12 (40%) pts in G2 had LAVI > 29 mL/m2(p = 0.02). LAEF was comparable in G1 and G2 [46,9 (46; 48) vs 45,9% (45,3; 46,6)] as well as reduced LAEF [9 (19%) vs 9 (26%) pts]. LA exp inx was significantly higher in G1 [88,5 (85,3; 92,3) vs 85,1% (82,8; 87,3), p = 0,004]. Decreased LA exp inx was observed more frequently in G2 than in G1 group [24 (80%) vs 20 (46%) pts, p = 0,003]. In G1 group LAVI significantly (p < 0.05) correlated with LA size (r = 0,65), MMI and E/e’ (r = 0,37 for both cases). LAEF and LA exp inx correlated with mean day DBP (r = −0,57), min day SBP (r = −0,46) and max day HR (r = −0,50). There was significant correlation LAVI with LA size (r = 0,57), MMI (r = 0,42), mean night systolic (r = 0,81) and diastolic (r = 0,76) BP in G2 group. Conclusions: LA structure was greater abnormal in hypertensive pts with AF compared to pts without arrhythmia. Short-standing paroxysmal AF did not significantly influence on LA function in pts with AH. LA structure and function correlated with BP level. Negative correlation between LA exp inx and max day HR was additionally found for hypertensive pts with AF.

Reversible Changes of Left Atrial Function during Pregnancy Assessed by Two-Dimensional Speckle Tracking Echocardiography.

BackgroundLeft ventricular diastolic function is impaired during pregnancy. However, changes in left atrial (LA) function remain unclear. We aimed to evaluate changes in LA function during pregnancy using two-dimensional speckle tracking echocardiography (2DSTE).Methods and Results50 pregnant and 50 healthy nulliparous (control group) women were enrolled in this study. All pregnant women were followed up postpartum in sixth-month. The LA maximum volume, LA minimal volume and LA preatrial contraction volume were obtained using biplane modified Simpson’s method. LA filling volume, LA expansion index, LA ejection fraction, passive volume, passive emptying index, active volume, and active emptying index were calculated. LA longitudinal systolic strain (SS), systolic strain rate (s-SR), early diastolic strain rate (e-SR), and late diastolic strain rate (a-SR) were obtained by 2DSTE. Compared to the control group, the reservoir function was increased in pregnant patients (P<0.05); conduit function was decreased in pregnant patients (P<0.05); booster pump function was increased in pregnant patients (P<0.05). There was no statistically significant difference between the control group and postpartum group.ConclusionsLA reservoir and booster pump function were increased, while conduit function was decreased during pregnancy using 2DSTE. The changes were reversible. 2DSTE can easily assess LA function during pregnancy with good repeatability.

Echocardiographic Predictors of Progression to Persistent or Permanent Atrial Fibrillation in Patients with Paroxysmal Atrial Fibrillation (E6P Study)

Paroxysmal atrial fibrillation (AF) frequently, but not always, progresses to persistent/permanent AF. The aim of this study was to evaluate the echocardiographic predictors of AF progression in patients with paroxysmal AF. A multicenter, prospective, observational study was conducted that included 313 patients with paroxysmal AF who underwent two-dimensional speckle-tracking echocardiography. The diameter, volume, and mechanical function of the left atrium, including global strain (ε) and ε rate, were measured. Progression to persistent or permanent AF occurred in 52 patients (16.6%) during a median follow-up period of 26months. Echocardiographic measure of left atrial (LA) diameter, volume, and function (E velocity, E/A and E/e' ratio, LA expansion index, active emptying fraction, global longitudinal ε and ε rate) were associated with AF progression. LA ε ≤ 30.9% was the strongest predictor of AF progression, which was associated with a more than fourfold hazard increase for AF progression (hazard ratio, 4.224; P=.001). LA diameter > 39mm and maximal LA volume index > 34.2mL/m(2) were associated with about a twofold hazard increase for AF progression (hazard ratios, 1.994 and 2.649; P=.016 and P= .001, respectively). When adjusted for a model combining maximal LA volume index, E velocity, LA expansion index, and active emptying fraction, LA ε ≤ 30.9% maintained a more than threefold hazard increase for AF progression (adjusted hazard ratio, 3.970; P=.003). Echocardiographic measures of LA diameter, volume, and mechanical function, including LA ε, were associated with AF progression. LA ε was the strongest independent predictor of AF progression and is expected to serve as a valuable predictor of AF progression.

Effect of radiofrequency catheter ablation of persistent atrial fibrillation on the left atrial function: Assessment by 320-row multislice computed tomography

BackgroundAtrial fibrillation (AF) increases the left atrial (LA) volume and deteriorates LA function. Whether successful radiofrequency catheter ablation (RFCA) of persistent AF can reverse this process has not been yet established. MethodsPatients with persistent AF undergoing RFCA were evaluated with pre- and post- (at 6-months of follow-up) procedural multislice computed tomography (MSCT). The LA functions were assessed through LA time–volume curves. ResultsThe study population consisted of 44 patients [age 64 (interquartile ranges: 58, 70) years old, 93% male]. Among those, 31 patients (70%) maintained sinus rhythm during the follow-up (no recurrence group; NR group). The remaining 13 patients were classified as the recurrence group (R group). A significant decrease in the minimal and maximal LA volumes was observed in both groups, although this was less pronounced in the R group. Only the NR group had an improvement in the LA expansion index [18% (13, 25) vs. 37% (23, 43), p<0.001], ejection fraction [15% (11, 20) vs. 27% (19, 30), p<0.001] and conduit function [17ml/m2 (13, 20) vs. 25ml/m2 (20, 34), p<0.001]. An improvement of LV function was also observed only in the NR group. ConclusionsLA anatomical and functional reverse remodeling after RFCA of persistent AF was demonstrated by MSCT during follow-up, which was more pronounced in patients without AF recurrence.

Left atrial expansion index is an independent predictor of diastolic dysfunction in patients with preserved left ventricular systolic function: a three dimensional echocardiography study.

In the absence of mitral valve disease left atrial (LA) volume is a marker of diastolic dysfunction and its severity. This study investigated the relationship between left ventricular (LV) end diastolic pressure (LVEDP) and LA volumes and phasic atrial functions detected by real-time full volume three-dimensional echocardiography (RT3DE), in a patient population with preserved LV systolic function. Seventy-two (39 female and 33 male; mean age 56.1 ± 9.0 years) stable patients with normal LV ejection fraction (EF) undergoing cardiac catheterization were studied. All patients underwent comprehensive echocardiographic examination just before catheterization and LVEDP was obtained. In addition to conventional echocardiographic measurements and Doppler indices; by using RT3DE LA maximum, minimum and pre-a-wave volumes were measured; LA total, passive and active emptying volumes and fractions were calculated. LV systolic function was assessed by EF and global longitudinal strain by speckle tracking. RT3DE minimum LA volume index, RT3DE active LAEF and LA expansion index (EI) were statistically significant univariate predictors of LVEDP ≥ 16 mmHg. When age and hypertension adjusted multivariate analysis was performed EI [β = -1.741, p = 0.015; OR 0.175; 95 % CI (0.043-0.717)] was an independent predictor of elevated LVEDP. RT3DE evaluation of LA function during entire cardiac cycle has incremental value for the diagnosis of diastolic dysfunction in patients with preserved EF. We suggest that RT3DE evaluation of LA may find clinical application in this field.

Atrial apoptosis and fibrosis adversely affect atrial conduit, reservoir and contractile functions.

Chronic atrial volume overload and atrial fibrillation (AF) induce structural changes within atrial myocardium. The aim of this study was to evaluate the effect of adverse cellular remodelling on echocardiographic strain rate (SR) deformation indices of atrial contractile, conduit and reservoir functions. Forty-four consecutive patients with organic mitral regurgitation were analysed. Twenty-eight patients had long-standing persistent AF (AF group), while 16 were in normal sinus rhythm (NSR group). Left atrial (LA) samples were harvested from all the patients for histological analysis. Postoperative echocardiographic data acquisition was performed exclusively during organized atrial electrical activity in order to assess the contractile reserve of patients from both groups. Fibrotic atria had inferior conduit (SR-E: r = -0.36, P = 0.017), reservoir (SR-S: r = -0.31, P = 0.041) and contractile functions (SR-A: r = -0.33, P = 0.027). Analogously, atria with greater apoptotic burdens showed a negative correlation with multiple indices of left atrial functions (SR-E: r = -0.38, P = 0.010; SR-S: r = -0.33, P = 0.028; SR-A: r = -0.28, P = 0.067). The efficiency of atrial contractility was significantly reduced among AF-group patients after conversion to sinus rhythm, when compared with patients in the NSR group (LA active emptying fraction: 20 ± 12 vs 30 ± 10%, P = 0.004; SR-A: 1.1 ± 1.0 vs 2.8 ± 1.9 s(-1), P < 0.001). Superior strain-rate indices of atrial conduit and reservoir functions were noted in the NSR group (SR-E: 3.5 ± 2.3 vs 1.3 ± 1.0 s(-1), P < 0.001; LA expansion index: 86 ± 31 vs 60 ± 42%, P = 0.004). Fibrosis was evident in 7.2 [3.3;9.4]% of the LA tissue sample in the AF group, while it accounted for 3.4 [1.2;8.1]% of atrial tissue in the NSR group (P = 0.054). Apoptosis was documented in 13 (46%) patients in the AF group, whereas none of the patients in the NSR group exhibited signs of programmed cell death (P = 0.001). Myocyte degeneration was more prevalent in the AF group (odds ratio: 7.0, 95% confidence interval: 1.3-36.7, P = 0.021). Age showed a positive correlation with worsening degrees of atrial fibrosis and apoptosis (r = 0.41, P = 0.006; r = 0.49, P = 0.001, respectively). Multiple regression analysis identified SR-S (β = -1.263, P = 0.036) and age (β = 0.144, P = 0.057) as independent predictors of fibrosis. Independent determinants of apoptosis were preoperative AF (β = 4.539, P = 0.007), age (β = 0.188, P = 0.009) and SR-S (β = -1.780, P = 0.002). Atria exhibiting greater fibrotic and apoptotic burdens had impaired conduit, reservoir and contractile function, as evaluated by deformation imaging. Among patients with chronic LA volume overload, exposure to long-standing persistent AF induced more pronounced degrees of adverse atrial cellular remodelling. Strain-rate descriptors of atrial reservoir function harboured potential to predict atrial fibrosis and apoptosis.