Atrial Function, Left – ABC CARDIOL

ABCHF

Review Article

Left Atrial Cardiomyopathy as a Generator of Heart Failure with Preserved Ejection Fraction

Antonio José Lagoeiro Jorge et al. Wolney de Andrade Martins Evandro Tinoco Mesquita Marcio Roberto Moraes de Carvalho

Abstract

The left atrium is an anatomical structure relevant to the maintenance of the physiological hemodynamics of the cardiovascular system. Atrial cardiomyopathy (aCMP), defined as any change in the structure, architecture, contractility or electrophysiology of the atria, is associated with adverse clinical implications, and responsible for atrial fibrillation and stroke. Heart failure with preserved ejection fraction (HFpEF) with a predominance of atrial fibrillation (AF) is a unique clinical phenotype, characterized by mechanical dysfunction of the left atrium, congestive symptoms and poor prognosis. aCMP is a common condition among patients with HFpEF and AF. Due to the strong association between aCMP and HFpEF, the diagnosis of aCMP has clinical relevance in patients with HFpEF. The objective of this review is to help identify aCMP as a risk factor for the development of HFpEF.

Read Full Article

ABCIC

Original Article

Left Atrial Function Analysis in Patients with Functional Mitral Regurgitation Associated with Dilated Cardiomyopathy

Stephanie Macedo Andrade et al. Rodrigo Bellio de Mattos Barretto Francisco Thiago Tomaz de Sousa David Costa de Souza Le Bihan

Abstract

Background

Functional mitral regurgitation (FMR) is associated with dilated cardiomyopathy (DC), heart failure (HF) and worsening left atrial function (LAF). Patients with DC and FMR may present left atrial dysfunction resulting from both ventricular dysfunction and valve disease, but it is unknown whether the presence of valve disease will lead to greater LAF impairment.

Objective

This study aimed to evaluate the relationship between LAF parameters and FMR degree in patients with DC.

Methods

This cross-sectional observational study included 214 patients with DC, 46 without FMR (control group) and 168 with mild, moderate or severe FMR. An LAF analysis was performed by speckle tracking echocardiography (STE) and atrial volumetric variation.

Results

LAF analyzed by STE by means of reservoir strain, conduit strain and active contraction strain was reduced in the sample, with values of 14.3%, 8.49% and 5.92%, respectively. FMR degree was significantly associated with reservoir strain (0.27 ± 0.16 versus 0.15 ± 0.09; p < 0.001) and contraction strain (19.2 ± 7.3 versus 11.2 ± 2.7; p < 0.001). FMR was also associated with a reduced LAF assessed by volumetric analysis: total atrial emptying fraction of 0.51 ± 0.13 versus 0.34 ± 0.11 and active atrial emptying fraction of 0 .27 ± 0.16 versus 0.15 ± 0.09 (p < 0.001).

Conclusion

In a population with DC, FMR was associated with reduced LAF assessed by STE and atrial volume variation.

Read Full Article

ABC

Editorial

Left Atrial Stiffness, a Marker of Atrial Cardiomyopathy, and Atrial Fibrillation – Relationships and Predictors for Procedure Success after Catheter Ablation

Tan Chen Wu

Over the past years, catheter ablation (CA) for atrial fibrillation (AF) has established itself as a well-recognized strategy in the management of patients with AF and an important option for rhythm control. Although CA is more effective than antiarrhythmic drug therapy, AF recurrences are common during the follow-up.

Late recurrence, during the first 9 months after the blanking period, occurs in 25%-40% of cases and is predominantly linked to the recovery of electrical conduction between the pulmonary veins (PVs) and the left atrium (LA), irrespective of the type of AF. The incidence of very late recurrence (after more than 12 months postablation) has been shown to be higher than previously expected, with an annual recurrence rate estimated at 7.6%. Bunch et al. reported AF recurrence rates ranging from 52% (≤ 50 years + paroxysmal AF) to 75% (> 80 years + paroxysmal AF). In a series of 509 consecutive patients undergoing paroxysmal AF ablation by Teunissen et al., after a single procedure, antiarrhythmic drugs free success rate was 41.3%. The predominant mechanism of very late recurrence includes, in addition to the PV connection, the development of non-PV triggers, and development and maturation of substrate. The predictors appears to be the nonparoxysmal form of AF at baseline, organic heart disease, advanced age, and obesity.

[…]

Read Full Article

ABC

Review Article

Methodological Gaps in Left Atrial Function Assessment by 2D Speckle Tracking Echocardiography

Roxana Cristina Rimbaş et al. Raluca Elena Dulgheru Dragoş Vinereanu

Abstract

The assessment of left atrial (LA) function is used in various cardiovascular diseases. LA plays a complementary role in cardiac performance by modulating left ventricular (LV) function. Transthoracic two-dimensional (2D) phasic volumes and Doppler echocardiography can measure LA function non‑invasively. However, evaluation of LA deformation derived from 2D speckle tracking echocardiography (STE) is a new feasible and promising approach for assessment of LA mechanics. These parameters are able to detect subclinical LA dysfunction in different pathological condition. Normal ranges for LA deformation and cut-off values to diagnose LA dysfunction with different diseases have been reported, but data are still conflicting, probably because of some methodological and technical issues. This review highlights the importance of an unique standardized technique to assess the LA phasic functions by STE, and discusses recent studies on the most important clinical applications of this technique.

Read Full Article

ABC

Letter to the Editor

Assessment of Diastolic Dysfunction: Drugs Could Alter the Results

Emre Yalcinkaya et al. Murat Celik Baris Bugan

To the Editor,

We read with great interest the article by El Aouar et al., entitled “Relationship between left atrial volume and diastolic dysfunction in 500 Brazilian patients”, which was published in the previous issue of Arquivos Brasileiros de Cardiologia. The authors aimed to evaluate the relationship between left atrial volume index and different grades of diastolic dysfunction in Brazilian patients submitted to echocardiogram. Although we commend the authors for the detailed and valuable information that they have provided, some comments may be beneficial.

[…]

Read Full Article

ABC

Artigo Original

Disturbed Left Atrial Function is Associated with Paroxysmal Atrial Fibrillation in Hypertension

Erhan Tenekecioglu et al. Fahriye Vatansever Agca Ozlem Arican Ozluk Kemal Karaagac … Serafettin Demir Tezcan Peker Mustafa Kuzeytemiz Muhammed Senturk Mustafa Yılmaz

Background:

Hypertension is the most prevalent and modifiable risk factor for atrial fibrillation. The pressure overload in the left atrium induces pathophysiological changes leading to alterations in contractile function and electrical properties.

Objective:

In this study our aim was to assess left atrial function in hypertensive patients to determine the association between left atrial function with paroxysmal atrial fibrillation (PAF).

Method:

We studied 57 hypertensive patients (age: 53±4 years; left ventricular ejection fraction: 76±6.7%), including 30 consecutive patients with PAF and 30 age-matched control subjects. Left atrial (LA) volumes were measured using the modified Simpson’s biplane method. Three types of LA volume were determined: maximal LA(LAVmax), preatrial contraction LA(LAVpreA) and minimal LA volume(LAVmin). LA emptying functions were calculated. LA total emptying volume = LAVmax−LAVmin and the LA total EF = (LAVmax-LAVmin )/LAVmax, LA passive emptying volume = LAVmax− LAVpreA and the LA passive EF = (LAVmax-LAVpreA)/LAVmax, LA active emptying volume = LAVpreA−LAVmin and LA active EF = (LAVpreA-LAVmin )/LAVpreA.

Results:

The hypertensive period is longer in hypertensive group with PAF. LAVmax significantly increased in hypertensive group with PAF when compared to hypertensive group without PAF (p=0.010). LAAEF was significantly decreased in hypertensive group with PAF as compared to hypertensive group without PAF (p=0.020). A’ was decreased in the hypertensive group with PAF when compared to those without PAF (p = 0.044).

Conclusion:

Increased LA volume and impaired LA active emptying function was associated with PAF in untreated hypertensive patients. Longer hypertensive period is associated with PAF.

Read Full Article