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JACC. Cardiovascular Imaging Jan 2017The left atrium is considered a biomarker for adverse cardiovascular outcomes, particularly in patients with left ventricular diastolic dysfunction and atrial... (Review)
Review
The left atrium is considered a biomarker for adverse cardiovascular outcomes, particularly in patients with left ventricular diastolic dysfunction and atrial fibrillation in whom left atrial (LA) enlargement is of prognostic importance. LA enlargement with a consequent decrease in LA function represents maladaptive structural and functional "remodeling" that in turn promotes electrical remodeling and a milieu conducive for incident atrial fibrillation. Medical and nonmedical interventions may arrest this pathophysiologic process to the extent that subsequent reverse remodeling results in a reduction in LA size and improvement in LA function. This review examines cellular and basic mechanisms involved in LA remodeling, evaluates the noninvasive techniques that can assess these changes, and examines potential mechanisms that may initiate reverse remodeling.
Topics: Animals; Atrial Fibrillation; Atrial Function, Left; Atrial Remodeling; Cardiac Imaging Techniques; Fibrosis; Heart Atria; Humans; Predictive Value of Tests; Recovery of Function; Risk Factors; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 28057220
DOI: 10.1016/j.jcmg.2016.11.003 -
European Journal of Heart Failure Jul 2020
Topics: Heart Atria; Heart Failure; Heart Valve Prosthesis Implantation; Heart Ventricles; Humans; Mitral Valve; Mitral Valve Insufficiency; Registries
PubMed: 32452145
DOI: 10.1002/ejhf.1863 -
Cardiovascular Ultrasound Feb 2021The impact of volume overload due to aortic regurgitation (AR) on systolic and diastolic left ventricular (LV) indices and left atrial remodeling is unclear. We assessed...
BACKGROUND
The impact of volume overload due to aortic regurgitation (AR) on systolic and diastolic left ventricular (LV) indices and left atrial remodeling is unclear. We assessed the structural and functional effects of severe AR on LV and left atrium before and after aortic valve replacement.
METHODS
Patients with severe AR scheduled for aortic valve replacement (n = 65) underwent two- and three-dimensional echocardiography, including left atrial strain imaging, before and 1 year after surgery. A control group was selected, and comprised patients undergoing surgery for thoracic aortic aneurysm without aortic valve replacement (n = 20). Logistic regression analysis was used to assess predictors of impaired left ventricular functional and structural recovery, defined as a composite variable of diastolic dysfunction grade ≥ 2, EF < 50%, or left ventricular end-diastolic volume index above the gender-specific normal range.
RESULTS
Diastolic dysfunction was present in 32% of patients with AR at baseline. Diastolic LV function indices and left atrial strain improved, and both left atrial and LV volumes decreased in the AR group following aortic valve replacement. Preoperative left atrial strain during the conduit phase added to left ventricular end-systolic volume index for the prediction of impaired LV functional and structural recovery after aortic valve replacement (model p < 0.001, accuracy 70%; addition of left atrial strain during the conduit phase to end-systolic volume index p = 0.006).
CONCLUSIONS
One-third of patients with severe AR had signs of diastolic dysfunction. Aortic valve surgery reduced LV and left atrial volumes and improved diastolic indices. Left atrial strain during the conduit phase added to the well-established left ventricular end-diastolic dimension for the prediction of impaired left ventricular functional and structural recovery at follow-up. However, long-term follow-up studies with hard endpoints are needed to assess the value of left atrial strain as predictor of myocardial recovery in aortic regurgitation.
Topics: Aortic Valve; Aortic Valve Insufficiency; Heart Atria; Heart Valve Prosthesis Implantation; Humans; Retrospective Studies; Stroke Volume; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 33583414
DOI: 10.1186/s12947-021-00243-4 -
JACC. Cardiovascular Imaging Aug 2020
Topics: Atrial Fibrillation; Contrast Media; Fibrosis; Gadolinium; Heart Atria; Humans; Predictive Value of Tests
PubMed: 32682723
DOI: 10.1016/j.jcmg.2020.04.023 -
European Journal of Heart Failure Jun 2023
Topics: Humans; Heart Failure; Stroke Volume; Ventricular Function, Left; Hemodynamics; Heart Atria
PubMed: 37092327
DOI: 10.1002/ejhf.2872 -
JACC. Cardiovascular Imaging May 2020
Topics: Diastole; Echocardiography; Heart Atria; Heart Failure; Humans; Stroke Volume
PubMed: 32199843
DOI: 10.1016/j.jcmg.2020.01.007 -
Circulation Journal : Official Journal... Apr 2022
Topics: Heart Atria; Humans; Lung Neoplasms
PubMed: 34924464
DOI: 10.1253/circj.CJ-21-0946 -
Journal of the American Society of... Aug 2020Left atrial (LA) structural and functional evaluation have recently emerged as powerful biomarkers for adverse events in a variety of cardiovascular conditions.... (Review)
Review
Left atrial (LA) structural and functional evaluation have recently emerged as powerful biomarkers for adverse events in a variety of cardiovascular conditions. Moreover, noninvasive evaluation of LA pressure has gained importance in the characterization of the hemodynamic profile of patients. This review describes the methodology, benefits and pitfalls of measuring LA size and function by echocardiography and provides a brief overview of the prognostic utility of newer echocardiographic metrics of LA geometry and function (i.e., three-dimensional volumes, longitudinal strain, and phasic function parameters).
Topics: Atrial Appendage; Atrial Function, Left; Echocardiography; Heart Atria; Humans; Prognosis
PubMed: 32762920
DOI: 10.1016/j.echo.2020.03.021 -
Cardiovascular Research Mar 2015Atrial fibrillation (AF) is the most common sustained clinical arrhythmia and is associated with significant morbidity, mostly secondary to heart failure and stroke, and... (Review)
Review
Atrial fibrillation (AF) is the most common sustained clinical arrhythmia and is associated with significant morbidity, mostly secondary to heart failure and stroke, and an estimated two-fold increase in premature death. Efforts to increase our understanding of AF and its complications have focused on unravelling the mechanisms of electrical and structural remodelling of the atrial myocardium. Yet, it is increasingly recognized that AF is more than an atrial disease, being associated with systemic inflammation, endothelial dysfunction, and adverse effects on the structure and function of the left ventricular myocardium that may be prognostically important. Here, we review the molecular and in vivo evidence that underpins current knowledge regarding the effects of human or experimental AF on the ventricular myocardium. Potential mechanisms are explored including diffuse ventricular fibrosis, focal myocardial scarring, and impaired myocardial perfusion and perfusion reserve. The complex relationship between AF, systemic inflammation, as well as endothelial/microvascular dysfunction and the effects of AF on ventricular calcium handling and oxidative stress are also addressed. Finally, consideration is given to the clinical implications of these observations and concepts, with particular reference to rate vs. rhythm control.
Topics: Animals; Atrial Fibrillation; Atrial Function; Calcium Signaling; Coronary Circulation; Heart Atria; Heart Rate; Heart Ventricles; Humans; Inflammation Mediators; Oxidative Stress; Ventricular Function, Left; Ventricular Remodeling
PubMed: 25587048
DOI: 10.1093/cvr/cvv001 -
European Journal of Heart Failure Feb 2022
Topics: Collagen; Heart Atria; Heart Failure; Homeostasis; Humans
PubMed: 34989102
DOI: 10.1002/ejhf.2422