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Current Problems in Cardiology Mar 2024This paper delves into the progressive concept of atrial myopathy, shedding light on its development and its impact on atrial characteristics. It extensively explores... (Review)
Review
This paper delves into the progressive concept of atrial myopathy, shedding light on its development and its impact on atrial characteristics. It extensively explores the intricate connections between atrial myopathy, atrial fibrillation (AF), and strokes. Researchers have sought additional contributors to AF-related strokes due to the absence of a clear timing correlation between paroxysmal AF episodes and strokes in patients with cardiac implantable electronic devices. Through various animal models and human investigations, a close interrelation among aging, inflammation, oxidative stress, and stretching mechanisms has been identified. These mechanisms contribute to fibrosis, alterations in electrical properties, autonomic remodeling, and a heightened pro-thrombotic state. These interconnected factors establish a detrimental cycle, exacerbating atrial myopathy and elevating the risk of sustained AF and strokes. By emphasizing the significance of atrial myopathy and the risk of strokes that are distinct from AF, the paper also discusses methods for identifying patients with atrial myopathy. Moreover, it proposes an approach to incorporate the concept of atrial myopathy into clinical practice to guide anticoagulation decisions in individuals with AF.
Topics: Animals; Humans; Heart Atria; Atrial Fibrillation; Stroke; Thrombosis; Muscular Diseases
PubMed: 38191102
DOI: 10.1016/j.cpcardiol.2024.102381 -
The Journal of Vascular Access May 2020Catheter-related right atrial thrombosis is an under-recognized complication of central venous catheter placement. We performed a retrospective review, characterizing... (Review)
Review
INTRODUCTION
Catheter-related right atrial thrombosis is an under-recognized complication of central venous catheter placement. We performed a retrospective review, characterizing clinical aspects of catheter-related right atrial thrombosis (CRAT).
METHODS
To identify cases, a literature search was conducted in PubMed and additional items selected by review of related items and bibliography review. Key clinical data were extracted and analyzed both in total and as stratified by hemodialysis versus non-hemodialysis groups.
RESULTS
A total of 68 catheter-related right atrial thrombosis events were reported in 63 patients (five recurrences, of which 4 involved catheter left in place following primary treatment). Median (interquartile range) time to CRAT diagnosis was longer among hemodialysis patients - 12 (4.0-24.0) weeks compared to 5.5 (1.8-16.1) weeks among non-hemodialysis patients. The most common presentations were asymptomatic in 16/68 (23.5%), fever/sepsis in 21/68 (30.9%), pulmonary embolism in 11/68 (16.2%), catheter dysfunction in 8/68 (11.8%), dyspnea in 8/68 (11.8%), and new murmur or valvular dysfunction in 8/68 (11.8%) patients. Primary treatment selection was anticoagulation in 33/68 (48.5%), surgical thrombectomy in 17/68 (25.0%), thrombolysis in 12/68 (17.6%), or no active therapy in 6/68 (8.8%) patients. Primary treatment failure for anticoagulation and thrombolysis was 27.3% and 33.3%, respectively. The most common rescue therapy was surgical thrombectomy, ultimately resulting in an overall rate of 26/62 (41.9%). Overall, per-patient mortality was 13/63 (20.6%). Intracardiac tip position - 27/34 (79.4%) - overshadowed thrombophilia - 16/63 (25.4%) - as a risk factor for CRAT.
CONCLUSION
Catheter-related right atrial thrombosis is an underdiagnosed complication of central venous catheter placement. For the hemodialysis population, a fistula-first approach is advocated. While many instances were asymptomatic, the development of unexplained fever, dyspnea, catheter dysfunction, or new murmur should trigger a search for this complication.
Topics: Adolescent; Adult; Anticoagulants; Catheterization, Central Venous; Child; Female; Heart Atria; Heart Diseases; Humans; Male; Middle Aged; Recurrence; Renal Dialysis; Risk Factors; Thrombectomy; Thrombolytic Therapy; Thrombosis; Time Factors; Treatment Outcome; Young Adult
PubMed: 31552793
DOI: 10.1177/1129729819873851 -
Medical Ultrasonography Mar 2023
Topics: Humans; Atrial Fibrillation; Thrombosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Heart Atria
PubMed: 36996396
DOI: 10.11152/mu-4017 -
Archives of Cardiovascular Diseases Oct 2020
Topics: Atrial Appendage; Heart Atria; Heart Diseases; Humans; Thrombosis
PubMed: 32958416
DOI: 10.1016/j.acvd.2020.08.001 -
Journal of Cardiovascular... Apr 2022
Topics: Atrial Appendage; Atrial Fibrillation; Echocardiography, Transesophageal; Fibrosis; Humans; Stroke; Thrombosis
PubMed: 35064708
DOI: 10.1111/jce.15382 -
Journal of Clinical Ultrasound : JCU Oct 2022Atrial fibrillation (AF) is the most common arrhythmia in the general population. Systemic thromboembolism from left atrial appendage (LAA) thrombosis is a well-known... (Review)
Review
Atrial fibrillation (AF) is the most common arrhythmia in the general population. Systemic thromboembolism from left atrial appendage (LAA) thrombosis is a well-known complication of AF, whereas thromboembolic complications from a right atrial (RA) thrombus are infrequent. Nevertheless, the prevalence of RA thrombosis is debated; despite having a low prevalence in echocardiographic studies, the higher prevalence found in autoptic studies rises the hypothesis of an under detection of RA clots, possibly related to the limited evaluation of right atrial appendage (RAA) with non-invasive imaging. Here we present a review of the current literature about RA thrombosis, regarding its diagnosis, differentials, and best treatment options.
Topics: Atrial Appendage; Atrial Fibrillation; Echocardiography, Transesophageal; Heart Diseases; Humans; Risk Factors; Thrombosis
PubMed: 36218213
DOI: 10.1002/jcu.23311 -
Journal of the American College of... Aug 2023Precapillary pulmonary hypertension (precPH) patients have altered right atrial (RA) function and right ventricular (RV) diastolic stiffness.
BACKGROUND
Precapillary pulmonary hypertension (precPH) patients have altered right atrial (RA) function and right ventricular (RV) diastolic stiffness.
OBJECTIVES
This study aimed to investigate RA function using pressure-volume (PV) loops, isolated cardiomyocyte, and histological analyses.
METHODS
RA PV loops were constructed in control subjects (n = 9) and precPH patients (n = 27) using magnetic resonance and catheterization data. RA stiffness (pressure rise during atrial filling) and right atrioventricular coupling index (RA minimal volume / RV end-diastolic volume) were compared in a larger cohort of patients with moderate (n = 39) or severe (n = 41) RV diastolic stiffness. Cardiomyocytes were isolated from RA tissue collected from control subjects (n = 6) and precPH patients (n = 9) undergoing surgery. Autopsy material was collected from control subjects (n = 6) and precPH patients (n = 4) to study RA hypertrophy, capillarization, and fibrosis.
RESULTS
RA PV loops showed 3 RA cardiac phases (reservoir, passive emptying, and contraction) with dilatation and elevated pressure in precPH. PrecPH patients with severe RV diastolic stiffness had increased RA stiffness and worse right atrioventricular coupling index. Cardiomyocyte cross-sectional area was increased 2- to 3-fold in precPH, but active tension generated by the sarcomeres was unaltered. There was no increase in passive tension of the cardiomyocytes, but end-stage precPH showed reduced number of capillaries per mm accompanied by interstitial and perivascular fibrosis.
CONCLUSIONS
RA PV loops show increased RA stiffness and suggest atrioventricular uncoupling in patients with severe RV diastolic stiffness. Isolated RA cardiomyocytes of precPH patients are hypertrophied, without intrinsic sarcomeric changes. In end-stage precPH, reduced capillary density is accompanied by interstitial and perivascular fibrosis.
Topics: Humans; Myocytes, Cardiac; Hypertension, Pulmonary; Atrial Fibrillation; Heart Atria; Atrial Appendage
PubMed: 37587582
DOI: 10.1016/j.jacc.2023.05.063 -
JACC. Clinical Electrophysiology Jul 2023
Topics: Humans; Atrial Fibrillation; Heart Atria; Thrombosis; Fibrosis
PubMed: 37115117
DOI: 10.1016/j.jacep.2023.02.012 -
JACC. Clinical Electrophysiology Jul 2023Left atrial appendage (LAA) thrombus (LAAT) and ischemic stroke are considered important in atrial cardiomyopathy with progressive atrial fibrosis and endocardial...
BACKGROUND
Left atrial appendage (LAA) thrombus (LAAT) and ischemic stroke are considered important in atrial cardiomyopathy with progressive atrial fibrosis and endocardial endothelial damage.
OBJECTIVES
This study aimed to obtain histological evidence to clarify the association between LAA fibrosis and endocardial endothelial damage with LAAT, ischemic stroke, and clinical risk factors.
METHODS
Ninety-six patients with atrial fibrillation (AF) scheduled to undergo LAA excision during surgery were enrolled. They underwent transesophageal echocardiography before the surgery to validate the LAA function/morphology and LAAT presence or absence. The resected LAAs were subjected to Azan-Mallory staining and CD31 immunohistochemistry to quantify the degree of fibrosis and endocardial endothelial damage staged as F1-F4 and E1-E4 per the quantiles.
RESULTS
Patients with an LAAT and/or ischemic stroke history had higher fibrosis degrees (18.4% ± 9.9% vs 10.4% ± 7.0%, P < 0.0001) and lower CD31 expressions (0.27 [IQR: 0.05-0.57] vs 1.02 [IQR: 0.49-1.65]; P < 0.0001). Also, higher CHADS was associated with a higher degree of fibrosis and lower CD31 expression. Multivariate logistic regression analysis revealed that endothelial damage (E4) was associated with an LAAT and/or ischemic stroke history independent of AF type (paroxysmal or nonparoxysmal) with an OR of 3.47. Among patients with nonparoxysmal AF, fibrosis (F4, OR: 3.66), endothelial damage (E4, OR: 4.62), and LAA morphology (non-chicken-wing, OR: 3.79) were independently associated with LAAT and/or stroke. The degree of fibrosis correlated significantly with endothelial damage (R = -0.38, P = 0.0001).
CONCLUSIONS
These histological findings may be essential in considering the pathophysiology of LAAT and stroke within the atrial cardiomyopathy context.
Topics: Humans; Atrial Fibrillation; Atrial Appendage; Thrombosis; Fibrosis; Heart Diseases; Stroke; Ischemic Stroke
PubMed: 37495324
DOI: 10.1016/j.jacep.2023.01.029 -
Interventional Cardiology Clinics Apr 2022Although the left atrial appendage (LAA) seems useless, it has several critical functions that are not fully known yet, such as the causes for being the main origin of... (Review)
Review
Although the left atrial appendage (LAA) seems useless, it has several critical functions that are not fully known yet, such as the causes for being the main origin of cardioembolic stroke. Difficulties arise due to the extreme range of LAA morphologic variability, making the definition of normality challenging and hampering the stratification of thrombotic risk. Furthermore, obtaining quantitative metrics of its anatomy and function from patient data is not straightforward. A multimodality imaging approach, using advanced computational tools for their analysis, allows a complete characterization of the LAA to individualize medical decisions related to left atrial thrombosis patients.
Topics: Atrial Appendage; Atrial Fibrillation; Heart Atria; Heart Diseases; Humans; Thrombosis
PubMed: 35361457
DOI: 10.1016/j.iccl.2021.11.005