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Journal of the American College of... Apr 2022
Topics: Atrial Function, Left; Heart Atria; Heart Failure; Humans; Risk Assessment
PubMed: 35450572
DOI: 10.1016/j.jacc.2022.02.023 -
Cardiovascular Ultrasound Mar 2022In order to assess left atrial contractile function in disturbed circulatory conditions, it is necessary to have a clear understanding of how it behaves in a normal... (Clinical Trial)
Clinical Trial
BACKGROUND
In order to assess left atrial contractile function in disturbed circulatory conditions, it is necessary to have a clear understanding of how it behaves in a normal resting state with changes in loading conditions. However, currently the understanding of this relationship is incomplete. We hypothesize that in healthy individuals, left atrial contraction strain and its peak strain rate are increased or decreased by increasing or decreasing preload, respectively.
METHODS
Controlled maneuvers used to change preload included continuous positive airway pressure by mask (CPAP 20 cmHO) for preload decrease, and passive leg raise (15 degrees angle) for preload increase. Cardiac ultrasound 4-chamber views of the left atria and left ventricle were acquired at baseline and during maneuver. Acquired images were post processed and analyzed offline. Comparisons were made using paired t-test and means with 95% confidence interval.
RESULTS
There were 38 participants, complete results were obtained from 23 in the CPAP maneuver and 27 in the passive leg raise maneuver. For the CPAP group, left atrial contraction strain was 11.6% (10.1 to 13.1) at baseline and 12.8% (11.0 to 14.6) during the maneuver (p = 0.16). Left atrial contraction peak strain rate was - 1.7 s (- 1.8 to - 1.5) at baseline and - 1.8 s (- 2.0 to - 1.6) during the maneuver (p = 0.29). For the passive leg raise-group, left atrial contraction strain was 10.1% (9.0 to 11.2) at baseline and 10.8% (9.4 to 12.3) during the maneuver (p = 0.28). Left atrial contraction peak strain rate was - 1.5 s (- 1.6 to - 1.4) at baseline and - 1.6 s (- 1.8 to - 1.5) during the maneuver (p = 0.29). Left atrial area, an indicator of preload, increased significantly during passive leg raise and decreased during CPAP.
CONCLUSION
In healthy individuals, left atrial contraction strain and its peak strain rate seem to be preload-independent.
TRIAL REGISTRATION
The study was 2018-02-19 registered at clinicaltrials.gov ( NCT03436030 ).
Topics: Atrial Appendage; Atrial Function, Left; Echocardiography; Heart Atria; Humans
PubMed: 35354482
DOI: 10.1186/s12947-022-00278-1 -
Journal of Cardiovascular Medicine... Jul 2017Atrial fibrillation transcatheter ablation (TCA) is, within available atrial fibrillation rhythm control strategies, one of the most effective. To potentially improve...
BACKGROUND
Atrial fibrillation transcatheter ablation (TCA) is, within available atrial fibrillation rhythm control strategies, one of the most effective. To potentially improve ablation outcome in case of recurrent atrial fibrillation after a first procedure or in presence of structural myocardial disease, isolation of the pulmonary veins may be associated with extensive lesions within the left atrium. To avoid rare, but potentially life-threatening, complications, thorough knowledge and assessment of left atrium anatomy and its relation to structures in close proximity are, therefore, mandatory. Aim of the present study is to describe, by cardiac computed tomography, the anatomic relationship between aortic root, left coronary artery and left atrium in patients undergoing atrial fibrillation TCA.
METHODS AND RESULTS
The cardiac computed tomography scan of 21 patients affected by atrial fibrillation was elaborated to segment left atrium, aortic root and left coronary artery from the surrounding structures and the following distances measured: left atrium and aortic root; left atrium roof and aortic root; left main coronary artery and left atrium; circumflex artery and left atrium appendage; and circumflex artery and mitral valve annulus. Above all, the median distance between left atrium and aortic root (1.9, 1.5-2.1 mm), and between circumflex artery and left atrium appendage ostium (3.0, 2.1-3.4 mm) were minimal (≤3 mm). None of measured distances significantly varied between patients presenting paroxysmal versus persistent atrial fibrillation.
CONCLUSION
The anatomic relationship between left atrium and coronary arteries is extremely relevant when performing atrial fibrillation TCA by extensive lesions. Therefore, at least in the latter case, preablation imaging should be recommended to avoid rare, but potentially life-threatening, complications with the aim of an as well tolerated as possible procedure.
Topics: Aged; Anatomic Landmarks; Atrial Fibrillation; Catheter Ablation; Computed Tomography Angiography; Coronary Angiography; Coronary Vessels; Female; Heart Atria; Humans; Male; Middle Aged; Multidetector Computed Tomography; Postoperative Complications; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 27828828
DOI: 10.2459/JCM.0000000000000484 -
Clinical Cardiology Aug 2020The structural adaptations of the "athlete's heart" include left atrial (LA) enlargement. A literature search was performed based on PubMed listings up to November 2,... (Review)
Review
The structural adaptations of the "athlete's heart" include left atrial (LA) enlargement. A literature search was performed based on PubMed listings up to November 2, 2019 using "athletes AND left atrium," "athletes AND LA," "sports AND left atrium," "sports AND LA," "exercise AND left atrium," and "exercise AND LA" as the search terms. Eligible studies included those reporting the influence of demographic, anthropometric and athletic characteristics on LA size in athletes. A total of 58 studies were included in this review article. Although LA volume has been reported to be greater in males compared to females when indexed for body surface area (BSA), there was no difference between sexes. The positive association between LA size and age in athletes may reflect the increase in body size with maturation in nonadult athletes and the training age of endurance athletic activity in adult athletes. Caucasian and black athletes have been demonstrated to exhibit similar LA enlargement. The positive association of LA size with lean body mass (LBM) possibly accounts for the relationship of LA size with BSA. LA enlargement has been reported only in endurance-trained, but not in strength-trained athletes. LA size appears to increase with an increase in both the volume and intensity of endurance training. LA size correlates independently with the training age of endurance athletes. The athlete's characteristics that independently determine LA size include LBM, endurance training, and training age.
Topics: Adaptation, Physiological; Anthropometry; Athletes; Atrial Function, Left; Echocardiography; Exercise; Heart Atria; Humans; Sports
PubMed: 32271473
DOI: 10.1002/clc.23368 -
Current Cardiology Reviews 2017Transseptal puncture (TSP) remains a demanding procedural step in accessing the left atrium with inherent risks and safety concerns, mostly related to cardiac tamponade. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Transseptal puncture (TSP) remains a demanding procedural step in accessing the left atrium with inherent risks and safety concerns, mostly related to cardiac tamponade.
OBJECTIVE
Based on our own experience with 249 TSP procedures and in-depth literature review, we present our results and offer several tips and tricks that may render TSP successful and safe.
METHODS
This prospective study comprised 249 consecutive patients (146 men), aged 41.6±17.4 years, undergoing TSP by a single operator for ablation of a variety of arrhythmias, mostly related to left accessory pathways (n=145) or left atrial tachycardias (n=33) and more recently, atrial fibrillation (n=70). TSP was guided by fluoroscopy alone in all patients without the use of echocardiography imaging. In addition, an extensive literature review of TSP-related topics was carried out in PubMed, Scopus and Google Scholar.
RESULTS
Among 249 patients, 33 patients were children or young adolescents (aged 7-18 years); 14 patients were undergoing a repeat procedure. Patients with a manifest accessory pathway were the youngest (mean age 33.7±15.9) and patients with atrial fibrillation the oldest (mean age 56.0±10.8 years). A successful TSP was accomplished in 247 patients (99.2%). Two (0.8%) procedures were complicated by cardiac tamponade managed successfully with pericardiocentesis or surgical drainage. Review of the literature revealed no systematic reviews and meta-analyses of TSP studies; however, several patient series have documented that fluoroscopy-guided TSP, with various modifications in the technique employed in the present series, have been effective in 95-100% of the cases with a complication rate ranging from 0.0% to 6.7%, albeit with a mortality rate of 0.018%- 0.2%. Echo imaging techniques were employed in cases with difficult TSP.
CONCLUSION
Employing a standardized protocol with use of fluoroscopy alone minimized serious complications to 0.8% (2 patients) among 249 consecutive patients undergoing TSP for ablation of a variety of cardiac arrhythmias. Based on this single-operator experience and review of the literature, a list of practical tips and tricks is provided for a successful and safe procedure, reserving the more expensive and patient inconveniencing echo-imaging techniques for difficult or failed cases.
Topics: Atrial Fibrillation; Atrial Septum; Cardiac Catheterization; Catheter Ablation; Echocardiography; Heart Atria; Humans; Punctures
PubMed: 28969539
DOI: 10.2174/1573403X13666170927122036 -
JACC. Clinical Electrophysiology Nov 2019
Topics: Atrial Fibrillation; Catheter Ablation; Heart Atria; Humans
PubMed: 31753430
DOI: 10.1016/j.jacep.2019.10.012 -
PloS One 2015Aim of this study was to provide an echocardiographic protocol for the description of the normal murine venous reservoir (atrium, appendage and pulmonary veins) and to...
Aim of this study was to provide an echocardiographic protocol for the description of the normal murine venous reservoir (atrium, appendage and pulmonary veins) and to investigate the possibility to use this approach to discriminate changes on left atrium (LA) and left atrial appendage (LAA) in a stress-induced model such us myocardial infarction. Global left ventricular function and the venous reservoir were assessed by a Vevo2100 in 20 female C57BL/6N. LA and LAA were also studied in 10 CD-1 and 10 FVB mice, whereas modifications investigated in 15 C57BL/6N subjected to coronary artery ligation. Left ventricle function was evaluated as well as pulsed Doppler mitral valve, pulmonary vein, and LAA velocities. From 2D view monoplane LA volumes were obtained and LAA long axis measured. Macroscopic inspection with casts and immunohistochemistry were performed. Results show that compared to humans, in C57BL/6N mice left atrium was disproportionately smaller (5.2±1.4 μL) than the left ventricle (53±8 μL) and connected through a duct by a large LAA and posteriorly to three pulmonary veins. The LA volume increased 2-fold during reservoir with two distinct phases, early and late divided by a short pause. LAA long axis (4.1±0.5 mm) was almost 2 times longer than the LA. LAA flow volume together with LA volume reservoir account for about 36% of stroke volume and the rest was provided by conduit flow. Linear regressions showed that stroke volume was strongly influenced by LAA flow, LA early filling volume and left ventricle base descent. Moreover, we also report the ability to assess LA and LAA in other mice strains and discriminate size increase following myocardial infarction. In conclusion, we performed a complete characterization of murine left venous reservoir establishing an optimized protocol that can be used in both investigative and pharmacological studies requiring rapid and serial determination of cardiac structure and function.
Topics: Animals; Atrial Appendage; Atrial Function, Left; Echocardiography; Female; Heart Atria; Mice; Mice, Inbred C57BL; Myocardial Infarction
PubMed: 25928887
DOI: 10.1371/journal.pone.0125541 -
BMC Research Notes Sep 2022Atrial Fibrillation (A-fib) is an abnormal heartbeat condition in which the heart races and beats in an uncontrollable way. It is observed that the presence of increased...
OBJECTIVE
Atrial Fibrillation (A-fib) is an abnormal heartbeat condition in which the heart races and beats in an uncontrollable way. It is observed that the presence of increased epicardial fat/fatty tissue in the atrium can lead to A-fib. Persistent homology using topological features can be used to recapitulate enormous amounts of spatially complicated medical data into a visual code to identify a specific pattern of epicardial fat tissue with non-fat tissue. Our aim is to evaluate the topological pattern of left atrium epicardial fat tissue with non-fat tissue.
RESULTS
A topological data analysis approach was acquired to study the imaging pattern between the left atrium epicardial fat tissue and non-fat tissue patches. The patches of eight patients from CT images of the left atrium heart were used and categorized into "left atrium epicardial fat tissue" and "non-fat tissue" groups. The features that distinguish the "epicardial fat tissue" and "non-fat tissue" groups are extracted using persistent homology (PH). Our result reveals that our proposed research can discriminate between left atrium epicardial fat tissue and non-fat tissue. Specifically, the range of Betti numbers in the epicardial tissue is smaller (0-30) than the non-fat tissue (0-100), indicating that non-fat tissue has good topology.
Topics: Adipose Tissue; Atrial Fibrillation; Heart Atria; Humans; Pericardium
PubMed: 36109768
DOI: 10.1186/s13104-022-06173-2 -
Vascular Health and Risk Management 2022Enlargement of the left atrium has been thoroughly studied in many clinical situations, especially its association with mortality and morbidity.
BACKGROUND
Enlargement of the left atrium has been thoroughly studied in many clinical situations, especially its association with mortality and morbidity.
PATIENTS AND METHODS
The study cohort included patients with rheumatic valve pathology such as stenosis and regurgitation. All patients underwent valvular surgical procedures including mitral valve replacement (MVR), aortic valve replacement (AVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with or without CABG. This study included patients who underwent surgery between 2002 and 2017.
RESULTS
Three hundred and forty-six patients were included in this study. The mean patient age was 51.6±16.1 years; 37% of the patients underwent AVR, 28% underwent MVR, and 13% underwent a combination of MVR with AVR, AVR with CABG in 6%, and MVR with CABG in 10%. The operative mortality rate was 5.8% (n=20). Univariate analysis revealed that the predictors of mortality included age (P < 0.001), body mass index (BMI) (P = 0.003), type of surgery performed (P = 0.007), hypertension (P = 0.005), emergent surgeries (P = 0.018), left atrial diameter (P = 0.003), cross-clamp time greater than 90 minutes (P = 0.007), postoperative acute kidney injury (AKI) (P = 0.044), postoperative stroke (P = 0.049), and surgical site infection (P = 0.047). Multivariate analysis revealed that predictors of mortality included age (P = 0.028, AOR=10.6), BMI (P = 0.003, AOR=3.12), re-exploration (P = 0.006, AOR=8.38), length of intensive care unit stay (P ≤ 0.002, AOR=4.55), and left atrial diameter (P = 0.003, AOR=10.64).
CONCLUSION
Enlargement of the left atrium has been studied extensively as a predictor of mortality and morbidity in different clinical situations, to the extent that some authors suggest adding it to risk stratification models. In this study, left atrial size >4 cm was found to strongly predict mortality after rheumatic heart valve surgery.
Topics: Adult; Aged; Aortic Valve; Cardiac Surgical Procedures; Coronary Artery Bypass; Heart Atria; Humans; Middle Aged; Mitral Valve; Retrospective Studies
PubMed: 36212553
DOI: 10.2147/VHRM.S380463 -
The International Journal of... Nov 2021The left atrium (LA) plays a vital role in maintaining normal cardiac function. LA volume and function have been utilised as important imaging biomarkers, with their... (Review)
Review
The left atrium (LA) plays a vital role in maintaining normal cardiac function. LA volume and function have been utilised as important imaging biomarkers, with their prognostic value demonstrated in multiple cardiac conditions. More recently, there has been a sharp increase in the number of publications utilising LA strain by echocardiography and cardiac magnetic resonance (CMR) imaging. However, little is known about its prognostic value or reproducibility as a technique. In this review, we aim to highlight the conventional and novel imaging techniques available for LA assessment, using echocardiography and CMR, their role as an imaging biomarker in cardiovascular disease, the reproducibility of the techniques and the current limitations to their clinical application. We identify a need for further standardisation of techniques, with establishment of 'normal' cut-offs before routine clinical application can be made.
Topics: Atrial Function, Left; Biomarkers; Cardiovascular Diseases; Heart Atria; Humans; Magnetic Resonance Imaging, Cine; Predictive Value of Tests; Reproducibility of Results
PubMed: 34169399
DOI: 10.1007/s10554-021-02316-x