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Left atrial structure and function in atrial fibrillation: ENGAGE AF-TIMI 48.
Gupta DK, Shah AM, Giugliano RP, Ruff CT, Antman EM, Grip LT, Deenadayalu N, Hoffman E, Patel I, Shi M, Mercuri M, Mitrovic V, Braunwald E, Solomon SD, Effective aNticoaGulation with factor xA next GEneration in AF-Thrombolysis In Myocardial Infarction 48 Echocardiographic Study Investigators
(2014) Eur Heart J 35: 1457-65
MeSH Terms: Aged, Anticoagulants, Atrial Fibrillation, Atrial Function, Left, Double-Blind Method, Echocardiography, Female, Heart Atria, Humans, Male, Prospective Studies, Pyridines, Stroke Volume, Thiazoles, Ventricular Function, Left, Ventricular Remodeling
Show Abstract · Added February 28, 2014
AIMS - The complex relationship between left atrial (LA) structure and function, electrical burden of atrial fibrillation (AF) and stroke risk is not well understood. We aimed to describe LA structure and function in AF.
METHODS AND RESULTS - Left atrial structure and function was assessed in 971 subjects enrolled in the echocardiographic substudy of ENGAGE AF-TIMI 48. Left atrial size, emptying fraction (LAEF), and contractile function were compared across AF types (paroxysmal, persistent, or permanent) and CHADS2 scores as an estimate of stroke risk. The majority of AF patients (55%) had both LA enlargement and reduced LAEF, with an inverse relationship between LA size and LAEF (R = -0.57, P < 0.001). With an increasing electrical burden of AF and higher CHADS2 scores, LA size increased and LAEF declined. Moreover, 19% of AF subjects had impaired LAEF despite normal LA size, and LA contractile dysfunction was present even among the subset of AF subjects in sinus rhythm at the time of echocardiography.
CONCLUSIONS - In a contemporary AF population, LA structure and function were increasingly abnormal with a greater electrical burden of AF and higher stroke risk estimated by the CHADS2 score. Moreover, LA dysfunction was present despite normal LA size and sinus rhythm, suggesting that the assessment of LA function may add important incremental information in the evaluation of AF patients.
CLINICAL TRIAL REGISTRATION - http://www.clinicaltrials.gov; ID = NCT00781391.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: journals.permissions@oup.com.
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16 MeSH Terms
Left atrial hypertension after repeated catheter ablations for atrial fibrillation.
Shoemaker MB, Hemnes AR, Robbins IM, Langberg JJ, Ellis CR, Aznaurov SG, Fredi JL, Slosky DA, Roden DM, Murray KT, Piana RN, Mendes LA, Whalen SP
(2011) J Am Coll Cardiol 57: 1918-9
MeSH Terms: Aged, Atrial Fibrillation, Atrial Function, Left, Catheter Ablation, Female, Humans, Hypertension, Pulmonary, Male
Added June 26, 2014
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8 MeSH Terms
Comparison of the pulmonary dysfunction caused by cardiogenic and noncardiogenic pulmonary edema.
Bernard GR, Pou NA, Coggeshall JW, Carroll FE, Snapper JR
(1995) Chest 108: 798-803
MeSH Terms: Animals, Atrial Function, Left, Capillary Permeability, Hemodynamics, Hydrostatic Pressure, Lung, Monoterpenes, Pulmonary Edema, Pulmonary Gas Exchange, Radiography, Respiratory Distress Syndrome, Adult, Respiratory Mechanics, Sheep, Terpenes, Toxins, Biological
Show Abstract · Added March 5, 2014
We designed a series of experiments to compare the pulmonary dysfunction observed in models of cardiogenic and noncardiogenic pulmonary edema in chronically instrumented awake sheep. Cardiogenic pulmonary edema was induced by inflating the balloon of a Foley catheter surgically positioned in the mitral valve orifice causing increased left atrial pressure (increases PLA). Noncardiogenic pulmonary edema was induced by intravenous infusion of Perilla ketone (PK). Calculated microvascular pressure remained constant during PK infusion but increased from 9.4 +/- 0.7 to 42.8 +/- 2.4 cm H2O during increases PLA. Comparable increases in lung lymph flow (QL) were observed in the two protocols (five to seven times baseline). Pulmonary edema as quantified by chest radiograph scores increased from 0 (normal) to 2.9 +/- 0.5 and 3.4 +/- 0.1 in the PK and increases PLA groups, respectively. Room air alveolar to arterial oxygen pressure difference (P[A-a]O2) increased from 24 +/- 3 to 46 +/- 7 mm Hg in the PK group and from 23 +/- 4 to 56 +/- 6 mm Hg in the increases PLA group. Dynamic compliance of the lungs (Cdyn) expressed as the percentage of the baseline value decreased to 53 +/- 7 and 50 +/- 7% in the PK and increases PLA groups, respectively. Resistance to airflow across the lungs (RL) increased from 2.5 +/- 0.6 to 3.3 +/- 0.8 cm H2O.L-1.sec-1 in the PK group and from 1.4 +/- 0.3 to 4.2 +/- 1.1 in the increases PLA group. Significant correlations were observed between changes in the severity of pulmonary edema observed on chest radiographs, Cdyn, delta P(A-a)O2, and QL in both the increases PLA groups. We conclude that similar degrees of pulmonary edema, regardless of the mechanism, are associated with similar changes in QL, Cdyn, and delta P(A-a)O2. Hydrostatic pulmonary edema appeared to cause greater changes in RL than that resulting from increased microvascular permeability.
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15 MeSH Terms