Aug 2026· Heart and Vessels· 0 citations· 34 references
Medicine
TL;DR
Impaired RA reservoir strain was independently associated with TR progression in AF patients with initially insignificant TR, suggesting that RA functional assessment may provide additional information complementary to RA structural remodeling and help identify patients at higher risk of TR progression.
A
BSTRACT
Chronic left atrial (LA) pressure overload and rheumatic inflammation cause subclinical atrial remodeling even without severe valvular stenosis. This study intended to determine whether advanced atrial deformation parameters identify patients with increased risk of atrial fibrillation (AF) from mild rheumatic mitral stenosis (MS).
A prospective cohort study of patients with mild rheumatic MS and sinus rhythm was conducted in Baghdad, Iraq. LA Reservoir Strain (LASr) and LA Mechanical Dispersion (LAMD) were calculated via two-dimensional strain echocardiography at baseline. Patients were followed up for at least 2 years. The primary outcome was the occurrence of AF.
Of 211 patients, 39 were found to have new-onset AF. The two strain parameters remained independent predictors of new-onset AF on multivariable Cox proportional hazards regression analysis. New AF occurrence was positively correlated with LAMD (adjusted Hazard ratio [aHR]: 1.047 [95% confidence interval (CI): 1.02–1.06],
P
< 0.001) and inversely correlated with LASr (aHR: 0.848 [95% CI: 0.79–0.90],
P
< 0.001). The optimal thresholds for LAMD and LASr for predicting new AF were >58.7 ms and ≤16.6%, respectively, which were defined by the Receiver Operating Characteristic curve.
The presence of subclinical electromechanical dysfunction is an independent predictor of AF in mild rheumatic MS. Recognizing this high-risk phenotype supports closer ambulatory rhythm monitoring to allow timely arrhythmia detection and subsequent initiation of anticoagulation to prevent thromboembolic events.
BACKGROUND
Atrial fibrillation (AF) is pervasive and an independent driver of stroke and death in hypertrophic cardiomyopathy (HCM). Despite guideline recommendations for AF surveillance, effective risk stratification remains elusive, and the hemodynamic and functional states of the left atrium (LA) preceding AF onset remain poorly characterized.
OBJECTIVES
We aimed to delineate the hemodynamic and functional states of the LA in HCM, derive a novel LA staging system, and evaluate its prognostic performance for new-onset atrial fibrillation (NOAF).
METHODS
This multicenter retrospective study included consecutive HCM patients with normal left ventricular systolic function from January 2007 to February 2024 at 2 academic referral centers. Patients with valvular heart disease or prior AF were excluded. Patients were categorized by combining the presence of elevated LA pressure (hemodynamic load) and LA contractile strain (intrinsic LA function): stage 1 (normal LA pressure and function), stage 2 (relative contractile augmentation for a given LA pressure), stage 3 (loss of relative contractile augmentation despite elevated LA pressure), stage 4 (elevated LA pressure with decreased LA contractile strain), and isolated LA contractile dysfunction. The primary outcome was NOAF. External validation was conducted in an independent HCM cohort.
RESULTS
Of 1,856 patients screened, 705 were eligible (mean age 57.6 ± 13.0 years, 30.1% female). During a median follow-up of 7.5 years (Q1-Q3: 3.6-11.0 years), NOAF occurred in 101. The staging system was independently associated with a significant, stepwise increase in the risk of NOAF (adjusted HR: 1.83 per increment; 95% CI: 1.42-2.37; P < 0.001) and conferred incremental predictive value beyond established risk models (CHARGE-AF and HCM-AF). Consistent results were demonstrated in 1-year landmark and competing-risk analyses, as well as in an external validation cohort (n = 425; age 59.7 ± 13.5 years, 33.9% female). Importantly, serial echocardiography performed in 217 patients 4 to 6 years after baseline revealed a predominantly unidirectional evolution of the proposed LA stage, with most patients remaining stable (39.6%) or progressing to higher stages or AF (43.8%).
CONCLUSIONS
The proposed LA staging framework offers mechanistic insights into how the LA adapts to progressive diastolic dysfunction in HCM. It is associated with a graded risk of NOAF and may help tailor AF surveillance strategies.
Jaehyun Lim, I. Hwang, Ji-Hyun Kim et al.· Journal of the American Coll...· 0 citations
BACKGROUND
Diagnosis of heart failure with preserved left ventricular ejection fraction (HFpEF) remains a significant clinical challenge, particularly in patients with atrial fibrillation (AF). Recently, the HFA-PEFF score was introduced to aid in the diagnostic work-up of HFpEF. This study aimed to investigate the distribution of the HFA-PEFF score and its relationship with left atrial (LA) function, pressure, and reverse remodeling in patients with AF.
METHODS
We investigated 155 AF patients who underwent their first catheter ablation (CA). Echocardiography was performed before CA, and the HFA-PEFF score was calculated. Direct LA pressure (LAP) was measured at CA. Echocardiography was repeated 6 months after CA to evaluate LA reverse remodeling.
RESULTS
High (5-6), intermediate (2-4) and low (0-1) HFA-PEFF scores were observed in 19 (12.3%), 99 (63.9%) and 37 (23.9%) patients, respectively. Higher HFA-PEFF scores were associated with worse LA function and LA stiffness (both P<0.05). Elevated LAP was detected in 31.6%, 19.2%, and 5.4% of the high, intermediate, and low HFA-PEFF score groups, respectively. In the intermediate HFA-PEFF score group, LA stiffness was a good predictor of elevated LAP, whereas left ventricular global longitudinal strain was more predictive in the high HFA-PEFF score group. Six months after CA, all groups exhibited LA reverse remodeling, while the high-score group retained larger LA size and worse LA function.
CONCLUSIONS
Higher HFA-PEFF scores were associated with advanced LA functional remodeling and elevated LAP in AF patients. Persistent LA remodeling after CA in the high-score group demonstrates the need for careful follow-up.
Satoshi Konoma, K. Nakanishi, M. Daimon et al.· Journal of the American Soci...· 0 citations
ABSTRACT Purpose The aim of this study is to evaluate left atrium (LA) and left atrial appendage (LAA) remodeling using two‐dimensional speckle tracking echocardiography (2D‐STE) and investigate its predictive value for atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA). Methods One hundred patients with AF underwent TTE and TEE before undergoing RFCA. LA and LAA strain and strain rate values obtained by 2D‐STE. Logistic regression analysis was used to analyze independent contributors for AF recurrence after RFCA. The prediction efficiency of clinical ultrasound parameter models associated with the presence of AF recurrence was evaluated by the receiver operating characteristic (ROC) curve with area under curve (AUC). Results ①During the 1‐year follow‐up, 33% of patients experienced AF recurrence. ②The recurrent group had significantly higher NLR, NT‐proBNP, and LAVImin values compared to the non‐recurrent group (p < 0.05). ③The recurrence group had significantly lower LAEF, LAEI, LAA‐EV, LAS, LASR, LAAS, LAASR values than the non‐recurrent group (p < 0.05). ④LAAS and LAASR were potential factors contributing to AF recurrence (p < 0.05). In addition, incorporating LAAS and LAASR into predictive models can provide extra valuable information to identify patients at a higher risk of AF recurrence. Conclusion LAAS and LAASR, as obtained by 2D‐STE, are potential predictors of AF recurrence after RFCA. By incorporating these 2D‐STE parameters into preoperative clinical data along with TTE and TEE, it may be possible to identify impaired LA/LAA function in AF patients early. This could aid in choosing suitable patients and improving the benefit ratio of RFCA.
Bin-Yang Zhu, Shaohui Qu, Hai-Ru Li et al.· Clinical Cardiology· 0 citations
In severe rheumatic mitral stenosis with sinus rhythm, left atrial appendage (LAA) dysfunction increases thromboembolic risk, yet clinical guidelines provide no recommendations, and its assessment via transesophageal echocardiography is not feasible for routine or repeated use. This study assessed whether left atrial (LA) strain imaging could noninvasively predict LAA contractile dysfunction.
We prospectively enrolled 138 patients with severe rheumatic MS in sinus rhythm who underwent transthoracic and transesophageal echocardiography. LAA inactivity was defined as LAA emptying velocity <25 cm/s. LA reservoir (LASr), conduit, and contractile strain were quantified using speckle-tracking echocardiography. Multivariable logistic regression and receiver-operating characteristic (ROC) analyses were performed to evaluate predictors of LAA inactivity. LAA inactivity was observed in 108 patients (78.2%), and LAA thrombus was detected in 8 patients (5.8%)—all in sinus rhythm. In multivariate analysis, LASr was the strongest independent predictor of LAA inactivity (OR 0.61 per 1% increase; 95% CI: 0.50–0.75; p < 0.0001). LASr yielded an AUC of 0.950 (95% CI: 0.911-0.989), with a threshold of ≤22.95% showing a sensitivity of 93.5%, and specificity of 90% for predicting LAA inactivity. Impaired LA strain identified patients with elevated fibrinogen, D-dimer, and the presence of LAA thrombus.
LA strain imaging provides a robust noninvasive predictor of LAA dysfunction in severe rheumatic MS patients in sinus rhythm. These findings support the potential clinical utility of LA strain in improving risk stratification and guiding anticoagulation decisions in this under-recognized high-risk population.
J. Yusuf, Gaurav Sharma, Ankit Bansal et al.· European Heart Journal Open· 0 citations
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