Aug 2026· Frontiers in Cardiovascular Medicine· Vol 13· 0 citations· 39 references
Medicine
TL;DR
In individuals free of overt cardiovascular disease, MRI-derived LV filling dynamics were associated with structural alterations of the left atrium and pulmonary vasculature, suggesting that changes across the cardiopulmonary axis may already be detectable by whole-body MRI before clinical disease becomes apparent.
Abstract
Introduction Left ventricular diastolic dysfunction is associated with left atrial remodeling and alterations of the pulmonary circulation. However, whether these interconnected changes across the cardiopulmonary axis can be simultaneously characterized using a non-dedicated whole-body MRI examination in individuals free of overt cardiovascular disease remains unclear. Methods 339 subjects (mean age 56.4 years; 43.4% female) without overt cardiovascular disease were included. Linear regression models, adjusted for age, sex, and cardiovascular risk factors, explored the association of Left ventricle (LV) filling rates with left atrium (LA) size and function, and mean pulmonary artery (MPA). Results Average maximal LA was 19.6 cm2, minimal LA 11.8 cm2, area-based LA function 39.8%, non-electrocardiogram-synchronized LA size 16.8 cm2, LV early filling rate 227.1 mL/s, late filling rate 238.4 mL/s, and MPA diameter 2.67 cm. Higher early and late LV filling rates were associated with larger maximal LA size across all models (β = 2.30; β = 1.00), minimal LA size (β = 1.41; β = 0.77), and non-electrocardiogram-synchronized LA size (β = 1.86; β = 0.90, all p < 0.001, fully adjusted model). Higher early LV filling rates, but not higher late LV filling rates, were associated with larger MPA diameter across all models (β = 0.06, p = 0.03, fully adjusted model). Conclusion In individuals free of overt cardiovascular disease, MRI-derived LV filling dynamics were associated with structural alterations of the left atrium and pulmonary vasculature, suggesting that changes across the cardiopulmonary axis may already be detectable by whole-body MRI before clinical disease becomes apparent.
BACKGROUND
Right ventricular (RV) to left ventricular (LV) end-diastolic volume ratio (RV/LV) is a validated marker of RV dilation in pulmonary arterial hypertension (PAH), yet its impact on LV myocardial function and the underlying mediating pathway is incompletely characterized.
PURPOSE
To investigate the association between RV/LV volume ratio and LV dysfunction in PAH patients, with a focus on regional strain patterns and mediating pathways.
STUDY TYPE
Retrospective.
POPULATION
188 PAH patients were divided into normal (ratio < 1.27, n = 74) and elevated (ratio ≥ 1.27, n = 114) RV/LV volume ratio groups, and 81 age- and sex-matched controls.
FIELD STRENGTH/SEQUENCE
3.0-T/balanced steady-state free precession cine sequence.
ASSESSMENT
LV global longitudinal, circumferential, and radial strains (LVGLS, LVGCS, and LVGRS, respectively) and regional strains were measured using feature tracking. Strain parameters were compared among controls and PAH subgroups.
STATISTICAL TESTS
One-way ANOVA with Bonferroni-corrected post hoc tests, Kruskal-Wallis test, and Pearson or Spearman correlation. Multivariable linear regression was used to identify independent determinants and mediation analysis to examine the mediating pathways. A two-tailed p < 0.05 was deemed statistically significant.
RESULTS
PAH patients with elevated volume ratio had significantly reduced LVGCS and LVGLS. Regional analysis showed that the most extensive strain impairment was at the mid-ventricular septum. The RV/LV volume ratio was independently associated with LVGCS (β = -0.194) and LVGLS (β = -0.307). Mediation analysis demonstrated that the mPAP-LVGLS relationship was statistically mediated by the RV/LV volume ratio, with a significant indirect effect (β = -0.192, 95% confidence interval: -0.302 to -0.096) and a non-significant (p = 0.544) direct effect.
DATA CONCLUSION
Elevated RV/LV volume ratio in PAH is associated with spatially heterogeneous LV strain impairment, with the mid-septum being most vulnerable. The ratio mediates the adverse impact of pulmonary pressure on LV longitudinal strain and may serve as an imaging marker for assessing LV dysfunction.
EVIDENCE LEVEL
3.
TECHNICAL EFFICACY
Stage 3.
Han Fang, Yuan Li, Jin Wang et al.· Journal of Magnetic Resonanc...· 1 citation
Left atrial (LA) stiffness integrates information related to LA mechanical properties and left ventricular (LV) filling dynamics and may provide a comprehensive assessment of cardiac hemodynamic burden in heart failure (HF). However, its clinical significance in patients with chronic HF and impaired LV systolic function remains unclear. We investigated the association between the LA stiffness index (LASI) and clinical outcomes in patients with chronic HF and impaired LV systolic function. We retrospectively analyzed 1,147 patients with chronic HF and left ventricular ejection fraction (LVEF) <50% who underwent comprehensive echocardiography between January 2018 and March 2023. LASI was calculated as the ratio of E/e' to LA reservoir strain and stratified into tertiles. The primary endpoint was a composite of cardiovascular death or HF hospitalization. Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate the association between LASI and clinical outcomes. During a median follow-up of 34 months, 218 patients experienced the primary endpoint. Event-free survival progressively decreased across LASI tertiles (log-rank P < 0.01). After adjustment for age, sex, LVEF, LA volume index, and tricuspid regurgitation velocity, higher LASI remained independently associated with adverse outcomes (hazard ratio 2.41, 95% confidence interval 1.55-3.73, P < 0.01). This association was consistent across clinically relevant subgroups, including age, diabetes mellitus, LV geometry, and LA size. In conclusion, in patients with chronic HF and impaired LV systolic function, increased LASI was independently associated with cardiovascular death and HF hospitalization, suggesting that LASI may serve as a practical echocardiographic marker reflecting atrial dysfunction and hemodynamic burden.
R. Nakayama, Y. Takaya, M. Nakashima et al.· American Journal of Cardiolo...· 1 citation
Background: Left ventricular (LV) mass and left atrial (LA) strain are physiologically coupled and individually predict adverse cardiovascular outcomes. Their imbalance may reflect early atrioventricular uncoupling and atrial myopathy before overt structural disease. Aims: We evaluated whether a cardiac magnetic resonance (CMR)-derived LV mass-to-LA strain ratio identifies early atrioventricular mechanical uncoupling and predicts cardiovascular events. Methods: Participants from the Multi-Ethnic Study of Atherosclerosis (MESA) underwent CMR at Exams 1 (2000-2002) and 5 (2010-2012). The LV mass-to-LA strain ratio was calculated as indexed end-diastolic LV mass divided by peak LA strain. Classification and regression tree analysis identified cut points for baseline ratio and longitudinal change, defining low (<1.04), reference (1.04-3.26), and high (>3.26) groups, and lesser-(≤130%) versus greater-change (>130%) groups. Multivariable Cox models assessed associations with heart failure (HF), atrial fibrillation (AF), myocardial infarction (MI), and all-cause mortality. Results: Among 4,232 participants (mean age 61.5±10.1 years; 52.8% female), the mean ratio was 1.95±0.72. Over a median 18-year follow-up, 6.0% developed HF, 5.2% MI, 18.7% AF, and 25.6% died. A high LV mass-to-LA strain ratio independently predicted HF (HR 2.85), AF (HR 2.00), MI (HR 1.96), and death (HR 1.70; all P≤.003). With repeat CMR, an increasing ratio also predicted cardiovascular events, including among individuals with normal LV mass and LA strain. Higher baseline ratios were associated with progression toward abnormal volumetric atrioventricular coupling over time. Conclusion: A higher LV mass-to-LA strain ratio and its increase independently predict cardiovascular events before overt chamber abnormalities, supporting impaired atrial adaptation as an early stage of atrial myopathy.
Elio Salameh, M. Hoballah, E. Ebrahimihoor et al.· American Journal of Physiolo...· 0 citations
In patients with DMR, AF was associated with more advanced LA structural remodeling, impaired LA function, and higher CMR LGE burden, and echocardiographic LA functional parameters may provide complementary information for the discrimination of AF.
X. Li, Y. Song, Y. Hu et al.· medRxiv· 0 citations
BACKGROUND
Obesity is a major risk factor for atrial fibrillation and heart failure. We aimed to characterize left atrial (LA) structural and functional changes across body mass index (BMI) strata in patients with atrial fibrillation referred for catheter ablation.
METHODS
We studied 1040 consecutive patients (67% male; mean age, 62 years; 71% in sinus rhythm). Participants were stratified by BMI (<25.0, 25-29.9, 30-34.9, and ≥35 kg/m2). Comprehensive echocardiographic assessment of LA structure and function was integrated with invasive LA pressure measurements obtained via transseptal access during the ablation procedure. Associations across BMI strata were evaluated using regression analyses.
RESULTS
Patients with higher BMI had larger estimated total blood and plasma volumes along with higher LA volumes and pressures, greater cyclic wall stress, and a rightward shift of the estimated LA pressure-volume relationship. Conversely, estimated operant LA stiffness did not differ across BMI strata. BMI-related differences in LA volume were attenuated by body surface area indexing but preserved with height-based indexing. Conventional volumetric indices of LA phasic function were similar across BMI strata, whereas available LA strain indices (n=107) were lower with greater adiposity, consistent with worse LA phasic function. Compared with patients without heart failure, those with heart failure exhibited more pronounced structural, functional, and hemodynamic atrial remodeling, consistent with a more advanced atrial myopathy phenotype.
CONCLUSIONS
In patients undergoing atrial fibrillation ablation, higher BMI is associated with a predominantly load-related pattern of LA remodeling, characterized by larger LA volume and pressures, greater cyclic wall stress, and a rightward shift of the estimated pressure-volume relationship. BMI-associated early atrial remodeling may precede overt atrial dysfunction, potentially contributing to the link between excess adiposity, atrial fibrillation, and heart failure with preserved ejection fraction.
L. Monzo, B. Borlaug, K. Kroupova et al.· Circulation: Heart Failure· 0 citations
Background: Chronic kidney disease (CKD) is associated with an increasedriskofcardiovascular disease, with left ventricular diastolic dysfunction occurring earlyindiseaseprogression. Tissue Doppler Imaging (TDI)-derived E/e′ ratio is a reliable non-invasivemarkerof left ventricular filling pressure (LVFP). Methods: This prospective cross-sectional study included 33 adults with CKDStages3–5.Transthoracic echocardiography with TDI was performed to assess LVFP usingtheE/e′ ratio.The association between LVFP and CKD stage was analyzed using the Chi-squaretest. Results: The mean age was 51.55 ± 11.68 years, and 60.6% were males. Stage 5CKDwasmostcommon (51.5%). Normal LVFP was observed in 60.6% of patients, while 39.4%hadabnormalLVFP. The mean E/e′ ratio was 8.17 ± 3.12, and mean left ventricular ejectionfractionwas50.91 ± 9.32%. No significant association was found between CKDstage andLVFP(p=0.626). Conclusion: TDI-derived E/e′ ratio is a valuable non-invasive tool for assessingLVFPandidentifying early cardiac dysfunction in CKD patients.
Amirtha P, Anandsekar G, S. B et al.· INDIAN JOURNAL OF ALLIED HEA...· 0 citations
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