Multimodality imaging assessment of the Biatrial remodeling of the burden of atrial high-rate episodes in patients with cardiac implanted electronic devices. (15th January 2023)

• Record Type: Journal Article
• Authors: Huang, Sung-Hao; Tsao, Hsuan-Ming; Liao, Chao-Feng; Chen, Zu-Yin; Chao, Tze-Fan; Chen, Shih-Ann
• Is Part Of: International journal of cardiology. Volume 371(2023)
• Page Start: 175
• Page End: 183
• Publication Date: 2023-01-15
• Subjects: Atrial fibrillation -- Atrial high-rate episodes -- Atrial remodeling -- Computed tomography -- Strain echocardiography; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.10.007
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: The underlying mechanisms of atrial remodeling in cardiac implanted electronic device(CIED)-detected atrial high-rate episodes(AHRE) remains to be elucidated. Methods: A cardiac computed tomography and a strain echocardiography were performed to delineate the structural and functional characteristics of both atria. Biatrial volumes, emptying fraction(EF) and peak atrial longitudinal/contractile strain(PALS/PACS) were evaluated. All AHRE were analyzed. Results: A total of 80 CIED patients with AHRE were categorized by AHRE duration into 3 groups: Group 1: <6 min( n = 42), Group 2: 6 min ∼ 6 h( n = 23), and Group 3: >6 h( n = 15). Left atrial(LA) maximal volume(Vmax ), atrial precontraction volume(Vapc ), minimal volume(Vmin ), LAEF, and PALS/PACS were all increasingly worsened among the patients in the 3 groups ( p value for trend <0.05). Compared to Group 1, Group 2 had decreased LA PALS/PACS. There was no significant difference in LA volume or EF between Group 1 and 2. Group 3 had enlarged biatrial volumes (LAVmax : 57.1(SD 16.0) vs. 45.4(SD 9.2) mL/m 2, p = 0.002; LAVmin : 42.6(SD 18.2) vs. 28.2(SD 7.2) mL/m 2, p < 0.001), impaired total LAEF (28.0(SD 13.7) vs. 38.2(SD 7.7)%, p = 0.004) and reduced PALS/PACS compared to Group 1. Atrial remodeling in those with AHRE >6 h had increased LA volumes, impaired LAEF and reduced PALS/PACS compared to those with AHRE <6 h. Conclusion: Functional remodeling of the atria manifested after AHRE >6 min. Increased biatrial volumes and decreased LA reservoir and pump function occurred when AHRE were > 6 h. These LA structural and functional may be considered surrogate imaging markers for stroke risk assessment in patients with CHA2 DS2 -VASc ≥2 and AHRE. Graphical abstract: Unlabelled Image Highlights: Functional remodeling of the atria manifested as reduced strain after atrial high-rate episode (AHRE) >6 min. Increased biatrial volumes and decreased left atrial (LA) reservoir/pump function occurred when AHRE were >6 h. No obvious LA volume differences occurred when comparing the group of AHRE <6 min to those whose AHRE were 6 min ∼ 6 h. These imaging items may be considered surrogate markers for stroke risk assessment in patients with AHRE.