학술논문
Rest and Stress Left Atrial Dysfunction in Patients with Atrial Fibrillation
Document Type
article
Author
Angela Zagatina; Maria Rivadeneira Ruiz; Quirino Ciampi; Karina Wierzbowska-Drabik; Jaroslaw Kasprzak; Elena Kalinina; Irina Begidova; Jesus Peteiro; Rosina Arbucci; Sofia Marconi; Jorge Lowenstein; Alla Boshchenko; Fiore Manganelli; Jelena Čelutkienė; Doralisa Morrone; Elisa Merli; Federica Re; Clarissa Borguezan-Daros; Maciej Haberka; Ariel K. Saad; Ana Djordjevic-Dikic; Nithima Chaowalit Ratanasit; Fausto Rigo; Paolo Colonna; José Luis de Castro e Silva Pretto; Fabio Mori; Maria Grazia D’Alfonso; Miodrag Ostojic; Bojan Stanetic; Tamara Kovacevic Preradovic; Fabio Costantino; Andrea Barbieri; Rodolfo Citro; Annalisa Pitino; Mauro Pepi; Scipione Carerj; Patricia A. Pellikka; Eugenio Picano
Source
Journal of Clinical Medicine, Vol 12, Iss 18, p 5893 (2023)
Subject
Language
English
ISSN
2077-0383
Abstract
Background: Left atrial (LA) myopathy with paroxysmal and permanent atrial fibrillation (AF) is frequent in chronic coronary syndromes (CCS) but sometimes occult at rest and elicited by stress. Aim: This study sought to assess LA volume and function at rest and during stress across the spectrum of AF. Methods: In a prospective, multicenter, observational study design, we enrolled 3042 patients [age = 64 ± 12; 63.8% male] with known or suspected CCS: 2749 were in sinus rhythm (SR, Group 1); 191 in SR with a history of paroxysmal AF (Group 2); and 102 were in permanent AF (Group 3). All patients underwent stress echocardiography (SE). We measured left atrial volume index (LAVI) in all patients and LA Strain reservoir phase (LASr) in a subset of 486 patients. Results: LAVI increased from Group 1 to 3, both at rest (Group 1 = 27.6 ± 12.2, Group 2 = 31.6 ± 12.9, Group 3 = 43.3 ± 19.7 mL/m2, p < 0.001) and at peak stress (Group 1 = 26.2 ± 12.0, Group 2 = 31.2 ± 12.2, Group 3 = 43.9 ± 19.4 mL/m2, p < 0.001). LASr progressively decreased from Group 1 to 3, both at rest (Group 1 = 26.0 ± 8.5%, Group 2 = 23.2 ± 11.2%, Group 3 = 8.5 ± 6.5%, p < 0.001) and at peak stress (Group 1 = 26.9 ± 10.1, Group 2 = 23.8 ± 11.0 Group 3 = 10.7 ± 8.1%, p < 0.001). Stress B-lines (≥2) were more frequent in AF (Group 1 = 29.7% vs. Group 2 = 35.5% vs. Group 3 = 57.4%, p < 0.001). Inducible ischemia was less frequent in SR (Group 1 = 16.1% vs. Group 2 = 24.7% vs. Group 3 = 24.5%, p = 0.001). Conclusions: In CCS, rest and stress LA dilation and reservoir dysfunction are often present in paroxysmal and, more so, in permanent AF and are associated with more frequent inducible ischemia and pulmonary congestion during stress.