Insights on Distinct Left Atrial Remodeling Between Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction

被引：2

作者：

Kuo, Jen-Yuan

Jin, Xuanyi

Sun, Jing-Yi

Chang, Sheng-Hsiung

Chi, Po-Ching

Sung, Kuo-Tzu

Mok, Greta S. P.

Yun, Chun-Ho

Chang, Shun-Chuan

Chung, Fa-Po

Yu, Ching-Hsiang

Wu, Tung-Hsin

Hung, Chung-Lieh

Yeh, Hung-, I

Lam, Carolyn S. P.

机构：

[1] Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei

[2] Department of Medicine, Mackay Medical College, New Taipei City

[3] Mackay Medicine, Nursing and Management College, Taipei

[4] National Heart Centre Singapore, and Duke-National University of Singapore, Singapore

[5] Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen

[6] Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei

[7] Division of Cardiology, Department of Internal Medicine, Taoyuan General Hospital, Taoyuan

[8] Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau

[9] Department of Radiology, MacKay Memorial Hospital, Taipei

[10] Holistic Education Center, Mackay Medical College, New Taipei City

[11] Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei

[12] Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei

[13] Institute of Biomedical Sciences, Mackay Medical College, New Taipei City

来源：

FRONTIERS IN CARDIOVASCULAR MEDICINE | 2022年 / 9卷

关键词：

atrial fibrillation; heart failure with preserved ejection fraction; strain; multi-detector computed tomography; left atrial remodeling; left atrial wall; UNDERLYING ATRIAL;

D O I：

10.3389/fcvm.2022.857360

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundHeart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) commonly coexist with overlapping pathophysiology like left atrial (LA) remodeling, which might differ given different underlying mechanisms. ObjectivesWe sought to investigate the different patterns of LA wall remodeling in AF vs. HFpEF. MethodsWe compared LA wall characteristics including wall volume (LAWV), wall thickness (LAWT), and wall thickness heterogeneity (LAWT[SD]) and LA structure, function among the controls (without AF or HFpEF, n = 115), HFpEF alone (n = 59), AF alone (n = 37), and HFpEF+AF (n = 38) groups using multi-detector computed tomography and echocardiography. ResultsLA wall remodeling was most predominant and peak atrial longitudinal strain (PALS) was worst in HFpEF+AF patients as compared to the rest. Despite lower E/e' (9.8 +/- 3.8 vs. 13.4 +/- 6.4) yet comparable LA volume, LAWT and PALS in AF alone vs. HFpEF alone, LAWV [12.6 (11.6-15.3) vs. 12.0 (10.2-13.7); p = 0.01] and LAWT(SD) [0.68 (0.61-0.71) vs. 0.60 (0.56-0.65); p < 0.001] were significantly greater in AF alone vs. HFpEF alone even after multi-variate adjustment and propensity matching. After excluding the HFpEF+AF group, both LAWV and LAWT [SD] provided incremental values when added to PALS or LAVi (all p for net reclassification improvement <0.05) in discriminating AF alone, with LAWT[SD] yielding the largest C-statistic (0.78, 95% CI: 0.70-0.86) among all LA wall indices. ConclusionsDespite a similar extent of LA enlargement and dysfunction in HFpEF vs. AF alone, larger LAWV and LAWT [SD] can distinguish AF from HFpEF alone, suggesting the distinct underlying pathophysiological mechanism of LA remodeling in AF vs. HFpEF.

引用

页数：10