The impact of atrial fibrillation and stroke risk factors on left atrial blood flow characteristics
Abstract Aims Altered left atrial (LA) blood flow characteristics account for an increase in cardioembolic stroke risk in atrial fibrillation (AF). Here, we aimed to assess whether exposure to stroke risk factors is sufficient to alter LA blood flow even in the presence of sinus rhythm (SR). Method...
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| Veröffentlicht in: | European heart journal cardiovascular imaging 2021-12, Vol.23 (1), p.115-123 |
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| creator | Spartera, Marco Stracquadanio, Antonio Pessoa-Amorim, Guilherme Von Ende, Adam Fletcher, Alison Manley, Peter Ferreira, Vanessa M Hess, Aaron T Hopewell, Jemma C Neubauer, Stefan Wijesurendra, Rohan S Casadei, Barbara |
| description | Abstract
Aims
Altered left atrial (LA) blood flow characteristics account for an increase in cardioembolic stroke risk in atrial fibrillation (AF). Here, we aimed to assess whether exposure to stroke risk factors is sufficient to alter LA blood flow even in the presence of sinus rhythm (SR).
Methods and results
We investigated 95 individuals: 37 patients with persistent AF, who were studied before and after cardioversion [Group 1; median CHA2DS2-VASc = 2.0 (1.5–3.5)]; 35 individuals with no history of AF but similar stroke risk to Group 1 [Group 2; median CHA2DS2-VASc = 3.0 (2.0–4.0)]; and 23 low-risk individuals in SR [Group 3; median CHA2DS2-VASc = 0.0 (0.0–0.0)]. Cardiac function and LA flow characteristics were evaluated using cardiac magnetic resonance. Before cardioversion, Group 1 displayed impaired left ventricular (LV) and LA function, reduced LA flow velocities and vorticity, and a higher normalized vortex volume (all P |
| doi_str_mv | 10.1093/ehjci/jeab213 |
| format | Article |
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Aims
Altered left atrial (LA) blood flow characteristics account for an increase in cardioembolic stroke risk in atrial fibrillation (AF). Here, we aimed to assess whether exposure to stroke risk factors is sufficient to alter LA blood flow even in the presence of sinus rhythm (SR).
Methods and results
We investigated 95 individuals: 37 patients with persistent AF, who were studied before and after cardioversion [Group 1; median CHA2DS2-VASc = 2.0 (1.5–3.5)]; 35 individuals with no history of AF but similar stroke risk to Group 1 [Group 2; median CHA2DS2-VASc = 3.0 (2.0–4.0)]; and 23 low-risk individuals in SR [Group 3; median CHA2DS2-VASc = 0.0 (0.0–0.0)]. Cardiac function and LA flow characteristics were evaluated using cardiac magnetic resonance. Before cardioversion, Group 1 displayed impaired left ventricular (LV) and LA function, reduced LA flow velocities and vorticity, and a higher normalized vortex volume (all P < 0.001 vs. Groups 2 and 3). After restoration of SR at ≥4-week post-cardioversion, LV systolic function and LA flow parameters improved significantly (all P < 0.001 vs. pre-cardioversion) and were no longer different from those in Group 2. However, in the presence of SR, LA flow peak and mean velocity, and vorticity were lower in Groups 1 and 2 vs. Group 3 (all P < 0.01), and were associated with impaired LA emptying fraction (LAEF) and LV diastolic dysfunction.
Conclusion
Patients at moderate-to-high stroke risk display altered LA flow characteristics in SR in association with an LA myopathic phenotype and LV diastolic dysfunction, regardless of a history of AF.
Graphical Abstract</description><identifier>ISSN: 2047-2404</identifier><identifier>EISSN: 2047-2412</identifier><identifier>DOI: 10.1093/ehjci/jeab213</identifier><identifier>PMID: 34687541</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Atrial Appendage ; Atrial Fibrillation ; Atrial Function, Left - physiology ; Humans ; Original Papers ; Risk Factors ; Stroke - complications ; Stroke - etiology</subject><ispartof>European heart journal cardiovascular imaging, 2021-12, Vol.23 (1), p.115-123</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c420t-d54923c1aa5230c3b9f3c081a4517a050e5885c764d9db0b8e260f67850f1bab3</citedby><cites>FETCH-LOGICAL-c420t-d54923c1aa5230c3b9f3c081a4517a050e5885c764d9db0b8e260f67850f1bab3</cites><orcidid>0000-0002-8991-3396 ; 0000-0002-6801-1617 ; 0000-0001-9017-5645</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34687541$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Spartera, Marco</creatorcontrib><creatorcontrib>Stracquadanio, Antonio</creatorcontrib><creatorcontrib>Pessoa-Amorim, Guilherme</creatorcontrib><creatorcontrib>Von Ende, Adam</creatorcontrib><creatorcontrib>Fletcher, Alison</creatorcontrib><creatorcontrib>Manley, Peter</creatorcontrib><creatorcontrib>Ferreira, Vanessa M</creatorcontrib><creatorcontrib>Hess, Aaron T</creatorcontrib><creatorcontrib>Hopewell, Jemma C</creatorcontrib><creatorcontrib>Neubauer, Stefan</creatorcontrib><creatorcontrib>Wijesurendra, Rohan S</creatorcontrib><creatorcontrib>Casadei, Barbara</creatorcontrib><title>The impact of atrial fibrillation and stroke risk factors on left atrial blood flow characteristics</title><title>European heart journal cardiovascular imaging</title><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><description>Abstract
Aims
Altered left atrial (LA) blood flow characteristics account for an increase in cardioembolic stroke risk in atrial fibrillation (AF). Here, we aimed to assess whether exposure to stroke risk factors is sufficient to alter LA blood flow even in the presence of sinus rhythm (SR).
Methods and results
We investigated 95 individuals: 37 patients with persistent AF, who were studied before and after cardioversion [Group 1; median CHA2DS2-VASc = 2.0 (1.5–3.5)]; 35 individuals with no history of AF but similar stroke risk to Group 1 [Group 2; median CHA2DS2-VASc = 3.0 (2.0–4.0)]; and 23 low-risk individuals in SR [Group 3; median CHA2DS2-VASc = 0.0 (0.0–0.0)]. Cardiac function and LA flow characteristics were evaluated using cardiac magnetic resonance. Before cardioversion, Group 1 displayed impaired left ventricular (LV) and LA function, reduced LA flow velocities and vorticity, and a higher normalized vortex volume (all P < 0.001 vs. Groups 2 and 3). After restoration of SR at ≥4-week post-cardioversion, LV systolic function and LA flow parameters improved significantly (all P < 0.001 vs. pre-cardioversion) and were no longer different from those in Group 2. However, in the presence of SR, LA flow peak and mean velocity, and vorticity were lower in Groups 1 and 2 vs. Group 3 (all P < 0.01), and were associated with impaired LA emptying fraction (LAEF) and LV diastolic dysfunction.
Conclusion
Patients at moderate-to-high stroke risk display altered LA flow characteristics in SR in association with an LA myopathic phenotype and LV diastolic dysfunction, regardless of a history of AF.
Graphical Abstract</description><subject>Atrial Appendage</subject><subject>Atrial Fibrillation</subject><subject>Atrial Function, Left - physiology</subject><subject>Humans</subject><subject>Original Papers</subject><subject>Risk Factors</subject><subject>Stroke - complications</subject><subject>Stroke - etiology</subject><issn>2047-2404</issn><issn>2047-2412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNqFkU1LAzEQhoMoWqpHr5Kjl7X53M1eBCl-geBFzyHJJjZ1u6lJqvjvjbZWPTmXGZhn3hnmBeAYozOMWjqxs7nxk7lVmmC6A0YEsaYiDJPdbY3YAThKaY5KcFYzgvfBAWW1aDjDI2AeZhb6xVKZDIODKkeveui8jr7vVfZhgGroYMoxPFsYfXqGrrAhJlhavXX5e0b3IXTQ9eENmpmKBbIFz96kQ7DnVJ_s0SaPwePV5cP0prq7v76dXtxVhhGUq46zllCDleKEIkN166hBAivGcaMQR5YLwU1Ts67tNNLCkhq5uhEcOayVpmNwvtZdrvTCdsYOOapeLqNfqPgug_Lyb2fwM_kUXqWoBa8RLgKnG4EYXlY2ZbnwydjyiMGGVZKEC05527Z1Qas1amJIKVq3XYOR_PRGfnkjN94U_uT3bVv624mf3WG1_EfrA9DXm6A</recordid><startdate>20211218</startdate><enddate>20211218</enddate><creator>Spartera, Marco</creator><creator>Stracquadanio, Antonio</creator><creator>Pessoa-Amorim, Guilherme</creator><creator>Von Ende, Adam</creator><creator>Fletcher, Alison</creator><creator>Manley, Peter</creator><creator>Ferreira, Vanessa M</creator><creator>Hess, Aaron T</creator><creator>Hopewell, Jemma C</creator><creator>Neubauer, Stefan</creator><creator>Wijesurendra, Rohan S</creator><creator>Casadei, Barbara</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8991-3396</orcidid><orcidid>https://orcid.org/0000-0002-6801-1617</orcidid><orcidid>https://orcid.org/0000-0001-9017-5645</orcidid></search><sort><creationdate>20211218</creationdate><title>The impact of atrial fibrillation and stroke risk factors on left atrial blood flow characteristics</title><author>Spartera, Marco ; Stracquadanio, Antonio ; Pessoa-Amorim, Guilherme ; Von Ende, Adam ; Fletcher, Alison ; Manley, Peter ; Ferreira, Vanessa M ; Hess, Aaron T ; Hopewell, Jemma C ; Neubauer, Stefan ; Wijesurendra, Rohan S ; Casadei, Barbara</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c420t-d54923c1aa5230c3b9f3c081a4517a050e5885c764d9db0b8e260f67850f1bab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Atrial Appendage</topic><topic>Atrial Fibrillation</topic><topic>Atrial Function, Left - physiology</topic><topic>Humans</topic><topic>Original Papers</topic><topic>Risk Factors</topic><topic>Stroke - complications</topic><topic>Stroke - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Spartera, Marco</creatorcontrib><creatorcontrib>Stracquadanio, Antonio</creatorcontrib><creatorcontrib>Pessoa-Amorim, Guilherme</creatorcontrib><creatorcontrib>Von Ende, Adam</creatorcontrib><creatorcontrib>Fletcher, Alison</creatorcontrib><creatorcontrib>Manley, Peter</creatorcontrib><creatorcontrib>Ferreira, Vanessa M</creatorcontrib><creatorcontrib>Hess, Aaron T</creatorcontrib><creatorcontrib>Hopewell, Jemma C</creatorcontrib><creatorcontrib>Neubauer, Stefan</creatorcontrib><creatorcontrib>Wijesurendra, Rohan S</creatorcontrib><creatorcontrib>Casadei, Barbara</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European heart journal cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Spartera, Marco</au><au>Stracquadanio, Antonio</au><au>Pessoa-Amorim, Guilherme</au><au>Von Ende, Adam</au><au>Fletcher, Alison</au><au>Manley, Peter</au><au>Ferreira, Vanessa M</au><au>Hess, Aaron T</au><au>Hopewell, Jemma C</au><au>Neubauer, Stefan</au><au>Wijesurendra, Rohan S</au><au>Casadei, Barbara</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of atrial fibrillation and stroke risk factors on left atrial blood flow characteristics</atitle><jtitle>European heart journal cardiovascular imaging</jtitle><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><date>2021-12-18</date><risdate>2021</risdate><volume>23</volume><issue>1</issue><spage>115</spage><epage>123</epage><pages>115-123</pages><issn>2047-2404</issn><eissn>2047-2412</eissn><abstract>Abstract
Aims
Altered left atrial (LA) blood flow characteristics account for an increase in cardioembolic stroke risk in atrial fibrillation (AF). Here, we aimed to assess whether exposure to stroke risk factors is sufficient to alter LA blood flow even in the presence of sinus rhythm (SR).
Methods and results
We investigated 95 individuals: 37 patients with persistent AF, who were studied before and after cardioversion [Group 1; median CHA2DS2-VASc = 2.0 (1.5–3.5)]; 35 individuals with no history of AF but similar stroke risk to Group 1 [Group 2; median CHA2DS2-VASc = 3.0 (2.0–4.0)]; and 23 low-risk individuals in SR [Group 3; median CHA2DS2-VASc = 0.0 (0.0–0.0)]. Cardiac function and LA flow characteristics were evaluated using cardiac magnetic resonance. Before cardioversion, Group 1 displayed impaired left ventricular (LV) and LA function, reduced LA flow velocities and vorticity, and a higher normalized vortex volume (all P < 0.001 vs. Groups 2 and 3). After restoration of SR at ≥4-week post-cardioversion, LV systolic function and LA flow parameters improved significantly (all P < 0.001 vs. pre-cardioversion) and were no longer different from those in Group 2. However, in the presence of SR, LA flow peak and mean velocity, and vorticity were lower in Groups 1 and 2 vs. Group 3 (all P < 0.01), and were associated with impaired LA emptying fraction (LAEF) and LV diastolic dysfunction.
Conclusion
Patients at moderate-to-high stroke risk display altered LA flow characteristics in SR in association with an LA myopathic phenotype and LV diastolic dysfunction, regardless of a history of AF.
Graphical Abstract</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>34687541</pmid><doi>10.1093/ehjci/jeab213</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-8991-3396</orcidid><orcidid>https://orcid.org/0000-0002-6801-1617</orcidid><orcidid>https://orcid.org/0000-0001-9017-5645</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | European heart journal cardiovascular imaging, 2021-12, Vol.23 (1), p.115-123 |
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| language | eng |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Atrial Appendage Atrial Fibrillation Atrial Function, Left - physiology Humans Original Papers Risk Factors Stroke - complications Stroke - etiology |
| title | The impact of atrial fibrillation and stroke risk factors on left atrial blood flow characteristics |
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