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. 2023 Sep 11;12(18):5893.
doi: 10.3390/jcm12185893.

Rest and Stress Left Atrial Dysfunction in Patients with Atrial Fibrillation

Angela Zagatina  1 , Maria Rivadeneira Ruiz  2 , Quirino Ciampi  3 , Karina Wierzbowska-Drabik  4 , Jaroslaw Kasprzak  5 , Elena Kalinina  1 , Irina Begidova  1 , Jesus Peteiro  6 , Rosina Arbucci  7 , Sofia Marconi  7 , Jorge Lowenstein  7 , Alla Boshchenko  8 , Fiore Manganelli  9 , Jelena Čelutkienė  10 , Doralisa Morrone  11 , Elisa Merli  12 , Federica Re  13 , Clarissa Borguezan-Daros  14 , Maciej Haberka  15 , Ariel K Saad  16 , Ana Djordjevic-Dikic  17 , Nithima Chaowalit Ratanasit  18 , Fausto Rigo  19 , Paolo Colonna  20 , José Luis de Castro E Silva Pretto  21 , Fabio Mori  22 , Maria Grazia D'Alfonso  22 , Miodrag Ostojic  23 , Bojan Stanetic  23 , Tamara Kovacevic Preradovic  23 , Fabio Costantino  24 , Andrea Barbieri  25 , Rodolfo Citro  26 , Annalisa Pitino  27 , Mauro Pepi  28 , Scipione Carerj  29 , Patricia A Pellikka  30 , Eugenio Picano  27 ; Stress Echo 2030 Study Group
Affiliations

Rest and Stress Left Atrial Dysfunction in Patients with Atrial Fibrillation

Angela Zagatina et al. J Clin Med. .

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.

Keywords: atrial fibrillation; left atrium; reservoir function; strain; stress echocardiography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Consort Diagram Flow diagram showing how many individuals were excluded at each step (LAVI miss, LASr miss, unclear history of AF).
Figure 2
Figure 2
On the left, the normal response in a patient in SR showing a normal pattern, with small increase of LAV (48 mL rest, 54 mL stress) and increase of LASr (26% rest, 31% stress) during exercise. In the middle, a patient in SR but with a history of paroxysmal AF showing unchanged LAV (44 mL rest, 45 mL stress) and LASr decrease (29% rest, 21% stress) during exercise. On the right, a patient in permanent AF showing a near-normal LAV (74 mL rest, 59 mL stress) and severe reduction of LASr (8% rest, 11% stress) at rest and during exercise.
Figure 3
Figure 3
Scattergram of the patients with LAVI and LASr data at rest (left panel) and during stress (right panel), divided according to the stressors used (black: exercise; green: vasodilator; red: dobutamine).
See this image and copyright information in PMC

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