Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation.

OBJECTIVES The purpose of this study was to investigate whether there may be a bi-atrial dysfunction in Takotsubo syndrome (TS) during the transient course of the disease, using cardiac magnetic resonance imaging feature tracking (CMR-FT) in analyzing bi-atrial strain. METHOD Eighteen TS patients and 13 healthy controls were studied. Reservoir, conduit, and booster bi-atrial functions were analyzed by CMR-FT. The correlation between LA and RA strain parameters was assessed. Intra- and inter-observer reproducibility was evaluated for all strain and strain rate (SR) parameters using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. RESULTS Atrial strain were feasible in all patients and controls. Takotsubo patients showed an impaired LA Reservoir strain (∊s), LA Reservoir strain rate (SRs), LA and RA Conduit strain(∊e), LA and RA conduit strain rate (SRe) in comparison with controls (P < 0.001 for all of them), while no differences were found as to LA and RA booster deformation parameters (∊a and SRa). Analysis of correlation showed that LA ∊s, SRs, ∊e, and SRe were positively correlated with corresponding RA strain measurements (P < 0.001, r = 0.61 and P = 0,03, r = 0,54, respectively). Reproducibility was good to excellent for all atrial strain and strain rate parameters (ICCs ranging from 0,50 to 0,96). CONCLUSION Atrial strain analysis using CMR-FT may be a useful tool to reveal new pathophysiological insights in Takotsubo cardiomyopathy. Additional studies, with a larger number of patients, are needed to confirm the possible role of these advanced CMR tools in characterizing TS patients.

Atrial Strain by Feature-Tracking Cardiac Magnetic Resonance Imaging in Takotsubo Cardiomyopathy. Features, Feasibility, and Reproducibility.

Abstract Aims Bi-atrial remodelling in patients with atrial fibrillation (AF) is rarely assessed and data on the presence of right atrial (RA) fibrosis, the relationship between RA and left atrial (LA) fibrosis, and possible association of RA remodelling with AF recurrence after ablation in patients with AF is limited. Methods and results A total of 110 patients with AF undergoing initial pulmonary vein isolation (PVI) were included in the present study. All patients were in sinus rhythm during cardiac magnetic resonance (CMR) imaging performed prior to ablation. LA and RA volumes and function (volumetric and feature tracking strain) were derived from cine CMR images. The extent of LA and RA fibrosis was assessed from 3D late gadolinium enhancement images. AF recurrence was followed up for 12 months after PVI using either 12-lead electrocardiograms or Holter monitoring. Arrhythmia recurrence was observed in 39 patients (36%) after the 90-day blanking period, occurring at a median of 181 (interquartile range: 122–286) days. RA remodelling parameters were not significantly different between patients with and without AF recurrence after ablation, whereas LA remodelling parameters were different (volume, emptying fraction, and strain indices). LA fibrosis had a strong correlation with RA fibrosis (r = 0.88, P < 0.001). Both LA and RA fibrosis were not different between patients with and without AF recurrence. Conclusions This study shows that RA remodelling parameters were not predictive of AF recurrence after AF ablation. Bi-atrial fibrotic remodelling is present in patients with AF and moreover, the amount of LA fibrosis had a strong correlation with the amount of RA fibrosis.

Right atrial function and fibrosis in relation to successful atrial fibrillation ablation

The right atrium (RA) is the cardiac chamber that has been least well studied. Due to recent advances in interventional cardiology, the need for greater understanding of the RA anatomy and physiology has garnered significant attention. In this article, we review how a comprehensive assessment of RA dimensions and function using either echocardiography, cardiac computed tomography, and magnetic resonance imaging may be used as a first step towards a better understanding of RA pathophysiology. The recently published normative data on RA size and function will likely shed light on RA atrial remodelling in atrial fibrillation (AF), which is a complex phenomenon that occurs in both atria but has only been studied in depth in the left atrium. Changes in RA structure and function have prognostic implications in pulmonary hypertension (PH), where the increased right ventricular (RV) afterload first induces RV remodelling, predominantly characterized by hypertrophy. As PH progresses, RV dysfunction and dilatation may begin and eventually lead to RV failure. Thereafter, RV overload and increased RV stiffness may lead to a proportional increase in RA pressure. This manuscript provides an in-depth review of RA anatomy, function, and haemodynamics with particular emphasis on the changes in structure and function that occur in AF, tricuspid regurgitation, and PH.

Imaging assessment of the right atrium: anatomy and function.

Right atrial (RA) structural and functional evaluations have recently emerged as powerful biomarkers for adverse events in various cardiovascular conditions. Quantitative analysis of the right atrium, usually performed with volume changes or speckle-tracking echocardiography (STE), has markedly changed our understanding of RA function and remodeling. Knowledge of reference echocardiographic values and measurement methods of RA volumes and myocardial function is a prerequisite to introduce RA quantitation in the clinical routine. This review describes the methodology, benefits and pitfalls of measuring RA size and function by echocardiography based on the current understanding of right atrial anatomy and physiological function and provides the current knowledge of right atrial function in related cardiac diseases. 

Echocardiographic evaluation of the right atrial size and function: Relevance for clinical practice

Biatrial remodelling in atrial fibrillation: A three-dimensional and strain echocardiography insight.

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Biatrial remodelling in atrial fibrillation: A three-dimensional and strain echocardiography insight.