Rest and Stress Left Atrial Dysfunction in Patients with Atrial Fibrillation.
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Zagatina Angela, Rivadeneira Ruiz Maria, Ciampi Quirino, Wierzbowska-Drabik Karina, Kasprzak Jaroslaw, Kalinina Elena, Begidova Irina, Peteiro Jesus, Arbucci Rosina, Marconi Sofia, Lowenstein Jorge, Boshchenko Alla, Manganelli Fiore, Čelutkienė Jelena, Morrone Doralisa, Merli Elisa, Re Federica, Borguezan-Daros Clarissa, Haberka Maciej, Saad Ariel K, Djordjevic-Dikic Ana, Ratanasit Nithima Chaowalit, Rigo Fausto, Colonna Paolo, Pretto José Luis de Castro E Silva, Mori Fabio, D'Alfonso Maria Grazia, Ostojic Miodrag, Stanetic Bojan, Preradovic Tamara Kovacevic, Costantino Fabio, Barbieri Andrea, Citro Rodolfo, Pitino Annalisa, Pepi Mauro, Carerj Scipione, Pellikka Patricia A, Picano Eugenio, Stress Echo 2030 Study Group
Аннотация
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.