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Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling

The pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characterist...

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Autores principales: Demirkiran, Ahmet, Amier, Raquel P., Hofman, Mark B. M., van der Geest, Rob J., Robbers, Lourens F. H. J., Hopman, Luuk H. G. A., Mulder, Mark J., van de Ven, Peter, Allaart, Cornelis P., van Rossum, Albert C., Götte, Marco J. W., Nijveldt, Robin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966746/
https://www.ncbi.nlm.nih.gov/pubmed/33727587
http://dx.doi.org/10.1038/s41598-021-85176-8
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author Demirkiran, Ahmet
Amier, Raquel P.
Hofman, Mark B. M.
van der Geest, Rob J.
Robbers, Lourens F. H. J.
Hopman, Luuk H. G. A.
Mulder, Mark J.
van de Ven, Peter
Allaart, Cornelis P.
van Rossum, Albert C.
Götte, Marco J. W.
Nijveldt, Robin
author_facet Demirkiran, Ahmet
Amier, Raquel P.
Hofman, Mark B. M.
van der Geest, Rob J.
Robbers, Lourens F. H. J.
Hopman, Luuk H. G. A.
Mulder, Mark J.
van de Ven, Peter
Allaart, Cornelis P.
van Rossum, Albert C.
Götte, Marco J. W.
Nijveldt, Robin
author_sort Demirkiran, Ahmet
collection PubMed
description The pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.
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spelling pubmed-79667462021-03-19 Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling Demirkiran, Ahmet Amier, Raquel P. Hofman, Mark B. M. van der Geest, Rob J. Robbers, Lourens F. H. J. Hopman, Luuk H. G. A. Mulder, Mark J. van de Ven, Peter Allaart, Cornelis P. van Rossum, Albert C. Götte, Marco J. W. Nijveldt, Robin Sci Rep Article The pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling. Nature Publishing Group UK 2021-03-16 /pmc/articles/PMC7966746/ /pubmed/33727587 http://dx.doi.org/10.1038/s41598-021-85176-8 Text en © The Author(s) 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Demirkiran, Ahmet
Amier, Raquel P.
Hofman, Mark B. M.
van der Geest, Rob J.
Robbers, Lourens F. H. J.
Hopman, Luuk H. G. A.
Mulder, Mark J.
van de Ven, Peter
Allaart, Cornelis P.
van Rossum, Albert C.
Götte, Marco J. W.
Nijveldt, Robin
Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
title Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
title_full Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
title_fullStr Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
title_full_unstemmed Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
title_short Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
title_sort altered left atrial 4d flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966746/
https://www.ncbi.nlm.nih.gov/pubmed/33727587
http://dx.doi.org/10.1038/s41598-021-85176-8
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