Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany.
Boston Scientific Corp., Amsterdam, the Netherlands.
Int J Cardiol. 2018 Dec 1;272:108-112. doi: 10.1016/j.ijcard.2018.07.048. Epub 2018 Jul 9.
The extent of left atrial (LA) adverse remodeling as a cardiac disease marker has become increasingly important. In patients with atrial fibrillation (AF), atrial remodeling (AR) is accompanied by increased mortality. The relation between LA function and the extent of low-voltage areas (LVAs) has not yet been systematically investigated.
In patients with AF undergoing catheter-ablation, LA was studied using echocardiography and ultra-high-density mapping (Rhythmia®). Fibrosis (i.e. extent of LVAs) was estimated by quantifying areas with bipolar electrogram amplitudes of ≤0.5, ≤0.4, ≤0.3, ≤0.2 or ≤0.1 mV.
A total of 22 patients with a mean LVEF of 53 ± 2% was studied. Mean LA volume index (LAVI) was significantly increased at 39 ± 3 ml/m indicating AR. Size of LVAs was 57 ± 7 cm representing 47 ± 5% of the total LA area (low-voltage set to ≤0.5 mV). With low-voltage set to ≤0.4, ≤0.3, ≤0.2 and ≤0.1, total area decreased to 34 ± 6, 28 ± 6, 22 ± 5 and 12 ± 3 cm. LAVI positively correlated with the extent of LVAs at all cut-offs. Mean LA emptying fraction was 42 ± 3% and showed a negative correlation with LVAs with low-voltage set to ≤0.4 mV. Moreover, mean LA strain was 13 ± 2% and correlated with LVAs with low-voltage at all cut-offs further supporting the notion that the extent of LVAs impacts LA function. Notably, with low-voltage set to ≤0.2, ≤0.3 and ≤0.4 mV impaired LA strain was detected with an accuracy of >76% (p < 0.05).
Structural (i.e. LAVI) and functional (i.e. LA emptying fraction and LA strain) parameters of the LA correlate with the extent of LVAs.
左心房（LA）不良重构作为心脏疾病标志物的程度变得越来越重要。在心房颤动（AF）患者中，心房重构（AR）伴随着死亡率的增加。LA 功能与低电压区（LVAs）的程度之间的关系尚未得到系统研究。
在接受导管消融的 AF 患者中，使用超声心动图和超高密度映射（Rhythmia®）研究 LA。通过量化双极电图幅度≤0.5、≤0.4、≤0.3、≤0.2 或≤0.1 mV 的区域来估计纤维化（即 LVAs 的程度）。
共研究了 22 名平均 LVEF 为 53±2%的患者。LA 容积指数（LAVI）显著增加至 39±3 ml/m，表明 AR。LVAs 的大小为 57±7 cm，代表总 LA 面积的 47±5%（低电压设定为≤0.5 mV）。当低电压设定为≤0.4、≤0.3、≤0.2 和≤0.1 时，总面积分别减少至 34±6、28±6、22±5 和 12±3 cm。LAVI 与所有截止值的 LVAs 程度呈正相关。LA 排空分数的平均值为 42±3%，与低电压设定为≤0.4 mV 的 LVAs 呈负相关。此外，LA 平均应变率为 13±2%，与所有截止值的低电压 LVAs 相关，进一步支持 LVAs 程度影响 LA 功能的观点。值得注意的是，当低电压设定为≤0.2、≤0.3 和≤0.4 mV 时，LA 应变受损的检出率>76%（p<0.05）。
LA 的结构（即 LAVI）和功能（即 LA 排空分数和 LA 应变）参数与 LVAs 的程度相关。
