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Left Atrial Roof Enlargement Is a Distinct Feature of Heart Failure With Preserved Ejection Fraction. | LitMetric

Left Atrial Roof Enlargement Is a Distinct Feature of Heart Failure With Preserved Ejection Fraction.

Circ Cardiovasc Imaging

Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany (T.L., A. Schulz, R.E., G.H., A. Schuster).

Published: July 2024

AI Article Synopsis

  • The study investigates the role of intrinsic atrial cardiomyopathy and left ventricular diastolic dysfunction in atrial remodeling and functional issues in patients with heart failure with preserved ejection fraction (HFpEF).
  • Researchers created 3D models of the left atrium using cardiovascular magnetic resonance imaging to analyze shape differences between patients diagnosed with HFpEF and those with noncardiac dyspnea.
  • Results showed that roof dilation in the left atrium is a key indicator of masked HFpEF that can evolve into increased overall atrial size in overt HFpEF, and a new shape score was developed to help differentiate between the two conditions and predict risks for complications like atrial fibrillation.

Article Abstract

Background: It remains unknown to what extent intrinsic atrial cardiomyopathy or left ventricular diastolic dysfunction drive atrial remodeling and functional failure in heart failure with preserved ejection fraction (HFpEF). Computational 3-dimensional (3D) models fitted to cardiovascular magnetic resonance allow state-of-the-art anatomic and functional assessment, and we hypothesized to identify a phenotype linked to HFpEF.

Methods: Patients with exertional dyspnea and diastolic dysfunction on echocardiography (E/e', >8) were prospectively recruited and classified as HFpEF or noncardiac dyspnea based on right heart catheterization. All patients underwent rest and exercise-stress right heart catheterization and cardiovascular magnetic resonance. Computational 3D anatomic left atrial (LA) models were generated based on short-axis cine sequences. A fully automated pipeline was developed to segment cardiovascular magnetic resonance images and build 3D statistical models of LA shape and find the 3D patterns discriminant between HFpEF and noncardiac dyspnea. In addition, atrial morphology and function were quantified by conventional volumetric analyses and deformation imaging. A clinical follow-up was conducted after 24 months for the evaluation of cardiovascular hospitalization.

Results: Beyond atrial size, the 3D LA models revealed roof dilation as the main feature found in masked HFpEF (diagnosed during exercise-stress only) preceding a pattern shift to overall atrial size in overt HFpEF (diagnosed at rest). Characteristics of the 3D model were integrated into the LA HFpEF shape score, a biomarker to characterize the gradual remodeling between noncardiac dyspnea and HFpEF. The LA HFpEF shape score was able to discriminate HFpEF (n=34) to noncardiac dyspnea (n=34; area under the curve, 0.81) and was associated with a risk for atrial fibrillation occurrence (hazard ratio, 1.02 [95% CI, 1.01-1.04]; =0.003), as well as cardiovascular hospitalization (hazard ratio, 1.02 [95% CI, 1.00-1.04]; =0.043).

Conclusions: LA roof dilation is an early remodeling pattern in masked HFpEF advancing to overall LA enlargement in overt HFpEF. These distinct features predict the occurrence of atrial fibrillation and cardiovascular hospitalization.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03260621.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11251503PMC
http://dx.doi.org/10.1161/CIRCIMAGING.123.016424DOI Listing

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