The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation

KHOLMOVSKİ, Eugene; DAMAL, Kavitha; MCGANN, Chris; MARROUCHE, Nassir; AKKAYA, Mehmet; HİGUCHİ, Koji; KOOPMANN, Matthias

The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation

Mehmet AKKAYA, (University of Utah, Carma (Comprehensive Arrhythmia Research and Management) Center, Salt Lake City, Utah, USA,)

Nassir MARROUCHE, (University of Utah, Carma (Comprehensive Arrhythmia Research and Management) Center, Salt Lake City, Utah, USA,)

Koji HİGUCHİ, (University of Utah, Carma (Comprehensive Arrhythmia Research and Management) Center, Salt Lake City, Utah, USA,)

Matthias KOOPMANN, (University of Utah, Carma (Comprehensive Arrhythmia Research and Management) Center, Salt Lake City, Utah, USA,)

Kavitha DAMAL, (University of Utah, Carma (Comprehensive Arrhythmia Research and Management) Center, Salt Lake City, Utah, USA,)

Eugene KHOLMOVSKİ, (University of Utah, Carma (Comprehensive Arrhythmia Research and Management) Center, Salt Lake City, Utah, USA,)

Chris MCGANN (University of Utah, Carma (Comprehensive Arrhythmia Research and Management) Center, Salt Lake City, Utah, USA,)

Türk Kardiyoloji Derneği Arşivi

2 1

Yıl: 2014 Cilt: 42 Sayı: 1 Sayfa Aralığı: 11 - 19 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation

Öz:

Amaç: Geç gadolinyum tutulumlu manyetik rezonans görüntüleme (LGE-MRI) ile saptanan sol atriyum (SA) duvarının yeniden yapılanma (fibroz) derecesi ilerlemiş atriyum fibrilasyonu (AF) ile bağıntılıdır. AF ile sol ventrikül (SV) fonksiyon bozukluğu beraberliği nadir değildir. Bu çalışmada, hem AF hem de SV fonksiyon buzukluğunda meydana gelebilen SA fibrozunun, SV ejeksiyon fraksiyonu (EF) üzerine etkisini araştırdık. Çalışma planı: Geriye dönük AF veritabanımızdan, AF ablasyonu öncesi LGE-MRI ve transtorasik ekokardiyografi yapılmış olan 384 hasta çalışmaya dahil edildi. SA fibrozunun miktarına göre hastalar dört evreye ayrıldı; Utah I (SA fibrozu <%5), Utah II (fibroz %5%20), Utah III (fibroz %20%35) and Utah IV (fibroz >%35). Bulgular: Ablasyon öncesi ortalama SVEF; Utah I evre hastalarda %60.5±%8.5 (n=24), Utah II evresindekilerde %55.7±%10.3 (n=240), Utah III hastalarda %51.7±%11.5 (n=90) ve Utah IV evre hastalarda %48.9±%11.6 (n=30) bulundu (p<0.001, tekyönlü ANOVA). Tek değişkenli analizde, SA fibrozu oranı LVEF ile anlamlı şekilde negatif korelasyon gösterdi (p<0.001). Yaş, cinsiyet, AF çeşidi ve diyabet, hipertansiyon gibi komorbiditeleri içeren çok değişkenli analizde, Utah evresi, ablasyon öncesi SVEF için halen anlamlı bir öngördürücüydü (p<0.001). Sonuç: İleri derecede SA fibrozu bulunan hastalar ablasyon öncesi daha bozuk SV fonksiyonuna sahiptirler; bu da SA içindeki yeniden yapılanmanın aynı zamanda ventrikül miyokardı içindeki yeniden yapılanmayı tetikleyici ve ilerletici olabileceğini düşündürmektedir.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Atriyum fibrilasyonlu hastalarda sol atriyumun yeniden yapılanma derecesi sol ventrikül ejeksiyon fraksiyonunu etkilemektedir

Öz:

Objectives: The extent of left atrial (LA) wall structural re- modeling (fibrosis) detected by late gadolinium enhancement- magnetic resonance imaging (LGE-MRI) is correlated with advanced atrial fibrillation (AF). The concomitant occurrence of AF and left ventricular (LV) dysfunction is not uncommon. We studied the effect of LA fibrosis, a confounder of both AF and LV dysfunction, on LV ejection fraction (EF). Study design: For the analysis, we identified and included 384 patients from our retrospective AF database who under- went LGE-MRI and transthoracic echocardiography prior to AF ablation. Based on the degree of LA fibrosis, patients were categorized into four stages as: Utah 1 (<5% LA fibrosis), Utah 2 (5 20% fibrosis), Utah 3 (20 35% fibrosis), and Utah 4 (>35% fibrosis). Results: The average pre-ablation LVEF was 60.5%±8.5% (n=24) in Utah stage 1 patients, 55.7%±10.3% (n=240) in Utah stage 2 patients, 51.7±11.5% (n=90) in Utah stage 3 patients, and 48.9%±11.6% (n=30) in Utah stage 4 patients (p<0.001, one-way ANOVA). The percentage of LA fibrosis was significantly negatively correlated to LVEF pre-ablation in a univariate analysis (p<0.001). In a multivariate model ac- counting for age, gender, AF type, and comorbidities such as diabetes and hypertension, Utah stage remained a significant predictor of pre-ablation EF (p<0.001). Conclusion: Patients with extensive LA fibrosis appear to have depressed LV function pre-ablation, suggesting that structural remodeling in the LA may also be triggering and promoting remodeling within the ventricular myocardium.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	AKKAYA M, MARROUCHE N, HİGUCHİ K, KOOPMANN M, DAMAL K, KHOLMOVSKİ E, MCGANN C (2014). The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation. , 11 - 19.
Chicago	AKKAYA Mehmet,MARROUCHE Nassir,HİGUCHİ Koji,KOOPMANN Matthias,DAMAL Kavitha,KHOLMOVSKİ Eugene,MCGANN Chris The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation. (2014): 11 - 19.
MLA	AKKAYA Mehmet,MARROUCHE Nassir,HİGUCHİ Koji,KOOPMANN Matthias,DAMAL Kavitha,KHOLMOVSKİ Eugene,MCGANN Chris The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation. , 2014, ss.11 - 19.
AMA	AKKAYA M,MARROUCHE N,HİGUCHİ K,KOOPMANN M,DAMAL K,KHOLMOVSKİ E,MCGANN C The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation. . 2014; 11 - 19.
Vancouver	AKKAYA M,MARROUCHE N,HİGUCHİ K,KOOPMANN M,DAMAL K,KHOLMOVSKİ E,MCGANN C The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation. . 2014; 11 - 19.
IEEE	AKKAYA M,MARROUCHE N,HİGUCHİ K,KOOPMANN M,DAMAL K,KHOLMOVSKİ E,MCGANN C "The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation." , ss.11 - 19, 2014.
ISNAD	AKKAYA, Mehmet vd. "The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation". (2014), 11-19.

APA	AKKAYA M, MARROUCHE N, HİGUCHİ K, KOOPMANN M, DAMAL K, KHOLMOVSKİ E, MCGANN C (2014). The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation. Türk Kardiyoloji Derneği Arşivi, 42(1), 11 - 19.
Chicago	AKKAYA Mehmet,MARROUCHE Nassir,HİGUCHİ Koji,KOOPMANN Matthias,DAMAL Kavitha,KHOLMOVSKİ Eugene,MCGANN Chris The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation. Türk Kardiyoloji Derneği Arşivi 42, no.1 (2014): 11 - 19.
MLA	AKKAYA Mehmet,MARROUCHE Nassir,HİGUCHİ Koji,KOOPMANN Matthias,DAMAL Kavitha,KHOLMOVSKİ Eugene,MCGANN Chris The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation. Türk Kardiyoloji Derneği Arşivi, vol.42, no.1, 2014, ss.11 - 19.
AMA	AKKAYA M,MARROUCHE N,HİGUCHİ K,KOOPMANN M,DAMAL K,KHOLMOVSKİ E,MCGANN C The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation. Türk Kardiyoloji Derneği Arşivi. 2014; 42(1): 11 - 19.
Vancouver	AKKAYA M,MARROUCHE N,HİGUCHİ K,KOOPMANN M,DAMAL K,KHOLMOVSKİ E,MCGANN C The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation. Türk Kardiyoloji Derneği Arşivi. 2014; 42(1): 11 - 19.
IEEE	AKKAYA M,MARROUCHE N,HİGUCHİ K,KOOPMANN M,DAMAL K,KHOLMOVSKİ E,MCGANN C "The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation." Türk Kardiyoloji Derneği Arşivi, 42, ss.11 - 19, 2014.
ISNAD	AKKAYA, Mehmet vd. "The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation". Türk Kardiyoloji Derneği Arşivi 42/1 (2014), 11-19.