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Insights on Distinct Left Atrial Remodeling Between Atrial Fibrillation and Heart Failure With Preserved Ejection
Jen-Yuan Kuo1,2,3, Xuanyi Jin4,5, Jing-Yi Sun6
1Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
Frontiers in Cardiovascular Medicine
|May 13, 2022
Summary
Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) show distinct left atrial (LA) remodeling patterns. Larger LA wall volume and thickness heterogeneity differentiate AF from HFpEF, indicating unique disease mechanisms.
Area of Science:
- Cardiology
- Medical Imaging
- Pathophysiology
Background:
- Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) frequently coexist.
- Left atrial (LA) remodeling is a common feature in both conditions, but its specific patterns may differ based on underlying mechanisms.
Purpose of the Study:
- To investigate and compare the distinct patterns of LA wall remodeling in patients with AF versus HFpEF.
- To elucidate the differences in LA structure and function between controls, HFpEF alone, AF alone, and combined HFpEF+AF groups.
Main Methods:
- Utilized multi-detector computed tomography and echocardiography to assess LA wall characteristics.
- Compared LA wall volume (LAWV), wall thickness (LAWT), and wall thickness heterogeneity (LAWT[SD]) across four patient groups: controls, HFpEF alone, AF alone, and HFpEF+AF.
- Evaluated LA structure and function, including peak atrial longitudinal strain (PALS).
Main Results:
- LA wall remodeling was most pronounced in the HFpEF+AF group.
- Patients with AF alone exhibited significantly greater LAWV and LAWT[SD] compared to those with HFpEF alone, despite similar LA volume and PALS.
- LAWT[SD] demonstrated the highest C-statistic (0.78) in discriminating AF alone when combined with other LA indices.
Conclusions:
- Distinct LA wall remodeling patterns, specifically larger LAWV and LAWT[SD], can differentiate AF alone from HFpEF alone.
- These findings suggest different underlying pathophysiological mechanisms driving LA remodeling in AF compared to HFpEF.
- LA wall characteristics provide valuable insights into the distinct mechanisms of LA remodeling in these overlapping conditions.
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