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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Coronary artery disease is associated with impaired atrial function regardless of left ventricular filling pressure

Oleg F Sharifov1, Thomas S Denney2, Andrew A Girard1

  • 1Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.

International Journal of Cardiology
|May 31, 2023
PubMed

Insights

Coronary artery disease (CAD) severity impacts left atrial (LA) strain, even with preserved left ventricular ejection fraction (LVEF). LA function impairment is linked to CAD severity and nitrate use, influencing LA-LV interaction.

Area of Science:

  • Cardiology
  • Cardiac Imaging
  • Hemodynamics

Background:

  • Left atrial (LA) strain is impaired in left ventricular (LV) diastolic dysfunction, linked to elevated LV end-diastolic pressure (LVEDP).
  • Coronary artery disease (CAD) is known to affect LV diastolic function in patients with preserved LV ejection fraction (LVEF).
  • The specific relationship between LVEDP, CAD, and its impact on LA strain remains understudied.

Purpose of the Study:

  • To investigate the association between coronary artery disease (CAD) severity and left atrial (LA) strain parameters.
  • To explore the influence of left ventricular end-diastolic pressure (LVEDP) and CAD on LA function in patients with preserved LVEF.
  • To assess the impact of medications like Nitrates on LA strain in the context of CAD.

Main Methods:

  • Retrospective analysis of 37 patients with LVEF >50% undergoing coronary angiography, high-fidelity LV pressure measurements, and cardiac MRI.
  • Quantification of LA volumes, LA emptying fraction (LAEF), LA reservoir strain (LARS), and LA long-axis shortening (LALAS).
  • Patients categorized into severe-CAD, mild-to-moderate-CAD, and no-CAD groups based on coronary angiography findings.

Main Results:

  • The severe-CAD group exhibited significantly lower LAEF, LALAS, and LARS compared to the no-CAD group.
  • LA reservoir strain (LARS) and LA long-axis shortening (LALAS) were associated with CAD severity and Nitrate treatment.
  • LA emptying fraction (LAEF) was associated with CAD severity, Nitrate treatment, and LA minimum volume; LAEFpassive was linked to LVED volume.

Conclusions:

  • Impairment in LA function is associated with the severity of coexistent coronary artery disease (CAD).
  • Medications, particularly Nitrates, and hemodynamic loading conditions influence LA strain assessment.
  • These factors are crucial for understanding LA function and LA-LV interaction, warranting further investigation in larger cohorts.
Abstract

Keywords:
Cardiac magnetic resonance imagingCoronary artery diseaseLeft atrial functionLeft atrium strainLeft ventricular diastolic dysfunctionLeft ventricular relaxation

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