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Updated: Jul 16, 2025

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Prevalence, Associated Factors, and Echocardiographic Estimation of Left Atrial Hypertension in Patients With Atrial

Yasuhiro Mukai1, Koki Nakanishi1, Masao Daimon1,2

  • 1Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan.

Journal of the American Heart Association
|September 13, 2023
PubMed

Insights

Left atrial hypertension affects 18% of atrial fibrillation patients undergoing catheter ablation. Echocardiographic LA stiffness is a key predictor, potentially aiding pre-ablation risk assessment.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • Elevated left atrial (LA) pressure is linked to atrial fibrillation (AF) initiation and persistence.
  • LA hypertension is associated with AF recurrence post-catheter ablation (CA), but its prevalence and predictors are unclear.
  • Noninvasive estimation of LA hypertension remains challenging.

Purpose of the Study:

  • To investigate the prevalence and determinants of LA hypertension in patients with AF undergoing their first CA.
  • To assess the utility of echocardiographic parameters, including LA stiffness, in predicting LA hypertension.

Main Methods:

  • 183 AF patients underwent conventional and speckle-tracking echocardiography before CA.
  • LA size, reservoir strain, and stiffness were assessed via echocardiography.
  • Direct LA pressure was measured during CA; LA hypertension defined as mean LA pressure >15 mmHg.

Main Results:

  • 18.0% of patients (33/183) had LA hypertension.
  • LA hypertension was associated with larger LA volume index, reduced LA reservoir strain, and increased LA stiffness.
  • Independent predictors of LA hypertension included waist circumference, C-reactive protein, LA reservoir strain, and LA stiffness.

Conclusions:

  • Approximately 20% of AF patients undergoing CA exhibit LA hypertension.
  • Central obesity and inflammation may contribute to LA hypertension pathophysiology.
  • Echocardiography-derived LA stiffness shows potential clinical utility for detecting LA hypertension before CA.

Keywords:
C‐reactive proteinatrial fibrillationleft atrial hypertensionleft atrial stiffnessspeckle‐tracking echocardiographywaist circumference

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