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Updated: Jul 15, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Rest and Stress Left Atrial Dysfunction in Patients with Atrial Fibrillation
Angela Zagatina1, Maria Rivadeneira Ruiz2, Quirino Ciampi3
1Cardiology Department, Research Scientific Cardiocenter "Medika", 197110 St. Petersburg, Russia.
Insights
Left atrial dilation and dysfunction are common in chronic coronary syndromes with atrial fibrillation (AF), worsening with AF severity. Stress echocardiography reveals these issues, linking them to increased pulmonary congestion.
Area of Science:
- Cardiology
- Echocardiography
- Atrial Fibrillation Research
Background:
- Left atrial (LA) myopathy is frequent in chronic coronary syndromes (CCS) with atrial fibrillation (AF).
- LA dysfunction can be occult at rest and only apparent during stress.
- Understanding LA changes in CCS-AF is crucial for risk stratification.
Purpose of the Study:
- To assess left atrial (LA) volume and function at rest and during stress in patients with chronic coronary syndromes (CCS).
- To evaluate these parameters across the spectrum of atrial fibrillation (AF), from sinus rhythm to permanent AF.
- To correlate LA changes with inducible ischemia and pulmonary congestion during stress echocardiography.
Main Methods:
- Prospective, multicenter observational study of 3042 patients with known or suspected CCS.
- Patients categorized into sinus rhythm (SR), SR with prior paroxysmal AF, and permanent AF groups.
- Stress echocardiography (SE) performed, measuring left atrial volume index (LAVI) and LA Strain reservoir phase (LASr).
Main Results:
- Left atrial volume index (LAVI) increased significantly from SR to permanent AF groups, both at rest and stress.
- LA Strain reservoir phase (LASr) progressively decreased across the AF spectrum, indicating impaired function.
- Stress-induced B-lines (pulmonary congestion) and inducible ischemia were more frequent in patients with AF.
Conclusions:
- Rest and stress left atrial dilation and reservoir dysfunction are prevalent in CCS patients with AF, particularly permanent AF.
- These LA abnormalities are associated with increased inducible ischemia and pulmonary congestion during stress.
- Stress echocardiography is valuable for detecting occult LA dysfunction in CCS-AF patients.
Background:
Left atrial (LA) myopathy with paroxysmal and permanent atrial fibrillation (AF) is frequent in chronic coronary syndromes (CCS) but sometimes occult at rest and elicited by stress.
Aim:
This study sought to assess LA volume and function at rest and during stress across the spectrum of AF.
Methods:
In a prospective, multicenter, observational study design, we enrolled 3042 patients [age = 64 ± 12; 63.8% male] with known or suspected CCS: 2749 were in sinus rhythm (SR, Group 1); 191 in SR with a history of paroxysmal AF (Group 2); and 102 were in permanent AF (Group 3). All patients underwent stress echocardiography (SE). We measured left atrial volume index (LAVI) in all patients and LA Strain reservoir phase (LASr) in a subset of 486 patients.
Results:
LAVI increased from Group 1 to 3, both at rest (Group 1 = 27.6 ± 12.2, Group 2 = 31.6 ± 12.9, Group 3 = 43.3 ± 19.7 mL/m2, p < 0.001) and at peak stress (Group 1 = 26.2 ± 12.0, Group 2 = 31.2 ± 12.2, Group 3 = 43.9 ± 19.4 mL/m2, p < 0.001). LASr progressively decreased from Group 1 to 3, both at rest (Group 1 = 26.0 ± 8.5%, Group 2 = 23.2 ± 11.2%, Group 3 = 8.5 ± 6.5%, p < 0.001) and at peak stress (Group 1 = 26.9 ± 10.1, Group 2 = 23.8 ± 11.0 Group 3 = 10.7 ± 8.1%, p < 0.001). Stress B-lines (≥2) were more frequent in AF (Group 1 = 29.7% vs. Group 2 = 35.5% vs. Group 3 = 57.4%, p < 0.001). Inducible ischemia was less frequent in SR (Group 1 = 16.1% vs. Group 2 = 24.7% vs. Group 3 = 24.5%, p = 0.001).
Conclusions:
In CCS, rest and stress LA dilation and reservoir dysfunction are often present in paroxysmal and, more so, in permanent AF and are associated with more frequent inducible ischemia and pulmonary congestion during stress.
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