Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling

Abstract The pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling cha...

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Autores principales:	Ahmet Demirkiran, Raquel P. Amier, Mark B. M. Hofman, Rob J. van der Geest, Lourens F. H. J. Robbers, Luuk H. G. A. Hopman, Mark J. Mulder, Peter van de Ven, Cornelis P. Allaart, Albert C. van Rossum, Marco J. W. Götte, Robin Nijveldt
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/28406551780b4bb58399830d7723a994
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spelling	oai:doaj.org-article:28406551780b4bb58399830d7723a9942021-12-02T17:05:12ZAltered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling10.1038/s41598-021-85176-82045-2322https://doaj.org/article/28406551780b4bb58399830d7723a9942021-03-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-85176-8https://doaj.org/toc/2045-2322Abstract The pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.Ahmet DemirkiranRaquel P. AmierMark B. M. HofmanRob J. van der GeestLourens F. H. J. RobbersLuuk H. G. A. HopmanMark J. MulderPeter van de VenCornelis P. AllaartAlbert C. van RossumMarco J. W. GötteRobin NijveldtNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ahmet Demirkiran Raquel P. Amier Mark B. M. Hofman Rob J. van der Geest Lourens F. H. J. Robbers Luuk H. G. A. Hopman Mark J. Mulder Peter van de Ven Cornelis P. Allaart Albert C. van Rossum Marco J. W. Götte Robin Nijveldt Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
description	Abstract The pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.
format	article
author	Ahmet Demirkiran Raquel P. Amier Mark B. M. Hofman Rob J. van der Geest Lourens F. H. J. Robbers Luuk H. G. A. Hopman Mark J. Mulder Peter van de Ven Cornelis P. Allaart Albert C. van Rossum Marco J. W. Götte Robin Nijveldt
author_facet	Ahmet Demirkiran Raquel P. Amier Mark B. M. Hofman Rob J. van der Geest Lourens F. H. J. Robbers Luuk H. G. A. Hopman Mark J. Mulder Peter van de Ven Cornelis P. Allaart Albert C. van Rossum Marco J. W. Götte Robin Nijveldt
author_sort	Ahmet Demirkiran
title	Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
title_short	Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
title_full	Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
title_fullStr	Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
title_full_unstemmed	Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
title_sort	altered left atrial 4d flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/28406551780b4bb58399830d7723a994
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Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling

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