OBJECTIVES: Left atrial (LA) function is an important marker of hemodynamic status in cardiac amyloidosis (CA), and its characterization may provide relevant prognostic information. We sought to assess the prevalence and prognostic impact of LA dysfunction by cardiac magnetic resonance (CMR) in patients with CA. METHODS: We performed CMR in 80 consecutive patients with CA, including 38 with AL (47%) and 42 with ATTR (53%). LA function was assessed by acquiring short axis cine steady-state free precession (SSFP) covering the entire chamber. The atrial emptying fraction (AEF) was calculated as the ratio between the difference of LA maximal and minimal volume to LA maximal volume, expressed as percentage. Severe atrial dysfunction was defined as AEF ≤ 14%. RESULTS: Mean AEF was 18% (13-35%). Overall, AEF ≤ 14% was present in 19 patients (24%), including 21% of those in sinus rhythm (SR) with no history of atrial fibrillation (AF). After a median of 3 years (IQR 2-4), 36 patients (44%) died of cardiac causes. Patients with AEF ≤ 14% showed increased cardiac mortality, with an independent OR of 4.2 (95 IC 2.1-8.2, P < 0.0001). Of note, AEF ≤ 14% was the stronger independent predictor of cardiac death. Patients in SR with AEF ≤ 14% had worse outcome than those with AF. CONCLUSIONS: Severe impairment of LA contractile function was present in three-quarters of patients with CA, and was prevalent irrespective of CA etiology, both in the presence and absence of AF. Severe LA dysfunction was associated with an independent 4-fold increase in risk for cardiac death at three years.
OBJECTIVES: Left atrial (LA) function is an important marker of hemodynamic status in cardiac amyloidosis (CA), and its characterization may provide relevant prognostic information. We sought to assess the prevalence and prognostic impact of LA dysfunction by cardiac magnetic resonance (CMR) in patients with CA. METHODS: We performed CMR in 80 consecutive patients with CA, including 38 with AL (47%) and 42 with ATTR (53%). LA function was assessed by acquiring short axis cine steady-state free precession (SSFP) covering the entire chamber. The atrial emptying fraction (AEF) was calculated as the ratio between the difference of LA maximal and minimal volume to LA maximal volume, expressed as percentage. Severe atrial dysfunction was defined as AEF ≤ 14%. RESULTS: Mean AEF was 18% (13-35%). Overall, AEF ≤ 14% was present in 19 patients (24%), including 21% of those in sinus rhythm (SR) with no history of atrial fibrillation (AF). After a median of 3 years (IQR 2-4), 36 patients (44%) died of cardiac causes. Patients with AEF ≤ 14% showed increased cardiac mortality, with an independent OR of 4.2 (95 IC 2.1-8.2, P < 0.0001). Of note, AEF ≤ 14% was the stronger independent predictor of cardiac death. Patients in SR with AEF ≤ 14% had worse outcome than those with AF. CONCLUSIONS: Severe impairment of LA contractile function was present in three-quarters of patients with CA, and was prevalent irrespective of CA etiology, both in the presence and absence of AF. Severe LA dysfunction was associated with an independent 4-fold increase in risk for cardiac death at three years.
Authors: Michael Y Henein; Ole B Suhr; Sandra Arvidsson; Björn Pilebro; Per Westermark; Rolf Hörnsten; Per Lindqvist Journal: Amyloid Date: 2018-01-25 Impact factor: 7.141
Authors: Barry J Maron; Tammy S Haas; Martin S Maron; John R Lesser; Joseph A Browning; Raymond H Chan; Iacopo Olivotto; Ross F Garberich; Robert S Schwartz Journal: Am J Cardiol Date: 2014-01-31 Impact factor: 2.778
Authors: Julian D Gillmore; Mathew S Maurer; Rodney H Falk; Giampaolo Merlini; Thibaud Damy; Angela Dispenzieri; Ashutosh D Wechalekar; John L Berk; Candida C Quarta; Martha Grogan; Helen J Lachmann; Sabahat Bokhari; Adam Castano; Sharmila Dorbala; Geoff B Johnson; Andor W J M Glaudemans; Tamer Rezk; Marianna Fontana; Giovanni Palladini; Paolo Milani; Pierluigi L Guidalotti; Katarina Flatman; Thirusha Lane; Frederick W Vonberg; Carol J Whelan; James C Moon; Frederick L Ruberg; Edward J Miller; David F Hutt; Bouke P Hazenberg; Claudio Rapezzi; Philip N Hawkins Journal: Circulation Date: 2016-04-22 Impact factor: 29.690
Authors: Francesco Bandera; Raffaele Martone; Liza Chacko; Sharmananthan Ganesananthan; Janet A Gilbertson; Markella Ponticos; Thirusha Lane; Ana Martinez-Naharro; Carol Whelan; Cristina Quarta; Dorota Rowczenio; Rishi Patel; Yousuf Razvi; Helen Lachmann; Ashutosh Wechelakar; James Brown; Daniel Knight; James Moon; Aviva Petrie; Francesco Cappelli; Marco Guazzi; Luciano Potena; Claudio Rapezzi; Ornella Leone; Philip N Hawkins; Julian D Gillmore; Marianna Fontana Journal: JACC Cardiovasc Imaging Date: 2021-08-18