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Left atrial adaptation in ischemic heart disease: insights from a cardiovascular magnetic resonance study

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Abstract

Left atrium (LA) plays a key role in the overall cardiac performance. However, it remains unclear how LA adapts, in terms of function and volumes, to left ventricular dysfunction in the acute and post-acute phases of myocardial infarction. LA volumes and function were evaluated in patients in the acute phase of ST-segment elevation myocardial infarction (acute-STEMI group) and in the post-acute phase after STEMI (post-acute STEMI group). Ten age and sex-matched healthy controls served as control group. In all subjects LA was assessed by a compressed-sensing cine pulse sequence and by a 3D non-model-based reconstruction. LV infarct size and microvascular obstruction were determined on late-gadolinium-enhancement data and LV myocardial oedema and myocardial haemorrhage were measured on T2-map** data. Indexed LA maximum and minimum volumes did not differ between the acute (n = 50) and post-acute (n = 47) STEMI groups. LA active emptying fraction (LAAEF) was higher in the acute-STEMI as compared with the post-acute STEMI groups (0.63 ± 0.23 vs 0.37 ± 0.24, p < 0.0001). Conversely, LA passive emptying fraction (LAPEF) was lower in the acute-STEMI compared with post-acute-STEMI (0.34 ± 0.15 vs 0.65 ± 0.15, p < 0.0001) patients. In the acute-STEMI group, LAAEF was positively and LAPEF negatively correlated with LV myocardial tissue damage (r = 0.523 p = 0.0001; r = − 0.451 p = 0.0013). Negative and positive correlations were also found between LAAEF and LAPEF and time after STEMI (r = − 0.559 p = 0.0013 and r = 0.589 p = 0.0006, respectively). LA increases its active contractile function in the acute phase of STEMI to support LV filling. The extent (but not the type) of LV damage determines LA adaptions which normalizes over time.

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Acknowledgements

The authors thank all the technical staff of the Department of Radiology, in particular, Chantal Rohner, Carole Chautems, Marisa Azevedo dos Santos, Patricia Da Silva Ferreira for their skillful collaboration.

Funding

The study was supported by Swiss Heart Foundation (Grant to J. Schwitter, MD).

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Authors and Affiliations

  1. Center of Cardiac Magnetic Resonance – Lausanne University Hospital, Lausanne, Switzerland

    Anna Giulia Pavon, Pier Giorgio Masci, Lorenzo Pucci, Tobias Rutz, Pierre Monney, Rita Godihno & Juerg Schwitter

  2. Cardiology Division, Cardiovascular Department, Lausanne University Hospital, Lausanne, Switzerland

    Anna Giulia Pavon, Pier Giorgio Masci, Lorenzo Pucci, Tobias Rutz, Pierre Monney, Rita Godihno, Olivier Muller & Juerg Schwitter

  3. Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Via Tesserete 48, 6900, Lugano, Switzerland

    Anna Giulia Pavon, Antonio Landi & Marco Valgimigli

  4. School of Bioengineer and Medical Sciences, Life Sciences, King’s College London, London, UK

    Pier Giorgio Masci

  5. The Blavatnik School of Computer Science, Tel-Aviv University, Tel Aviv, Israel

    Amit Bermano

  6. Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands

    Amir Vaxman

  7. Ying Wu College of Computing, New-Jersey Institute of Technology, Newark, USA

    Craig Gotsman

  8. Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland

    David Saraiva Rodrigues

  9. University of Lausanne (UniL), Lausanne, Switzerland

    Tobias Rutz, Pierre Monney, Olivier Muller & Juerg Schwitter

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  1. Anna Giulia Pavon
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Contributions

AGP participated in conceiving the study, drafted the manuscript, conducted analysis, and acquired images. PGM, TR, PM, acquired images, LP and RG collected data, AB, AV, CG provided the 3D left atrium reconstruction. DSR was responsible for accurate image acquisition, AL and MV critically revise the manuscript, JS Conceived the study, interpreted the data and edited the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Anna Giulia Pavon.

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Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. J. Schwitter receives research grants from Bayer Healthcare AG, Switzerland. Other authors do not have any potential conflict of interest.

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Pavon, A.G., Masci, P.G., Pucci, L. et al. Left atrial adaptation in ischemic heart disease: insights from a cardiovascular magnetic resonance study. Int J Cardiovasc Imaging 38, 1533–1543 (2022). https://doi.org/10.1007/s10554-022-02536-9

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  • DOI: https://doi.org/10.1007/s10554-022-02536-9

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