Changes in left atrial function after percutaneous closure of patent foramen ovale

doi:10.21203/rs.3.rs-2969365/v1

Download PDF

Research Article

Changes in left atrial function after percutaneous closure of patent foramen ovale

https://doi.org/10.21203/rs.3.rs-2969365/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Purpose

This study aimed to investigate left atrial (LA) function following patent foramen ovale (PFO) closure.

Methods

Patients with PFO who underwent transcatheter closure between 2015 and 2022 and had complete echocardiography examination data available at baseline and at least twice during 1-year of follow-up were enrolled. LA function was evaluated by measuring LA reservoir strain (LASr), conduit strain (LAScd), and contractile strain (LASct) through speckle-tracking echocardiography. Differences in LA strain between baseline and at the different follow-up times were compared using repeated-measures analysis. The association between risk factors and LA strain was evaluated in a univariable and multivariable linear regression model.

Results

Forty-five patients were included. After 3 months, we observed a decrease in LASr (from 40.98–33.09%, P < 0.05), which recovered to 37.30% at 6 months (P = 0.06). LAScd decreased significantly from baseline after the procedure (P < 0.05) but had recovered by 3 months (19.96% vs 19.04%, P = 0.06). LASct decreased significantly between baseline and 6 months (from 17.92–14.01%, P < 0.05). All changes resolved by 1 year. Multivariable models showed that LA strain at baseline was the most important factor affecting LA function. LA diameter was significantly associated with sustained changes in LAScd (β = 7.19, P = 0.038). Age was a risk factor for difficult recovery of LASct after PFO at 3 months.

Conclusions

Implantation of a PFO occluder has a transient adverse impact on LA function in the area adjacent to the device but resolves within 1 year.

patent foramen ovale

echocardiography

speckle-tracking echocardiography

left atrial strain

Patent foramen ovale (PFO) is implicated in the pathogenesis of several medical conditions, including ischemic stroke, migraine, and platypnoea-orthodeoxia syndrome. The prevalence of PFO in the general population is approximately 20–25%[1].The Society for Cardiovascular Angiography and Interventions guidelines recommend PFO closure in certain clinical scenarios, including young PFO-associated stroke and systemic embolism without other embolic etiology[2]. However, PFO closure can affect atrial function. The procedure itself, the inflammatory response triggered by the device, and intrinsic patient-related factors, such as age and left atrial (LA) size, are all possible mechanisms[3–7]. Atrial fibrillation (AF) is a commonly reported complication of PFO closure and often occurs in the first 45 days after the procedure[8]. Occurrence of AF is closely related to the function of the LA[9]. Therefore, it is important to evaluate the function of the left atrium during the PFO closure.

LA strain has recently emerged as a powerful tool for structural and functional evaluation of the left atrium and can predict adverse events in various cardiovascular conditions[10]. LA longitudinal strain consists of three distinct phases during the cardiac cycle, namely, the contractile, reservoir, and conduit phases, which precede the change in LA volume and have demonstrated prognostic value in several cardiac diseases[11, 12]. A previous study demonstrated transitional segmental changes in LA function after PFO closure but had a small sample size and lacked long-term follow-up[13]. Therefore, the aim of this study was to monitor LA function by LA strain every 3–6 months from baseline to 1 year after PFO closure.

Study population

Patients who were referred to Peking University First Hospital for percutaneous closure of PFO between April 2015 and January 2022, underwent echocardiography at baseline and 1 year after the procedure and had complete echocardiographic data available were enrolled in the study. PFO was diagnosed by echocardiography and transoesophageal echocardiography plus contrast echocardiography in accordance with the guidelines[14]. Patients were also required to have echocardiographic data that were assessable in at least two of the three time points, including at 1–3 days, 3 months, and 6 months after the procedure. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Peking University First Hospital.

PFO closure

An occluder device was introduced via the right femoral vein and deployed under guidance by digital subtraction angiography. Transthoracic echocardiography was performed immediately after closure to confirm the location. Aspirin 100 mg/day and clopidogrel 75 mg/day were prescribed for 3–6 months.

Echocardiographic assessment of LA function

Echocardiographic imaging was performed as part of routine medical care using various ultrasound systems (Vivid E95 and E9, GE Vingmed, Horton, Norway; IE33 and EPIQ7C, Philips Medical Systems, Andover, MA, USA).

LA and left ventricular (LV) diameter and LV systolic and diastolic function were assessed in accordance with the American Society of Echocardiography guidelines[15]. Standard two-dimensional pulsed-wave and tissue Doppler imaging were performed, and images were stored in DICOM format. LV mass, LV end-diastolic diameter, LV end-systolic diameter, LV posterior wall thickness, and LA and RV dimensions were obtained from two-dimensional or M-mode images. Parameters were normalized to body surface area. Septal E' was measured by tissue Doppler imaging.

LV mass (LVM) was calculated as follows: LVM = 0.8 × 1.04 × ([PWTd + SWTd + LVIDd]³ – [LVIDd]³) + 0.6 g, where PWTd and SWTd are the posterior and middle septal wall thicknesses at LV end-diastole, respectively, and LVIDd is the LV dimension at end-diastole. LVM index (LVMI) was then calculated, as previously described[16].

Speckle-tracking echocardiography

Two experienced cardiologists assessed LA strain using speckle-tracking echocardiography with an off-line TomTec Imaging System (Unterschleissheim, Germany). Speckle-tracking echocardiography was performed in apical four-chamber, three-chamber, and two-chamber views. LA deformation was analyzed in the four-chamber apical views, with evaluation of LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contractile strain (LASct). The software ensured optimal tracking throughout the cardiac cycle, and the operator confirmed true boundaries were traced. Interobserver variability was calculated using the intraclass correlation coefficient.

Statistical analysis

Continuous variables are presented as the mean ± standard deviation or the median (interquartile range). Categorical variables are expressed as the frequency and percentage. Differences in LA strain between baseline and the follow-up were compared using repeated-measures analysis.

Due to the fact that LASr has not yet been restored in the 3 months, we further evaluated the association between risk factors and LA strain using a univariable and multivariable linear regression model that included age (per 10 years), sex, body mass index, hypertension, LVMI, LA size, LV ejection fraction, E/E', baseline LA strain and PFO occluder device (LA disc) size between the changes (Delta) in LA strain at 3 months in comparison with baseline. The PFO occluder size is divided into two categories with an LA disc size of 18 mm as the reference for comparison with other devices. All statistical analyses were performed using Empower (R) (www.empowerstats.com, X&Y Solutions, Boston, MA, USA) and R (http://www.R-project.org). A two-sided P-value of < 0.05 was considered statistically significant.

Forty-five patients were enrolled in the study. Table 1 summarizes their baseline demographic characteristics. The median age was 44.00 years and 60.0% were men. Eighteen patients (40.0%) had a history of hypertension, one (2.22%) had a history of AF, and two (4.44%) had a history of diabetes mellitus. The median PFO device (LA disc) size was 25.00 mm. Standard echocardiographic measurements are illustrated in Table 2. The median left atrial diameter was 3.3 cm, left ventricular ejection fraction was 71%, pulmonary artery pressure was 26.25 mmHg.

Table 1

Clinical characteristics at baseline in patients with patent foramen ovale
	N = 45
Age, years	44.00 (37.00–52.00)
Male	27 (60.00%)
BMI, kg/m²	25.47 (22.86–27.31)
Hypertension(n,%)	18 (40.00%)
Diabetes mellitus(n,%)	2 (4.44%)
Coronary artery disease(n,%)	1 (2.22%)
Atrial fibrillation(n,%)	1 (2.22%)
Smoker(n,%)	5 (11.36%)
Drink(n,%)	11 (24.44%)
Systolic blood pressure(mmHg)	129.00 (115.00-144.00)
Diastolic blood pressure(mmHg)	78.00 (68.00–89.00)
PFO device size (left atrial disc), mm	25.00 (25.00–25.00)
PFO device size (right atrial disc), mm	25.00 (25.00–25.00)
Data are shown as the number (percentage) or as the median (interquartile range)
BMI, body mass index; PFO, patent foramen ovale.

Table 2

Echocardiographic measurements at baseline in patients with patent foramen ovale
	N = 45
IVS(cm)	0.93 (0.85-1.00)
LAD(cm)	3.30 (3.15–3.60)
LVPWT(cm)	0.94 (0.80-1.00)
LVEDD(cm)	4.70 (4.40-5.00)
LVESD(cm)	2.70 (2.50–3.10)
LVMI(g/m²)	79.04 (71.39–90.28)
RVD(cm)	2.00 (1.80–2.20)
LVEF(%)	71.00 (66.10–75.00)
E (cm/s)	72.30 (62.10–81.70)
A (cm/s)	64.20 (52.80–81.00)
sPAP(mmHg)	26.25 (23.43–30.43)
E' (cm/s)	8.00 (6.70–9.40)
E/E’	9.10 (7.94–10.74)
Data are shown as the median (interquartile range)
E, early diastolic filling; A, filling wave due to atrial contraction; E′, left ventricle myocardial relaxation; IVS, interventricular septum; LAD, left atrial diameter; LVEDD, left ventricular end-diastolic diameter; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic diameter; LVMI, left ventricular mass index; LVPWT, left ventricular posterior wall thickness; RVD, right ventricular diameter; sPAP, systolic pulmonary artery pressure.

Table 3 shows the trends in LA strain after transcatheter PFO closure. LASr decreased significantly from 40.98% at baseline to 31.70% after the procedure (P < 0.05) and recovered to 37.30% at 6 months (P = 0.06). Notably, LAScd decreased significantly after the procedure (P < 0.05) but recovered at 3 months when compared with baseline (19.96% vs 19.04%, P = 0.06). LASct also decreased significantly between baseline and 6 months (17.92% vs 14.01%, P < 0.05) and recovered at 1 year (17.92% vs 15.40%, P = 0.15). The intraclass correlation coefficient for interobserver agreement was 0.899 for LASr, 0.963 for LAScd, and 0.882 for LASct (P < 0.001).

Table 3

Left atrial strain at baseline, immediately after transcatheter closure of patent foramen ovale, and at follow-up 3, 6, and 12 months later
	baseline	after procedure	3 months	6 months	1 year
LASr (%)	40.98 (28.64–46.39)	31.70 (23.58–36.66)^a	33.09 (26.55–39.64)^b	37.30 (29.36–41.87)	36.45 (29.75–42.45)
LAScd (%)	19.96 (12.62–27.94)	15.11 (11.25–21.93)^a	19.04 (13.76–23.84)	21.32 (15.89–27.39)	18.98 (15.28–25.06)
LASct (%)	17.92 (13.01–23.35)	13.27 (10.18–17.55)^a	12.91 (10.49–17.38)^b	14.01 (11.41–19.54)^c	15.40 (10.52–20.70)
^ap<0.05, baseline vs. immediately after the procedure; ^bp<0.05, baseline vs. the 3-month follow-up; ^cp<0.05, baseline vs. the 6-month follow-up.
LASr, left atrial reservoir strain; LAScd, left atrial conduit strain; LASct, left atrial contractile strain.

Univariable and multivariable linear analysis showed that baseline LA strain was the most important factor affecting LA function by 3 months after PFO. At the 3-month follow-up, patients with a worse LA strain value at baseline showed a greater change after PFO closure than those with a better LA strain value at baseline (P < 0.001). Notably, in the multivariable model, baseline LA diameter (β = 7.19, P = 0.038) remained significantly associated with sustained changes in LAScd after adjusting for age, sex, body mass index, hypertension, LVMI, LA size, LVEF, E/E', PFO size, and baseline LAScd. Each 10-year increment in age was identified to be a risk factor for LASct (β = 2.31, P = 0.017) (Table 4).

Table 4

Predictors of left atrial reservoir strain, left atrial conduit strain, and left atrial contractile strain at baseline and 3 months after closure of patent foramen ovale
Exposure	Delta LASr				Delta LAScd				Delta LASct
	Univariable β(95%CI)	P	Multivariable β(95%CI)	P	Univariable β(95%CI)	P	Multivariable β(95%CI)	P	Univariable β(95%CI)	P	Multivariable β(95%CI)	P
Age, per 10years	2.41 (-0.81, 5.62)	0.150	-0.04 (-3.22, 3.13)	0.978	2.84 (0.80, 4.87)	0.010	-1.17 (-3.49, 1.16)	0.334	-0.43 (-2.47, 1.61)	0.684	2.31 (0.54, 4.09)	0.017
Female	-5.16 (-13.17, 2.86)	0.215	4.92 (-4.05, 13.90)	0.292	-5.20 (-10.46, 0.06)	0.060	2.21 (-3.48, 7.91)	0.453	0.05 (-5.02, 5.11	0.985	1.81 (-2.72, 6.35)	0.440
BMI, kg/m²	0.19 (-1.07, 1.44)	0.771	-0.71 (-1.98, 0.55)	0.278	0.29 (-0.55, 1.13)	0.498	-0.72 (-1.50, 0.06)	0.082	-0.11 (-0.88, 0.67)	0.792	0.06 (-0.59, 0.70)	0.869
Hypertension	5.94 (-1.73, 13.60)	0.137	2.04 (-6.33, 10.42)	0.637	4.73 (-0.37, 9.83)	0.077	1.68 (-3.53, 6.89)	0.532	1.21 (-3.66, 6.08)	0.629	0.73 (-3.50, 4.96)	0.737
LVMI, g/m²	0.12 (-0.06, 0.29)	0.202	-0.06 (-0.25, 0.14)	0.571	0.05 (-0.06, 0.17)	0.378	-0.10 (-0.22, 0.02)	0.117	0.06 (-0.05, 0.17)	0.274	0.03 (-0.07, 0.13)	0.520
LAD, cm	9.60 (-0.29, 19.50)	0.065	9.02 (-1.48, 19.53)	0.104	7.51 (1.32, 13.71)	0.023	7.19 (0.72, 13.66)	0.038	2.09 (-4.35, 8.52)	0.529	2.17 (-3.23, 7.57)	0.438
LVEF, %	0.43 (-0.17, 1.03)	0.170	0.07 (-0.46, 0.60)	0.794	0.24 (-0.17, 0.65)	0.252	0.01 (-0.31, 0.33)	0.964	0.19 (-0.19, 0.56)	0.338	0.05 (-0.22, 0.32)	0.707
E/E’	0.71 (-1.02, 2.43)	0.426	-0.36 (-2.30, 1.58)	0.721	0.76 (-0.39, 1.90)	0.204	0.31 (-0.88, 1.50)	0.618	-0.05 (-1.12, 1.03)	0.935	-0.72 (-1.72, 0.28)	0.169
Baseline LA strain, %	-0.78 (-1.02, -0.53)	< 0.001	-0.83 (-1.16, -0.49)	< 0.001	-0.57 (-0.76, -0.39)	< 0.001	-0.69 (-1.01, -0.37)	< 0.001	-0.89 (-1.13, -0.65)	< 0.001	-1.06 (-1.34, -0.79)	< 0.001
PFO size, mm
18	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref
Other sizes	1.72 (-8.54, 11.97)	0.745	-1.54 (-9.81, 6.73)	0.718	1.40 (-5.51, 8.30)	0.694	-1.94 (-7.16, 3.28)	0.472	0.32 (-6.04, 6.67)	0.923	1.34 (-2.91, 5.59)	0.543
BMI, body mass index; LA, left atrial; LAD, left atrial diameter; LAScd, left atrial conduit strain; LASct, left atrial contractile strain; LASr, left atrial reservoir strain; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index; PFO, patent foramen ovale.
Delta indicates change of corresponding parameter between baseline and within 3 months.

The findings of this study indicate that PFO closure leads to a change in LA function when evaluated by LA strain within 3–6 months that recovers fully after 1 year. We observed that LAScd resumed as early as 3 months after the procedure and that LASct did not return to the baseline value by 6 months. Multivariable models showed that baseline LA strain was the most important factor affecting LA function and that LA diameter was significantly associated with sustained changes in LAScd. Age was a risk factor for difficult recovery of LASct after PFO at 3 months after the procedure.

With ongoing development of new evaluation techniques, LA function has become an increasingly important and clinically significant parameter. LA strain analysis can improve the stratification of risk of embolism in patients with AF and is a good predictor of onset of AF in patients with mitral stenosis[17]. Furthermore, LA strain is a powerful clinical and prognostic factor in heart failure[18]. Reduced LA strain has been shown to be independently associated with heart failure outcomes in patients with hypertrophic cardiomyopathy, and LA strain has additional prognostic value in patients with acute myocardial infarction who undergo primary percutaneous coronary intervention[19, 20]. Thus, LA strain can detect early LA dysfunction and has potential value in patients with cardiovascular disease, which could improve clinical interventions and the prognosis.

A retrospective study that included 39 patients with atrial septal defect or PFO who had complete baseline and 1-year follow-up echocardiographic results available found that LASr decreased significantly from 32.8 ± 13.9% at baseline to 26.7 ± 10.7% at 1 year after transcatheter closure (p = 0.01) [21]. Vavuranakis et al. investigated 25 patients who underwent percutaneous PFO closure found a decrease in LA anterior wall strain (P < 0.045) and an increase in LA lateral wall strain (P < 0.001) after 3 months, these changes resolved at 6 months[13]. We expanded our results by including more patients and found that LASr decreased after 3 months and reversed at 6 months, which is in line with previous report and indicating that the occluder device had an adverse impact on the atrial myocardium. In addition, we also found that recovery of LASct was slower than recovery of LAScd, indicating that LAScd has a compensatory role when LA function is impaired.

One of the commonly reported complications of PFO closure is AF. The closure technique itself and the device used may trigger an inflammatory response or act as a mechanical barrier, creating a macro-reentrant circuit[4, 22]. A retrospective cohort study in 1533 patients found that the incidence of new-onset AF was 6.26% following PFO closure[23]. Moreover, a meta-analysis showed that patients who underwent percutaneous PFO closure had a 5-fold increase in risk of AF, which was highest in the first 45 days after closure[8]. Although AF is often viewed as a transient postoperative phenomenon, studies have shown that it may persist in the medium to long term, suggesting that changes in cardiac conduction pathways may be more persistent than previously thought. Based on this, accurate assessment of atrial fibrillation is crucial. LA strain could be easily utilized for better diagnosis, prognostication, and follow-up of AF[9] and can help to predict recurrence of AF[24]. A prospective longitudinal study in which 4466 participants without AF were followed up for 5.3 years showed that peak atrial longitudinal and contraction strain values were significantly associated with development of AF[25]. Our results indicate that LA strain can fully recover within 1 year because of the strong correlation between LA strain and AF[26], this finding is consistent with the notion that AF is self-limiting after PFO closure. The results of randomized clinical trials suggest that AF is not associated with a higher risk of stroke but that closure of PFO can effectively reduce the stroke risk[8]. Therefore, the safety of PFO closure is confirmed to a certain extent.

Multivariate regression analysis showed that patients with worse LA strain at baseline had a greater decrease in LA strain at the 3-month follow-up. Previous studies showed speckle tracking analysis may help to understand functional left atrial remodeling following percutaneous closure[27], Therefore, the left atrial function of patients should be carefully evaluated through this technique before PFO closure, and based on our conclusion, we believe that PFO procedures appear to be relatively safe in patients with better baseline LA strain. We also found that LA diameter was associated with a reduction in LAScd at the 3-month follow-up, which is consistent with the results of previous studies showing that LA enlargement is associated with reduced LAScd[28]. Age is also a risk factor for LASct in that advancing age is associated with gradual loss of myocytes and replacement with fibrotic tissue[29]. The decrease in LASct observed in our study may reflect early fibrotic changes. Based on the above results, older patients and those with enlarged atria should be carefully evaluated before the procedure and be followed up very closely.

Limitations

The major limitation of this study is its relatively small sample size. However, we included patients undergoing transcatheter PFO closure with full echocardiographic data available for up to 1 year. Furthermore, the study had a retrospective design with limited clinical follow-up. Finally, we did not follow up AF events after PFO, therefore, we could not accurately determine the relationship between LA strain and AF. Prospective studies that include larger sample sizes are needed to confirm the postoperative changes in LA function and their relationship with AF. Further studies that include ambulatory electrocardiographic monitoring or implanted devices are also needed to confirm our findings.

LA strain could be used to assess changes in LA function after PFO closure. Postoperative changes in global LA strain were transient and recovered within 1 year after surgery. LA conduit strain resumed earlier than LA contractile strain, indicating the compensatory role of conduit function. Older patients and those with enlarged atria should be carefully evaluated before the procedure and be followed up more closely afterwards.

Acknowledgment

None.

Funding Statement

This study was financially supported by the National Key Research and Development Program of China (No. 2021YFC2501106, 2021YFC2501100).

Conflicts of Interest

The authors have no relevant financial or non-financial interests to disclose.

Author Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Lin Qiu], [Min Li], [Wei Ma] and [Zhi Wang]. The first draft of the manuscript was written by [Lin Qiu], [Min Li], [Wei Ma], and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript

Pristipino C, Germonpré P, Toni D, Sievert H, Meier B, D'Ascenzo F, Berti S, Onorato EM, Bedogni F, Mas JL, Scacciatella P, Hildick-Smith D, Gaita F, Kyrle PA, Thomson J, Derumeaux G, Sibbing D, Chessa M, Hornung M, Zamorano J, Dudek D, D'Ascenzo F, Omedè P, Ballocca F, Barbero U, Giordana F, Gili S, Iannaccone M, Akagi T, Anzola G, Carroll J, Dalvi B, Angelis C, Junbo G, Kasner SE, Michel-Behnke I, Musumeci G, Søndergaard L, Tarantini G, Biondi-Zoccai GGL, Capodanno D, Valgimigli M, Byrne R, Kunadian V (2021) European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions. European heart journal 42:1545-1553.http://doi.org/10.1093/eurheartj/ehaa1070
Clifford J. Kavinsky MS, Andrew M. Goldsweig, Zahid Amin, Konstantinos Dean Boudoulas, John D. Carroll, Megan Coylewright, Sammy Elmariah,Lee A. MacDonald, Atman P. Shah, Christian Spies,Jonathan M. Tobis, Steven R, Emily Senerth, Yngve Falck-Ytter Ifeoluwa Babatunde, Rebecca L. Morgan (2022) SCAI Guidelines for the Management of Patent Foramen Ovale. Journal of the Society for Cardiovascular Angiography & Interventions, https://doi.org/10.1016/j.jscai.2022.100039
Pristipino C, Filice FB (2021) Long-term benefits and risks in patients after persistent foramen ovale closure: a contemporary approach to guide clinical decision making. Kardiologia polska 79:248-254.http://doi.org/10.33963/kp.15817
Chubb H, Whitaker J, Williams SE, Head CE, Chung NA, Wright MJ, O'Neill M (2014) Pathophysiology and Management of Arrhythmias Associated with Atrial Septal Defect and Patent Foramen Ovale. Arrhythmia & electrophysiology review 3:168-172.http://doi.org/10.15420/aer.2014.3.3.168
Alaeddini J, Feghali G, Jenkins S, Ramee S, White C, Abi-Samra F (2006) Frequency of atrial tachyarrhythmias following transcatheter closure of patent foramen ovale. The Journal of invasive cardiology 18:365-368,
Leclercq F, Odorico X, Marin G, Christophe Macia J, Delseny D, Agullo A, Pages L, Robert P, Lattuca B, Cayla G, Roubille F, Gaillard N, Arquizan C, Akodad M (2021) Atrial fibrillation screening on systematic ambulatory electrocardiogram monitoring after percutaneous patent foramen ovale closure: A prospective study. International journal of cardiology Heart & vasculature 37:100919.http://doi.org/10.1016/j.ijcha.2021.100919
Maesen B, Nijs J, Maessen J, Allessie M, Schotten U (2012) Post-operative atrial fibrillation: a maze of mechanisms. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 14:159-174.http://doi.org/10.1093/europace/eur208
Chen JZ, Thijs VN (2021) Atrial Fibrillation Following Patent Foramen Ovale Closure: Systematic Review and Meta-Analysis of Observational Studies and Clinical Trials. Stroke 52:1653-1661.http://doi.org/10.1161/strokeaha.120.030293
Cameli M, Mandoli GE, Loiacono F, Sparla S, Iardino E, Mondillo S (2016) Left atrial strain: A useful index in atrial fibrillation. International journal of cardiology 220:208-213.http://doi.org/10.1016/j.ijcard.2016.06.197
Thomas L, Muraru D, Popescu BA, Sitges M, Rosca M, Pedrizzetti G, Henein MY, Donal E, Badano LP (2020) Evaluation of Left Atrial Size and Function: Relevance for Clinical Practice. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 33:934-952.http://doi.org/10.1016/j.echo.2020.03.021
Genovese D, Singh A, Volpato V, Kruse E, Weinert L, Yamat M, Mor-Avi V, Addetia K, Lang RM (2018) Load Dependency of Left Atrial Strain in Normal Subjects. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 31:1221-1228.http://doi.org/10.1016/j.echo.2018.07.016
Kim J, Yum B, Palumbo MC, Sultana R, Wright N, Das M, You C, Moskowitz CS, Levine RA, Devereux RB, Weinsaft JW (2020) Left Atrial Strain Impairment Precedes Geometric Remodeling as a Marker of Post-Myocardial Infarction Diastolic Dysfunction. JACC Cardiovascular imaging 13:2099-2113.http://doi.org/10.1016/j.jcmg.2020.05.041
Vavuranakis M, Kavouras C, Vlasseros I, Aggeli C, Felekos I, Vrachatis DA, Stefanadis C (2013) Assessment of left atrial function after percutaneous closure of patent foramen ovale. Echocardiography (Mount Kisco, NY) 30:765-771.http://doi.org/10.1111/echo.12123
Silvestry FE, Cohen MS, Armsby LB, Burkule NJ, Fleishman CE, Hijazi ZM, Lang RM, Rome JJ, Wang Y (2015) Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 28:910-958.http://doi.org/10.1016/j.echo.2015.05.015
Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, Horton K, Ogunyankin KO, Palma RA, Velazquez EJ (2019) Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 32:1-64.http://doi.org/10.1016/j.echo.2018.06.004
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 18:1440-1463.http://doi.org/10.1016/j.echo.2005.10.005
Pourafkari L, Ghaffari S, Bancroft GR, Tajlil A, Nader ND (2015) Factors associated with atrial fibrillation in rheumatic mitral stenosis. Asian cardiovascular & thoracic annals 23:17-23.http://doi.org/10.1177/0218492314530134
Freed BH, Daruwalla V, Cheng JY, Aguilar FG, Beussink L, Choi A, Klein DA, Dixon D, Baldridge A, Rasmussen-Torvik LJ, Maganti K, Shah SJ (2016) Prognostic Utility and Clinical Significance of Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction: Importance of Left Atrial Strain. Circulation Cardiovascular imaging 9.http://doi.org/10.1161/circimaging.115.003754
Reant P, Mirabel M, Lloyd G, Peyrou J, Lopez Ayala JM, Dickie S, Bulluck H, Captur G, Rosmini S, Guttmann O, Demetrescu C, Pantazis A, Tome-Esteban M, Moon JC, Lafitte S, McKenna WJ (2016) Global longitudinal strain is associated with heart failure outcomes in hypertrophic cardiomyopathy. Heart (British Cardiac Society) 102:741-747.http://doi.org/10.1136/heartjnl-2015-308576
Antoni ML, ten Brinke EA, Atary JZ, Marsan NA, Holman ER, Schalij MJ, Bax JJ, Delgado V (2011) Left atrial strain is related to adverse events in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Heart (British Cardiac Society) 97:1332-1337.http://doi.org/10.1136/hrt.2011.227678
Jin X, Hummel YM, Tay WT, Nauta JF, Bamadhaj NSS, van Melle JP, Lam CSP, Voors AA, Hoendermis ES (2021) Short- and long-term haemodynamic consequences of transcatheter closure of atrial septal defect and patent foramen ovale. Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 29:402-408.http://doi.org/10.1007/s12471-021-01543-0
Staubach S, Steinberg DH, Zimmermann W, Wawra N, Wilson N, Wunderlich N, Sievert H (2009) New onset atrial fibrillation after patent foramen ovale closure. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 74:889-895.http://doi.org/10.1002/ccd.22172
Oliva L, Huszti E, Hall R, Abrahamyan L, Horlick E (2022) Incidence of new-onset atrial fibrillation after transcatheter patent foramen ovale closure using 15 years of Ontario administrative health data. Heart rhythm 19:1414-1420.http://doi.org/10.1016/j.hrthm.2022.04.006
Motoc A, Luchian ML, Scheirlynck E, Roosens B, Chameleva H, Gevers M, Galloo X, von Kemp B, Ramak R, Sieira J, de Asmundis C, Chierchia GB, Magne J, Weytjens C, Droogmans S, Cosyns B (2021) Incremental value of left atrial strain to predict atrial fibrillation recurrence after cryoballoon ablation. PloS one 16:e0259999.http://doi.org/10.1371/journal.pone.0259999
Hauser R, Nielsen AB, Skaarup KG, Lassen MCH, Duus LS, Johansen ND, Sengeløv M, Marott JL, Jensen G, Schnohr P, Søgaard P, Møgelvang R, Biering-Sørensen T (2021) Left atrial strain predicts incident atrial fibrillation in the general population: the Copenhagen City Heart Study. European heart journal Cardiovascular Imaging 23:52-60.http://doi.org/10.1093/ehjci/jeab202
Huang T, Patrick S, Mayer LK, Müller-Edenborn B, Eichenlaub M, Allgeier M, Allgeier J, Lehrmann H, Ahlgrim C, Bohnen M, Schoechlin S, Trenk D, Jander N, Neumann FJ, Arentz T, Jadidi A (2022) Echocardiographic and Electrocardiographic Determinants of Atrial Cardiomyopathy Identify Patients with Atrial Fibrillation at Risk for Left Atrial Thrombogenesis. Journal of clinical medicine 11.http://doi.org/10.3390/jcm11051332
Molnár A, Ábrahám P, Merkely B, Nardai S (2022) Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure. Journal of visualized experiments : JoVE.http://doi.org/10.3791/61240
Cheema B, Kinno M, Gu D, Ryan J, Mitter S, Rigolin V, Thomas J, Puthumana J (2020) Left atrial size and strain in elite athletes: A cross-sectional study at the NBA Draft Combine. Echocardiography (Mount Kisco, NY) 37:1030-1036.http://doi.org/10.1111/echo.14680
Stefani LD, Trivedi SJ, Ferkh A, Altman M, Thomas L (2021) Changes in left atrial phasic strain and mechanical dispersion: Effects of age and gender. Echocardiography (Mount Kisco, NY) 38:417-426.http://doi.org/10.1111/echo.14997

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Changes in left atrial function after percutaneous closure of patent foramen ovale

Status:

Version 1

Abstract

Introduction

Methods

Study population

PFO closure

Echocardiographic assessment of LA function

Speckle-tracking echocardiography

Statistical analysis

Results

Discussion

Limitations

Conclusions

Declarations

References

Additional Declarations

Status:

Version 1