Left atrial remodeling and atrial fibrillation in cardiac amyloidosis – a myocardial deformation study

Introduction: Left atrial (LA) remodelling and atrial fibrillation (AF) are common in patients with cardiac amyloidosis (CA), putting them at risk for heart failure and thromboembolic events.

Objective: The purpose of this study is to evaluate the correlates of AF in a CA population.

Methods: We prospectively studied consecutive CA patients (pts). History of AF was evaluated by clinical history, ECG and 24-hours ECG monitoring. LA and left ventricular (LV) size, function and mechanics were assessed by conventional and speckle tracking echo-cardiography. LA deformation was measured from 4-chamber apical views using the QRS complex as the zero reference point. Linear regression with Pearson test was used to test correlation between LA volume and LA functional parameters.

Results: We included 31 CA patients (56.3 ± 11.1 years old, 51.6% men). Eight patients had a history of AF (group 1.5 patients in AF at the moment of examina-tion) while 23 patients did not (group 2). There was no difference in CA etiology (AL vs. ATTR), age or gender distribution between the two groups. Patients in group 1 had a more dilated LA (AP LA diameter AS 48 ± 3 vs. 44 ± 6 mm, p=0.05; LAVi 56 ± 22 vs. 48 ± 13 ml/ m2, p=0.03), lower A wave (27 ± 8 vs. 52 ± 18 cm/s, p=0,01), reservoir (Peak systolic 9,4%, p=0,02) and contractile (Contractile LA 1,64 vs. -5,3 ± 4,7, p<0,001) LA strain values, without any significand difference regarding parameters mea-sured by strain rate (Peak systolic SR, Early diastolic SR, Late diastolic SR). Reduction of LA function para-meters was unrelated to LA volume.

Conclusions: Patients with CA and AF have more dila-ted LA and worse LA reservoir and contractile functi-on. LA dysfunction does not appear to correlate to LA volume in CA.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)