Skip to main content

Advertisement

SpringerLink
Log in

Enlarged left atrium and decreased left atrial strain are associated with atrial fibrillation in patients with hyperthyroidism irrespective of conventional risk factors

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

The purpose of this study was to investigate factors associated with AF in patients with hyperthyroidism beyond heart failure (HF), coronary heart disease (CHD), or valvular diseases. A total of 136 patients (mean age, 52 ± 15 years; 86 [63%] female) who were diagnosed with hyperthyroidism for the first time were enrolled. Patients who had HF, CHD, or significant valvular diseases were excluded. Patients were classified into two groups according to the presence (group 1, n = 40) and absence of AF (group 2, n = 96). AF occurred in 40 (29%) patients and 23 (58%) of these patients showed paroxysmal AF. Among the symptoms of hyperthyroidism, the most common chief complaint was palpitation (30%). Advanced age, presence of prior cerebrovascular events, and presence of palpitations were associated with AF. Larger left atrial volume index (LAVI), increased left ventricular mass index, and decreased left ventricular ejection fraction (LVEF) and S′ velocity were associated with AF. Among them, presence of palpitations and increased LAVI were independently associated with the occurrence of AF. In addition, strain analysis, decreased LA expansion index (EI), ejection fraction (EF), peak atrial longitudinal strain, contraction strain, and late diastolic strain rate (A sr) and systolic strain rate (S sr) were associated with the occurrence of AF and LAVI. Presence of palpitations and enlarged left atrium were associated with the occurrence of AF in patients with hyperthyroidism irrespective of conventional risk factors. Additional LA analysis revealed that decreased LA function was associated with AF and enlarged left atrium.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wasmer K, Eckardt L, Breithardt G (2017) Predisposing factors for atrial fibrillation in the elderly. J Geriatr Cardiol 14:179–184

    PubMed  PubMed Central  Google Scholar 

  2. Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH (2017) Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circ Res 120:1501–1517

    Article  CAS  Google Scholar 

  3. Goudis CA, Korantzopoulos P, Ntalas IV, Kallergis EM, Ketikoglou DG (2015) Obesity and atrial fibrillation: a comprehensive review of the pathophysiological mechanisms and links. J Cardiol 66:361–369

    Article  Google Scholar 

  4. Shapira-Daniels A, Mohanty S, Contreras-Valdes FM, Tieu H, Thomas RJ, Natale A et al (2020) Prevalence of undiagnosed sleep apnea in patients with atrial fibrillation and its impact on therapy. JACC Clin Electrophysiol 6:1499–1506

    Article  Google Scholar 

  5. Voskoboinik A, Prabhu S, Ling LH, Kalman JM, Kistler PM (2016) Alcohol and atrial fibrillation: a sobering review. J Am Coll Cardiol 68:2567–7256

    Article  CAS  Google Scholar 

  6. Lubitz SA, Yin X, Rienstra M, Schnabel RB, Walkey AJ, Magnani JW et al (2015) Long-term outcomes of secondary atrial fibrillation in the community: the Framingham Heart Study. Circulation 131:1648–1655

    Article  Google Scholar 

  7. Vahdatpour CA, Luebbert JJ, Palevsky HI (2020) Atrial arrhythmias in chronic lung disease-associated pulmonary hypertension. Pulm Circ 10:2045894020910685

    Article  Google Scholar 

  8. Woeber KA (1992) Thyrotoxicosis and the heart. N Engl J Med 327:94–98

    Article  CAS  Google Scholar 

  9. Reddy V, Taha W, Kundumadam S, Khan M (2017) Atrial fibrillation and hyperthyroidism: a literature review. Indian Heart J 69:545–550

    Article  Google Scholar 

  10. Wustmann K, Kucera JP, Zanchi A, Burow A, Stuber T, Chappuis B et al (2008) Activation of electrical triggers of atrial fibrillation in hyperthyroidism. J Clin Endocrinol Metab 93:2104–2108

    Article  CAS  Google Scholar 

  11. Klein I, Danzi S (2007) Thyroid disease and the heart. Circulation 116:1725–1735

    Article  Google Scholar 

  12. Markides V, Schilling RJ (2003) Atrial fibrillation: classification, pathophysiology, mechanisms and drug treatment. Heart 89:939–943

    Article  Google Scholar 

  13. Watanabe H, Ma M, Washizuka T, Komura S, Yoshida T, Hosaka Y et al (2003) Thyroid hormone regulates mRNA expression and currents of ion channels in rat atrium. Biochem Biophys Res Commun 308:439–444

    Article  CAS  Google Scholar 

  14. Bielecka-Dabrowa A, Mikhailidis DP, Rysz J, Banach M (2009) The mechanisms of atrial fibrillation in hyperthyroidism. Thyroid Res 2:4

    Article  Google Scholar 

  15. Klein I, Ojamaa K (2001) Thyroid hormone and the cardiovascular system. N Engl J Med 344:501–509

    Article  CAS  Google Scholar 

  16. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39

    Article  Google Scholar 

  17. Hsiao SH, Huang WC, Lin KL, Chiou KR, Kuo FY, Lin SK et al (2010) Left atrial distensibility and left ventricular filling pressure in acute versus chronic severe mitral regurgitation. Am J Cardiol 105:709–715

    Article  Google Scholar 

  18. Hoit BD (2014) Left atrial size and function: role in prognosis. J Am Coll Cardiol 63:493–505

    Article  Google Scholar 

  19. Cameli M, Lisi M, Righini FM, Mondillo S (2012) Novel echocardiographic techniques to assess left atrial size, anatomy and function. Cardiovasc Ultrasound 10:4

    Article  Google Scholar 

  20. Frost L, Vestergaard P, Mosekilde L (2004) Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study. Arch Intern Med 164:1675–1678

    Article  Google Scholar 

  21. Auer J, Scheibner P, Mische T, Langsteger W, Eber O, Eber B (2001) Subclinical hyperthyroidism as a risk factor for atrial fibrillation. Am Heart J 142:838–842

    Article  CAS  Google Scholar 

  22. Hiss RG, Lamb LE (1962) Electrocardiographic findings in 122,043 individuals. Circulation 25:947–965

    Article  CAS  Google Scholar 

  23. Ghandour A, Reust C (2011) Hyperthyroidism: a stepwise approach to treatment. J Fam Pract 60:388–395

    PubMed  Google Scholar 

  24. Palitzsch KD (2008) Prevention and multimodal therapy of hyperthyroidism. Internist (Berl) 49:1428–1436

    Article  Google Scholar 

  25. Ertek S, Cicero AF (2013) Hyperthyroidism and cardiovascular complications: a narrative review on the basis of pathophysiology. Arch Med Sci 9:944–952

    Article  Google Scholar 

  26. Klein I, Ojamaa K (1998) Thyrotoxicosis and the heart. Endocrinol Metab Clin N Am 27:51–62

    Article  CAS  Google Scholar 

  27. Nordyke RA, Gilbert FI Jr, Harada ASM (1988) Graves’ disease: influence of age on clinical findings. Arch Intern Med 148:626–631

    Article  CAS  Google Scholar 

  28. Krahn AD, Klein GJ, Kerr CR, Boone J, Sheldon R, Green M et al (1996) How useful is thyroid function testing in patients with recent-onset atrial fibrillation? Arch Intern Med 156:2221–2224

    Article  CAS  Google Scholar 

  29. Henry WL, Morganroth J, Pearlman AS, Clark CE, Redwood DR, Itscoitz SB et al (1976) Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation 53:273–279

    Article  CAS  Google Scholar 

  30. Seko Y, Kato T, Haruna T, Izumi T, Miyamoto S, Nakane E et al (2018) Association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodeling. Sci Rep 8:6366

    Article  Google Scholar 

  31. Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ et al (2006) Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol 47:2357–2363

    Article  Google Scholar 

  32. Cuspidi C, Rescaldani M, Sala C (2013) Prevalence of echocardiographic left-atrial enlargement in hypertension: a systematic review of recent clinical studies. Am J Hypertens 26:456–464

    Article  Google Scholar 

  33. Patel DA, Lavie CJ, Milani RV, Shah S, Gilliland Y (2009) Clinical implications of left atrial enlargement: a review. Ochsner J 9:191–196

    PubMed  PubMed Central  Google Scholar 

  34. Kizer JR, Bella JN, Palmieri V, Liu JE, Best LG, Lee ET et al (2006) Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: the Strong Heart Study (SHS). Am Heart J 151:412–418

    Article  Google Scholar 

  35. Wj M, Silverman DI, Katz SE, Douglas PS (1993) Atrial ejection force: a noninvasive assessment of atrial systolic function. J Am Coll Cardiol 22:221–225

    Article  Google Scholar 

  36. Hesse B, Schuele SU, Thamilasaran M, Thomas J, Rodriguez L (2004) A rapid method to quantify left atrial contractile function: Doppler tissue imaging of the mitral annulus during atrial systole. Eur J Echocardiogr 5:86–92

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea

    Dong Geum Shin, Min-Kyung Kang, Donghoon Han, Seonghoon Choi, Jung Rae Cho & Namho Lee

Authors
  1. Dong Geum Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Min-Kyung Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Donghoon Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seonghoon Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jung Rae Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Namho Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Min-Kyung Kang.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shin, D.G., Kang, MK., Han, D. et al. Enlarged left atrium and decreased left atrial strain are associated with atrial fibrillation in patients with hyperthyroidism irrespective of conventional risk factors. Int J Cardiovasc Imaging 38, 613–620 (2022). https://doi.org/10.1007/s10554-021-02450-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-021-02450-6

Keywords

Search

Navigation