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Left atrial remodeling in heart failure: the role of sphericity index (the SPHERICAT-HF study)

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Abstract

Left atrial sphericity index (LASI) is an echocardiographic index easily obtained; its use in patients with heart failure (HF) has never been investigated so far. This single-centre study aimed to investigate the usefulness of LASI in an unselected cohort of patients hospitalized for acute HF, and its potential correlation with the amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) levels and with New York Heart Association (NYHA) functional class. Ninety-four consecutive HF patients underwent a transthoracic echocardiogram with a detailed study of the left atrium (LA) including LASI (calculated from the apical four-chamber view as the ratio between the transverse and longitudinal diameters), and blood tests (including NT-proBNP) on the same day. Median age was 75.5 (interquartile range-IQR 62–82) years and 55% were males, 58.5% had a NYHA class III–IV, and median NT-proBNP was 3284 (IQR 1215–7055) pg/ml. The LA was dilated in 94%, and median biplane LA volume index was 62 ml/m2. Patients with advanced NYHA class showed more advanced LA remodeling. Mean LASI was 0.78 ± 0.09 and did not correlate with NT-proBNP levels (r 0.03; p 0.75) or with patient NYHA class (R2 0.011; p 0.287). None of the echocardiographic indices of LA structural and functional remodeling proved to be independently associated with a high NYHA class on multivariate regression analysis. In conclusion, LA remodeling is almost invariably present in patients with HF. LASI does not correlate with NT-proBNP levels or with NYHA functional class. Further studies are needed to describe the complex patterns of atrial remodeling in HF.

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References

  1. Rossi A, Temporelli PL, Quintana M, Dini FL, Ghio S, Hillis GS et al (2009) Independent relationship of left atrial size and mortality in patients with heart failure: an individual patient meta-analysis of longitudinal data (MeRGE Heart Failure). Eur J Heart Fail 11(10):929–936

    Article  PubMed  Google Scholar 

  2. Hoit BD (2014) Left atrial size and function: role in prognosis. J Am Coll Cardiol 63(6):493–505

    Article  PubMed  Google Scholar 

  3. Pellicori P, Zhang J, Lukaschuk E, Joseph AC, Bourantas CV, Loh H et al (2015) Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value. Eur Heart J 36(12):733–742

    Article  CAS  PubMed  Google Scholar 

  4. Mondillo S, Cameli M, Caputo ML, Lisi M, Palmerini E, Padeletti M et al (2011) Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr 24(8):898–908

    Article  PubMed  Google Scholar 

  5. Al Saikhan L, Hughes AD, Chung WS, Alsharqi M, Nihoyannopoulos P (2019) Left atrial function in heart failure with mid-range ejection fraction differs from that of heart failure with preserved ejection fraction: a 2D speckle-tracking echocardiographic study. Eur Heart J Cardiovasc Imaging 20(3):279–290

    Article  PubMed  Google Scholar 

  6. Bisbal F, Alarcón F, Ferrero-de-Loma-Osorio A, González-Ferrer JJ, Alonso C, Pachón M et al (2013) Left atrial sphericity: a new method to assess atrial remodeling. Impact on the outcome of atrial fibrillation ablation. J Cardiovasc Electrophysiol 24(7):752–759

    Article  PubMed  Google Scholar 

  7. Yi JE, Chung WB, Cho JS, Park CS, Cho EJ, Jeon HK et al (2013) Left atrial eccentricity in chronic mitral regurgitation: relation to left atrial function. Eur Heart J Cardiovasc Imaging 14(2):110–117

    Article  PubMed  Google Scholar 

  8. Osmanagic A, Moller S, Osmanagic A, Sheta HM, Vinther KH, Egstrup K (2016) Left atrial sphericity index predicts early recurrence of atrial fibrillation after direct-current cardioversion: an echocardiographic study. Clin Cardiol 39(7):406–412

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bisbal F, Alarcón F, Ferrero-de-Loma-Osorio A, González-Ferrer JJ, Alonso C, Pachón M et al (2018) Left atrial geometry and outcome of atrial fibrillation ablation: results from the multicentre LAGO-AF study. Eur Heart J Cardiovasc Imaging 19(9):1002–1009

    Article  PubMed  Google Scholar 

  10. Yazaki M, Nabeta T, Inomata T, Maemura K, Oki T, Fujita T et al (2021) Clinical significance of left atrial geometry in dilated cardiomyopathy patients: a cardiovascular magnetic resonance study. Clin Cardiol 44(2):222–229

    Article  PubMed  Google Scholar 

  11. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200

    Article  PubMed  Google Scholar 

  12. Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G et al (2017) Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 18(12):1301–1310

    Article  PubMed  Google Scholar 

  13. Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC et al (2019) Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 32(1):1–64

    Article  PubMed  Google Scholar 

  14. 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):1-39.e14

    Article  PubMed  Google Scholar 

  15. Badano LP, Miglioranza MH, Mihăilă S, Peluso D, Xhaxho J, Marra MP et al (2016) Left atrial volumes and function by three-dimensional echocardiography: reference values, accuracy, reproducibility, and comparison with two-dimensional echocardiographic measurements. Circ Cardiovasc Imaging 9(7):e004229

    Article  PubMed  Google Scholar 

  16. The Criteria Committee of the New York Heart Association (1994) Functional capacity and objective assessment. In: Dolgin M (ed) Nomenclature and criteria for diagnosis of diseases of the heart and great vessels, 9th edn. Little, Brown and Company, Boston, pp 253–255

    Google Scholar 

  17. Bennett JA, Riegel B, Bittner V, Nichols J (2002) Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease. Heart Lung 31:262–270

    Article  PubMed  Google Scholar 

  18. Prastaro M, Paolillo S, Savarese G, Dellegrottaglie S, Scala O, Ruggiero D et al (2011) N-terminal pro-b-type natriuretic peptide and left atrial function in patients with congestive heart failure and severely reduced ejection fraction. Eur J Echocardiogr 12(7):506–513

    Article  PubMed  Google Scholar 

  19. Triposkiadis F, Pieske B, Butler J, Parissis J, Giamouzis G, Skoularigis J et al (2016) Global left atrial failure in heart failure. Eur J Heart Fail 18:1307–1320

    Article  PubMed  Google Scholar 

  20. Carluccio E, Biagioli P, Mengoni A, Francesca Cerasa M, Lauciello R, Zuchi C et al (2018) Left atrial reservoir function and outcome in heart failure with reduced ejection fraction. Circ Cardiovasc Imaging 11(11):e007696

    Article  PubMed  Google Scholar 

  21. Melenovsky V, Hwang SJ, Redfield MM, Zakeri R, Lin G, Borlaug BA (2015) Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail 8(2):295–303

    Article  PubMed  Google Scholar 

  22. Toma M, Ezekowitz JA, Bakal JA, O’Connor CM, Hernandez AF, Sardar MR et al (2014) The relationship between left ventricular ejection fraction and mortality in patients with acute heart failure: insights from the ASCEND-HF Trial. Eur J Heart Fail 16(3):334–341

    Article  PubMed  Google Scholar 

  23. Deferm S, Martens P, Verbrugge FH, Bertrand PB, Dauw J, Verhaert D et al (2020) LA mechanics in decompensated heart failure: insights from strain echocardiography with invasive hemodynamics. JACC Cardiovasc Imaging 13(5):1107–1115

    Article  PubMed  Google Scholar 

  24. Yap J, Lim FY, Gao F, Teo LL, Lam CS, Yeo KK (2015) Correlation of the New York Heart Association Classification and the 6-minute walk distance: a systematic review. Clin Cardiol 38(10):621–628

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sugimoto T, Bandera F, Generati G, Alfonzetti E, Bussadori C, Guazzi M (2017) Left atrial function dynamics during exercise in heart failure: pathophysiological implications on the right heart and exercise ventilation inefficiency. JACC Cardiovasc Imaging 10(10):1253–1264

    Article  PubMed  Google Scholar 

  26. Sanna GD, Canonico ME, Santoro C, Esposito R, Masia SL, Galderisi M, Parodi G, Nihoyannopoulos P (2021) Echocardiographic longitudinal strain analysis in heart failure: real usefulness for clinical management beyond diagnostic value and prognostic correlations? A comprehensive review. Curr Heart Fail Rep 18(5):290–303

    Article  PubMed  Google Scholar 

  27. Sanna GD, Brignole M, Parodi G (2021) Atrial myopathy in amyloidosis: should we ignore simple surface ECG and basic echocardiographic indexes? JACC Cardiovasc Imaging 14(11):2268

    Article  PubMed  Google Scholar 

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Acknowledgements

The Authors would like to thank Dr Paolo Franca for his help with clinical data collection.

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Authors and Affiliations

  1. Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico De Nicola, 07100, Sassari, Italy

    Giuseppe D. Sanna & Stefano L. Masia

  2. The Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy

    Eleonora Moccia, Mario Enrico Canonico, Silvia Sanna, Chiara De Toni & Guido Parodi

  3. Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy

    Mario Enrico Canonico & Ciro Santoro

  4. Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy

    Laura Saderi & Giovanni Sotgiu

Authors
  1. Giuseppe D. Sanna
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  2. Eleonora Moccia
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  3. Mario Enrico Canonico
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  4. Silvia Sanna
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  5. Chiara De Toni
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  6. Ciro Santoro
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  7. Stefano L. Masia
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  8. Laura Saderi
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  9. Giovanni Sotgiu
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  10. Guido Parodi
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Contributions

Main contributions: GDS, SLM (conceptualization), GDS, EM, MEC, SS, CDT (patient recruitment and data analysis), GDS, EM, SLM, GP (manuscript drafting), LS, GS (statistical analysis), CS and GP (manuscript critical revision as senior Authors). All the Authors were actively involved in all the stages of the project. All Authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Corresponding author

Correspondence to Giuseppe D. Sanna.

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The Authors have no conflict of interest to declare.

Ethical approval

The study protocol conformed to the principles outlined in the Declaration of Helsinki and was approved by the local Research Ethics Committee.

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Written informed consent was obtained from the patients or their legal guardians.

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Sanna, G.D., Moccia, E., Canonico, M.E. et al. Left atrial remodeling in heart failure: the role of sphericity index (the SPHERICAT-HF study). Int J Cardiovasc Imaging 38, 1723–1732 (2022). https://doi.org/10.1007/s10554-022-02562-7

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  • DOI: https://doi.org/10.1007/s10554-022-02562-7

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