Arrhythmias & electrophysiologyResearch article
Left Atrial Remodeling and Functional Maladaptations in Obesity: An Invasive Pressure-Volume Analysis
- Invasive pressure-volume analysis
- consecutive patients
- echocardiographic assessment integrated with invasive left atrial (LA) pressure measurements
- regression analyses
Authors' conclusion
In patients undergoing atrial fibrillation ablation, higher BMI is associated with a predominantly load-related pattern of LA remodeling, characterized by larger LA volume and pressures, greater cyclic wall stress, and a rightward shift of the estimated pressure-volume relationship. BMI-associated early atrial remodeling may precede overt atrial dysfunction, potentially contributing to the link between excess adiposity, atrial fibrillation, and heart failure with preserved ejection fraction.
Study context
- Population
- Patients with atrial fibrillation referred for catheter ablation, stratified by body mass index (BMI)consecutive patients (67% male, mean age, 62 years, 71% in sinus rhythm)
- Participants
- 1,040 patients
- Comparison
- LA structural and functional changes across BMI strata
Main finding
As reported in the abstract
- Higher BMI: larger estimated total blood and plasma volumes, higher LA volumes and pressures, greater cyclic wall stress, rightward shift of the estimated LA pressure-volume relationship
Further findings
Estimated operant LA stiffness
- Did not differ across BMI strata
Indexed LA volume
- BMI-related differences attenuated by body surface area indexing but preserved with height-based indexing
LA phasic function
- Conventional volumetric indices similar across BMI strata
- LA strain indices lower with greater adiposity
- LA strain indices available in n=107
Atrial remodeling, heart failure vs no heart failure
- Heart failure: more pronounced structural, functional, and hemodynamic atrial remodeling, consistent with a more advanced atrial myopathy phenotype
Original publication
Summarised from the published abstract; every number is checked against it