Difference in left atrial appendage remodeling between diabetic and nondiabetic patients with atrial fibrillation

Background Diabetes mellitus (DM) is a common and increasingly prevalent condition in patients with atrial fibrillation (AFib). The left atrium appendage (LAA), a small outpouch from the LA, is the most common location for thrombus formation in patients with AFib. Hypothesis In this study, we examin...

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Published inClinical cardiology (Mahwah, N.J.) Vol. 43; no. 1; pp. 71 - 77
Main Authors Yosefy, Chaim, Pery, Marina, Nevzorov, Roman, Piltz, Xavier, Osherov, Azriel, Jafari, Jamal, Beeri, Ronen, Gallego‐Colon, Enrique, Daum, Aner, Khalameizer, Vladimir
Format Journal Article
LanguageEnglish
Published New York Wiley Periodicals, Inc 01.01.2020
Subjects
Aged
Atrial Appendage - diagnostic imaging
Atrial Appendage - physiopathology
Atrial Appendage - surgery
atrial fibrillation
Atrial Fibrillation - physiopathology
Atrial Fibrillation - surgery
Atrial Remodeling - physiology
Clinical Investigations
diabetes mellitus
Diabetic Cardiomyopathies - diagnostic imaging
Diabetic Cardiomyopathies - physiopathology
Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Electric Countershock
Female
Hemodynamics
Humans
left atrial appendage
left atrium
Male
Middle Aged
Prosthesis Implantation
real‐time 3‐dimensional transesophageal echocardiography
Retrospective Studies
Risk Assessment
Risk Factors
stroke
real-time 3-dimensional transesophageal echocardiography
atrial fibrillation
diabetes mellitus
left atrial appendage
left atrium
stroke
Online AccessGet full text
ISSN0160-9289
1932-8737
1932-8737
DOI10.1002/clc.23292

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Abstract Background Diabetes mellitus (DM) is a common and increasingly prevalent condition in patients with atrial fibrillation (AFib). The left atrium appendage (LAA), a small outpouch from the LA, is the most common location for thrombus formation in patients with AFib. Hypothesis In this study, we examined LAA remodeling differences between diabetic and nondiabetic patients with AFib. Methods This retrospective study analyzed data from 242 subjects subdivided into two subgroups of 122 with DM (diabetic group) and 120 without DM (nondiabetic group). The study group underwent real‐time 3‐dimensional transesophageal echocardiography (RT3DTEE) for AFib ablation, cardioversion, or LAA device closure. The LAA dimensions were measured using the “Yosefy rotational 3DTEE method.” Results The RT3DTEE analysis revealed that diabetic patients display larger LAA diameters, D1‐lengh (2.09 ± 0.50 vs 1.88 ± 0.54 cm, P = .003), D2‐width (1.70 ± 0.48 vs 1.55 ± 0.55 cm, P = .024), D3‐depth (2.21 ± 0.75 vs 1.99 ± 0.65 cm, P = .017), larger orifice areas (2.8 ± 1.35 and 2.3 ± 1.49 cm2, P = .004), and diminished orifice flow velocity (37.3 ± 17.6 and 43.7 ± 19.5 cm/sec, P = .008). Conclusions Adverse LAA remodeling in DM patients with AFib is characterized by significantly LAA orifice enlargement and reduced orifice flow velocity. Analysis of LAA geometry and hemodynamics may have clinical implications in thrombotic risk assessment and treatment of DM patients with AFib.
AbstractList Diabetes mellitus (DM) is a common and increasingly prevalent condition in patients with atrial fibrillation (AFib). The left atrium appendage (LAA), a small outpouch from the LA, is the most common location for thrombus formation in patients with AFib. In this study, we examined LAA remodeling differences between diabetic and nondiabetic patients with AFib. This retrospective study analyzed data from 242 subjects subdivided into two subgroups of 122 with DM (diabetic group) and 120 without DM (nondiabetic group). The study group underwent real-time 3-dimensional transesophageal echocardiography (RT3DTEE) for AFib ablation, cardioversion, or LAA device closure. The LAA dimensions were measured using the "Yosefy rotational 3DTEE method." The RT3DTEE analysis revealed that diabetic patients display larger LAA diameters, D1-lengh (2.09 ± 0.50 vs 1.88 ± 0.54 cm, P = .003), D2-width (1.70 ± 0.48 vs 1.55 ± 0.55 cm, P = .024), D3-depth (2.21 ± 0.75 vs 1.99 ± 0.65 cm, P = .017), larger orifice areas (2.8 ± 1.35 and 2.3 ± 1.49 cm , P = .004), and diminished orifice flow velocity (37.3 ± 17.6 and 43.7 ± 19.5 cm/sec, P = .008). Adverse LAA remodeling in DM patients with AFib is characterized by significantly LAA orifice enlargement and reduced orifice flow velocity. Analysis of LAA geometry and hemodynamics may have clinical implications in thrombotic risk assessment and treatment of DM patients with AFib.
Diabetes mellitus (DM) is a common and increasingly prevalent condition in patients with atrial fibrillation (AFib). The left atrium appendage (LAA), a small outpouch from the LA, is the most common location for thrombus formation in patients with AFib.BACKGROUNDDiabetes mellitus (DM) is a common and increasingly prevalent condition in patients with atrial fibrillation (AFib). The left atrium appendage (LAA), a small outpouch from the LA, is the most common location for thrombus formation in patients with AFib.In this study, we examined LAA remodeling differences between diabetic and nondiabetic patients with AFib.HYPOTHESISIn this study, we examined LAA remodeling differences between diabetic and nondiabetic patients with AFib.This retrospective study analyzed data from 242 subjects subdivided into two subgroups of 122 with DM (diabetic group) and 120 without DM (nondiabetic group). The study group underwent real-time 3-dimensional transesophageal echocardiography (RT3DTEE) for AFib ablation, cardioversion, or LAA device closure. The LAA dimensions were measured using the "Yosefy rotational 3DTEE method."METHODSThis retrospective study analyzed data from 242 subjects subdivided into two subgroups of 122 with DM (diabetic group) and 120 without DM (nondiabetic group). The study group underwent real-time 3-dimensional transesophageal echocardiography (RT3DTEE) for AFib ablation, cardioversion, or LAA device closure. The LAA dimensions were measured using the "Yosefy rotational 3DTEE method."The RT3DTEE analysis revealed that diabetic patients display larger LAA diameters, D1-lengh (2.09 ± 0.50 vs 1.88 ± 0.54 cm, P = .003), D2-width (1.70 ± 0.48 vs 1.55 ± 0.55 cm, P = .024), D3-depth (2.21 ± 0.75 vs 1.99 ± 0.65 cm, P = .017), larger orifice areas (2.8 ± 1.35 and 2.3 ± 1.49 cm2 , P = .004), and diminished orifice flow velocity (37.3 ± 17.6 and 43.7 ± 19.5 cm/sec, P = .008).RESULTSThe RT3DTEE analysis revealed that diabetic patients display larger LAA diameters, D1-lengh (2.09 ± 0.50 vs 1.88 ± 0.54 cm, P = .003), D2-width (1.70 ± 0.48 vs 1.55 ± 0.55 cm, P = .024), D3-depth (2.21 ± 0.75 vs 1.99 ± 0.65 cm, P = .017), larger orifice areas (2.8 ± 1.35 and 2.3 ± 1.49 cm2 , P = .004), and diminished orifice flow velocity (37.3 ± 17.6 and 43.7 ± 19.5 cm/sec, P = .008).Adverse LAA remodeling in DM patients with AFib is characterized by significantly LAA orifice enlargement and reduced orifice flow velocity. Analysis of LAA geometry and hemodynamics may have clinical implications in thrombotic risk assessment and treatment of DM patients with AFib.CONCLUSIONSAdverse LAA remodeling in DM patients with AFib is characterized by significantly LAA orifice enlargement and reduced orifice flow velocity. Analysis of LAA geometry and hemodynamics may have clinical implications in thrombotic risk assessment and treatment of DM patients with AFib.
Background Diabetes mellitus (DM) is a common and increasingly prevalent condition in patients with atrial fibrillation (AFib). The left atrium appendage (LAA), a small outpouch from the LA, is the most common location for thrombus formation in patients with AFib. Hypothesis In this study, we examined LAA remodeling differences between diabetic and nondiabetic patients with AFib. Methods This retrospective study analyzed data from 242 subjects subdivided into two subgroups of 122 with DM (diabetic group) and 120 without DM (nondiabetic group). The study group underwent real‐time 3‐dimensional transesophageal echocardiography (RT3DTEE) for AFib ablation, cardioversion, or LAA device closure. The LAA dimensions were measured using the “Yosefy rotational 3DTEE method.” Results The RT3DTEE analysis revealed that diabetic patients display larger LAA diameters, D1‐lengh (2.09 ± 0.50 vs 1.88 ± 0.54 cm, P = .003), D2‐width (1.70 ± 0.48 vs 1.55 ± 0.55 cm, P = .024), D3‐depth (2.21 ± 0.75 vs 1.99 ± 0.65 cm, P = .017), larger orifice areas (2.8 ± 1.35 and 2.3 ± 1.49 cm2, P = .004), and diminished orifice flow velocity (37.3 ± 17.6 and 43.7 ± 19.5 cm/sec, P = .008). Conclusions Adverse LAA remodeling in DM patients with AFib is characterized by significantly LAA orifice enlargement and reduced orifice flow velocity. Analysis of LAA geometry and hemodynamics may have clinical implications in thrombotic risk assessment and treatment of DM patients with AFib.
Author Jafari, Jamal
Piltz, Xavier
Nevzorov, Roman
Osherov, Azriel
Beeri, Ronen
Pery, Marina
Gallego‐Colon, Enrique
Yosefy, Chaim
Daum, Aner
Khalameizer, Vladimir
AuthorAffiliation 2 Diagnostic Cardiology Unit Heart Institute, Hadassah Hebrew University Medical Center Jerusalem Israel
1 Cardiology Department Barzilai University Medical Center, Ben‐Gurion University Ashkelon Israel
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Keywords real-time 3-dimensional transesophageal echocardiography
atrial fibrillation
diabetes mellitus
left atrial appendage
left atrium
stroke
Language English
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Snippet Background Diabetes mellitus (DM) is a common and increasingly prevalent condition in patients with atrial fibrillation (AFib). The left atrium appendage...
Diabetes mellitus (DM) is a common and increasingly prevalent condition in patients with atrial fibrillation (AFib). The left atrium appendage (LAA), a small...
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StartPage 71
SubjectTerms Aged
Atrial Appendage - diagnostic imaging
Atrial Appendage - physiopathology
Atrial Appendage - surgery
atrial fibrillation
Atrial Fibrillation - physiopathology
Atrial Fibrillation - surgery
Atrial Remodeling - physiology
Clinical Investigations
diabetes mellitus
Diabetic Cardiomyopathies - diagnostic imaging
Diabetic Cardiomyopathies - physiopathology
Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Electric Countershock
Female
Hemodynamics
Humans
left atrial appendage
left atrium
Male
Middle Aged
Prosthesis Implantation
real‐time 3‐dimensional transesophageal echocardiography
Retrospective Studies
Risk Assessment
Risk Factors
stroke
Title Difference in left atrial appendage remodeling between diabetic and nondiabetic patients with atrial fibrillation
URI https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fclc.23292
https://www.ncbi.nlm.nih.gov/pubmed/31755572
https://www.proquest.com/docview/2317600868
https://pubmed.ncbi.nlm.nih.gov/PMC6954381
Volume 43
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