Generic placeholder image

Current Hypertension Reviews

Editor-in-Chief

ISSN (Print): 1573-4021
ISSN (Online): 1875-6506

Research Article

Stiff Left Atrial Syndrome; Prospects and Possibilities. Retrospective Analysis and Review of the Literature

Author(s): Muhammad Ali Chaudhry*, Allen Johnson and James Thomas Heywood

Volume 15, Issue 1, 2019

Page: [17 - 21] Pages: 5

DOI: 10.2174/1573402114666180917095654

Price: $65

Abstract

Objectives: Stiff left atrial syndrome is an intriguing clinical phenomena characterized by reduced left atrial compliance, pulmonary venous hypertension and exacerbations of volume overload. We conducted a retrospective review of patients diagnosed with stiff left atrial syndrome at our center.

Methods: All patients admitted to our hospital with volume overload and pulmonary venous hypertension who were diagnosed with stiff left atrial syndrome based on evidence by echocardiogram and right heart catheterization between July 2011 and July 2013 were included in this retrospective review.

Results: Twentythree patients (mean age 73 ± 11 years, 39% male and 61% female) were diagnosed with stiff left atrial syndrome at our center. Thirty-five percent had persistent while 39% had permanent atrial fibrillation. Mean duration of atrial fibrillation was 7.6 ± 2.1 years. Forty-three percent of patients had long standing hypertension. There was no mitral regurgitation in 39% of patients while 48% had mild mitral regurgitation. On right heart catheterization, mean right atrial pressure was 12.6±4.8 mm of Hg, mean pulmonary arterial pressure was 33±7.2 mm of Hg, mean pulmonary capillary wedge pressure was 24.8± 4.2mm of Hg while peak V waves were seen at mean of 37.8± 5.3 mm of Hg. Mean left atrial volume index was 49.8±17.1 mL/m 2. After the initial diagnosis with a two year follow- up, there were no readmissions in 65% of patients who were on appropriate diuretic therapy and had regular clinical visits. Frequent readmissions were seen in 35% of patients inspite of appropriate diuretic therapy. All-cause mortality rate was 4.3% at two year follow up.

Conclusion: In patients with stiff left atrial syndrome, the presence of left atrial dilation, long standing atrial fibrillation and hypertension are the key factors associated with pathogenesis and clinical course. Close follow up and monitoring of volume status is essential to prevent hospital readmissions and improve long term prognosis.

Keywords: Stiff left atrial syndrome, prospects, Restrospective analysis, hypertension, echocardiogram, right heart catheterization.

Graphical Abstract

[1]
Fuchs RM, Heuser RR, Yin FCP, Brinker JA. Limitations of pulmonary wedge V waves in diagnosing mitral regurgitation. Am J Cardiol 1982; 49: 849-54.
[2]
January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014; 130(23): 2071-104.
[3]
Fick A. (9 July 1870).Ueber die Messung dea Blutquantums in den Herzventrikela. Verhandlungen der Physikalisch-medizinische Gesellschaft zu Würzburg ;(in German) 2: XVI-XVII. [in German].
[4]
"Arteriovenous oxygen difference". Sports Medicine, Sports Science and Kinesiology. Net Industries and its Licensors. 2011.
[5]
Lang RM, Badano LP, Mor-Avi V. 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 2015; 28(1): 1-39.e14.
[6]
Thomas L, Levett K, Boyd A, Leung DYC, Schiller NB, Ross DL. Compensatory changes in atrial volumes with normal aging: Is atrial enlargement inevitable? J Am Coll Cardiol 2002; 40: 1630-5.
[7]
Yamaguchi K, Tanabe K, Tani T, et al. Left atrial volume in normal Japanese adults. Circ J 2006; 70: 285-8.
[8]
Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23(7): 685-713.
[9]
Kaul S, Tei C, Hopkins JM, Shah PM. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 1984; 107: 526-31.
[10]
Innelli P, Esposito R, Olibet M, Nistri S, Galderisi M. The impact of ageing on right ventricular longitudinal function in healthy subjects: A pulsed tissue Doppler study. Eur J Echocardiogr 2009; 10: 491-8.
[11]
Meluzin J, Spinarova L, Bakala J, et al. Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular systolic function. Eur Heart J 2001; 22: 340-8.
[12]
Chrysohoou C, Antoniou CK, Kotrogiannis I, et al. Role of right ventricular systolic function on long-term outcome in patients with newly diagnosed systolic heart failure. Circ J 2011; 75(9): 2176-81.
[13]
Pu M, Griffin BP, Vandervoort PM, et al. The value of assessing pulmonary venous flow velocity for predicting severity of mitral regurgitation: A quantitative assessment integrating left ventricular function. J Am Soc Echocardiogr 1999; 12: 736-43.
[14]
Biner S, Rafique A, Rafii F, et al. Reproducibility of proximal isovelocity surface area, vena contracta, and regurgitant jet area for assessment of mitral regurgitation severity. JACC Cardiovasc Imaging 2010; 3: 235-43.
[15]
Grigioni F, Detaint D, Avierinos JF, Scott C, Tajik J, Enriquez-Sarano M. Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction. J Am Coll Cardiol 2005; 45: 260-7.
[16]
Lancellotti P, Troisfontaines P, Toussaint AC, Pierard LA. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation 2003; 108: 1713-7.
[17]
Rossi A, Dini FL, Faggiano P, et al. Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy. Heart 2011; 97: 1675-80.
[18]
Pu M, Prior DL, Fan X, et al. Calculation of mitral regurgitant orifice area with use of a simplified proximal convergence method: Initial clinical application. J Am Soc Echocardiogr 2001; 14: 180.
[19]
McLaughlin VV, Archer SL, Badesch DB, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension: A report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation 2009; 119: 2250-94.
[20]
Urzua J, Kiraly RJ, Wright JI, Cloesmeyer R, Nose Y. A rationally designed artificial heart for calves. Trans Am Soc Artif Intern Organs 1974; 20: 660-6.
[21]
Kahn TA, Heywood JT, Johnson AD, Smith MR, Rubenson D. Left atrial diastolic dysfunction and pulmonary venous hypertension: Hemodynamic and echocardiographic characteristics. J Card Fail 2009; 15: S25.
[22]
Parr GVS, Kirklin JW, Pacifico AD, Blackstone EH, Lauridsen P. Cardiac performance in infants after repair of total anomalous venous connection. Ann Thorac Surg 1974; 17: II-2-8.
[23]
Pilote L, Hunter I, Marpole D, Sniderman A. Stiff left atrial syndrome. Can J Cardiol 1988; 4: 255-7.
[24]
Mehta S, Charbonneau F, Fitchett DH, Marpole DG, Patton R, Sniderman AD. The clinical consequences of a stiff left atrium. Am Heart J 1991; 122: 1184-91.
[25]
Gibson DN, Di Biase L, Mohanty P, et al. Stiff left atrial syndrome after catheter ablation for atrial fibrillation: clinical characterization, prevalence, and predictors. Heart Rhythm 2011; 8(9): 1364-71.
[26]
Wilber DJ, Pappone C, Neuzil P, et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: A randomized controlled trial. JAMA 2010; 30: 333-40.
[27]
Elayi CS, Verma A, Di Biase L, et al. Ablation for longstanding permanent atrial fibrillation: Results from a randomized study comparing three different strategies. Heart Rhythm 2008; 5: 1658-64.
[28]
Di Biase L, Burkhardt JD, Mohanty P, et al. Left atrial appendage: An underrecognized trigger site of atrial fibrillation. Circulation 2010; 122: 109-18.
[29]
Jeevanantham V, Ntim W, Navaneethan SD, et al. Meta-analysis of the effect of radiofrequency catheter ablation of left atrial size, volumes and function in patients with atrial fibrillation. Am J Cardiol 2010; 105: 1317-26.
[30]
Verma A, Wazni OM, Marrouche NF, et al. Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation an independent predictor of procedural failure. J Am Coll Cardiol 2005; 45: 285-92.
[31]
Welch TD, Coylewright M, Powell BD, et al. Symptomatic pulmonary hypertension with giant left atrial v waves after surgical maze procedures: evaluation by comprehensive hemodynamic catheterization. Heart Rhythm 2013; 10: 1839-42.
[32]
Yang Y, Liu Q, Wu Z, et al. Stiff left atrial syndrome: a complication undergoing catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2016; 27: 884-9.
[33]
Beltrami M, Palazzuoli A, Padeletti L, et al. The importance of integrated left atrial evaluation: From hypertension to heart failure with preserved ejection fraction. Int J Clin Pract 2018; 72(2)
[http://dx.doi.org/10.1111/ijcp.13050]
[34]
Maeder MT, Nägele R, Rohner P, Weilenmann D. Pulmonary hypertension in stiff left atrial syndrome: pathogenesis and treatment in one. ESC Heart Fail 2018; 5(1): 189-92.
[35]
Urey MA, Darden D, Stoller D, et al. Stiff left atrial syndrome after multiple percutaneous catheter ablations. Role for invasive hemodynamic exercise testing. Circ Heart Fail 2017; 10: e003885.
[36]
Sondergaard L, Reddy V, Kaye D, et al. Transcatheter treatment of heart failure with preserved or mildly reduced ejection fraction using a novel interatrial implant to lower left atrial pressure. Eur J Heart Fail 2014; 16: 796-801.
[37]
Hasenfuss G, Hayward C, Burkhoff D, et al. REDUCE LAP-HF study investigators. A transcatheter intracardiac shunt device for heart failure with preserved ejection fraction (REDUCE LAP-HF): A multicentre, open-label, single-arm, phase 1 trial. Lancet 2016; 387: 1298-304.
[38]
Chandrashekar P, Park JY, Al-Hijji MA, et al. Atrial septostomy to treat stiff left atrium syndrome. Circ Heart Fail 2017; 10: e004160.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy