Left Atrial 4D Blood Flow Dynamics and Hemostasis following Electrical Cardioversion of Atrial FibrillationVisa övriga samt affilieringar
2017 (Engelska)Ingår i: Frontiers in Physiology, E-ISSN 1664-042X, Vol. 8, artikel-id 1052Artikel i tidskrift (Refereegranskat) Published
Abstract [en]
Background: Electrical cardioversion in patients with atrial fibrillation is followed by a transiently impaired atrial mechanical function, termed atrial stunning. During atrial stunning, a retained risk of left atrial thrombus formation exists, which may be attributed to abnormal left atrial blood flow patterns. 4D Flow cardiovascular magnetic resonance (CMR) enables blood flow assessment from the entire three-dimensional atrial volume throughout the cardiac cycle. We sought to investigate left atrial 4D blood flow patterns and hemostasis during left atrial stunning and after left atrial mechanical function was restored. Methods: 4D Flow and morphological CMR data as well as blood samples were collected in fourteen patients at two time-points: 2-3 h (Time-1) and 4 weeks (Time-2) following cardioversion. The volume of blood stasis and duration of blood stasis were calculated. In addition, hemostasis markers were analyzed. Results: From Time-1 to Time-2: Heart rate decreased (61 +/- 7 vs. 56 +/- 8 bpm, p = 0.01); Maximum change in left atrial volume increased (8 +/- 4 vs. 22 +/- 15%, p = 0.009); The duration of stasis (68 +/- 11 vs. 57 +/- 8%, p = 0.002) and the volume of stasis (14 +/- 9 vs. 9 +/- 7%, p = 0.04) decreased; Thrombin-antithrombin complex (TAT) decreased (5.2 +/- 3.3 vs. 3.3 +/- 2.2it.g/L, p = 0.008). A significant correlation was found between TAT and the volume of stasis (r(2) = 0.69, p amp;lt; 0.001) at Time-1 and between TAT and the duration of stasis (r(2) = 0.34, p = 0.04) at Time-2. Conclusion: In this longitudinal study, left atrial multidimensional blood flow was altered and blood stasis was elevated during left atrial stunning compared to the restored left atrial mechanical function. The coagulability of blood was also elevated during atrial stunning. The association between blood stasis and hypercoagulability proposes that assessment of left atrial 4D flow can add to the pathophysiological understanding of thrombus formation during atrial fibrillation related atrial stunning.
Ort, förlag, år, upplaga, sidor
FRONTIERS MEDIA SA , 2017. Vol. 8, artikel-id 1052
Nyckelord [en]
atrial fibrillation; cardioversion; atrial stunning; 4D flow CMR; hemostasis; stasis
Nationell ämneskategori
Fysiologi
Identifikatorer
URN: urn:nbn:se:liu:diva-143904DOI: 10.3389/fphys.2017.01052ISI: 000417739200003OAI: oai:DiVA.org:liu-143904DiVA, id: diva2:1169731
Anmärkning
Funding Agencies|European Unions Seventh Framework Programme (FP7) [310612]; Swedish Research Council [621-2014-6191]; Swedish Heart and Lung Foundation [20140398]
2017-12-292017-12-292024-01-17