Electrocardiographic diagnosis of atrial cardiomyopathy to predict atrial contractile dysfunction, thrombogenesis and adverse cardiovascular outcomes
Abstract Thromboembolism and stroke are dreaded complications in atrial fibrillation (AF). Established risk stratification models identify susceptible patients, but their discriminative properties are poor. Atrial cardiomyopathy (ACM) is associated to thromboembolism and stroke in smaller studies, b...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2022-01-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-021-04535-7 |
| _version_ | 1798026556885434368 |
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| author | Björn Müller-Edenborn Jan Minners Cornelius Keyl Martin Eichenlaub Nikolaus Jander Sherif Abdelrazek Christoph Ahlgrim Jürgen Allgeier Heiko Lehrmann Franz-Josef Neumann Thomas Arentz Amir Jadidi |
| author_facet | Björn Müller-Edenborn Jan Minners Cornelius Keyl Martin Eichenlaub Nikolaus Jander Sherif Abdelrazek Christoph Ahlgrim Jürgen Allgeier Heiko Lehrmann Franz-Josef Neumann Thomas Arentz Amir Jadidi |
| author_sort | Björn Müller-Edenborn |
| collection | DOAJ |
| description | Abstract Thromboembolism and stroke are dreaded complications in atrial fibrillation (AF). Established risk stratification models identify susceptible patients, but their discriminative properties are poor. Atrial cardiomyopathy (ACM) is associated to thromboembolism and stroke in smaller studies, but the modalities used for ACM-diagnosis (MRI and endocardial mapping) are unsuitable for widespread population screening. We aimed to investigate an ECG-based diagnosis of ACM using amplified p-wave analysis (APWA) for stratification of thromboembolic risk and cardiovascular outcome. In this case–control study, ACM-staging was performed using APWA on digital 12-lead sinus rhythm-ECGs in patients with LAA-thrombus and a propensity-score-matched control-cohort. Left atrial contractile function and thrombi were evaluated by transesophageal echocardiography (TEE). Outcome for MACCE including death was assessed using official registries and structured phone interviews. Left-atrial appendage [LAA]-thrombi and appropriate sinus rhythm-ECGs for ACM-staging were found in 109 of 4086 patients that were matched 1:1 to control patients without thrombus (218 patients in total). Both cohorts were comparable regarding cardiovascular risk factors, anticoagulants and CHA2DS2-VASC-score. ACM-stages 1 to 3 (equivalent to no, moderate and extensive ACM) were found in 63 (57.8%), 36 (33.0%) and 10 (9.2%) of patients without and 3 (2.8%), 23 (21.1%) and 83 (76.1%) of patients with LAA-thrombi. Atrial contractile function decreased from ACM-stages 1 to 3 (LAA-flow velocities 38 ± 16 cm/s, 31 ± 15 cm/s and 21 ± 12 cm/s; p < 0.0001), while the likelihood for LAA-thrombus increased (2.8%, 21.1% and 76.1%, p < 0.001). Multivariable analysis confirmed an independent odds ratio for LAA-thrombus of 24.6 (p < 0.001) per ACM-stage. Two-year survival free of stroke/TIA, hospitalization for heart failure, myocardial infarction or all-cause death was strongly reduced in ACM-stage 3 (53.8%) compared to no or moderate ACM (82.8% and 84.7%, respectively; p < 0.0001). Electrocardiographic diagnosis of ACM identifies patients with atrial contractile dysfunction and atrial thrombi at risk for adverse cardiovascular outcomes and death. |
| first_indexed | 2024-04-11T18:37:14Z |
| format | Article |
| id | doaj.art-1e8a48e0ab084228bf900297e9ce7b6e |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-04-11T18:37:14Z |
| publishDate | 2022-01-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-1e8a48e0ab084228bf900297e9ce7b6e2022-12-22T04:09:13ZengNature PortfolioScientific Reports2045-23222022-01-011211910.1038/s41598-021-04535-7Electrocardiographic diagnosis of atrial cardiomyopathy to predict atrial contractile dysfunction, thrombogenesis and adverse cardiovascular outcomesBjörn Müller-Edenborn0Jan Minners1Cornelius Keyl2Martin Eichenlaub3Nikolaus Jander4Sherif Abdelrazek5Christoph Ahlgrim6Jürgen Allgeier7Heiko Lehrmann8Franz-Josef Neumann9Thomas Arentz10Amir Jadidi11Department of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of FreiburgDepartment of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of FreiburgDepartment of Cardiology and Angiology II, Heart Center, Section of Anesthesiology, University of FreiburgDepartment of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of FreiburgDepartment of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of FreiburgDepartment of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of FreiburgDepartment of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of FreiburgDepartment of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of FreiburgDepartment of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of FreiburgDepartment of Cardiology and Angiology II, Heart Center, University of FreiburgDepartment of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of FreiburgDepartment of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of FreiburgAbstract Thromboembolism and stroke are dreaded complications in atrial fibrillation (AF). Established risk stratification models identify susceptible patients, but their discriminative properties are poor. Atrial cardiomyopathy (ACM) is associated to thromboembolism and stroke in smaller studies, but the modalities used for ACM-diagnosis (MRI and endocardial mapping) are unsuitable for widespread population screening. We aimed to investigate an ECG-based diagnosis of ACM using amplified p-wave analysis (APWA) for stratification of thromboembolic risk and cardiovascular outcome. In this case–control study, ACM-staging was performed using APWA on digital 12-lead sinus rhythm-ECGs in patients with LAA-thrombus and a propensity-score-matched control-cohort. Left atrial contractile function and thrombi were evaluated by transesophageal echocardiography (TEE). Outcome for MACCE including death was assessed using official registries and structured phone interviews. Left-atrial appendage [LAA]-thrombi and appropriate sinus rhythm-ECGs for ACM-staging were found in 109 of 4086 patients that were matched 1:1 to control patients without thrombus (218 patients in total). Both cohorts were comparable regarding cardiovascular risk factors, anticoagulants and CHA2DS2-VASC-score. ACM-stages 1 to 3 (equivalent to no, moderate and extensive ACM) were found in 63 (57.8%), 36 (33.0%) and 10 (9.2%) of patients without and 3 (2.8%), 23 (21.1%) and 83 (76.1%) of patients with LAA-thrombi. Atrial contractile function decreased from ACM-stages 1 to 3 (LAA-flow velocities 38 ± 16 cm/s, 31 ± 15 cm/s and 21 ± 12 cm/s; p < 0.0001), while the likelihood for LAA-thrombus increased (2.8%, 21.1% and 76.1%, p < 0.001). Multivariable analysis confirmed an independent odds ratio for LAA-thrombus of 24.6 (p < 0.001) per ACM-stage. Two-year survival free of stroke/TIA, hospitalization for heart failure, myocardial infarction or all-cause death was strongly reduced in ACM-stage 3 (53.8%) compared to no or moderate ACM (82.8% and 84.7%, respectively; p < 0.0001). Electrocardiographic diagnosis of ACM identifies patients with atrial contractile dysfunction and atrial thrombi at risk for adverse cardiovascular outcomes and death.https://doi.org/10.1038/s41598-021-04535-7 |
| spellingShingle | Björn Müller-Edenborn Jan Minners Cornelius Keyl Martin Eichenlaub Nikolaus Jander Sherif Abdelrazek Christoph Ahlgrim Jürgen Allgeier Heiko Lehrmann Franz-Josef Neumann Thomas Arentz Amir Jadidi Electrocardiographic diagnosis of atrial cardiomyopathy to predict atrial contractile dysfunction, thrombogenesis and adverse cardiovascular outcomes Scientific Reports |
| title | Electrocardiographic diagnosis of atrial cardiomyopathy to predict atrial contractile dysfunction, thrombogenesis and adverse cardiovascular outcomes |
| title_full | Electrocardiographic diagnosis of atrial cardiomyopathy to predict atrial contractile dysfunction, thrombogenesis and adverse cardiovascular outcomes |
| title_fullStr | Electrocardiographic diagnosis of atrial cardiomyopathy to predict atrial contractile dysfunction, thrombogenesis and adverse cardiovascular outcomes |
| title_full_unstemmed | Electrocardiographic diagnosis of atrial cardiomyopathy to predict atrial contractile dysfunction, thrombogenesis and adverse cardiovascular outcomes |
| title_short | Electrocardiographic diagnosis of atrial cardiomyopathy to predict atrial contractile dysfunction, thrombogenesis and adverse cardiovascular outcomes |
| title_sort | electrocardiographic diagnosis of atrial cardiomyopathy to predict atrial contractile dysfunction thrombogenesis and adverse cardiovascular outcomes |
| url | https://doi.org/10.1038/s41598-021-04535-7 |
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