Aims: Left atrial (LA) volume and LA epicardial fat are both substrates for atrial fibrillation (AF), but may relate with AF at different (early vs. late) stages in the AF disease process. We... Show moreAims: Left atrial (LA) volume and LA epicardial fat are both substrates for atrial fibrillation (AF), but may relate with AF at different (early vs. late) stages in the AF disease process. We evaluated associations between LA epicardial fat and LA volume in patients with sinus rhythm (SR), paroxysmal AF (PAF), and persistent/permanent AF. Methods and results: In total, 300 patients (100 with SR, 100 with PAF, and 100 with persistent/permanent AF) who underwent cardiac computed tomography angiography (CTA) were included. The epicardial fat mass posterior to the LA and the LA volume were quantified from CTA and compared between patients with SR, PAF, and persistent/permanent AF. Furthermore, four groups were created by classifying LA epicardial fat and LA volume into large or small according to their median. The mean age of the population was 58.9 +/- 10.5 years and 69.7% was male. Left atrial epicardial fat mass was larger in patients with PAF compared with SR, but did not further increase from PAF to persistent/permanent AF. Left atrial volume increased significantly from SR to PAF and to persistent/permanent AF. Left atrial epicardial fat and LA volume were both concordantly large or small in 184 (61%) patients, and discordant in 116 (39%). When both were small, 65.2% of the patients had SR, 23.9% PAF, and 10.9% persistent/permanent AF. When the LA epicardial fat mass was large and the LA volume small (compared with both being small), patients were significantly more often in PAF (55.2 vs. 23.9, P < 0.05), less frequently in SR (32.8% vs. 65.2%, P < 0.05) but showed comparable rates of persistent/permanent AF (12.0% vs. 10.9%, P < 0.05). When the LA volume was large, most patients had persistent/permanent AF. Conclusion: Left atrial epicardial fat mass was larger in PAF vs. SR, possibly indicating a marker of early disease, while large LA volumes were associated with a high prevalence of persistent/permanent AF. Elevated LA epicardial fat mass without large LA volume may reflect the early AF disease process. Show less
Kim, M.; Lee, S.P.; Kwak, S.; Yang, S.; Kim, Y.J.; Andreini, D.; ... ; Chang, H.J. 2021
Background: The association of age with coronary plaque dynamics is not well characterized by coronary computed tomography angiography (CCTA).Methods: From a multinational registry of patients who... Show moreBackground: The association of age with coronary plaque dynamics is not well characterized by coronary computed tomography angiography (CCTA).Methods: From a multinational registry of patients who underwent serial CCTA, 1153 subjects (61 +/- 5 years old, 61.1% male) were analyzed. Annualized volume changes of total, fibrous, fibrofatty, necrotic core, and dense calcification plaque components of the whole heart were compared by age quartile groups. Clinical events, a composite of all-cause death, acute coronary syndrome, and any revascularization after 30 days of the initial CCTA, were also analyzed. Random forest analysis was used to define the relative importance of age on plaque progression.Results: With a 3.3-years' median interval between the two CCTA, the median annual volume changes of total plaque in each age quartile group was 7.8, 10.5, 10.8, and 12.1 mm(3)/year and for dense calcification, 2.5, 4.6, 5.4, and 7.1 mm(3)/year, both of which demonstrated a tendency to increase by age (p-for-trend = 0.001 and < 0.001, respectively). However, this tendency was not observed in any other plaque components. The annual volume changes of total plaque and dense calcification were also significantly different in the propensity score-matched lowest age quartile group versus the other age groups as was the composite clinical event (log-rank p = 0.003). In random forest analysis, age had comparable importance in the total plaque volume progression as other traditional factors.Conclusions: The rate of whole-heart plaque progression and dense calcification increases depending on age. Age is a significant factor in plaque growth, the importance of which is comparable to other traditional risk factors. Show less
Transcatheter aortic valve replacement (TAVR) is a safe and efficient alternative for surgical valve aortic replacement in patients with symptomatic severe aortic stenosis who are inoperable or... Show moreTranscatheter aortic valve replacement (TAVR) is a safe and efficient alternative for surgical valve aortic replacement in patients with symptomatic severe aortic stenosis who are inoperable or have a high risk for surgery. Randomised clinical trials have shown that TAVR is not inferior to surgical aortic valve replacement in intermediate-risk patients and ongoing trials will demonstrate the effects of TAVR in asymptomatic severe aortic stenosis patients and in patients with heart failure and moderate aortic stenosis. Continuous developments in procedural and post-procedural management along with increased operator experience and technical improvements and ongoing advances in imaging modalities (particularly in three-dimensional techniques), have reduced the procedural risks and the incidence of complications such as paravalvular aortic regurgitation. Importantly, proper selection of both patient and prosthesis, procedural guidance and follow-up of prosthesis performance remain paramount for the success of the TAVR. In all these steps, echocardiography plays a crucial role. An overview of the clinical applications and current role of echocardiographic techniques in patient selection, prosthesis sizing, periprocedural guidance and postprocedural follow-up will be provided in this review article. Show less
