title: Left atrial stiffness relates to left ventricular diastolic dysfunction and recurrence after pulmonary vein isolation for atrial fibrillation.
abstract: BACKGROUND
  An increased left atrial (LA) stiffness reflects the structural remodeling and deterioration of the LA function. This study was designed to estimate LA stiffness by measuring a combination of the strain and LA pressure in patients undergoing pulmonary vein isolation (PVI) of atrial fibrillation (AF) and to evaluate the influence of the LA stiffness on the cardiac function, serum markers, and recurrence of AF after PVI.
  
  
  METHODS
  In 155 consecutive patients with AF, the brain natriuretic peptide (BNP) and aminoterminal procollagen type III propeptide (PIIIP) plasma levels were measured before the PVI. The difference between the minimum and maximum LA systolic pressures was directly measured by a transseptal puncture. The ratio of the difference in the LA pressures to the peak systolic LA strain evaluated by speckle-tracking echocardiography was used as an index of the LA stiffness.
  
  
  RESULTS
  The calculated LA stiffness index was related to the BNP level (r(s) = 0.444, P < 0.001), E/E' ratio (r(s) = 0.444, P < 0.001), LA volume index (r(s) = 0.370, P < 0.001), and PIIIP level (r(s) = 0.305, P = 0.002). During a mean follow-up period of 33.8 ± 12.2 months, 45 patients (29%) presented with AF recurrences. A Cox proportional hazard regression analysis showed the LA stiffness index was an independent predictor of recurrence of AF (HR 2.88; 95% CI 1.75 to 4.73, P < 0.001).
  
  
  CONCLUSIONS
  In patients with AF, the LA stiffness index is related to left ventricular diastolic dysfunction, LA dilatation, and collagen synthesis and may predict AF recurrences after PVI.
authors: Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba Graduate School of Comprehensive Human Sciences, Tsukuba, Ibaraki, Japan.
authors: Tomoko
authors: T
authors: Machino-Ohtsuka
authors: Yoshihiro
authors: Y
authors: Seo
authors: Hiroshi
authors: H
authors: Tada
authors: Tomoko
authors: T
authors: Ishizu
authors: Takeshi
authors: T
authors: Machino
authors: Hiro
authors: H
authors: Yamasaki
authors: Miyako
authors: M
authors: Igarashi
authors: Dongzhu
authors: D
authors: Xu
authors: Yukio
authors: Y
authors: Sekiguchi
authors: Kazutaka
authors: K
authors: Aonuma
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D016279:Atrial Function, Left / Q000502:physiology*; D017115:Catheter Ablation / Q000379:methods; D003971:Diastole / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000502:physiology*; D012008:Recurrence; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology*