High prevalence of atrial fibrosis in patients with dilated cardiomyopathy

Department of Internal Medicine, Kobe Ekisakai Hospital, Japan.

OBJECTIVES. We examined the extent of fibrotic changes in the left atrium of cardiomyopathic human hearts and investigated the relation of mechanical overload caused by left ventricular dysfunction to fibrosis of the left atrium. BACKGROUND. Left atrial dysfunction in dilated cardiomyopathy may contribute to progression of heart failure. In contrast to fibrosis of the left ventricle, atrial fibrosis has not been extensively studied in cardiomyopathic hearts. METHODS. The extent of fibrosis in the left atrium and left ventricle was determined by an automatic image analyzer in 38 autopsied hearts obtained from 9 patients who died of noncardiac illness (control group), 16 patients with dilated cardiomyopathy, 6 patients with hypertrophic cardiomyopathy with features mimicking dilated cardiomyopathy and 7 patients with a previous myocardial infarction. Transverse sections were obtained at the upper margins of the foramen ovale and left auricle in the left atrium and the median level of the left ventricle. RESULTS. There were no significant differences in extent of left atrial dilation, left ventricular dysfunction or duration of illness among the three groups with cardiac disease. Percent area of left atrial fibrosis (mean +/- SD) was significantly greater in the specimens from patients with dilated cardiomyopathy (13.1 +/- 6.1%, p < 0.01) and hypertrophic cardiomyopathy mimicking dilated cardiomyopathy (26.5 +/- 9.5%, p < 0.01) than in those from patients with an old myocardial infarction (3.8 +/- 1.1%). Percent area of left ventricular fibrosis in hearts from patients with dilated cardiomyopathy (12.9 +/- 8.6%) was significantly smaller than that in hearts from patients with hypertrophic cardiomyopathy mimicking dilated cardiomyopathy (35.8 +/- 11.9%, p < 0.01) and a previous myocardial infarction (38.4 +/- 8.0%, p < 0.01). Percent area of atrial fibrosis was significantly correlated with left ventricular ejection fraction in the group with a previous myocardial infarction but not in the other groups. CONCLUSIONS. There was a high degree of fibrotic change in the left atrium in the groups with dilated cardiomyopathy and hypertrophic cardiomyopathy mimicking dilated cardiomyopathy. Our findings suggest that atrial fibrosis in these patients may not have been related to mechanical overload of the left atrium but to some other, still unknown mechanisms.

This article has been cited by other articles:

				C. A. Goudis, E. M. Kallergis, and P. E. Vardas Extracellular matrix alterations in the atria: insights into the mechanisms and perpetuation of atrial fibrillation Europace, January 10, 2012; (2012) eur398v1. [Abstract] [Full Text] [PDF]

				J. W. Magnani, M. Rienstra, H. Lin, M. F. Sinner, S. A. Lubitz, D. D. McManus, J. Dupuis, P. T. Ellinor, and E. J. Benjamin Atrial Fibrillation: Current Knowledge and Future Directions in Epidemiology and Genomics Circulation, November 1, 2011; 124(18): 1982 - 1993. [Full Text] [PDF]

				M. M. Barbosa, M. O. C. Rocha, F. A. Botoni, A. L. P. Ribeiro, and M. C. P. Nunes Is atrial function in Chagas dilated cardiomyopathy more impaired than in idiopathic dilated cardiomyopathy? Eur Heart J Cardiovasc Imaging, September 1, 2011; 12(9): 643 - 647. [Abstract] [Full Text] [PDF]

				J. Ng, R. Villuendas, I. Cokic, J. E. Schliamser, D. Gordon, H. Koduri, B. Benefield, J. Simon, S. N. P. Murthy, J. W. Lomasney, et al. Autonomic Remodeling in the Left Atrium and Pulmonary Veins in Heart Failure: Creation of a Dynamic Substrate for Atrial Fibrillation Circ Arrhythm Electrophysiol, June 1, 2011; 4(3): 388 - 396. [Abstract] [Full Text] [PDF]

				U. Schotten, S. Verheule, P. Kirchhof, and A. Goette Pathophysiological Mechanisms of Atrial Fibrillation: A Translational Appraisal Physiol Rev, January 1, 2011; 91(1): 265 - 325. [Abstract] [Full Text] [PDF]

				F. Mayyas, M. Niebauer, A. Zurick, J. Barnard, A. M. Gillinov, M. K. Chung, and D. R. Van Wagoner Association of Left Atrial Endothelin-1 With Atrial Rhythm, Size, and Fibrosis in Patients With Structural Heart Disease Circ Arrhythm Electrophysiol, August 1, 2010; 3(4): 369 - 379. [Abstract] [Full Text] [PDF]

				G. Laurent, G. Moe, X. Hu, H. Leong-Poi, K. A. Connelly, P. P.-S. So, A. Ramadeen, L. Doumanovskaia, A. Konig, J. Trogadis, et al. Experimental studies of atrial fibrillation: a comparison of two pacing models Am J Physiol Heart Circ Physiol, March 1, 2008; 294(3): H1206 - H1215. [Abstract] [Full Text] [PDF]

				B. Burstein and S. Nattel Atrial Fibrosis: Mechanisms and Clinical Relevance in Atrial Fibrillation J. Am. Coll. Cardiol., February 26, 2008; 51(8): 802 - 809. [Abstract] [Full Text] [PDF]

				A. D'Andrea, P. Caso, S. Romano, R. Scarafile, L. Riegler, G. Salerno, G. Limongelli, G. Di Salvo, P. Calabro, L. Del Viscovo, et al. Different effects of cardiac resynchronization therapy on left atrial function in patients with either idiopathic or ischaemic dilated cardiomyopathy: a two-dimensional speckle strain study Eur. Heart J., November 2, 2007; 28(22): 2738 - 2748. [Abstract] [Full Text] [PDF]

				C.-M. Yu, F. Fang, Q. Zhang, G. W.K. Yip, C. M. Li, J. Y.-S. Chan, L. Wu, and J. W.-H. Fung Improvement of Atrial Function and Atrial Reverse Remodeling After Cardiac Resynchronization Therapy for Heart Failure J. Am. Coll. Cardiol., August 21, 2007; 50(8): 778 - 785. [Abstract] [Full Text] [PDF]

				F. Kilicaslan, A. Verma, H. Yamaji, N. F. Marrouche, O. Wazni, J. E. Cummings, S. Hao, M. W. Andrews, S. Beheiry, A. Abdul-Karim, et al. The need for atrial flutter ablation following pulmonary vein antrum isolation in patients with and without previous cardiac surgery J. Am. Coll. Cardiol., March 1, 2005; 45(5): 690 - 696. [Abstract] [Full Text] [PDF]

				P. Knaapen, R. Boellaard, M. J.W. Gotte, P. A. Dijkmans, L. M.C. van Campen, C. C. de Cock, G. Luurtsema, C. A. Visser, A. A. Lammertsma, and F. C. Visser Perfusable Tissue Index as a Potential Marker of Fibrosis in Patients with Idiopathic Dilated Cardiomyopathy J. Nucl. Med., August 1, 2004; 45(8): 1299 - 1304. [Abstract] [Full Text] [PDF]

				P. Sanders, J. B. Morton, N. C. Davidson, S. J. Spence, J. K. Vohra, P. B. Sparks, and J. M. Kalman Electrical Remodeling of the Atria in Congestive Heart Failure: Electrophysiological and Electroanatomic Mapping in Humans Circulation, September 23, 2003; 108(12): 1461 - 1468. [Abstract] [Full Text] [PDF]

				K. Shinagawa, Y.-F. Shi, J.-C. Tardif, T.-K. Leung, and S. Nattel Dynamic Nature of Atrial Fibrillation Substrate During Development and Reversal of Heart Failure in Dogs Circulation, June 4, 2002; 105(22): 2672 - 2678. [Abstract] [Full Text] [PDF]

				M. P. van den Berg, G. Tjeerdsma, P. J. de Kam, F. Boomsma, H. J.G.M. Crijns, and D. J. van Veldhuisen Longstanding atrial fibrillation causes depletion of atrial natriuretic peptide in patients with advanced congestive heart failure Eur J Heart Fail, June 1, 2002; 4(3): 255 - 262. [Abstract] [Full Text] [PDF]

				A. Goette, G. Juenemann, B. Peters, H. U. Klein, A. Roessner, C. Huth, and C. Rocken Determinants and consequences of atrial fibrosis in patients undergoing open heart surgery Cardiovasc Res, May 1, 2002; 54(2): 390 - 396. [Abstract] [Full Text] [PDF]

				K. Shinagawa, D. Li, T. K. Leung, and S. Nattel Consequences of Atrial Tachycardia-Induced Remodeling Depend on the Preexisting Atrial Substrate Circulation, January 15, 2002; 105(2): 251 - 257. [Abstract] [Full Text] [PDF]

				M.-J. Hung, C.-H. Wang, L.-T. Kuo, and W.-J. Cherng Coronary Artery Spasm-Induced Paroxysmal Atrial Fibrillation: A Case Report Angiology, August 1, 2001; 52(8): 559 - 562. [Abstract] [PDF]

				P. Jais, D. C. Shah, M. Haissaguerre, M. Hocini, J. T. Peng, A. Takahashi, S. Garrigue, P. Le Metayer, and J. Clementy Mapping and Ablation of Left Atrial Flutters Circulation, June 27, 2000; 101(25): 2928 - 2934. [Abstract] [Full Text] [PDF]

				M. Pozzoli, G. Cioffi, E. Traversi, G. D. Pinna, F. Cobelli, and L. Tavazzi Predictors of primary atrial fibrillation and concomitant clinical and hemodynamic changes in patients with chronic heart failure: a prospective study in 344 patients with baseline sinus rhythm J. Am. Coll. Cardiol., July 1, 1998; 32(1): 197 - 204. [Abstract] [Full Text] [PDF]

				F. Ouyang, S. Ernst, T. Vogtmann, M. Goya, M. Volkmer, A. Schaumann, D. Bansch, M. Antz, and K.-H. Kuck Characterization of Reentrant Circuits in Left Atrial Macroreentrant Tachycardia: Critical Isthmus Block Can Prevent Atrial Tachycardia Recurrence Circulation, April 23, 2002; 105(16): 1934 - 1942. [Abstract] [Full Text] [PDF]