Evaluation of the Left Atrium: Its role in atrial fibrillation and diastolic function

About this Research Topic

Background

The clinical utility of left atrial parameters has been evolving with a lot of recent interest in this area. While evaluation of left atrial size was seen to have incremental value in addition to left ventricular function assessment, particularly as a prognostic biomarker in a variety of cardiovascular conditions, more recently focus has expanded to evaluation of LA function as well.

Left atrial mechanical function is typically quantified as reservoir, conduit and contractile function and non-invasive imaging modalities including echocardiography and cardiac magnetic resonance imaging have been utilised.

Specific clinical conditions that would be significantly impacted from LA evaluation are diastolic function assessment and atrial fibrillation. Evaluation of diastolic dysfunction is important especially in patients presenting with heart failure as HFpEF is as common and with similar poor prognosis as heart failure with reduced systolic function. Non-invasive evaluation of diastolic function is typically performed using echocardiography. The 2016 diastolic function evaluation guidelines have incorporated left atrial volume as one of the 4 central markers. However, ~10% of patients have indeterminate diastolic function and the inclusion of left atrial function using strain imaging may add utility. Inclusion of left atrial metrics could improve identification of diastolic dysfunction and permit reclassification of indeterminate cases.

Atrial fibrillation is the commonest clinical arrhythmia with significant associated morbidity and mortality. Evaluation of electromechanical properties of the left atrium are useful both in patient evaluation, management as well as follow up. There are emerging data on predictors of maintaining sinus rhythm post electrophysiologic procedures. Hence a more comprehensive evaluation of various aspects of left atrial characteristics in patients with atrial fibrillation is timely.

The importance of evaluation of the left atrium has been highlighted by recent reports and the two main domains of clinical interest are those related to diastolic function assessment and of patient with atrial fibrillation.

What we would like to achieve through this research topic is to:
1) Provide a comprehensive state of the art review on evaluation of atrial phasic function and it correlation with haemodynamics.
2) Provide a second comprehensive ‘state of the art ‘ review on evaluation of a patient with or at risk of atrial fibrillation, in the context of treatment options and monitoring and surveillance of patients with AF.
3) Invite submissions of original research articles relating to evaluation of atrial dynamics and function, demonstrating clinical utility particularly in evaluation of diastolic function and atrial fibrillation.

The Research Topic special issue would comprise of 2 invited state of the art reviews as detailed above, provided by leaders in the field.

The remainder of the issue would comprise of high quality original articles that evaluate various aspects of left atrial structure and function, demonstrating it clinical utility particularly relating to diastolic function assessment, HFpEF and atrial fibrillation. The scope would cover basic, clinical and translational research areas pertaining to this topic area.

We would additionally seek to provide 2-3 editorials for submitted articles that merit such an inclusion. Once again, editorial comment will be sought from knowledgeable researchers in the field.

Keywords: Left atrium, Left atrial size, Left atrial ectromechanical function, atrial fibrillation, diastolic function

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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