Atrial Mechanical Function Research Articles

The Effect of Training Experience on Cardiac Morphology in Resistance Exercise Practitioners: A Study on Left Ventricular Systolic and Diastolic Parameters and Left Atrium Mechanical Functions

Background and Objectives: Resistance exercises (REs) are a type of physical activity that individuals from many age groups have been doing recreationally, both as amateurs and professionally, in their daily lives in recent years. It is crucial to understand the effects of such sports on cardiac morphology in order to maximize the benefit of training and to tailor the training content accordingly. The aim of this study was to investigate the relationship between training experience (TE) and left ventricular (LV) systolic and diastolic parameters and left atrial (LA) mechanical function in healthy subjects who regularly performed RE for different durations. Materials and Methods: Forty-five healthy adults [age = 28.91 ± 10.30 years, height = 178.37 ± 5.49 cm, weight = 83.15 ± 13.91 kg, body mass index = 26.03 ± 3.42 kg/m2, TE = 7.28 ± 6.49 years] who performed RE between 1 year and 20 years were included in our study. The transthoracic echocardiograms (ECHOs) of the participants were evaluated by the cross-sectional research method, which is often used to understand the current situation in a given time period. Correlations between TE and LV systolic and diastolic parameters and LA mechanical function were analyzed. Results: As a result, interventricular septal thickness (IVS; r = 0.33, p = 0.028), the aortic diameter systole (ADs; r = 0.56, p < 0.001), and aortic diameter diastole (ADd; r = 0.58, p < 0.001) were positively correlated with TE, indicating associations with increased left ventricular (LV) hypertrophy and reduced ventricular compliance, while the aortic strain (AS; r = −0.44, p = 0.002), aortic distensibility (AD; r = −0.62, p < 0.001), and diastolic flow parameters including E (r = −0.41, p = 0.005), E/A (r = −0.38, p = 0.011), and E/Em (r = −0.31, p = 0.041) were negatively correlated with TE, reflecting impairments in diastolic function. Conclusions: This study showed that diastolic parameters were adversely affected in chronic RE. Therefore, we think that these individuals may have decreased relaxation and filling functions of the heart, which may also reduce adequate oxygen and nutrient delivery to the tissues. In this context, cohort studies are needed to analyze in detail the reasons for the decrease in diastolic parameters in these individuals.

Left atrial functional changes associated with repeated catheter ablations for atrial fibrillation.

The impact of repeated atrial fibrillation (AF) ablations on left atrial (LA) mechanical function remains uncertain, with limited long-term follow-up data. This retrospective study involved 108 AF patients who underwent two catheter ablations with cardiac magnetic resonance imaging (MRI) done before and 3 months after each of the ablations from 2010 to 2021. The rate of change in peak longitudinal atrial strain (PLAS) assessed LA function. Additionally, a sub-study of 36 patients who underwent an extra MRI before the second ablation, gave us an additional time segment to evaluate the basis of change in PLAS. In the two-ablation, three MRI sub-study 1, the PLAS percent change rate was similar before and after the first ablation (r11 = -0.9 ± 3.1%/year, p = 0.771). However, the strain change rate from postablation 1 to postablation 2 was significantly worse (r12 = -23.7 ± 4.8%/year, p < 0.001). In the sub-study 2 with four MRIs, all three rates were negative, with reductions from postablation 1 to pre-ablation 2 (r22 = -13.3 ± 2.6%/year, p < 0.001) and from pre-ablation 2 to postablation 2 (r23 = -8.9 ± 3.9%/year, p = 0.028) being significant. The present study suggests that the more ablations performed, the more significant the decrease in the postablation mechanical function of the LA. The natural progression of AF (strain change from postablation 1 to pre-ablation 2) had a greater negative influence on LA mechanical function compared to the second ablation itself suggesting that second ablation in patients with recurrence after first ablation is an effective strategy even from the LA mechanical function aspect.

Echocardiographic associates of impaired sleep quality in patients with anxiety and depression

Abstract Objective Sleep health, mental health and cardiovascular health are multidimensional constructs that are strongly associated with each other. Anxiety and depression are the most common psychiatric diseases in the community and frequently comorbid in routine clinical practice. This study sought to investigate whether there is an association between sleep quality and echocardiographic parameters in patients with anxiety and/or depression. Methods The clinical and instrumental find­ings of consecutive patients diagnosed with either of anxiety disorders and/or depressive disorders and underwent cardiac examination in our tertiary center on the same day were retrospectively reviewed. The diagnosis was made by a psychiatrist according to the criteria listed in the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders. Afterwards, Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) were applied to patients to assess symptom severity and sleep quality, respectively. Subsequent to psychiatric examination, the patients underwent echocardiographic examination that includes two-dimensional conventional echocardiography, tissue doppler imaging (TDI) echocardiography, atrial conduction times, and left atrium (LA) volumes and functions. Results The final study population consisted of 167 patients and divided into two groups according to their PSQI score: PSQI&amp;lt;5 (normal sleep quality) (n=32) and PSQI≥5 (impaired sleep quality) (n=135). Aortic diameter, left ventricular (LV) end-systolic diameter, LV end-diastolic and -systolic volume, LV stroke volume and LV stroke volume index, LV outflow tract velocity–time integral (LVOT-VTI), and LA conduit volume calculations were significantly lower in patients with impaired sleep quality compared to patients with normal sleep quality. The other echocardiographic parameters including LV systolic functions, doppler and TDI echocardiography indices, atrial conduction times, atrial mechanical functions including LA function index (LAFI) were similar among groups. Correlation analysis yielded a negative, weak but statistically significant correlation between LAFI and PSQI score (r=-0.17, p=.030) (Figure 1A). Left intra-AEMD positively and significantly correlated with PSQI score at a weak level (r=0.16, p=.043) (Figure 1B). Aortic diameter, LV stroke volume index, LVOT-VTI and conduit volume were determined as echocardiographic parameters significantly associated with impaired sleep quality in univariate analysis. Among these parameters, only conduit volume remained as significant and independent associate of impaired sleep quality in multivariate logistic regression analysis (Odds ratio:0.91, 95% Confidence interval:0.85-0.98, p=.018) (Table 1). Conclusion There is an independent association between LA conduit volume and impaired sleep quality in patients suffering from anxiety and/or depressive disorders.Figure 1Table 1

Evaluation of Left Atrial Electromechanical Delay and Left Atrial Phasic Functions in Patients Undergoing Treatment with Cardiotoxic Chemotherapeutic Agents.

Background: The aim of this study is to evaluate atrial involvement by comparing pre- and post-chemotherapy left atrial mechanical and electromechanical parameters in patients treated with cardiotoxic chemotherapeutic agents. Methods: We designed our study as a prospective cohort study. Sixty-eight female patients between the ages of 18 and 50, scheduled for treatment with cardiotoxic chemotherapeutic agents, were included in our study. Atrial mechanical functions and electromechanical parameters were examined and compared with basic echocardiographic parameters before and after chemotherapy. Results: The mean age of the patients was 41.6 ± 7.9 years. After chemotherapy, lateral PA, septal PA, and tricuspid PA durations showed a significant increase (p < 0.001), but there were no statistically significant changes in the left intra-atrial electromechanical delay, the right intra-atrial electromechanical delay, or the interatrial electromechanical delay values. Following treatment, LAVmax, LAVmin, and LApreA significantly increased (p < 0.001). Additionally, the left atrial passive and active emptying volumes increased (p < 0.001), while the reservoir and pump (active emptying) functions decreased (with p-values of 0.03 and 0.01, respectively). The passive emptying function, however, showed no significant change (p = 0.65). Decreases in LVEF were observed, while LVEDD, LVESD, IVS, PW, and LA diameters increased (p-value of 0.02 for IVS and <0.001 for the others). Conclusions: Significant impairment of atrial mechanical functions and electromechanical parameters was observed after treatment with cardiotoxic chemotherapeutic agents. This suggests an elevated likelihood of atrial arrhythmia linked to the use of cardiotoxic chemotherapeutic agents.

Investigation of left atrial mechanical function and left ventricular systolic and diastolic parameters in athletes performing resistance exercise and combined exercise

Some individuals who go to fitness centers for various purposes perform resistance exercise (RE) alone, while others engage in combined exercise (CE) by including cardio exercises along with RE. Studying the effects of these two different training methods on left ventricular (LV) systolic and diastolic parameters and left atrial mechanical function is an important step toward understanding the effects of different types of exercise on cardiac function. This knowledge has significant implications for public health, as it can inform the development of targeted and effective exercise programs that prioritize cardiovascular health and reduce the risk of adverse outcomes. Therefore, the primary aim of this study is to comprehensively investigate the LV systolic and diastolic parameters of athletes who engage in RE and CE using ECHO, to contribute to the growing body of literature on the cardiovascular effects of different types of exercise. Forty-two amateur athletes aged between 17 and 52 were included in our study. The participants consisted of the RE (n = 26) group who did only resistance exercise during the weekly exercise period, and the CE group (n = 16) who also did cardio exercise with resistance exercises. After determining sports age (year), weekly exercise frequency (day), and training volume (min) in addition to demographic information of RE and CE groups, left ventricular systolic and diastolic parameters and left atrial functions were determined by ECHO. Findings from our study revealed that parameters including the left ventricular end-diastolic diameter (LVEDD) (p = .008), left ventricular end-diastolic volume (LVEDV) (p = .020), stroke volume index (SV-I) (p = .048), conduit volume (CV-I) (p = .001), and aortic strain (AS) (p = .017) were notably higher in the RE group compared to the CE group. Also left atrial active emptying volüme (LAAEV) of CE was higher than the RE group (p = .031). In conclusion, the cardiac parameters of the RE group showed more athlete’s heart characteristics than the CE group. These results may help to optimize the cardiovascular benefits of exercise routines while minimizing the potential risks associated with improper training.

Ablation-induced left atrial mechanical dysfunction recovers in weeks after ablation.

The immediate impact of catheter ablation on left atrial mechanical function and the timeline for its recovery in patients undergoing ablation for atrial fibrillation (AF) remain uncertain. The mechanical function response to catheter ablation in patients with different AF types is poorly understood. A total of 113 AF patients were included in this retrospective study. Each patient had three magnetic resonance imaging (MRI) studies in sinus rhythm: one pre-ablation, one immediate post-ablation (within 2days after ablation), and one post-ablation follow-up MRI (≤ 3months). We used feature tracking in the MRI cine images to determine peak longitudinal atrial strain (PLAS). We evaluated the change in strain from pre-ablation, immediately after ablation to post-ablation follow-up in a short-term study (< 50days) and a 3-month study (3months after ablation). The PLAS exhibited a notable reduction immediately after ablation, compared to both pre-ablation levels and those observed in follow-up studies conducted at short-term (11.1 ± 9.0days) and 3-month (69.6 ± 39.6days) intervals. However, there was no difference between follow-up and pre-ablation PLAS. The PLAS returned to 95% pre-ablation level within 10days. Paroxysmal AF patients had significantly higher pre-ablation PLAS than persistent AF patients in pre-ablation MRIs. Both type AF patients had significantly lower immediate post-ablation PLAS compared with pre-ablation and post-ablation PLAS. The present study suggested a significant drop in PLAS immediately after ablation. Left atrial mechanical function recovered within 10days after ablation. The drop in PLAS did not show a substantial difference between paroxysmal and persistent AF patients.

Assessment of Bi-Atrial Mechanical Function in Patients with Isolated Atrial Septal Aneurysm.

Atrial mechanical dysfunction may be an alternative mechanism underlying the increased risk of systemic embolism in patients with atrial septal aneurysm (ASA). This study aimed to evaluate left atrial (LA) and right atrial (RA) function using two-dimensional speckle tracking echocardiography (2D STE) in patients with isolated ASA. Fifty-four patients with ASA (mean age 50.3 ± 12.48, 37% male) and 48 healthy individuals of similar age and gender (mean age 48.3 ± 10.84, 39.6% male) were included in the study. To assess atrial mechanical function, measurements of left and right atrial reservoir strain (RS), peak contraction strain (PCS), and conduit strain (CS) were conducted using 2D STE, in addition to conventional evaluation with transthoracic echocardiography. LA RS and PCS values were significantly lower in the ASA group than in the controls (37.52 ± 2.89 vs. 40.16 ± 2.68%, P < 0.001 and 17.29 ± 2.5 vs. 19.18 ± 2.23%, P < 0.001, respectively). Similarly, RA RS and RA PCS were significantly lower in patients with ASA (36.97 ± 2.19 vs. 39.77 ± 2.36%, P < 0.001 and 16.78 ± 2.10 vs. 18.54 ± 2.43%, P < 0.001, respectively). A multivariate regression analysis revealed a strong independent association between ASA and the measures LA RS, LA PCS, RA RS, and RA PCS. Our findings indicate that bi-atrial function are diminished in patients with isolated ASA. This may be a possible cause for the increased risk of arterial embolism in this patient group, aside from atrial arrhythmias and patent foramen ovale. Validating these results with larger studies may influence the treatment and follow-up strategies for patients with isolated ASA.

Contribution of TNF-R1 to reduced exercise capacity in hypertensive heart disease. Mediating role of left atrial mechanical function reserve

Abstract Background Tumor necrosis factor alpha (TNF-alpha) plays a relevant pathophysiological role in cardiovascular disorders, including hypertensive heart disease (HHD) – a clinical condition frequently contributing to the development of heart failure with preserved ejection fraction (HFpEF). TNF receptor 1 (TNF-R1) has been found to mediate proinflammatory and proapoptotic effects of TNF-alpha, and its soluble circulating form proved to be effective in predicting incident HF. Existing evidence indicates the association between TNF pathways activation and cardiac dysfunction, but exact mechanisms mediating this link are unclear. Objectives We sought to investigate the association of TNF-R1 with exercise capacity, and left ventricular (LV) and left atrial (LA) function reserve in asymptomatic patients with HHD. Methods We enrolled 80 (55±12 yo) patients with HHD and normal exercise tolerance (stage A and B HF). Echocardiography (including LA and LV strain assessment) was performed at rest and immediately post exercise test. Blood samples for TNF-R1 were drawn in fasting conditions. Exercise reserve of cardiac function parameters was calculated by subtracting resting value from exercise value. Results The study population was categorized into 2 subsets using a median value of exercise capacity (9.2 METs). Patients with higher exercise capacity were characterized by lower TNF-R1 concentrations and higher LA reservoir and LA contractile strain reserves (Table). No significant intergroup differences were found for exercise reserves in LV ejection fraction (LVEF), LV global longitudinal strain and diastolic parameters (e’ and E/e’). TNF-R1 significantly correlated with peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) reserves (r=-0.27; p&amp;lt;0.02 and r=-0.24; p&amp;lt;0.04, respectively), but not with LVEF, global longitudinal strain (GLS), e’ and E/e’ reserves. Regression-based mediation analysis revealed that the relationships between TNF-R1 and exercise capacity were mediated by PALS and PACS reserve, as evidenced by the reduction in variance of exercise capacity (METs) explained by TNF-R1 after the inclusion of PALS and PACS reserve to the models (decrease in beta coefficient from -0.24 to -0.19 for PALS, and to -0.20 for PACS, Figure). Conclusions In patients with HHD, higher TNF-R1 is associated with lower exercise capacity, and this relationship may be mediated by lower LA strain reserve. This finding may contribute to elucidating the mechanisms behind the involvement of the left atrium in HF progression.Mediation analysis

Left Atrial Mechanical Function And Stiffness In Patients With Premature Ventricular Contraction: A Speckle Tracking Study.

Ventricular extrasystole (PVC) is characterized by premature ventricular depolarization and is associated with increased risk of arrhythmias and structural heart disease. This study aimed to investigate the association between the PVC burden and left atrial (LA) function in individuals without known cardiac disease. A cross-sectional study was conducted on 102 patients with PVCs who were admitted to a cardiology clinic. Transthoracic echocardiography was used to assess left ventricle (LV) parameters, including LV mass, LV ejection fraction (LVEF), LV global longitudinal strain (LVGLS), and LA function was evaluated using strain imaging. The PVC burden was categorized into three groups: &lt;10 %, 10-20 %, and &gt;20 %. Changes in LV dimensions and LV mass index were associated with the groups with the PVC burden with 10-20 %, and &gt;20 %. but differences in LVEF and LVGSL were not significant. Mean E / e' increased as the PVC burden increased (p&lt;0.001). The mean global LA peak strain decreased as the PVC burden increased (p&lt;0.001), while other mean LA measurements increased as the PVC burden increased (p&lt;0.001) A higher PVC burden was associated with impaired LA function, as indicated by decreased global LA peak strain (PVC burden &lt;10 %=38.1±3.2 vs. PVC burden 10-20 %=32.4±3.2 vs. PVC burden &gt;20 %=27.7±2.6, in all groups p&lt;0.001) and with increased LA stiffness (PVC burden &lt;10 %=18.6±3.2 vs. PVC burden 10-20 %=27.5±5.5 vs. PVC burden &gt;20 %=39.0±7.9, in all groups p&lt;0.001). A strong negative correlation was found between global LA peak strain and LA stiffness (r=-0.779, p&lt;0.001). In individuals without known cardiac disease, a higher PVC burden was associated with impaired LA function, indicated by increased E / e', decreased LA strain, and increased LA stiffness. These findings suggest that PVC burden may contribute to LA dysfunction, potentially increasing the risk of cardiovascular events.

The insufficiency of recreational exercises in improving cardiovascular fitness: an investigation of ventricular systolic and diastolic parameters and left atrial mechanical functions

AimThis study aimed to compare the left ventricular (LV) systolic and diastolic parameters and left atrial (LA) mechanical functions of individuals engaging in recreational sports and resistance exercises on a weekly basis.MethodsA total of 43 male amateur athletes were included in this study, of which 24 performed resistance exercises (REs) (29.70 ± 8.74 year, weight: 81.70 ± 12.64 kg, height: 176.05 ± 7.73 cm, BMI: 27.64 ± 4.97 kg/m2), and 19 participated in recreational football training and were included in the recreational sports group (31.73 ± 6.82 year, weight: 86.00 ± 18.52 kg, height: 178.62 ± 4.95 cm, BMI: 25.55 ± 3.42 kg/m2). The exercises were standardized according to the weekly exercise frequency and volume. After recording the participants’ demographic information, the LV systolic and diastolic parameters and LA mechanical functions were measured using echocardiography (ECHO) and Tissue Doppler Imaging.ResultsSignificant differences were observed in various cardiac parameters between the recreational sports group (REG) and resistance exercise Group (RSG). Specifically, the left ventricular (LV) diastolic diameter, LV end diastolic volume index (LVEDVi), and stroke volume index were notably higher in the REG compared to the RSG (t = 2.804, p = .010, effect size (ES) = 2.10; t = 3.174, p = .003, ES = 0.98; t = 3.36, p = .002, ES = 1.02, respectively). Notably, the RSG exhibited higher values for LV mass index (LVMi) and isovolumic relaxation time (IVRT) than the REG (t = 2.843, p = .007, ES = 0.87; t = 2.517, p = .016, ES = 0.76) in terms of LV systolic and diastolic parameters. Regarding left atrial (LA) mechanics, the REG demonstrated increased LA total emptying volume index, LA maximum volume index, LA volume before systole measured at the onset of the p-wave index, and conduit volume index compared to RSG (t = 2.419, p = .020, ES = 0.75; t = 2.669, p = .011, ES = 0.81; t = 2.111, p = .041, ES = 0.64; t = 2.757, p = .009, ES = 0.84, respectively).ConclusionOur study revealed significant variations in LV and LA functions between REG and RSG. Our data suggest that REs led to substantial cardiac remodeling, altering myocardial structure and function. In contrast, the effect of recreational exercise on cardiac adaptation was less pronounced than that of resistance exercise. Consequently, we propose that individuals engaging in recreational exercise should consider modalities that impose higher cardiovascular demand for more effective cardiac conditioning.

Role of reduced left atrial mechanical function reserve in exercise intolerance progression in hypertensive heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Background The identification of mechanisms in hypertensive heart disease (HHD) that favor the development of symptomatic heart failure (HF) is essential. Little is known about the role of left atrial (LA) mechanical response to exertion in this context. Objectives We sought to investigate the association of LA strain parameters response to exercise with functional capacity and symptomatic HF in a representative group with HHD. Methods Echocardiography (including LA strain and strain-derived LA stiffness index assessment) was performed at rest and immediately post exercise test in 61 patients with stage A, 67 patients with stage B and 73 patients with stage C HF. Results There was a progressive worsening of exercise capacity from stage A through stage B to stage C, which was accompanied by a gradual impairment of changes from rest to exercise in LA reservoir and contractile strain, whereas LA stiffness reserve remained unchanged until the HF stage C (Table). In multivariable analysis including LA and left ventricular reserve and clinical variables, changes from rest to exercise in LA reservoir strain and mitral annular e’ (both beta 0.16, SE 0.07, p = 0.02) were the only cardiac function parameters independently correlating with exercise capacity. However, LA stiffness reserve and E/e’ were the strongest associations of symptomatic HF stage C (Akaike information criterion 111.6 and 101.1, respectively). Conclusions LA reservoir strain and LA stiffness exercise reserves are among the mediators of reduced functional capacity in HHD, however the trajectories of changes of these parameters are not parallel. While LA strain reserve progressively deteriorates across HF stages, a marked impairment in LA stiffness reserve can only be seen in patients with HF symptoms. This suggests a potential role for these parameters in stratifying the risk of progression to overt HF in HHD.

Hypertensive Heart Disease-The Imaging Perspective.

Hypertensive heart disease (HHD) develops in response to the chronic exposure of the left ventricle and left atrium to elevated systemic blood pressure. Left ventricular structural changes include hypertrophy and interstitial fibrosis that in turn lead to functional changes including diastolic dysfunction and impaired left atrial and LV mechanical function. Ultimately, these changes can lead to heart failure with a preserved (HFpEF) or reduced (HFrEF) ejection fraction. This review will outline the clinical evaluation of a patient with hypertension and/or suspected HHD, with a particular emphasis on the role and recent advances of multimodality imaging in both diagnosis and differential diagnosis.

ETIOLOGICAL PROFILE OF PATIENTS WITH ATRIAL FIBRILLATION WITH SPECIAL REFERENCE TO VALVULAR HEART DISEASES.

Background : Atrial brillation is the most commonly encountered quivering or irregular heart beat(arrhythmia) in our population and it is the disordered supraventricular (atrial) event characterised by irregular heart rhythm, thereby altered atrial electrical and mechanical function. Atrial brillation often inuences the quality of life as atrial brillation may be associated with disability, anxiety, cognitive impairment, chest pain, hospitalization and even absence from work. Many diseases have been implicated to the development of atrial brillation; amongst which Rheumatic valvular heart disease, systemic hypertension, ischemic heart disease, thyroid disease is very important. Alcohol and smoking add up to risk factors leading to development of atrial brillation. Although various studies had been reported from different parts of the country, not much clinical data is available on etiological and clinical prole of Atrial fribillation in north eastern part of the country hence this study has been undertaken. In this Hospital ba Materials and Methods: sed observational Study conducted in the department of Medicine, Jorhat Medical College and Hospital, Jorhat, Assam among 90 patients etiology of valvular and non-valvular atrial brillation was taken into account. In our study, mean age of study populat Results: ion was 46.5±5.09 years, for valvular etiology mean age 34.8± 2.05 years, for non valvular mean age 51.64± 3.08 years. 55.57% of study population were males, 44.43% were females. Valvular atrial brillation was found in 30% cases, non valvular etiology found in 70% cases.

Mechanical function of the left atrium within 28 days after restoration of sinus rhythm in patients with paroxysmal atrial fibrillation

Objective: Atrial fibrillation is a strong independent risk factor for cardioembolic stroke, with a significant impact on morbidity, mortality and healthcare costs. The aim of our study is to investigate left atrial mechanical function in healthy subjects and patients with atrial fibrillation paroxysms less than 48 hours with low risk of thromboembolic complications at 1 and 28 days after restoration of sinus rhythm. Methods: Thirty-six healthy controls and patients with paroxysms of non-valvular atrial fibrillation less than 48 hours (n=25) with low-risk CHA2DS2VASc score were included in the study. The mechanical function of the left atrium (LA) was investigated by the 2D speckle tracking program. Transthoracic echocardiography was performed on the 1st and 28th days after restoration of sinus rhythm by pharmacological cardioversion. Results: Despite the absence of differences in left ventricular systolic function and LA size between the groups, there was a significant decrease in LA deformation and strain rate on day 1 immediately after sinus rhythm recovery in the patients. In the pump phase, the decrease was about 3%, reservoir phase – 10%, and conduit phase – 7% compared to the control group. The strain rate also decreased in the patient group: -1.5 s-1 versus control: -2.14 s-1 (p&amp;lt;0.0001). On the 28th day after restoration of sinus rhythm, there were significant changes in reservoir and conduit functions in patients group in comparison with control group. Global longitudinal LA strain (reservoir phase) decreased to 7%, conduit phase decreased to 11% compared with the control group. In patients group we can see the dynamics during 28 days: pump phase and strain rate were significantly improved, however reservoir and conduit did not significantly change and were lower than in healthy. Conclusion: Mechanical function of the LA in patients with non-valvular atrial fibrillation and low risk of thromboembolic complications, studied with speckle tracking on the first day was significantly impaired compared with the control group (reservoir phase and strain rate). By day 28, mechanical function improved compared to day 1, but reservoir phase remained significantly lower than normal.

Left atrial strain quantified after myocardial infarction is associated with early left ventricular remodeling.

Left ventricular remodeling (LVR) is common and associated with adverse outcome after ST-elevation myocardial infarction (STEMI). We aimed to investigate the association between left atrial (LA) mechanical function using speckle tracking imaging and early LVR at follow-up in STEMI patients. Baseline 3D thoracic echocardiograms were performed within 48h following admission and at a median follow-up of 7 months after STEMI. A>20% increase in the left ventricular (LV) end-diastolic volume compared to baseline at follow-up was defined as LVR. LA global longitudinal strain was evaluated for the reservoir, conduit, and contraction (LASct) phases. A total of 121 patients without clinical heart failure (HF) were prospectively included, between June 2015 and October 2018 (age 58.3±12.5 years, male 98 (81%)). Baseline and follow-up LV ejection fraction (LVEF) were 46.8% [41.0, 52.9] and 52.1% [45.8, 57.0] respectively (p<.001). Compared to other patients, those with LVR had significantly lower values of LASct at baseline(-7.4% [-10.1, -6.5] vs. -9.9% [-12.8, -8.1], p<.01), both on univariate and baseline LV volumes-adjusted analyses. Baseline LA strain for reservoir and conduit phases were not associated with significant LVR at follow-up. Intra- and interobserver analysis showed good reproducibility of LA strain. Baseline LASct may help identifying patients without HF after STEMI who are at higher risk of further early LVR and subsequent HF and who may benefit from more intensive management.

Abstract 9757: Real World Experience With Anticoagulation in Atrial Fibrillation Patients After Pulmonary Vein Isolation: Associations With Cha 2 Ds 2 -vasc Score, Sex and Maintenance of Sinus Rhythm

Background: Guidelines recommend using the CHA 2 DS 2 -VASc score to determine anticoagulation decisions in atrial fibrillation (AF) patients, including those who undergo pulmonary vein isolation (PVI), however this may not consistently occur in the real-world setting because of other clinical factors. We sought to evaluate the anticoagulation prescription patterns in AF patients 1 year PVI at our institution. Methods: Consecutive AF patients undergoing PVI in our prospective registry during 2014-2018 who were alive at 1-year post-PVI were studied. Anticoagulation prescription rates at this time-point were adjudicated, and correlated to CHA 2 DS 2 -VASc score, sex and maintenance of normal sinus rhythm (NSR) at 1 year. Results: Amongst 4596 patients undergoing PVI, mean age was 64.1±10.0 years, 3308 (71.2%) were male, and based on CHA 2 DS 2 -VASc Score anticoagulation was not indicated, can be considered and indicated in 872 (19.0%), 1183 (25.7%) and 2541 (55.3%) patients respectively. At 1-year after PVI, 3504 (76.2%) patients were on anticoagulation, and 792 (17.2%) had recurrence of AF. Anticoagulation rates by sex, CHA 2 DS 2 -VASc Score category and NSR at 1-year after PVI are illustrated in the Figure. Anticoagulation was continued in over half of AF patients without classic CHA 2 DS 2 -VASc indication particularly in those with AF recurrence and women, while they were mildly under-prescribed in those with indication, especially for those without AF recurrence and men. Conclusion: In a large real world cohort of patients post PVI, anticoagulation is prescribed independent of CHA 2 DS 2 -VASc score, and is affected by both sex and NSR status. Factors determining continuous anticoagulation after successful PVI may include parameters not covered in the CHA 2 DS 2 -VASc score such as return of atrial mechanical function on echocardiography, valve disease or extra-cardiac pathologies.

Impact of empagliflozin on left atrial mechanical and conduction functions in patients with type 2 diabetes mellitus.

Empagliflozin, an oral anti-diabetic drug that inhibits the sodium-dependent glucose co-transporter 2 (SGLT2), has pleiotropic effects on the myocardium. The aim of the study is to investigate the effect of empagliflozin on atrial electromechanical delay (AEMD) and the left atrial (LA) mechanical functions in patients with type 2 diabetes mellitus (DM). In total 62 patients (40.3% female, mean age 50.5 ± 8.6 years old) with type 2 DM were enrolled to the study. Participants were used a SGLT2 inhibitor (empagliflozin 10-25 mg/daily) for 6months. Patients were examined initially and after 6 months with echocardiography. LA volume was recorded, atrial conduction times were measured using tissue Doppler imaging (TDI). No significant change was observed in LA volumes (maximal, minimal, and presystolic), total emptying and passive emptying volume at the end of 6months; however, there was a significant decrease in active emptying volume (8.3 ± 2.9ml/m2 vs. 7.9 ± 2.9ml/m2 , p=0.04). The posteroanterior lateral, septal, and tricuspid conduction times significantly decreased after the empagliflozin treatment. The decrease in right inter-AEMD was statistically significant (13.25 ± 10.21 ms vs. 10.85 ± 9.14 ms, p=0.011). The changes in inter-AEMD were found to be correlated with the changes in LA active emptying volume (r=0.408). Empagliflozin may enhance the structure and electrical conductions of the atrium and may prevent DM patients from DM-2-related functional disorder and arrhythmia.

Clinical Utility of Left Atrial Asynchrony and Mechanical Function in Patients with Hypertrophic Cardiomyopathy.

The aim of this study was to examine whether left atrial dispersion and left atrial strain as measured by speckle tracking echocardiography and clinical parameters are predictors of the development of atrial fibrillation in patients with hypertrophic cardiomyopathy. A total of 151 patients (69% male, mean age 48.9 ± 14.2 years) with hypertrophic cardiomyopathy were included in the study. The patients' demographic, clinical, electrocardiographic, 2-dimensional classic and speckle tracking echocardiographic data were collected. Atrial fibrillation was identified by 12-lead electrocardiograms or 24-72 hours of Holter recordings during the follow-up period. Atrial dispersion was defined as the standard deviation of time to peak strain in 12 left atrial segments. During the follow-up period, 40 patients (26%) developed atrial fibrillation. Peak atrial longitudinal strain (16.8 ± 6 vs. 22.1 ± 6.6, p ≤ 0.001) was significantly lower in the patients who developed atrial fibrillation than in those who did not. However, atrial dispersion was significantly higher in the group which developed atrial fibrillation (61 [46.7,78.6] vs. 41.3 [30.6-51], p ≤ 0.001). In multivariate Cox regression analysis, atrial dispersion (msn) (hazard ratio: 1.019, 95% confidence interval: 1.004-1.033, p = 0.01), peak atrial longitudinal strain, and age were found to be independent predictors of atrial fibrillation. In patients with hypertrophic cardiomyopathy, atrial dispersion, peak atrial longitudinal strain and age are predictive of the development of atrial fibrillation. Atrial dispersion measured by a speckle tracking-based method may provide further information on left atrial function in patients with hypertrophic cardiomyopathy or other disease states.

Atrial longitudinal strain in cardiac aTTR amyloidosis and occurrence of atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND In systemic amyloidosis cardiac infiltration by amyloid fibrils leads to increased stiffness of the myocardium and of the atrial walls. There is a reduction in left atrial mechanical function and a high risk of thrombi formation. Atrial deformation by speckle tracking echocardiography peak atrial longitudinal strain (PALS) can predict the incidence of atrial fibrillation (AF) and ischaemic stroke in the general population and in patients (pts) with cryptogenic stroke. The predictive value of PALS seems to differ in different pts populations according to the prevalence of ventricular versus atrial myopathy (1). PURPOSE to compare parameters of atrial function in cardiac amyloidosis pts in sinus rhythm (SR) and AF and to observe if they are associated with the occurrence of new onset AF at follow-up (FUP). METHODS between 2016-2021 all pts with diagnosis of cardiac aTTR amyloidosis referred to the Clinic underwent an echocardiographic study including 2D-speckle tracking evaluation of left ventricular and left and right atrial strain. All pts received a regular FUP (clinical, echo, ECG and 24 hours Holter monitoring). Atrial function was evaluated by PALS in all pts and by PALS and PACS (peak atrial longitudinal strain during atrial contraction phase) in pts in SR. RESULTS 47 pts with aTTR cardiac amyloid (39/47 wild-tipe) were studied. Mean age = 82 ± 5 years, LV mass = 190 ± 46 g/m2; LV EF= 53%±9, GLS= -10%±4, EF/GLS ratio=-5,5 ± 2, left atrial (LA) volume = 49 ± 9 ml/m2, LA PALS 9,7%±6,6, right atrial (RA) PALS 15,9 ± 9,6. At the time of diagnosis 29 pts were in SR and 18 pts were in AF. Pts in AF had lower PALS (5,1%±3,7 in AF pts vs 11,9%±6,9 in SR pts, p = 0,001) and lower (less negative) GLS (-9,1%±3,1 in AF pts vs -11,8%± 4,2 in SR pts, p = 0,02). LA volume was not significantly different in AF pts compare to SR pts (51,4 ml/m2 ± 7,65 vs 47,6 ml/m2 ± 10,9; p = 0,19). During a median FUP of 21 months 8 pts had a new onset AF. There was no significant difference in atrial size and atrial deformation parameters between pts who had new onset AF at FUP compared to pts who did not (Tab 1). The only parameter associated with new onset AF at FUP was GLS (-8.21%± 2,8 vs -13.01%±4,02, CI -10.8—5.6 vs -14.8—11.18, respectively, in pts who developed new onset AF compared to pts who did not, p = 0.007). 5 pts had a cardioembolic stroke at FUP: at the time of the admission for stroke they were all in AF. CONCLUSIONS Our data show that in this group of pts with aTTR cardiac amyloidosis all echo parameters of LA size and function were overall impaired. In this setting of advanced disease LA volume was not significantly different in pts in AF compared to pts in SR and was not associated with new-onset AF at FUP. Deformation parameters were significantly more impaired in pts in AF compared to pts in SR, however PALS was not associated with the occurrence of new onset AF at follow-up. The only parameter associated with the occurrence of new onset AF at follow-up was GLS. Abstract Table 1

Impact of hypertension in left atrial size and mechanical function

Left atrium (LA) have an important role in the normal functioning of the heart thanks to its three functions: reservoir, conduct and pump. Several pathologies lead directly or indirectly to morphological and functional modifications of the LA. Investigate the effect of arterial hypertension on LA size and function. Prospective study including 50 hypertensive patients compared to 50 healthy controls. LA Volumes were measured using transthoracic echocardiography by biplane Simpson method at different times of cardiac cycle: at the end of systole [maximum LA volume (Vmax)], at mitral valve closure [minimum LA volume (Vmin)] and immediately before LA contraction (Vp). LA reservoir function (total emptying volume and expansion index), conduct function (passive emptying volume and passive emptying fraction) and pumping function (active emptying volume and active emptying fraction) have been calculated. Hypertension was associated with an increase of all LA volumes: Vmax (P < 0.001), Vmin (P = 0.001) and Vp (P < 0.001). LA reservoir function evaluated by LA total emptying volume was higher in hypertensives than in control group (P = 0.032). LA conduct function was impaired in hypertensive patients with a significantly lower passive emptying fraction in hypertensive group compared to control group (22 ± 12% versus 32 ± 11%, P < 0.001, respectively). This decrease was greater in the presence of left ventricular hypertrophy (P = 0.02). LA pumping function was significantly higher in hypertensive patients than in controls with an increase of LA active emptying fraction (35 ± 12% versus 30 ± 12% respectively; P = 0.037). The increase of LA pumping function was found to be higher in hypertensive patients with impaired diastolic function (P = 0.029). Hypertension was associated with an increase of pumping and reservoir functions and a decrease in left atrial passive emptying function.