Atrial Mechanical Function Research Articles

Effect of exercise on left atrial mechanical functions in professional wrestlers

Background: The adaptation of the cardiovascular system to exercise differs according to the type of sport. The aim of this study is to evaluate the effect of regular exercise on left atrial (LA) mechanical functions in professional wrestlers at internationally competitive level versus controls. Methods: Twenty professional male wrestlers (mean age, 21.90 + 2.49 years) and twenty male controls (mean age, 22.3 + 1.49 years) participated in this study. Echocardiographic assessments were performed using the criteria of the American Society of Echocardiography. The following LA volumes (LAVs) were measured: maximal volume (Vmax), minimal volume (Vmin), and LAV before atrial contraction (VpreA) at the onset of the pulsed wave of the simultaneously recorded electrocardiogram. LA ejection fraction (LAEF), LA expansion index (LAEI), LA active emptying volume index (LAAEVI) and fraction (LAAEFr), and LA passive emptying volume index (LAPEVI) and fraction (LAPEFr) were calculated. Results: Body mass index and LA diameter were statistically significantly higher in the wrestlers' group (P

P204 Recovery of left atrial function after restoration of sinus rhythm in patients with atrial fibrillation

Abstract Background Atrial fibrillation (AF) is associated with impaired mechanical function of the atria. The restoration of sinus rhythm (SR) leads to improvement of mechanics, however the onset of those changes is not established yet. Purpose To analyse changes in left atrial (LA) mechanical function after conversion to SR. Methods Forty patients (mean age 65 ± 12 years, 63% male) with nonvalvular AF underwent successful electrical cardioversion. Transthoracic echocardiography with speckle tracking analysis (STE) of LA was performed in AF and within 24 hours after cardioversion, in SR. We analysed standard parameters of left ventricle (LV) and LA. By the use of STE we assessed peak atrial longitudinal strain (PALS), time to PALS indexed to RR interval (TT-PALS/RR) and intra-atrial asynchrony. Results Heart rate during echocardiography was higher before cardioversion - median (IQR) 90 beats per minute (80-110) vs 61 (56-72); p < 0.0001. The mean LV ejection fraction in our study group was 48 ± 11%. We noticed significant improvement in LA STE measurements and in early diastolic (E’) mitral annular velocity. There were no significant changes in systolic (S’) mitral annular velocity and in the ratio of transmitral Doppler early filling velocity to E’ (E/E’). Detailed results are present in the table. Conclusions Speckle tracking measurements are able to detect early mechanical changes in LA even within 24 hours of SR. Atrial fibrillation Sinus rhythm p S" (cm/s) 6 (5-6.5) 6 (5-6.6) NS E" (cm/s) 10 (7.5-13) 9.5 (6.8-10.5) 0.0008 E/E" 8.2 (6.3-12.3) 9.3 (7.5-13) NS PALS (%) 9.9 ± 4.6 14.5 ± 6 <0.0001 TTP-PALS/RR (%) 51 (44-58) 42 (38-45) 0.0001 LA asynchrony 15 (11-19) 9 (8-14) 0.0007

365 Left Atrial Functional Index is a Predictor of Persistent/permanent Non-Valvular Atrial Fibrillation

Chronicity of atrial fibrillation (AF) has been associated with poor cardiovascular outcomes. Left atrial function index (LAFI) is a rhythm-independent measure of LA reservoir function adjusted for LA size and stroke volume and is an established marker of risk for cardiac disease states. We sought to evaluate the role of LA function by LAFI in predicting persistent/permanent AF. Patients attending our institution between Jan 2013 and Dec 2017 were assessed. Patients with history of non-valvular AF who received transthoracic echocardiogram (TTE) evaluation were included. In these patients, we evaluated demographic profiles, AF history, clinical comorbidities and echocardiographic data. We excluded patients with valvular AF, poor quality TTE images and incomplete clinical data. Of the 665 patients (67.78±13.62years, 52% male) included, 27.8% had persistent/permanent AF. Persistent/permanent AF was associated with older age (p<0.01), heart failure (p<0.01), diabetes mellitus (p=0.02), ischaemic heart disease (p=0.02), obstructive sleep apnoea (p=0.04), renal impairment (p<0.01), lower left ventricular ejection fraction (p<0.01), higher E/e’ (p<0.01), larger LA volume index (p<0.01) and lower LAFI (p<0.01). Multi-variable analysis revealed both heart failure (OR 3.024, 95% CI 1.737 to 5.265, p<0.01) and LAFI (OR 4.881, 95% CI 2.503 to 9.519, p<0.01) as independent predictors of persistent/permanent AF. Receiver operating characteristic curve showed LAFI (Figure1; AUC 0.75, 95% CI 0.703 to 0.793, p<0.01) of less than 16.5 to have a 70% sensitivity and 70% specificity in detecting persistent/permanent AF LAFI, an echocardiographic measure of atrial mechanical function, may be a useful tool in risk stratification for patients with non-valvular AF.

415 The Immediate Impact of Electrical Cardioversion on Right Ventricular Systolic Function in Patients With Non-Valvular Atrial Fibrillation

Successful electrical cardioversion (ECV) for atrial fibrillation (AF) is often followed by a transient period of atrial stunning, where depressed mechanical atrial function persists despite reversion to sinus rhythm (SR). Left ventricular (LV) changes following ECV are well characterised, but knowledge of early changes to right ventricular (RV) function is lacking. We aimed to assess the immediate impact of ECV on right heart function. Patients referred for ECV with non-valvular AF between Jan 2017 to Jan 2018 were assessed. Patients without history of heart failure, normal left ventricular ejection fraction, and who successfully reverted to SR following ECV were prospectively recruited. RV metrics of systolic function including 2-dimensional RV free wall longitudinal strain (RV-FWLs) was measured offline from transthoracic echocardiogram images obtained prior to and immediately following ECV (TomTec Imaging system). Of 50 patients (64.14±11.01yrs, 60% male) assessed, 28% had a history of ischaemic heart disease and 5% had obstructive sleep apnoea. Paired T-test analysis showed a significant improvement in RV-FWLs (pre-ECV: 14.18±4.42 vs post-ECV: 21.02±6.80; p<0.01) and RV-FAC (pre-ECV: 36.77±8.85 vs post-ECV: 40.80±10.16; p=0.02) following ECV. Based on a cut-off value of ≥23% for RV-FWLs, 10% of the cohort had normal RV-FWLs pre-ECV which significantly increased to 36% post-ECV (p<0.01). A similar trend was observed with RV-FAC (cut-off value of ≤35%), although not statistical significant (pre-ECV: 60% normal RV-FAC, post-ECV: 74% normal RV-FAC; p=0.17). Improvements in RV-FWLs and RV-FAC was observed following ECV, suggesting that there are immediate improvements in RV function in this population.

Atrial mechanical hypofunction after electrical cardioversion of persistent or long-lasting persistent atrial fibrillation: a retrospective cohort study.

In the present retrospective cohort study, we have evaluated the missed or delayed atrial mechanical recovery in a population of patients with persistent or long-lasting persistent AF who achieved restoration of sinus rhythm on the ECG by electrical cardioversion (ECV). The endpoint of our study was the failure to recover the normal mechanics of the left atrium. Inclusion criterion was the persistent or long-lasting persistent atrial fibrillation successfully treated by means of ECV , provided that a pertinent documentation was made available, comprising ECG, conventional 2D echo-color-Doppler and speckle tracking echocardiography(STE) evaluation, with also a STE assessment of the atria at the days 1, 30 and 90 from the ECV freely available within the clinical record of the patient. Out of a total of 80 patients with persistent or long-standing persistent AF, retrospectively enrolled, as many as 22.5% of them did not achieve the normalization of their atrial STE profile, even though they had been converted to sinus rhythm on the ECG by means of ECV. The building of ROC curves allowed us to establish that early measurements of global atrial strain could serve to predict both the risk of failure to recover the atrial mechanical function and the one of AF relapses over a 12 month follow-up. The values of 18% and 17% were also calculated to serve as cut off values, respectively, for the risk of atrial mechanical dysfunction and for the risk of AF relapses over a 12 month follow-up. Failure to recover the atrial reservoir function can accompany a restoration of sinus rhythm on the ECG in patients with long-standing persistent AF. In this case, a serial STE evaluation could be useful to evaluate the atrial hypofunction over time.

Troubles of Atrial Mechanical Recovery after Electrical Cardioversion in Patients with Persistent or Long-Lasting Persistent Atrial Fibrillation

Background: In the present retrospective cohort study we have evaluated the missed or delayed atrial mechanical recovery in a population of patients with persistent or long-lasting persistent atrial fibrillation (AF) who achieved restoration of sinus rhythm on the ECG by electrical cardioversion (ECV). Methods: The endpoint of our study was the failure to recover the normal mechanics of the left atrium. Inclusion criterion was the persistent or long-lasting persistent AF successfully treated by means of ECV, provided that a pertinent documentation was made available, comprising ECG, conventional 2D echo-color-Doppler and speckle tracking echocardiography(STE) evaluation, with also a STE assessment of the atria at the days 1, 30 and 90 from the ECV freely available within the clinical record of the patient. Results: Out of a total of 80 patients with persistent or long-standing persistent AF, retrospectively enrolled, as many as 22.5% of them did not achieve the normalization of their atrial STE profile, even though they had been converted to sinus rhythm on the ECG by means of ECV. The building of ROC curves allowed us to establish that early measurements of global atrial strain could serve to predict both the risk of failure to recover the atrial mechanical function and the one of AF relapses over a 12 month follow-up. The values of 18% and 17% were also calculated to serve as cut off values, respectively, for the risk of atrial mechanical dysfunction and for the risk of AF relapses over a 12 month follow-up. Conclusions: Failure to recover the atrial reservoir function can accompany a restoration of sinus rhythm on the ECG in patients with long –standing persistent AF.In this case a serial STE evaluation could be useful to evaluate the atrial hypofunction over time.

Echocardiographic and Biochemical Factors Predicting Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation-An Observational Study.

Background: RFA is a well-established treatment for symptomatic patients with AF. However, the success rate of a single procedure is low. We aimed to investigate the association between the risk of recurrence of atrial fibrillation (AF) after a single radiofrequency ablation (RFA) procedure and cardiac neurohormonal function, left atrial (LA) mechanical function as well as proteins related to inflammation, fibrosis, and apoptosis.Methods and Results: We studied 189 patients undergoing RFA between January 2012 and April 2014, with a follow-up period of 12 months. A logistic regression analysis was performed to investigate the association between pre-ablation LA emptying fraction (LAEF), MR-proANP, Caspase-8 (CASP8), Neurotrophin-3 (NT3), and the risk for recurrence of AF after a single RFA procedure. 119 (63.0%) patients had a recurrence during a mean follow-up of 402 ± 73 days. An increased risk of recurrence was associated with: Elevated MR-proANP (fourth quartile vs. first quartile: HR, 2.80 (95% CI, 1.14–6.90]; P = 0.025); Low LAEF (fourth quartile vs. first quartile: hazard ratio [HR], 2.41 [95% CI, 1.01–5.79]; P = 0.045); Elevated CASP8 (fourth quartile vs. first quartile: HR 12.198 95% CI 2.216–67.129; P = 0.004); Elevated NT-3 (fourth quartile vs. first quartile: HR 7.485 95% CI 1.353–41.402; P = 0.021). In a receiver operating characteristic curve analysis, the combination of MR-proANP, CASP8, and NT3 produced an area under the curve of 0.819; CI 95% (0.710–0.928).Conclusions: Patients with better LA mechanical function and lower levels of atrial neurohormones as well as of proteins related to fibrosis and apoptosis, have a better outcome after an RFA procedure.Unique identifier: No. NCT01553045 (https://clinicaltrials.gov/ct2/show/NCT01553045?term=NCT01553045&rank=1).

P1580Left atrial volume index predicts improvement in renal function after catheter ablation of atrial fibrillation

Abstract Background Atrial fibrillation (AF) increased the risk of development of kidney disease. The elimination of AF by catheter ablation is associated with improvement in renal function. However, the mechanism of cardio-renal interaction in AF has not been fully elucidated. Purpose We tested the hypothesis that left atrial volume index (LAVI), which is a marker of left atrial mechanical reserve, predicts improvement in renal function after restoring sinus rhythm with catheter ablation of AF. Methods We analyzed consecutive patients who underwent catheter ablation of AF from January 2012 to October 2018 and had completed follow-up more than 3 months after catheter ablation. Exclusion criteria were need for hemodialysis and acute hospitalization. Estimated glomerular filtration rate (eGFR) was assessed on admission and at the end of follow-up periods after catheter ablation and the difference was defined as ΔeGFR. Left atrial volume index was derived using the biplane area-length method. Results A total of 159 AF patients (paroxysmal 112 [70%], persistent 47 [30%]) were included in this study. The mean age was 65±11 years and 74% were male. During the mean follow-up period of 7.9±3.2 months, 105 patients (66%) were free from atrial tachyarrhythmias and 54 (34%) experienced the recurrence. Baseline eGFR and LAVI were not significantly different between the non-recurrence group and the recurrence group (71.0±17.4 and 75.1±22.8 mL/min/1.73m2; p=0.24, 35.7±12.5 and 37.9±15.0 ml/m2; p=0.34). ΔeGFR in the non-recurrence group was significantly greater compared with the recurrence group (+1.5±1.0 versus −4.3±1.4 mL/min/1.73m2; p=0.001). Baseline LAVI was negatively correlated with ΔeGFR in the non-recurrence group (r=−0.3; p=0.002; Figure), but not in the recurrence group (p=0.1). Multiple regression analysis in the non-recurrence group identified baseline LAVI (β=−0.35, p&lt;0.001), baseline age (β=−0.31, p&lt;0.001) and baseline eGFR (β=−0.59, p&lt;0.001) as independent predictors for eGFR improvement after catheter ablation. In the patients with LAVI &lt;34 ml/m2, age &lt;70 years and eGFR &lt;90 mL/min/1.73m2, the mean ΔeGFR was +6.3±1.9 mL/min/1.73m2. Figure 1 Conclusions LAVI, a marker of left atrial mechanical reserve, was an independent predictor of improvement in renal function after restoring sinus rhythm with catheter ablation of AF. This observation suggests that AF-related deterioration of renal function is due at least in part to impaired atrial mechanical function.

Two-Dimension Echocardiographic Assessment of Left Atrial Volumetric Changes in Patients with Paroxysmal Atrial Fibrillation After Reversion to Sinus Rhythm

Background: Although often referred to as “the forgotten chamber”, compared with left ventricle (LV), especially in the past years, the left atrium (LA) plays a critical role in the clinical expression and prognosis of patients with heart and cerebrovascular disease, as demonstrated by several studies. Objective: The aim of the work was to assess the left atrium functional and volume changes during atrial fibrillation (AF) and after sinus rhythm cardioversion in patients with paroxysmal AF, to detect recovery of effective mechanical atrial function (EMAF) after cardioversion with preserved bioelectrical function. Patients and methods: This prospective observational study included a total of 75 subjects divided on two groups: Group 1 (control) consisted of 25 apparently normal people with normal sinus rhythm, and Group 2 (patients) consisted of 50 patients with paroxysmal atrial fibrillation, attending at Damanhur Medical National Institute, for cardioversion. 25 (50%) of patients were cardioverted pharmacologically either by amiodarone or propafenone and 25 (50%) of patients were cardioverted by DC shock. Results: Mean age of controls involved in the study was 44.60 ± 9.82 years. 56% of them were males. Mean age of patients was 51.40 ± 7.23, 54% of them were males. Left Anterior Descending Artery (LAD) showed a significant decreased after cardioversion and after one month. It showed insignificant decrease after 2 months. Number of patients who did not recovered effective mechanical atrial function (EMAF) after one month were 6 (12%). Conclusion: Left atrial diameters and left atrial volumes increase in AF and showed significant reduction by the time after successfully cardioversion. Patients who were underwent DC shock had a slower recovery of atrial function and of LA volumes reduction, implying a greater degree of atrial dysfunction.

Left Atrial Mechanical Function and Incident Ischemic Cerebrovascular Events Independent of AF: Insights From the MESA Study

ObjectivesThis study sought to assess the association of baseline left atrial (LA) phasic function measured with cardia magnetic resonance (CMR) and incident ischemic cerebrovascular events (CVE). BackgroundLA remodeling is a known predictor of atrial fibrillation (AF), which is a risk factor for ischemic CVE. Despite studies showing an association between LA remodeling and ischemic CVE, the association of LA mechanical function with ischemic CVE in a population free of known cardiovascular disease is not fully studied. MethodsPhasic LA volumes; total, passive, and active LA emptying fractions (LAEF); and peak longitudinal LA strain were measured using feature-tracking CMR in 4,261 MESA (Multi-Ethnic Study of Atherosclerosis) participants (61 ± 10 years of age; 48% male). All individuals were free of clinical cardiovascular disease at baseline. Participants were followed for 11.6 ± 3.5 years for the diagnosis of incident ischemic CVE, defined as ischemic stroke or transient ischemic attack adjudicated by vascular neurologists. ResultsDuring the follow-up, 193 (1.26 per 1,000 person-years) ischemic CVE (134 ischemic strokes and 59 TIAs) occurred. Individuals with incident ischemic CVE had larger LA volumes and lower passive, active, and total LAEFs at baseline. In multivariate analysis adjusted for known CVE risk factors, left ventricular mass and interim AF, total LAEF was associated with incident ischemic CVE (hazard ratio [HR]: 0.85 per SD; 95% confidence interval [CI]: 0.74 to 0.98; p = 0.027). The unadjusted HR for the lowest tertile of total LAEF compared to the highest tertile was 2.0 (95% CI: 1.43 to 2.79; p < 0.001), and the adjusted HR was 1.47 (95% CI: 1.04 to 2.05; p = 0.031). Addition of total LAEF to known clinical risk factors of CVE and left ventricular mass resulted in an improved predictive accuracy (C statistic of 0.76 vs. 0.73, respectively; p = 0.039). ConclusionsReduced total LAEF was associated with incident ischemic CVE independent of known cerebrovascular risk factors and incident AF. Assessment of LA function may add further information in stratifying asymptomatic individuals at risk for ischemic stroke.

Evaluation of Left Atrial Electromechanical Delay and Left Atrial Phasic Functions in Surgical Early Menopause Patients.

BACKGROUNDThis study evaluated the atrial electromechanical delay (AEMD) and the left atrial (LA) mechanical functions in patients with surgical early menopause.METHODSA total of 62 patients were included in the study: 33 patients with surgical early menopause and 29 age- and sex-matched healthy controls. The duration distance from the start of the P wave to the beginning of the A wave for the lateral mitral annulus, septal mitral annulus, and lateral tricuspid annulus was assessed by tissue Doppler echocardiography. The differences in these durations were used to calculate the inter- and intra-atrial mechanical delays. LA volumes were evaluated using the biplane area-length technique, and LA mechanical function values were measured.RESULTSThe baseline laboratory and clinical characteristics were similar between the two groups. Surgical early menopause patients displayed increased static atrial electromechanical connection (PA′) times for the septal mitral annulus and lateral tricuspid annulus compared to the controls. However, the lateral mitral annulus, the inter-atrial, the intra-LA, and the right atrial EMD PA′ times were not significantly altered in surgical early menopause patients compared to controls. Importantly, the LA volume index (28.1 ± 8.17 vs. 24.89 ± 7.96 mL/m2, p = 0.019), the maximal LA volume (49.6 ± 14.1 vs. 42.9 ± 16.1 mL, p = 0.004), the minimal LA volume (18.4 ± 7.0 vs. 15.2 ± 9.0 mL, p = 0.022), and the atrial precontraction LA volume (31.0 ± 10.9 vs. 24.9 ± 10.1 mL, p = 0.006) were higher in the patients with surgical early menopause compared to the controls. The LA reservoir, conduit and pumping functions and the total, passive, and active emptying volumes were all comparable between the two groups (p = 0.09; 0.06; 0.68; 0.06; 0.48; 0.07, respectively).CONCLUSIONSPatients with surgical early menopause demonstrated impaired atrial electrical delay and electromechanical functions.

EVALUATION OF ATRIAL ELECTROMECHANICAL DELAY IN SILENT CEREBRAL ISCHEMIA PATIENTS

Objective: Silent cerebral ischemia (SSI) is found on cranial imaging, with no signs of stroke and has similar risk factors as stroke. There are few studies evaluating the relationship between SSI and AF. In this study, we aimed to evaluate left atrial functions and atrial mechanical delay (AED) in SSI cases with noninvasive tissue doppler imaging (TDI). Method: 39 SSI and 29 healthy subjects as control group included in this study. Atrial conduction times calculated by Tissue Doppler Imaging (TDI), demographic features, laboratory findings, ECG, transthoracic ECO were recorded. AED was calculated by measuring the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid) by TDI. Left atrial volumes were measured in the apical fourchamber view with the disk method. Left atrial mechanical functions were evaluated. The heart rate variability parameters of the patient group were compared by the holter. Results: The mean age of 39 patients (32K/7E) was 51 ± 10 years and the mean age of 29 healthy controls (24K/5E) was 48.8±5.9 years. There was no difference between the two groups in demographic characteristics (p>0,05). Blood glucose was significantly higher in the SSI group (p=0.034). Parameters related to AED were not statistically significant in the SSI group but were found longer (p>0.05). The parameters of left atrial function such as LAPEF (0,3±0,1 versus 0,2±0,1, p=0,050), LAPEV (12,1± 6,8 versus 10,3±8, p=0,197) and LATEV (23,6±11,1 versus 21,6±9,4 p=0,496) were higher but were not statistically significant. Conduit volum (26,8±12,7 versus 21,5±16,5, p=0,017), LVEDV (91,8±24,4 versus 74,8±25,3. P=0,002) and LVESV (41,4±13,4 versus 31,7,8±15,7. P=0,003) was found statistically significant. Conclusion: Regulation of blood glucose of SSI cases and follow-up the patienst for cardiac diastolic functions, and taking into consideration that these changes may lead to prolongation at the time of atrial conduction are important.

Impact of the Cox-Maze IV Procedure on Left Atrial Mechanical Function

The Cox-Maze IV procedure is a proven surgical treatment for atrial fibrillation (AF). Previous studies on the procedure and its effect on left atrial mechanical function have yielded mixed results. Sixty-four (64) patients underwent Cox-Maze IV at St Vincent's Hospital, Melbourne between March 2010 and May 2016. Baseline characteristics were collected and outcomes assessed including rhythm analysis. Preoperative and postoperative transthoracic echocardiograms were reviewed. Fifty-seven (57) patients had complete follow-up with all clinical measures collected. The mean age was 71.1±10.2years, 63% being male. Fifty-eight per cent (58%) (33/57) of patients were in AF and 42% (24/57) in sinus rhythm (SR) at preoperative transthoracic echocardiography. Follow-up postoperative transthoracic echocardiography was performed at a mean of 2.3±1.9years. Nineteen (19) patients with a history of paroxysmal AF were in SR both preoperatively and postoperatively. In these patients, there was a significant decrease in Mitral A wave 0.63±0.28m/s (pre-op) vs 0.47±0.29m/s (post-op), p=0.044. There was a significant decrease in left ventricular ejection fraction (LVEF) postoperatively 64.2±9.7% vs 55.0±12.9%, p=0.005. At follow-up, 28% (16/57) were in AF, 61% (35/57) in SR, and 11% (6/57) in a paced rhythm. In a multivariate analysis, predictors of AF recurrence included higher LA volumes (p=0.042) and younger age at surgery p=0.030. Preoperative AF, sex and LVEF had no impact on AF recurrence. The Cox-Maze IV procedure, while effective in converting patients to sinus rhythm, may reduce left atrial mechanical function in patients with paroxysmal AF.

Regular Alcohol Consumption IsAssociated With Impaired AtrialMechanical Function in the AtrialFibrillation Population: A Cross-Sectional MRI-Based Study.

This study sought to determine the impact of regular alcohol consumption on left atrial (LA) mechanical and reservoir function. Earlier studies suggest that regular alcohol intake is associated with increased atrial fibrillation (AF) and LA dilatation. This study prospectively enrolled 160 patients with paroxysmal or persistent AF to undergo 3-T cardiac magnetic resonance (CMR) imaging in sinus rhythm. Patients self-reported alcohol consumption in standard drinks (∼12 g alcohol) per week over the preceding 12 months and were categorized into 4 groups: 1) lifelong nondrinkers; 2) mild drinkers (3 to 10 standard drinks/week); 3) moderate drinkers (11 to 20 standard drinks/week); 4) heavy drinkers (>20 standard drinks/week). Permanent AF and cardiomyopathy were excluded. On CMR, maximum LA volume (LAmax) and minimum LA volume (LAmin), global LA emptying fraction (LAEF) as (LAmax- LAmin) / LAmax, and LA reservoir function as (LAmax- LAmin) / LAmin were calculated. Regular alcohol consumption (mean 15.8 ± 6.9 standard drinks/week, n= 120) was associated with larger LA size (LA volume index 50 ± 13 ml/m2 vs. 43 ± 12 ml/m2; p= 0.005), reduction in LAEF (40 ± 14% vs. 52 ± 15%; p<0.001), and reduction in reservoir function (77 ± 48% vs. 119 ± 63%; p< 0.001) compared with lifelong nondrinkers (n= 40). There were progressive dose-related impairments in LAEF (mild 45.4 ± 13.5% vs. moderate 39.1 ± 14.7% vs. heavy drinkers 35.6 ± 12.6%; p< 0.01) and reservoir function (mild 95.8 ± 55.6% vs. moderate 74.8 ± 47.1% vs. heavy drinkers 61.7 ± 34.4%; p< 0.01). Predictors of atrial mechanical dysfunction included weekly alcohol intake (p= 0.001), older age (p= 0.018), and persistent AF (p= 0.016), but not binge drinking or beverage type. In patients with AF, habitual alcohol consumption is associated with significantly increased LA sizeandatrial mechanical dysfunction compared with nondrinkers.

LEFT ATRIAL MECHANICAL FUNCTION AND ITS DISORDERS AFTER PULMONARY VEIN ANTRUM ISOLATION

The article presents new insights into the left atrial mechanical function, its main components and remodeling mechanisms after pulmonary vein antrum isolation. Left atrium is a cardiac chamber that transports blood. Being a complex «organ» both in anatomical and functional terms, it responds to hemodynamic derangements, the impact of humoral and vegetative factors. Structural, mechanical and electrical remodeling of the left atrium play a key role in the arrhythmogenesis of atrial fibrillation, as well as in the mechanism of arrhythmia maintenance. Left atrial mechanical dysfunction following catheter ablation of atrial fibrillation significantly affects intracardiac hemodynamics, worsens patients' well-being, and increases the risk of thromboembolic complications both in the immediate and long-term postoperative period.

The current profile of the patient with atrial fibrillation

Abstract: Atrial fibrillation (AF) is the most common supraventricular arrhythmia, characterized by an irregular and extremely rapid atrial electrical activation that causes loss of atrial mechanical function and important hemodynamic consequences. AF classification is important in both the therapeutic approach and the prognosis. Several classifications based on the ECG patch, epicardial or endocavitary records have been performed over time, but no classification can take into account all the characteristics of AF and especially associated diseases, which may be both the cause and consequence of arrhythmia. Aim: The aim of the study is to establish the current profile of the patient with atrial fibrillation in the new era of oral anticoagulant therapy and sinus rhythm restoration.&#x0D; Material and methods: The trial was conducted on patients with atrial fibrillation hospitalized between 01.10.2014-31.03.2015 at Institute of Cardiovascular Diseases ”Prof. Dr. G. Georgescu”, Iasi. Patients included in the study were analyzed according to age and sex, criteria for the clinical and paraclinic definition for atrial fibrillation.&#x0D; Results: Atrial fibrillation is an extremely common cardiovascular pathology and is present in about one-third of patients admitted to our clinic. Cardiovascular diseases such as hypertension, ischemic coronary artery disease, and valvulopathy are common in patients with AF. Patients with AF are usually elderly patients with many associated diseases in whom sinus rhythm restoration treatment and anticoagulant therapy are difficult to establish. AF is one of the most common arrhythmias that complicates the evolution of acute myocardial infarction, association between dual antiplatelet therapy and anticoagulation treatment, increasing the risk of bleeding complications.&#x0D; Conclusions: Atrial fibrillation is an extremely common cardiovascular pathology and is present in about one-third of patients admitted to our hospital. The data obtained revealed that this arrhythmia occurs in a small number of cases as the only pathology of the patient, usually associated with numerous comorbidities. Cardiovascular diseases such as hypertension, ischemic coronary artery disease, valvulopathy are common in our practice. Patient with AF is a patient who requires long-term anticoagulant therapy and in whom sinus rhythm recovery therapy is dependent on the precocity of presentation to the physician, as well as on the therapeutic resources of current medicine.

Early detection strain/strain rate and time to strain/strain rate abnormalities for left atrial mechanical function in hypertensive patients

Objective: To evaluate left atrial (LA) deformation parameters strain (S)/strain rate (SR) and time to peak S/SR obtained by two-dimensional speckle tracking echocardiography (2D-STE) in patients with hypertension for three LA mechanical phases and to compare them with the same indices in the control subjects.Methods: Fifty-five patients with hypertension (HT) and 29 healthy controls were included in the study. All patients had normal LA poster-anterior diameter, LA and left ventricular ejection fractions (LVEF >50%) in two-dimensional echocardiography (2-DE). The peak S/SR values (PS/PSR), the time to peak S/SR (TPS/TPSR) were measured using the 12-segment model for the left atrium during contractile (CP) reservoir (RP) and conduit period (COP) of the LA cycle.Results: For two periods (RP and COP), all of the PS and PSR values were significantly lower in hypertensive patients with preserved LAEF and LVEF compared to those in the controls, except for the CP. Similarly, hypertensive patients had significantly higher TPS and TPSR than those in the controls for the RP and COP in the LA wall, except for the CP.Conclusion: LA mechanical function was impaired in hypertensive patients with preserved LA and LV ejection fraction compared to the controls. Although the PS and PSR were decreased for the RP and COP of LA mechanical phases, the TPS/TPSR were prolonged in the HT patients compared to the controls. This might be additional diagnosis criteria to detect the LA myocardial dysfunction and might be a predisposing factor for atrial arrhythmia formation in the hypertensive patients.

Does High-Intensity Endurance Training Increase the Risk of Atrial Fibrillation? A Longitudinal Study of Left Atrial Structure and Function.

Exercise mitigates many cardiovascular risk factors associated with atrial fibrillation. Endurance training has been associated with atrial structural changes which can increase the risk for atrial fibrillation. The dose of exercise training required for these changes is uncertain. We sought to evaluate the impact of exercise on left atrial (LA) mechanical and electrical function in healthy, sedentary, middle-aged adults. Sixty-one adults (52±5 years) were randomized to either 10 months of high-intensity exercise training or yoga. At baseline and post-training, all participants underwent maximal exercise stress testing to assess cardiorespiratory fitness, P-wave signal-averaged electrocardiography for filtered P-wave duration and atrial late potentials (root mean square voltage of the last 20 ms), and echocardiography for LA volume, left ventricular end-diastolic volume, and mitral inflow for assessment of LA active emptying. Post-training data were compared with 14 healthy age-matched Masters athletes. LA volume, Vo2 max, and left ventricular end-diastolic volume increased in the exercise group (15%, 17%, and 16%, respectively) with no change in control (P<0.0001). LA active emptying decreased post-exercise versus controls (5%; P=0.03). No significant changes in filtered P-wave duration or root mean square voltage of the last 20 ms occurred after exercise training. LA and left ventricular volumes remained below Masters athletes. The athletes had longer filtered P-wave duration but no difference in the frequency of atrial arrhythmia. Changes in LA structure, LA mechanical function, and left ventricular remodeling occurred after 10 months of exercise but without significant change in atrial electrical activity. A longer duration of training may be required to induce electrical changes thought to cause atrial fibrillation in middle-aged endurance athletes. URL: https://www.clinicaltrials.gov. Unique Identifier: NCT02039154.

Prediction of postoperative atrial fibrillation with left atrial mechanical functions and NT‐pro ANP levels after coronary artery bypass surgery: A three‐dimensional echocardiography study

Postoperative AF (POAF) is the most common cause of morbidity after coronary artery bypass surgery. In this study, we aimed to show the relationship between POAF and N-terminal pro-atrial natriuretic peptide (NT-pro ANP) levels and the relationship between mechanical functions and left atrial volume measured using preoperative three-dimensional echocardiography (3D ECHO) among patients that will undergo isolated coronary artery bypass grafting (CABG) in elective conditions. Sixty-six consecutive patients (51 male, 15 female) who were decided to undergo CABG and had normal sinus rhythm were involved in the study. Patients were followed by continuous electrocardiography monitoring and daily electrocardiogram. LA volume and mechanical functions were calculated with 3D ECHO. In addition, for the analysis of plasma levels of NT-pro ANP, blood samples were collected before the surgery. During follow-up after the operation, 15 patients (22.7%) had postoperative atrial fibrillation. LA Vmax, Vmin, VpreA values were higher (P<.001, P=.004, P<.001 respectively) Also in POAF-developed group and SR group, LAVI values were 27.56±4.2 and 20.7±4.64mL/m2 , respectively (P<.001). In POAF-developing group, NT-pro ANP levels were significantly higher (P<.001). In multiple logistic regression analysis, age (β=0.355, P=.007) and LAVI (β=0.668, P=.012) are independent predictors of POAF. It was found that 3D echocardiography can be used as a helping noninvasive method to show subclinical atrial volume and mechanical dysfunction in patients undergoing CABG. Also, blood levels of NT-pro ANP in POAF group were increased.

Regular Alcohol Consumption is Associated with Impaired Atrial Mechanical Function in the Atrial Fibrillation Population: A Prospective Magnetic Resonance Imaging-Based Study

Regular Alcohol Consumption is Associated with Impaired Atrial Mechanical Function in the Atrial Fibrillation Population: A Prospective Magnetic Resonance Imaging-Based Study