Atrium Area Research Articles

Correlation between CHA2DS2-VASc score and left atrium size in non-valvular atrial fibrillation

The CHA2DS2-VASc score is validated to evaluate the risk of thromboembolism in non-valvular atrial fibrillation (AF). The relationship between the predictive value of thromboembolic risk by echocardiographic parameters and CHA2DS2-VASc score is still misunderstood. The aim of this study was to search a relationship between echocardiographic parameters and CHA2DS2-Vasc score in patients with non-valvular AF. One hundred and twenty-two patients were hospitalized for AF. The CHA2DS2-VASc score was evaluated and echocardiography with assessment of the left atrium (surface diameter and volume) was performed. Regular monitoring was provided during 8 ± 12 months. The mean age of our patients was 60 ± 15 years, 66% ( n = 71) men and 34% ( n = 36) women. AF was classified as paroxysmal (59%), as persistent (18%), and as permanent (28%). AF was idiopathic in 34% of cases and associated with hypertensive heart disease in 26%. The percentage of patients who had a CHA2DS2-VASc score 0, 1, and ≥ 2 was 21%, 24% and 55%. Sixty-six percent of patients have been treated with anticoagulant, 30% were put on aspirin and 4% abstaining. During follow-up, nine patients were hospitalized for heart failure, 6 patients (5%) had stroke, 4 patients (4%) had a non-major bleeding and one patient died. No correlation was found between CHA2DS2-VASc score and the left atrium dimensions ( P = 0.6, 0.2, 0.8 respectively for the diameter, surface area and volume of left atrium). Left atrial dimensions are not correlated to CHA2DS2-VASc score. Other techniques could possibly be more sensitive such as the atrial strain.

The role of high-density mapping in atrial fibrillation ablation

Aims. To determine the role of the prevalence of low-voltage areas in the occurrence of arrhythmia recurrence after interventional treatment of atrial fibrillation (AF).Methods. The study included 38 patients with paroxysmal (52.6%) and persistent (47.4%) forms of AF who underwent interventional treatment of AF using high-density electroanatomical mapping (at least 10,000 EGM points). Analysis of electroanatomical maps was performed after the completion of the ablation procedure. The area of the low-voltage zones was measured manually. Then, the areas of all regions of low-voltage activity were summed up; the resulting value was expressed as a percentage of the total surface area of the left atrium (LA).Results. The observation period was 12.8±3.2 months. Based on the results of endocardial mapping, all patients were divided into 2 groups according to the prevalence of low-voltage areas in the LA. The first group included patients with an area of low-voltage zones less than 5% of the total surface of the left atrium, and the second with an area of low-voltage areas of more than 5% of the total surface of the left atrium. The patients of the first group had a lower LA volume compared to patients from the second group, with mean values of 119.87±16.35 ml and 154.57±33.23 ml, respectively (p=0.007). In the first group, AF recurrence was recorded in one patient after catheter treatment, in the second group in 5 patients.Conclusion. Common areas of low-voltage activity in the left atrium, detected by high-density mapping before the procedure for catheter treatment of AF, are a predictor of arrhythmia recurrence after interventional treatment.

Signal Fingerprinting as a Novel Diagnostic Tool to Identify Conduction Inhomogeneity.

BackgroundInhomogeneous intra-atrial conduction facilitates both initiation and perpetuation of atrial fibrillation (AF) and is reflected in electrogram (EGM) morphology.ObjectiveThe primary objective of this study is to investigate regional differences in features of different EGM types during sinus rhythm (SR) and to design a patient-specific signal fingerprint, which quantifies the severity and extensiveness of inhomogeneity in conduction.MethodsPatients (N = 189, 86% male; mean age 65 ± 9 years) undergoing coronary artery bypass grafting (CABG) underwent high-resolution mapping of the right atrium (RA), left atrium (LA), and pulmonary vein area (PVA) including Bachmann’s bundle (BB). EGMs during 5 s of SR were classified as single potentials (SPs), short double potentials (SDPs, interval between deflections < 15 ms), long double potentials (LDPs, deflection interval > 15 ms), or fractionated potentials (FPs, ≥3 deflections). Of all SPs, differences in relative R- and S-wave amplitude were calculated (R/S ratios). Time difference between first and last deflection was determined (fractionation duration, FD) and potentials with amplitudes < 1.0 mV were labeled as low-voltage. Conduction block (CB) was defined as a difference in local activation time (LAT) between adjacent electrodes of ≥12 ms.ResultsA total of 1,763,593 EGMs (9,331 ± 3,336 per patient) were classified (Table 1).ConclusionThe signal fingerprint, consisting of quantified EGM features, including the R/S ratio of SPs, the relative frequency distribution of unipolar voltages, the proportion of low-voltage areas, the proportion of the different types of EGMs, and durations of LDP and FDP, may serve as a diagnostic tool to determine the severity and extensiveness of conduction inhomogeneity. Further studies are required to determine whether the signal fingerprint can be used to identify patients at risk for AF onset or progression.

Association between right heart dimensions and muscle performance and cardiorespiratory capacity in strength and endurance athletes

Our purpose was to investigate the association between right heart dimensions and muscle performance and cardiorespiratory capacity in athletes. We selected 90 men with a mean age of 33.0 ± 8.0 years: strength group (SG), 30 bodybuilders; endurance group (EG), 30 endurance athletes; and control group (CG), 30 healthy non-athletes. Comprehensive echocardiography and radionuclide angiography allowed the cardiac evaluation. VO2peak was assessed by cardiopulmonary testing, muscle strength by the one-repetition maximum test (1RM) and the relative strength (RS), and muscle endurance by the maximum repetitions test (MR) with 50% of 1RM. In SG was observed an association between right ventricle (RV) basal diameter and RS bench press (R2 = .188 β = 0.486 P = .017) and between right atrium (RA) area and MR leg press (R2 = .257 β = 0.143 P = .004). In EG was observed an association between RV basal diameter and VO2peak (R2 = .299 β = 0.026 P = .002) and between RA area and VO2peak (R2 = .417 β = 0.092 P ≤ .001). In conclusion, our data suggest that there is an association between right heart dimensions and muscle performance and cardiorespiratory capacity; moreover, muscle strength seems important for understanding cardiac adaptations to training.

Right ventricular echocardiographic parameters associated with prothrombotic abnormalities in normotensive patients with acute pulmonary embolism

BackgroundIn acute pulmonary embolism (PE) right ventricular (RV) pressure overload negatively affects prognosis. Recently we have shown that RV dilatation is associated with a prothrombotic state in PE. We investigated which RV echocardiographic parameters best indicate prothrombotic alterations in acute PE. MethodsIn 121 normotensive, noncancer PE patients, markers of RV dilatation and dysfunction were evaluated on admission using transthoracic echocardiography, along with prothrombotic state markers, i.e. increased endogenous thrombin generation (ETP), low fibrin clot permeability (Ks, a measure of clot density), and prolonged clot lysis time (CLT). ResultsRV parasternal long axis (RVOT PLAX) >30 mm was associated with ETP (OR 3.86; 95% CI 1.55–9.62; p = 0.004) and CLT (OR 4.08; 95% CI 1.58–10.54; p = 0.004) in the top quartiles, but not with Ks. RV short parasternal axis (RVOT PSAX) >27 mm showed similar associations with higher ETP (OR 3.54; 95% CI 1.50–8.37; p = 0.004) and prolonged CLT (OR 2.78; 95% CI 1.17–6.62; p = 0.021). RV basal diameter >41 mm solely predicted prolonged CLT (OR 2.93; 95% CI 1.23–6.99; p = 0.016). The right atrium area, pulmonary trunk diameter, and tricuspid regurgitation maximum velocity were not related to prothrombotic markers, except for tricuspid annular plane systolic excursion weakly associated with ETP. Multivariable analysis showed that RVOT PSAX is independently associated with prolonged CLT (OR 1.16; 95% CI 1.04–1.30; p = 0.007), low Ks (OR 1.21; 95% CI 1.02–1.44; p = 0.029), and higher ETP (OR 1.14; 95% CI 1.03–1.26; p = 0.009). ConclusionsAmong RV echocardiographic parameters, the RVOT dilatation measured in PSAX best predicts prothrombotic alterations in PE patients.

Gender difference in extreme cardiac remodelling in endurance olympic athletes assessed by non-contrast CMR

Abstract Funding Acknowledgements Type of funding sources: None. Background Male and female athletes present difference spectrum of cardiac remodelling related to their sport activity. However data in elite female athletes are scarce and mainly limited to echocardiography evaluation. Purpose The aim of the study was to assess gender difference in extreme cardiac remodelling in Olympic athletes engaged in endurance sport assessed by non-contrast Cardiovascular Magnetic Resonance including Mapping. Methods Olympic athletes engaged in endurance sport (rowing, canoeing, mid/long distance swimming) were examined with history, physical examination, 12-lead and exercise electrocardiogram, and echocardiography as part of their evaluation prior the Olympic games (Tokyo 2020). Athletes with unremarkable evaluation were undergone to non-contrast CMR including Mapping. The following parameters were calculated: indexed left ventricle (LV) and right ventricle (RV) end-diastolic (EDVi) and end-systolic volumes (ESVi), stroke volume (SVi), ejection fraction (EF), left and right atria area (LAAi and RAAi), LV Mass (Massi) and maximum wall thickness (MWT), RV/LV EDV ratio, spericity index [SI=(long axis diameter/2)3 * 4,187], myocardial native T1 (nT1) and T2 Mapping. Results 51 caucasian elite athletes (without difference in term of age, years of training and hours of training/week) were enrolled and 59% were male. Male showed greater LV EDVi (123 ± 28 ml vs 103 ± 10, p = 0.003), ESVi (55 ± 14 ml vs 44 ± 7, p = 0.001), SVi (68 ± 15 ml vs 59 ± 7, p = 0.023), Massi (76 ± 19 vs 57 ± 10, p &amp;lt; 0.001), MWT (10 ± 1 mm vs 8 ± 1, p &amp;lt; 0.001) and RV EDVi (129 ± 48 ml vs 104 ± 13, p = 0.026), ESVi (57 ± 10 ml vs 45 ± 9, p &amp;lt; 0.001), SVi (68 ± 15 ml vs 59 ± 7, p = 0.018) compared to female, as expected. LVEF (p = 0.05) and RVEF (p = 0.17) did not show significant difference. Despite greater volumes, SI (43 ± 12% vs 44 ± 8, p = 0.8) and RV/LV EDV ratio (0.99 ± 0.05 vs 1 ± 0.05, p = 0.405) did not differ between male and female athletes, as well as LAAi (13 ± 3 cm2 vs 13 ± 1.5, p = 0.86) and RAAi (13 ± 1.9 vs 13 ± 18, p = 0.56). Native T1 mapping was lower in male compared with female (934 ± 21 ms vs 956 ± 33, p = 0.028) while T2 Map values were slightly higher (53 ± 3.9 ms vs 50 ± 3.8, p = 0.027) . Conclusions Male endurance Olympic athletes presented higher volumes and LV mass compared to their female counterparts, while atria dimension, systolic function and sphericity index did not differ. Ventricles showed balanced dilatation in both gender. Lower T1 value observed in male suggested cellular hypertrophy. Figure 1 showed CMR images in a male (top row) and a female (bottom row) Olympic athletes: 4 chamber end-diastolic and end-systolic frame and end-diastolic basal short axis (SAX) showed balanced dilatation. Graphs showed higher EDVi and Massi in male compared o female, no difference in sphericity index and lower native T1 mapping. Abstract Figure 1

Evaluation of the morphology and mechanics of the right ventricle using echocardiography before and after transcatheter balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) leads to a progressive increase in pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP) with the development of severe dysfunction of the right heart and heart failure. Mortality for three years with an average pressure in the pulmonary artery (PA) of more than 50 mmHg is more than 90%. Balloon pulmonary angioplasty (BPA) has a significant advantage over other methods of surgical treatment, but it requires the determination of additional non-invasive markers of effectiveness. Transthoracic echocardiography (TTE) remains the main method for assessing the morphology and function of the heart. Purpose Compare different indicators reflecting the severity of CTEPH with TTE indicators before and after BPA. To evaluate the effectiveness of using BPA for the treatment of patients with CTEPH using routine TTE and speckle tracking mode. Materials and methods For 18 months 30 patients without concomitant cardiovascular pathology were subjected to several BPA sessions. Before treatment, 50% of patients belonged to the 3 CTEPH functional class (FC), 40% to 2 FC, 10% to 1 FC. The average number of sessions was 4.7 ± 1.3. Before the first BPA and after the last, all the patients were performed: six-minute walk test (6MWT, metres), Borg scale (in points), test for NT-proBNP (pg/ml); TTE with assessment of the right ventricle (RV) and left ventricle (LV) including areas of the right atrium (aRA, cm2), mean pulmonary artery pressure (PUPM,mmHg),RV free wall strain (GLSFW, %), RV free wall strain rate (GLSRFW, sm/sec), RV free wall postsystolic shortening (PSSFW, %), tricuspid annular plane systolic excursion (TAPSE, sm), tricuspid annulus systolic velocity (TASV, sm/sec). Results. Before the first BPA session, the 6MWT in the patient group averaged 315.9 ± 9.08 metres, after - 439.5 ± 11.45 m; the Borg from 5.4 ± 0.94 points decreased to 4 ± 1.01 points; NT-proBNP before the treatment was 1513 ± 13.01 pg/ml, after - 171 ± 6.09; according to TTE the ratio of RV/ LV before and after treatment was 1.31 ± 0.02 and 0.97 ± 0.04; aRA was 29.3 ± 4.87 and 22.3 ± 3.53 cm2; basal RV - 52 ± 5.11 and 44 ± 7.26 mm; PUPM decreased from 76.6 ± 7.65 to 31.3 ± 3.78 mmHg; GLSFW from -14.69 ± 2.33 came to 17.5 ± 3.45 %; GLSRFW with -0.9 ± 0.09 to -1.7 ± 0.11 cm/sec; TAPSE from 16.7 ± 1.87 to 18.2 ± 2.34 cm; TASV from 10.11 ± 1.45 to 12.25 ± 1.98 cm/s, PSSFW before treatment was -18.4 ± 1.2%, after treatment in 66% of patients disappeared, in 34% became an average of 17.4 ± 0.9% The distribution of STEPH FC has also changed. Conclusion. BPA leads to an improvement in the tolerance of physical activity, clinical indicators, and parameters of central hemodynamics in the pulmonary circulation, evaluated according to direct manometry, and leads to reverse remodeling of the RV in the long term. Performing a staged BPA leads to an improvement in the functional parameters of contractility of the RV.

Area of the right atrium of the fetal heart and its significance in fetuses with tricuspid regurgitation

Objectives The first aim was to develop a nomogram for the area of the right atrium (ARA) of the fetal heart in uncomplicated singleton pregnancies. The second aim was to assess diagnostic indices of ARA to distinguish between tricuspid regurgitation (TR) with and without concomitant congenital heart defect (CDH). Methods The study was conducted between 2014 and 2019. Fetal echocardiography was performed on fetuses with and without TR. For the first aim, ARA was measured in 460 fetuses without proven structural and chromosomal abnormalities, and for the second aim, ARA was measured in 1077 fetuses with TR. Results A nomogram for the ARA of fetuses with normal hearts was developed. TR was observed in 4.5% (1077/23,771) of euploid fetuses; 4.3% (1020/23,771) of fetuses had TR without a concomitant CHD, and 0.2% (57/23,771) fetuses had TR with a concomitant CHD. No significant differences in ARAs were found between fetuses with normal hearts without TR (n = 22,694) and fetuses with TR without CHD (n = 1020; p = .751). Fetuses with TR and CHDs had different ARA than fetuses with normal hearts without TR and fetuses with TR without CHD (p < .0005 in both cases). Conclusions ARA seems to be an auxiliary marker to distinguish the presence of CHD in fetuses with TR.

Risk assessment in precapillary pulmonary hypertension: a comparative analysis

BackgroundRisk stratification is essential to assess mortality risk and guide treatment in patients with precapillary pulmonary hypertension (PH). We herein compared the accuracy of different currently used PH risk stratification tools and evaluated the significance of particular risk parameters.MethodsWe conducted a retrospective longitudinal observational cohort study evaluating seven different risk assessment approaches according to the current PH guidelines. A comprehensive assessment including multi-parametric risk stratification was performed at baseline and 4 yearly follow-up time-points. Multi-step Cox hazard analysis was used to analyse and refine risk prediction.ResultsVarious available risk models effectively predicted mortality in patients with precapillary pulmonary hypertension. Right-heart catheter parameters were not essential for risk prediction. Contrary, non-invasive follow-up re-evaluations significantly improved the accuracy of risk estimations. A lack of accuracy of various risk models was found in the intermediate- and high-risk classes. For these patients, an additional evaluation step including assessment of age and right atrium area improved risk prediction significantly.DiscussionCurrently used abbreviated versions of the ESC/ERS risk assessment tool, as well as the REVEAL 2.0 and REVEAL Lite 2 based risk stratification, lack accuracy to predict mortality in intermediate- and high-risk precapillary pulmonary hypertension patients. An expanded non-invasive evaluation improves mortality risk prediction in these individuals.

Diagnostic and Prognostic Value of Several Color Doppler Jet Grading Methods in Patients With Mitral Regurgitation

Color Doppler is a widely used ultrasound imaging method for assessing mitral regurgitation (MR) in clinical practice. Nevertheless, color Doppler-based grading of the MR jet has been rarely considered in clinical studies. We investigated the diagnostic and prognostic value of several color Doppler MR jet grading methods and compared them with quantitative grading of MR. The MR color Doppler jet was assessed in 476 MR patients using an 'integrated' eyeballing approach by quantifying the color Doppler jet area, jet area/left atrium area and jet length and using quantitative methods. Clinical endpoints were scored as major adverse clinical events, including cardiovascular death, heart failure hospitalization and mitral valve intervention. When assessed by three echocardiographers, there was a moderate inter-observer agreement for eyeballing color Doppler grade of MR (intraclass correlation coefficient 0.69, p < 0.001). The intra-observer agreement was good for all color Doppler approaches. In primary MR, eyeballing color Doppler correlated well with (in)direct measures of MR severity, with a negative predictive value of 91% when using a grade 2 color Doppler as cut-off. In secondary MR, eyeballing color Doppler grade and jet length were predictors of clinical outcome in Cox proportional hazards analysis (p = 0.003), independent of pulmonary pressures, atrial and ventricular volumes. Overall, the integrated eyeballing approach performed better than color Doppler quantification of the MR jet area and length. In conclusion, this study shows that color Doppler grading of the distal MR jet performs well in predicting events in primary and secondary MR, compared to quantitative grading methods.

Diagnostic Accuracy of the Electrocardiogram for Detection of Atrial and Ventricular Overloads in Dogs

Background: Analysis of the electrocardiogram may suggest atrial and ventricular overloads. However, it has a low sensitivity and specificity for diagnosis of cardiac chamber overload. The accuracy of electrocardiographic interpretation can be improve using new cut-offs for the duration and amplitude of the electrocardiographic waves. Our objective was to evaluate the use of the electrocardiogram in the diagnosis of atrial and ventricular overload, using echocardiography as the gold standard test for the diagnosis of atrioventricular overload. We aimed to define new cut-off values that would increase the sensitivity and specificity of the electrocardiogram for diagnosis of chamber overload in dogs.Materials, Methods &amp; Results: Eletrocardiogram records were obtained in 81 dogs divided into 3 groups: Group 1A (healthy dogs 10 kg); Group 1B (dogs 10 kg with mitral or tricuspid valve disease); Group 2 (dogs weighing between 10.1 and 20 kg) and Group 3 (dogs &gt; 20.1 kg). Duration in milliseconds (ms) and amplitude in millivolts (mV) of P waves and QRS complexes, PR and QT segment, T wave amplitude and ST segment were evaluated in lead DII. Using leads I and III, the mean cardiac electrical axis in the frontal plane, expressed in degrees, was determined as the mean of three consecutive measurements. For Group 1A and 1B the duration of P wave was &lt; 45 ms and QRS duration &lt; 55 ms. In Group 2 the duration of P wave was &lt; 47 ms and QRS duration &lt; 57 ms. In Group 3 the duration of P wave was &lt; 50 ms and duration QRS &lt; 64 ms. These values (duration of P wave and QRS duration) were compared with echocardiographic measurements of the left atrium, considering the reference value AE/Ao &lt; 1.4 and measurements of the left ventricle in M-mode according to the body weight, respectively. A P wave amplitude &lt; 0.4 mV suggested that the right atrium size was normal and this was compared with the area of the right atrium measured on the echocardiogram. The right ventricle was assessed using the amplitude of S wave and right axis deviation and compared with the right ventricular area obtained by echocardiography. The reference value of the right atrium and right ventricle is according to the body weight. For both the right and left atria, there was concordance between the diagnoses with electrocardiography and echocardiography. For the right and left ventricle was no agreement between the diagnoses. All criteria examined had low sensitivities, usually with high specificities. But it was not possible to determine a new cut-off that would improve the sensitivity of the electrocardiogram for diagnosis of atrial and ventricular overload in dogs. Discussion: The electrocardiogram analysis produced false interpretations for the measures indicative of atrioventricular overloads and should not be used alone, for diagnosis of cardiac chamber overload. The standard electrocardiographic reference values, for P wave duration and amplitude, were excellent for identification of normal atrial size. However, QRS duration, R wave amplitude (dependent of the dog’s weight) and S wave amplitude, associated with cardiac electrical axis cannot be used for diagnosis of ventricle overload. Electrocardiographic analysis should not be used as a tool to assess cardiac chamber overload, which should be diagnosed by echocardiography and clinical investigation. Based on our findings echocardiogram is the gold standard test indicated to identify overload of cardiac chambers.

Left ventricular myocardial function in hemodialysis patients: the effects of preload decrease in conventional, Doppler and speckle tracking echocardiography parameters.

Introductionour aim was to investigate the value of conventional echocardiography, pulsed Doppler and speckle tracking imaging (STI) analysis in the assessment of the left ventricular (LV) myocardial function in hemodialysis (HD) patients with preserved LV ejection fraction and to evaluate the effect of a single HD session on the LV systolic and diastolic functions.Methodsthe study population consisted of 30 chronic HD patients. Echocardiography and Doppler studies were performed before and after HD. The LV global longitudinal, circumferential and radial strains were measured with two and three-dimensional STI.Resultsafter HD, LV dimensions, left atrium (LA) area, systolic pulmonary arterial pressure and inferior vena cava diameter decreased significantly. The peak mitral E velocity, the E/A ratio of the mitral inflow and the lateral E/E´ ratio decreased also significantly. The LV and LA volumes index and LV mass index (LVMi) decreased remarkably after HD. The 3D- LV and LA ejection fractions were unchanged after HD. Although, 3D-estimated LVEF seemed to be preserved in the HD patients, the 2D and 3D- strain rates were decreased in all directions. The global strain values improved in all directions after a single HD session. Inverse correlations were found between the LVMi, serum BNP and LV global longitudinal strain.Conclusionin HD patients with preserved LV ejection fraction, the STI analysis may add important information concerning the subclinical LV dysfunction.

Can echocardiography predict the diagnosis of obstructive sleep apnea or its severity in a Tunisian population with atrial fibrillation?

It is currently recognised that obstructive sleep apnea (OSA) may affect the function and geometry of heart chambers, which has promoted the development of echocardiographic exploration as one of the tools for screening for the diagnosis of OSA and its severity in the general population. However, few studies have investigated the impact of echocardiographic findings on screening for OSA or its severe forms in patients with atrial fibrillation (AF). Investigate the echocardiographic abnormalities that would be correlated with the positive diagnosis of OSA and the diagnosis of its severity in non-valvular AF patients. This is a cross-sectional study that included 100 patients with non-valvular AF. All patients had an echocardiographic study and overnight polygraphy. OSA's diagnosis was retained in 90% of patients: mild in 32% of cases, moderate in 27% of cases and severe in 31% of cases. In our study, there was no significant difference between groups with and without OSA in terms of left ventricular systolic function, percentage of patients with left ventricular hypertrophy (LVH), left atrium area, systolic function right ventricle and pulmonary systolic blood pressure level. Comparing patients with severe OSA to patients with non-severe OSA, analysis of echocardiographic parameters showed that LVH was significantly more found in patients with severe OSA compared with those with IAH < 30 (58% versus 35.4%, P = 0.036, OR = 2.52, CI 95% : 1.05–6.07). In addition, the surface of the left atrium was positively correlated with hypnea–apnea index ( P = 0.018) and therefore with the severity of OSA. In our study conducted in a Tunisian population with AF, we pointed out that OSA was not significantly associated with the different echocardiographic parameters used, whereas LVH and the left atrial area were significantly more noticeable in the severe OSA group compared to the rest of the population.

Echocardiographic predictors of exercise capacity in algerian patients with heart failure and systolic dysfunction: role of mitral regurgitation

Patients with heart failure and similar left ventricular systolic dysfunction have differing exercise capacity. The aim of this study was to identify echocardiographic predictors of exercise capacity in Algerian patients with heart failure and systolic dysfunction. We included 290 patients with class II (70%) or III (30%) heart failure with left ventricular ejection fraction below 40%. Six-minute walking test and cardiac color Doppler-echo, including tissue Doppler of mitral and tricuspid rings, were performed. Moderate and severe mitral regurgitation were considered as significant. Two groups were divided according to the median walking distance (290 m): Group 1 < 290 m and Group 2 > 290 m. Mitral regurgitation was detected in 215 patients (74%), which was significant in 87 (30%). Group 1 showed more significant mitral regurgitation (35 vs. 18%), increased left atrium area (27 ± 1 vs. 241 cm2), mitral E amplitude (88 ± 65 vs. 72 ± 3 cm/s) and systolic pulmonary pressure (37 ± 1 vs. 32 ± 1 mmHg, all P < 0.05). By logistic regression analysis, only the presence of significant mitral regurgitation was independently associated with less walked distance (odds ratio: 3.44 95% confidence interval 1.02-11.66, P < 0.05). By multiple linear regression, the only independent predictor of walked distance was left atrium area (r = 0.25, beta coefficient: _6.52 ± 2, P < 0.01). In patients with class II-III heart failure and left ventricular systolic dysfunction, the main echocardiographic predictors of exercise capacity are related to the presence of significant mitral regurgitation.

Evaluation of Echocardiographic Parameters for the Prediction of Prognosis in Patients Diagnosed with Pulmonary Arterial Hypertension

Background: We aimed to determine the importance of myocardial tissue Doppler flow rates, pulmonary artery/aorta diameter (PA/Ao), pulmonary venous flow transit time (pPTT), pulmonary artery acceleration time (PAAcTc), and right atrium area index (RAAI) parameters in the prediction of prognosis patients with a diagnosis of pulmonary arterial hypertension (PAH). Materials and Methods: : This retrospective study was done on 30 patients with systemic pulmonary arterial hypertension confirmed via catheterization who had negative vascular reactivity test results (pediatric patients with primary pulmonary hypertension and secondary pulmonary hypertension due to congenital heart disease). PA/Ao diameter, PAAcTc, pPTT, and RAAI were calculated. The patients were grouped as those with PA/Ao , SaO2% , and pro-B-type natriuretic peptide (BNP) , and those receiving combination therapy or monotherapy, and the parameters were compared between the groups. Results: pPTT was shorter in the group with SaO2 > 90%, which was attributed to the high number of patients with idiopathic PAH in this group and more severe PAH stage. PAAcTc was shorter in patients who showed no clinical improvement on monotherapy and required multidrug therapy. RAAI was significantly increased in patients with pro-BNP > 100 pg/ml. A decreased pPTT, accompanied by a lower PAAcTc in the group with PA/Ao >1.5, indicated the severity of PAH in this group. Conclusion: When managing PAH patients, the presence of RAAI > 18 cm2/m2, PA/Ao > 1.5, and PAAcTc < 80 msn indicates a higher disease severity, and suggested that the patients’ treatment regimen should be re-evaluated based on these parameters. Also, the RAAI parameter shows the closest association with pro-BNP levels, which is one of the correct prognosis indicators.

Conduction Heterogeneity: Impact of Underlying Heart Disease and Atrial Fibrillation.

The goal of this study is to investigate the impact of various underlying heart diseases (UHDs) and prior atrial fibrillation (AF) episodes on conduction heterogeneity. It is unknown whether intra-atrial conduction during sinus rhythm differs between various UHD or is influenced by AF episodes. Epicardial sinus rhythm mapping of the right atrium, Bachmann's bundle (BB), left atrium and pulmonary vein area was performed in 447 participants (median age: 67 [interquartile range (IQR): 59 to 73] years) with or without AF undergoing cardiac surgery for ischemic heart disease, (ischemic and) valvular heart disease, or congenital heart disease. Conduction times (CTs) were defined as Δ local activation time between 2 adjacent electrodes and used to assess frequency (CTs≥ 4ms) and magnitude of conduction disorders (in increments of 10ms). When comparing the 3 types of UHD, there were no differences in frequencies and magnitude of CTs at all locations (p≥ 0.017 and p≥ 0.005, respectively). Prior AF episodes were associated with conduction slowing throughout both atria (14.9% [IQR: 11.8 to 17.0] vs. 12.8% [IQR: 10.9 to 14.6]; p<0.001). At BB, CTs with magnitudes≥30ms were more common in patients with AF (n=56.2% vs. n=36.0%; p<0.004). UHD has no impact on the frequency and severity of conduction disorders. AF episodes are associated with more conduction disorders throughout both atria and with more severe conduction disorders at BB. The next step will be to determine the relevance of these conduction disorders for AF development and maintenance.

Cone reconstruction for Ebstein anomaly: Late biventricular function and possible remodeling

ObjectivesTo evaluate late-term tricuspid valve competence and biventricular function following cone reconstruction for Ebstein anomaly, and to explore biventricular remodeling. MethodsConsecutive adult and pediatric patients who underwent cone reconstruction from 2009 to 2019 were reviewed for inclusion in this retrospective cardiac magnetic resonance imaging study. Tricuspid valve competence was assessed with tricuspid regurgitation fraction. Biventricular systolic function was assessed by ejection fraction, cardiac index, indexed stroke volume, and indexed aortic and pulmonary artery beat volume. Biventricular remodeling was assessed by planimetered areas (right atrium, functional right ventricle, left heart), and indexed end-diastolic and end-systolic ventricular volumes. Paired t tests or Wilcoxon signed-rank tests were used for analyses. ResultsOf 58 included patients, 50 underwent cardiac magnetic resonance imaging. Twelve patients had both preoperative and late postoperative cardiac magnetic resonance imaging with a median follow-up of 5.11 years (interquartile range, 3.12-6.07 years). Focusing on these, tricuspid regurgitation fraction decreased (from 69% to 10%; P = .014), right ventricle ejection fraction remained stable, and antegrade pulmonary artery beat volume increased (from 26.7 to 41.6 mL/beat/m2; P = .037). The left ventricle stroke volume (from 30.4 to 44.1 mL/m2; P = .015) and antegrade aortic beat volume (from 28.5 to 41.1 mL/beat/m2; P = .014) also increased, and the left ventricle stroke volume improved progressively with time since surgery (P = .048). Whereas the right atrium area decreased (P = .004), the functional right ventricle and left heart area increased (cm2, P = .021 and P = .004). Right ventricle volumes showed a tendency to normalize and left ventricle indexed end-diastolic volume increased (from 50 to 69 mL/m2; P = .03) over time. ConclusionsCone valve integrity was sustained. Biventricular function improved progressively during follow-up, and there are positive signs of biventricular remodeling late after cone reconstruction.

The tricuspid annular peak systolic excursion to systolic pulmonary artery pressure index: association with all-cause mortality in patients with moderate or severe tricuspid regurgitation

Abstract Background In patients with significant tricuspid regurgitation (TR) the conventional markers for the assessment of right ventricular (RV) systolic function may be less accurate. Tricuspid annular plane systolic excursion (TAPSE) indexed to systolic pulmonary artery pressure (SPAP) (TAPSE/SPAP) may be prognostically useful in pulmonary hypertension and right ventricular (RV) dysfunction. Objective Our aim was to explore the prognostic value of TAPSE/SPAP index in patients with moderate or severe TR. Methods A total of 209 patients (72±14 years, 56% women) with moderate (n=123) or severe (n=86) TR (primary in 6% and secondary in 94%) were followed up for a median of 80 months (mean 70±33 months). The clinical correlates of TAPSE/SPAP ratio and association with all-cause mortality were assessed. Results The TAPSE/SPAP index was inversely correlated with all-cause mortality with an optimal threshold of 0.49 mm/mmHg. A low index was found in 139 (68%) patients and was associated with reduced survival (Figure). In a multivariate Cox regression analysis adjusted for age, smoking, coronary artery disease, left ventricular ejection fraction, right atrium area and mitral valve replacement, low TAPSE/SPAP index was associated with significantly higher hazard ratio of all-cause mortality (HR: 2.0; 95% CI 1.27–3.14, p=0.003). Age, coronary artery disease, left ventricular ejection fraction and right atrium area were other independent predictors of all-cause mortality. Conclusions The TAPSE/SPAP index, reflecting RV systolic function in the longitudinal axis corrected for force generating by the RV is a powerful predictor of all-cause mortality in patients with moderate or severe TR. Figure 1 Funding Acknowledgement Type of funding source: None

The Effects of Endobronchial Coil Therapy on Right Ventricular Functions

Lung hyperinflation is an important therapeutic target in symptomatic emphysema patients. Endobronchial therapies that reduce end-expiratory lung volume are increasingly being used in advanced cases. However, there is paucity of data regarding the effects of these therapies on the heart functions. The aim of this study is to evaluate the right ventricular functions before and after the procedure in patients who underwent endobronchial coil therapy (EBCT).Patients who were between 18 and 80 years of age and scheduled for EBCT with GOLD 3-4 were enrolled in the study. Right heart functions were evaluated using MPI, TAS, TAPSE. Right atrium area and maximum velocity of tricuspid regurgitation were also noted.A total of 23 patients were enrolled in the study. 21 patients underwent bilateral intervention, while only 2 patients received unilateral treatment. There was an improvement in MPI (0.49 ± 0.15 vs 0.39 ± 0.11, p < 0.001) and TAS (11.6 (9 − 15) vs 13.2 (9.80 − 17.0), p = 0.001). Peak TRV (2.52 ± 0.6, 2.38 ± 0.6, p = 0.02) and PASP values were lower in the post-operative period (41.15 ± 5.94 vs 36.83 ± 8.01 p = 0.019).In this current study, we found improved echocardiographic RtV parameters in patients who received EBCT treatment.

Clinical and imaging predictors of recovery in patient with pulmonary emboli

Abstract Background Post-pulmonary emboli impairment (PPEI), comprised significant morbidity and mortality. A single center registry of patients with PE was established in order to estimate patients' risk, monitor clinical management and develop a simple model to assess the risk for PPEI for the entire spectrum of patients treated in general clinical practice. Methods For developing the mentioned model, apart from approved imaging parameters, potential novel imaging parameters were also evaluated. Recovery were assessed according to Pulmonary Embolism Thrombolysis (PEITHO) trial definition (Figure 1). Results 140 patients have been registered with at least 6-month imaging follow up. PPEI was confirmed in 75 (53.6%) patients with PE. The prognostic value of traditional and novel imaging parameters on 6-month complete recovery were summarized in Table. A multivariable logistic regression model was developed using 140 patients. Previous PE, HRfollowing five in-hospital-parameters accounted for simple prognostic model for incomplete recovery: history of PE, heart rate≥110, serum blood urea nitrogen level, RV/LV ratio and right atrium area, The overall prediction ability was excellent with 80.6 overall percentage for PPEI. Conclusions PPPEI rate was considerable in our study. Our proposed simple prediction model might have a role on identification of patients at risk for PPEI. Figure 1 Funding Acknowledgement Type of funding source: None