Atrium Area Research Articles

Rhythm and rate control strategies in patients with long-standing persistent atrial fibrillation treated with cardiac resynchronization: the results of the randomized Pilot-CRAfT study.

Atrial fibrillation (AF) is common in cardiac resynchronization therapy (CRT) recipients. It is a marker of impaired CRT response mainly mediated by the reduction of effectively captured biventricular paced beats (BiVp). There are no randomized trials comparing strategies to maintain high BiVp percentage. To compare the efficacy of rhythm vs rate control strategies in CRT recipients with long-standing persistent AF. We performed a randomized trial including CRT recipients with persistent AF resulting in low BiVp%. All patients received amiodarone, the rhythm control group received external electrical cardioversion (EC), and the rate control group received atrioventricular node ablation, if needed. The primary end-point was 12-month BiVp% (NCT). 43 patients were included in the analysis. The mean age was 68.4 (SD: ± 8.3) years and the mean BiVp% 82.4% ± 9.7%. AF lasted 25 ± 19 months. The mean baseline left ventricular ejection fraction (LVEF), left atrium area, and the maximal oxygen uptake (VO2max) were: 30 ± 8%, 33 ± 7 cm2, and 14 ± 5 mL/(kg*min), respectively. The EC success rate was 58%. 38% patients remained in sinus rhythm (SR) after 12 months. BiVp% increased similarly in both arms reaching 99% [95% CI 97.3-99.8] and 98% [94.0-99.0], P = 0.14 in rhythm and rate control groups, respectively. LVEF raised significantly only in the rhythm control group (ΔLVEF 4.1 (± 7.3), P = 0,018) which was driven by the patients who maintained SR. No differences in VO2max, QoL, clinical and safety end-points were observed. Despite comparable BiVp% in both groups, only restoration of SR led to improved left ventricular ejection fraction in CRT patients with long-standing AF. NCT01850277 registered on 22/04/2013.

Correlation between vascular endothelial growth factor, soluble urokinase plasminogen activator receptor, and tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio in group E chronic obstructive lung disease.

Vascular endothelial growth factor is a signaling protein created by cells performing important bodily functions. Vascular endothelial growth factor is abundant in the lung, and plasma levels are elevated in patients with severe pulmonary arterial hypertension. An association between soluble urokinase plasminogen activator receptor, an inflammatory biomarker, and soluble urokinase plasminogen activator receptor levels and interstitial pulmonary and vascular involvement (e.g., development of pulmonary hypertension) has been shown in SSc patients. The tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio, which has been recommended as a useful diagnostic tool in the last guideline, is one of the additional echocardiographic signs suggestive of pulmonary hypertension. We aimed to examine whether these biomarkers contribute to the diagnosis and management of pulmonary hypertension. Patients with group E chronic obstructive lung disease were included in this prospective study. Demographic data, echocardiographic signs about the right ventricle (right atrium area, tricuspid annular plane systolic excursion/systolic pulmonary artery pressure, fractional area change, and right ventricular outflow tract), and peripheral blood analysis were examined and recorded. A total of 70 patients, 12 of whom were female, were analyzed in the study. The mean age was 66.6±8.7 years. The mean vascular endothelial growth factor-A and soluble urokinase plasminogen activator receptor were 91.05±70.7 and 955.8±571.1, and their Pearson correlation coefficients between vascular endothelial growth factor-A and tricuspid annular plane systolic excursion/systolic pulmonary artery pressure, and soluble urokinase plasminogen activator receptor and tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio were 0.341 (p=0.004) and -0.045 (p=0.70), respectively. The linear regression model included four variables with significant correlation (vascular endothelial growth factor-A, right atrium area, fractional area change, and right ventricular outflow tract). Three steps were performed, and adjusted r2 was 0.22, 0.22, 0.20, and p<0.001 for each step. Vascular endothelial growth factor-A and right ventricular outflow tract remained in the last step. It was detected a standardized coefficient beta of 0.322 (p=0.004) and a 95%CI 0.000-0.001 for vascular endothelial growth factor-A. Vascular endothelial growth factor-A is correlated with the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio and not with soluble urokinase plasminogen activator receptor.

Evaluation of right ventricular function in patients with Behcet's disease by four-dimensional echocardiography.

Behcet's disease (BD) is a systemic disorder characterized by vasculitis, resulting in thickened vascular walls that reduce elasticity and impair function. BD can involve the cardiovascular system in three ways: cardiac, arterial, and venous. In this study, our objective was to evaluate the efficacy of pulmonary arterial stiffness (PAS) and pulmonary pulse transit time (PPTT) measures in demonstrating right ventricular functions in asymptomatic BD patients. We aimed to objectively evaluate right ventricular function in patients with BD using four-dimensional echocardiography (4DE). This study included 40 patients diagnosed with BD and 40 healthy subjects. Demographic, clinical, laboratory, and echocardiographic parameters were compared. In addition to standard transthoracic echocardiographic evaluation, right ventricle quantification (RVQ) by using the 4DE and 2D-speckle tracking echocardiography were performed. The sPAP, 4D RVQ, and right ventricular strain values exhibited significant differences between the BD and control groups. Right ventricular end-diastolic diameter (RVDD), right ventricular end-systolic diameter (RVSD), right atrium (RA) area, right ventricular myocardial performance index (RVMPI), and PAS were increased in BD patients compared to the control group. Right ventricular ejection fraction (RVEF), right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), Tricuspid S', and PPTT were decreased in BD patients compared to control subjects. PPTT correlated with right ventricular free wall strain (RV-FWS) and PAS. In a multivariate linear regression analysis, PAS and RVFAC were found to be independent predictors of RVFWS. In addition, RVFAC and TAPSE are independent predictors for PPTT. Patients with BD may have elevated pulmonary arterial stiffness (PAS) in correlation with decreased PPTT. To ascertain the prognosis for these individuals, right ventricular (RV) functions must be evaluated. Measurements of RVFAC and RVEF via 4DE and deformation imaging techniques may be more useful in identifying subclinical impairment of RV. Individuals with BD, PAS, and PPTT may suggest a link between early pulmonary vascular remodeling and RV subclinical impairment.

Evaluation of Intraoperative Saline Injection Leak Test Without Transesophageal Echocardiography as a Reliable Method During Heart Valve Repair

Background: Valvular heart diseases (VHD) pose a significant global health challenge, leading to numerous cardiac surgeries. The quality of valve repair is typically assessed using transesophageal echocardiography (TEE) and saline injection tests intraoperatively. However, TEE is not universally available, particularly in resource-limited settings. Objectives: This study aimed to evaluate the effectiveness of saline injection tests as the sole method for assessing cardiac valve repair quality. Methods: This retrospective cohort study included patients who underwent cardiac valve surgery without intraoperative TEE assessment. Preoperative transthoracic echocardiography (TTE) was performed on all patients. A consistent team performed all valve repairs, and the quality of these repairs was assessed intraoperatively using the saline injection test. Postoperative TTE was also conducted to evaluate valve function and compare it with preoperative measurements. Results: The study comprised 16 patients (mean age: 63.8 ± 10.6), predominantly male. Mitral valve (MV) repair was performed on 11 patients, with nine showing improved function (P-value: 0.006). Seven patients underwent tricuspid valve repair (TVr), all of whom exhibited improved function (P-value: 0.01). Four patients received aortic valve repair, with three showing improved function (P-value: 0.10). Additionally, significant improvements were observed in left ventricular end-diastolic diameter (LVEDd), left ventricular end-diastolic volume (LVEDV), inter-ventricular septal diameter, posterior wall thickness (PWT), tricuspid annular plane systolic excursion (TAPSE), right ventricular peak systolic myocardial velocity (RVSm), pulmonary artery pressure, tricuspid regurgitation (TR) gradient, and right atrium area. Conclusions: The saline injection test can be a valuable tool for assessing the quality of mitral and tricuspid valve repairs, particularly when TEE is unavailable. However, its reliability for aortic valve repair remains uncertain.

Investigating the Actuation of Sidewall Sprinkler in an Atrium Using CFD Simulation

This study investigates the actuation of sidewall sprinklers in large-scale buildings with high-ceilinged atriums, addressing the challenges of unique architectural configurations. Compliance with NFPA 101 requires automatic sprinkler systems, including atrium areas, in these buildings. To maintain aesthetic considerations, design engineers, particularly in the middle east, often propose sidewall sprinklers as an alternative to traditional ceiling sprinklers. This research assesses whether the sidewall sprinklers would actuate during a fire using Fire Dynamic Simulator (FDS). The findings indicate that sidewall sprinklers will fail to actuate if the fire is located at the centre of the atrium, even if the edge of the fire area is below the sprinklers. Furthermore, the study emphasizes the importance of using an FDS mesh resolution (D*/dx) of 6 or finer resolution when measuring temperatures near the flame or fire plume to ensure accurate evaluations of sprinkler activation. These findings provide valuable insights for design engineers and authorities, assisting in decision-making processes related to fire safety measures, system designs, and regulatory compliance.

Transthyretin amyloid cardiomyopathy in patients with unexplained increased left ventricular wall thickness

Amyloid cardiomyopathy (CA) was previously considered a rare disease; however, rapid advancements in imaging modalities have led to an increased frequency of its diagnosis. The aim of this prospective study was to assess the prevalence and clinical phenotype of transthyretin amyloidosis (ATTR) cardiomyopathy in patients exhibiting unexplained increased left ventricular (LV) wall thickness. From 2020 to 2022, we enrolled 100 consecutive adults with unexplained increased LV wall thickness in the study. The analysis included clinical data, electrocardiography, transthoracic echocardiography, single-photon emission computed tomography/computed tomography with 3,3-disphono-1,2-propanodicarboxylic acid, genetic testing. Overall, 18% of patients were diagnosed with CA, comprising 5% with light-chain amyloidosis, and 12% with ATTR. To evaluate associations with the ATTR diagnosis, a LOGIT model and multivariate analysis were applied. Notably, age, polyneuropathy, gastropathy, carpal tunnel syndrome, lumbar spine stenosis, low voltage, ventricular arrhythmia, LV mass, LV ejection fraction, global longitudinal strain (GLS), E/A, E/E′, right ventricle (RV) thickness, right atrium area, RV VTI, TAPSE, apical sparing, ground glass appearance of myocardium, thickening of interatrial septum, thickening of valves, and the “5–5–5” sign were found to be significantly associated with ATTR (p < 0.05). The best predictive model for ATTR diagnoses exhibited an area under the curve of 0.99, including LV mass, GLS and RV thickness. This study, conducted at a cardiology referral center, revealed that a very considerable proportion of patients with unexplained increased LV wall thickness may suffer from underlying CA. Moreover, the presence of ATTR should be considered in patients with increased LV mass accompanied by reduced GLS and RV thickening.

Peculiarities of the evolution of pulmonary hypertension in patients with ischemic heart failure 12 months after myocardial revascularization

Pulmonary hypertension (PH) associated with left heart disease is common and has an important impact on disease progression, morbidity and mortality. We aimed to identify the particularities of PH evolution in patients with ischemic heart failure during 12 months after myocardial revascularization (MRev) by coronary artery bypass grafting or percutaneous coronary angioplasty.Methods: The research included 281 patients undergoing MRev (mean age=63.2±9.7 years, 76.5%- men). Follow up period - 12.6±1.6 months. The patients were divided according to the echocardiographic probability of PH (PHPr) into 3 groups: low PHPr (117 patients), intermediate PHPr (74 patients), high PHPr (90 patients). Results. The prevalence of PH 12 months after MRev constituted 69.7%, increasing by 10% compared to the initial period. We highlighted a negative evolution of PHPr during 1 year after MRev: 42.8% of patients with initially low PHPr and 54.1% of those with intermediate PHPr had a higher degree of PHPr. The peak tricuspid regurgitation velocity and the pulmonary artery systolic pressure did not change significantly during 12 months after the acute event. The negative evolution of PHPr was determined by the negative dynamics of additional echocardiographic signs suggestive for PH: the right atrium area (+2,2±0.4mm), the right ventricular outflow tract acceleration time (-7.6±1.2ms), the inferior vena cava diameter (+0.55±0.2mm). During 12 months after MRev, 5 patients died, all of them had high PHPr (p&lt;0.01), and the hospitalization rate was significantly higher in this group (high PHPr - 57.1%, intermediate PHPr - 43.2%, low PHPr - 38.7%, p&lt;0.05). Conclusions: The PH prevalence 12 months after MRev was 69.7%, increasing by 10% compared to the initial period. A negative evolution of PHPr was noted during 1 year follow up. Patients with high and intermediate PHPr had a higher rate of hospitalizations during the 12 months after MRev and all deceased patients had high PHPr.

HEMODYNAMIC PARAMETERS AND STRUCTURAL CHANGES OF THE MYOCARDIUM IN PATIENTS WITH HEART FAILURE AND ATRIAL FIBRILLATION: THE ROLE OF BRAIN NATRIURETIC PEPTIDE, NT-PRO BNP, GALECTIN-3 AND sST-2

Heart failure remains one of the most common causes of hospitalization, disability, and mortality in the working population in the world, particularly in Ukraine; it has a high prevalence, an unfavorable prognostic course, and also causes significant economic costs. The prevalence of heart failure (HF) in the general population is 1.5 - 2.0%, and among people over 65 years old - 6 - 10% [10]. The main etiological cause of the development of chronic heart failure (CHF) is coronary heart disease (CHD), which is confirmed by the data of multicenter studies. One of the features of CHF is the high heterogeneity of its clinical manifestations and the absence of absolutely pathognomonic symptoms, which often leads to late diagnosis and deterioration of the prognosis of the course of the disease [1-6]. In the last decade, biomarkers for the diagnosis and prognosis of HF have been actively researched in search of the "ideal" one that can characterize the activation of all links of the HF syndrome and provide additional information about natriuretic peptides (NAUP). Given the extremely complex and multifaceted biochemical interactions that underlie the pathophysiology of CHF, scientists are paying more attention to a multimarker strategy for the diagnosis and risk stratification of CHF.Aim. The purpose of the paper is to investigate the role of brain natriuretic peptide (BNP), NT-pro BNP, galectin-3, s-ST2 in the development of heart failure in patients with atrial fibrillation.Material and methods. 468 patients aged 45-65 years (54,3±7,2 years) and 56 healthy people were included in the study. Among the examined were 234 (50,0%) women and 234 (50,0%) men. Group I – control, 56 practically healthy individuals; Group II - patients with CHF without AF (n=234); III group - patients with CHF and AF (n=234).Diagnoses of AF and HF were carried out according to the clinical protocol for providing medical care to patients with atrial fibrillation and heart failure, confirmed by the order of the Ministry of Health of Ukraine №436 of 07.03.2006. and according to the 2021 Recommendations of the European Society of Cardiology (ESC) on the diagnosis and treatment of acute and chronic heart failure. In addition to the general clinical examination, an enzyme immunoassay was also performed to determine the content of brain natriuretic peptide, NT-pro BNP, galectin-3 and sST-2 in the blood.Results. The analysis of structural changes of the myocardium in various phenotypes of CHF revealed a probable increase in the transverse size of the left atrium by 18,5%, the index of the size of the left atrium by 25,4%, the area of the left atrium by 25,3%, the volume of the left atrium by 21,6% and left atrial volume index by 10,1% in patients with CHF and concomitant AF.The study founds a probable increase in the levels of NT-pro BNP (by 50,1%; p&lt;0,05) and brain natriuretic peptide (by 47,3%; p&lt;0,05) in patients with AF and CHF. With an increase in the size of the left atrium against the background of CHF and AF, a probable increase in the concentration of galectin-3 (by 24.3%, p&lt;0.05) and a probable increase in the level of sST-2 (by 41.4%, p&lt;0, 05) were set. It has been proven that an important aspect of the phenotype of CHF with accompanying AF is the enlargement of the left atrium (LA), which probably correlates with the content of brain natriuretic peptide (BNP) (r=0,35; p&lt;0,05), as well as with sST-2 content (r=0,41; p&lt;0,05).

Diagnosis of Ticks Boophilus annulatus (Say, 1821) Prying on Cows in Tikrit/Iraq

The study aimed to investigate the tick insect on cows in Tikrit city for period from the beginning of November 2018 until the end of March 2019. The results of the present study showed that cows were infected with one type of tick, Boophilus annulatus (say, 1821) parasitic on cows in atrium areas and the animal chest, rate of infection was 23.076%. The diagnosis was made based on phenotypic and standard traits.

Relationship of right ventricular functions with in-hospital and 1 year later mortality in patients hospitalized for COVID-19 pneumonia.

The aim of this study was to determine the association of right ventricular function with in-hospital mortality and mortality 1 year after discharge in patients hospitalized for COVID-19 pneumonia. The study was conducted in Van Yuzuncu Yil University Faculty of Medicine hospital between February 10, 2021 and August 10, 2022. A total of 156 patients hospitalized in intensive care and wards due to COVID-19 pneumonia were included in this study. Echocardiography was performed in all patients. Among the demographic findings of the patients included in the study, male gender, patients hospitalized in the intensive care unit (ICU), patients receiving O2 support, and smokers were found to have higher mortality rates during hospitalization. At the end of 1 year, the mortality rate was higher in patients who were hospitalized in the ICU received O2 support and had diabetes mellitus. Among echocardiographic findings, those with a low left ventricular ejection fraction had higher early and 1-year mortality rates. Of the right ventricular functions, low fractional area change, high systolic pulmonary artery pressure (SPAP), shortened pulmonary acceleration time, low right ventricle systolic wave S' velocity, increased right atrium area, and inferior vena cava diameter were found to be associated with high mortality. Increased right atrial area and inferior vena cava diameter, increased SPAP, and shortened pulmonary acceleration time were found to be significant in 1-year mortality. The presence of pericardial effusion was associated with mortality during hospitalization but not with 1-year mortality. B-type natriuretic peptide, D-dimer, and hemoglobin levels were significantly correlated with both hospital mortality and 1-year mortality. In the follow-up of COVID-19 pneumonia, right ventricular function is considered to be an important factor in early and late mortality. It could be helpful to establish a follow-up program for discharged patients from the parameters involved in mortality.

Evaluating the efficacy and safety of oral triple sequential combination therapy for treating patients with pulmonary arterial hypertension: A multicenter retrospective study.

This study aimed to evaluate the effectiveness and safety of an oral sequential triple combination therapy with selexipag after dual combination therapy with endothelin receptor antagonist (ERA) and phosphodiesterase-5 inhibitor (PDE5I)/riociguat in pulmonary arterial hypertension (PAH) patients. A total of 192 PAH patients from 10 centers had received oral sequential selexipag therapy after being on dual-combination therapy with ERA and PDE5i/riociguat for a minimum of 3 months. Clinical data were collected at baseline and after 6 months of treatment. The study analyzed the event-free survival at 6 months and all-cause death over 2 years. At baseline, the distribution of patients among the risk groups was as follows: 22 in the low-risk group, 35 in the intermediate-low-risk group, 91 in the intermediate-high-risk group, and 44 in the high-risk group. After 6 months of treatment, the oral sequential triple combination therapy resulted in reduced NT-proBNP levels (media from 1604 to 678 pg/mL), a decline in the percentage of WHO-FC III/IV (from 79.2% to 60.4%), an increased in the 6MWD (from 325 ± 147 to 378 ± 143 m) and a rise in the percentage of patients with three low-risk criteria (from 5.7% to 13.5%). Among the low-risk group, there was an improvement in the right heart remodeling, marked by a decrease in right atrium area and eccentricity index. The intermediate-low-risk group exhibited significant enhancements in WHO-FC and tricuspid annular plane systolic excursion. For those in the intermediate-high and high-risk groups, there were marked improvements in activity tolerance, as reflected by WHO-FC and 6MWD. The event-free survival rate at 6 months stood at 88%. Over the long-term follow-up, the survival rates at 1 and 2 years were 86.5% and 86.0%, respectively. In conclusion, the oral sequential triple combination therapy enhanced both exercise capacity and cardiac remodeling across PAH patients of different risk stratifications.

Performance of handheld ultrasound devices in diagnosis of pulmonary hypertension and right heart dysfunction in ICU patients.

The use of handheld ultrasonography devices (HHUD) has increased recently but there are limited data about their performance in the evaluation of right heart dysfunction (RHD) and pulmonary hypertension (PHT). The aim of the study is to compare the performance of a HHUD with a conventional ultrasound device (CUD) in assessing PHT and RHD. This single-center prospective study was performed in a seven-bed teaching hospital intensive care unit (ICU). PHT and RHD criteria were compared by HHUD and CUD. Additional PHT criteria and right ventricle (RV) systolic and diastolic dysfunction criteria were also measured. Forty-six patients were included in the study. There was no significant difference between the imaging rates and mean values of the parameters measured by both devices. When the positivity rates for additional PHT parameters and RHD criteria were compared, there were no significant differences between the devices. In Bland-Altman's analysis, there was good agreement and there was no bias between the measurements of the two devices but left ventricular end-systolic eccentricity index (LVSEI), right atrium area (RAA), and pulmonary artery diameter (PAD). Ninety percent of the patients had PHT probability, of whom 43% had a low, 37% had intermediate and 10% had a high probability of PHT. Ninety-two percent of the patients had RHD and there was no significant difference between the devices in the diagnosis of RHD (p=.212). When RV systolic and diastolic dysfunction evaluations of the devices were compared according to the British Society of Echocardiography (BSE) criteria there was no significant difference between the devices' measurements in the evaluation of systolic and diastolic function. The imaging and measurement capabilities of the HHUDs for PHT and RHD parameters were similar to CUDs, and considering the inconsistent parameters, the HHUD can be useful in diagnosing these problems.

Quantitative analysis of fractionated electrogram area of left atrium during right atrial pacing as an indicator of left atrial electrical remodeling in patients with atrial fibrillation.

The clinical significance of left atrial local electrogram fractionation after restoration of sinus rhythm in patients with atrial fibrillation (AF) has not been elucidated. We evaluated ultrahigh-resolution maps of the left atrium (LA) during RA pacing acquired after pulmonary vein isolation in 40 patients with AF. The association between low-voltage area (LVA, <0.5 mV), fractionated electrogram area (FEA, the highlighted area with LUMIPOINT™ Complex Activation), the interval from onset of LA activation to wavefront collision at the mitral isthmus (LA activation time), and wave propagation velocity (WPV) was evaluated quantitatively. The total LVA, total FEA with ≥5.0 peaks or ≥7.0 peaks were 7.0 ± 7.9 cm2, 15.9 ± 12.9 cm2, and 5.2 ± 7.5 cm2, respectively. These areas were predominantly observed in the anteroseptal region. Total LVA, total FEA with ≥5.0 peaks, and total FEA with ≥5.0 peaks in the normal voltage area (NVA: ≥0.5 mV) correlated with LA activation time (R = 0.69, 0.75, and 0.71; each p < .0001). In the anterior wall, these areas correlated with regional mean WPV (R = -0.75, -0.83, and - 0.55; each p < .0001) and the extent of slow conduction area (SCA) with WPV <0.3 m/s (R = 0.89, 0.84, 0.33; p < .0001 for LVA and FEA, p < .05 for FEA located in NVA). The anterior wall FEA with ≥7.0 peaks and that in the NVA showed a better correlation in predicting anterior wall SCA (R = 0.92 and 0.86, each p < .0001). Quantitative analysis of FEA together with LVA may facilitate the assessment of LA electrical remodeling.

Atrial functional tricuspid regurgitation in patients undergoing transcatheter aortic valve replacement

Abstract Introduction Recently, a novel entity of tricuspid regurgitation (TR) – atrial functional TR, which is caused by enlargement of the right atrium – has gained in awareness. In comparison, ventricular functional TR occurs in the setting of left heart disease with pulmonary hypertension and subsequent enlargement of the right ventricle. While it could be demonstrated that in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), an improvement of moderate or severe tricuspid regurgitation (TR) can be observed in many patients, knowledge about the association between entity and improvement of TR is scarce. Purpose The aim of this study was to analyse if atrial functional TR, defined by the enlargement of the right atrium is associated with the persistence of TR after TAVR in patients with severe AS and at least moderate concomitant TR at baseline. Moreover, 3-year all-cause mortality in patients with atrial and ventricular TR was assessed. Methods We retrospectively examined 363 patients with at least moderate tricuspid regurgitation undergoing TAVR from January 2013 to December 2020 due to severe AS. Patients with primary TR, a history of tricuspid valve surgery or with TAVR due to severe aortic regurgitation were excluded. Endsystolic area of the right atrium (RA) and enddiastolic area of the right ventricle (RV) were assessed in transthoracic echocardiography and atrial TR was defined as RA/RV area ratio above the median value of 1.125. Results TR improvement of at least one grade after transcatheter aortic valve replacement was significantly less frequent in patients with atrial compared to patients with ventricular TR (29.2% vs. 60.3%, p &amp;lt; 0.001, Figure 1). Multivariate logistic regression analysis with adjustment for left ventricular ejection fraction, Vena contracta and CT-determined tricuspid annulus diameter confirmed that atrial functional TR was an independent predictor for absence of TR improvement after TAVR (adjusted odds ratio: 3.03, 95% CI 1.65-5.64; p&amp;lt;0.001). Moreover, improvement of TR was associated with a significantly lower 3-year all-cause mortality compared to patients with persistence of TR (log rank test p&amp;lt;0.001, Figure 2A). However, no difference could be observed regarding 3-year all-cause mortality between patients with atrial and ventricular TR (log-rank test p=0.500, Figure 2B). Conclusion In patients undergoing TAVR for severe AS and at least moderate concomitant TR, atrial functional TR is an independent predictor for TR persistence. In addition, TR persistence is associated with increased 3-year all-cause mortality.Figure 1:Development of TR after TAVRFigure 2:3-year all-cause mortality

Postoperative atrial fibrillation after thoracic surgery (PoAF): risk factors and outcome

BackgroundPostoperative AF (PoAF) is a common complication of the early postoperative period of noncardiac, thoracic surgery and is associated with prolonged hospital stay. In order to investigate the predictors of PoAF in the specific setting of lung surgery of oncologic patients, we retrospectively analyzed 338 consecutive patients admitted to our department to be operated for lung cancer with a thoracotomy approach (i.e., open surgery). We determined this population’s prevalence, risk factors, and consequences of PoAF.ResultsPoAF occurred in 35/338 (10.4%) patients and was significantly more frequent in older patients, with a best predictive value of 71 years at ROC curve analysis (AUC 0.70, p < 0.001) and in those with chronic renal failure (p = 0.01). The left atrial area was also significantly associated with the risk of PoAF (AUC 0.78, p = 0.000). PoAF was more frequent in patients with small cell and squamous cell carcinoma (p = 0.03). The occurrence of PoAF was associated with a longer hospital stay (p = 0.001) but not with higher long-term mortality (follow-up mean length: 3.3 ± 0.3 years). At multivariable analysis, the only independent predictors of PoAF were age (OR for 1-year increase 1.089, 95% CI 1.039–1.141, p 0.001) and open surgery (OR 2.07, 95% CI 1.0–4.29, p 0.047). At the 3-year follow-up, all patients were in sinus rhythm.ConclusionsThe present study shows the association between age and open surgery with PoAF, furtherly highlighting that the incidence of arrhythmia leads to a longer hospital stay. Left atrium dilatation could identify at-risk patients. Those results suggest that older patients — especially those with larger left atrium areas — might benefit most from a VATS approach to further reduce the arrhythmia incidence. Such a finding supports the indication of a systematic echocardiographic evaluation before elective lung surgery, especially in patients with known clinical risk factors.

In-vivo evaluation of catheter integrity with the use of a novel catheter torque tool.

Electrophysiology studies and ablation procedures require strength, steadiness, and dexterity to manipulate catheters. We have previously described a novel catheter torque tool (Peritorq) that improves torqueability and stability and decreases user muscle fatigue. The objective was to evaluate measures of catheter integrity with and without the torque tool in place using multiple diagnostic and ablation catheters in an adult porcine model. Diagnostic and ablation catheters were inserted through the femoral or jugular vein into areas of the right atrium, coronary sinus (CS), and right ventricle. Electrical measurements including impedance, sensing, and capture thresholds were obtained with and without the torque tool. Ablation lesions (30 s) were given at different locations using both irrigated and nonirrigated catheters and measurements were recorded with and without the torque tool. Procedures were performed in eight adult pigs. Measurements with and without the torque tool in all locations did not differ significantly using any of the catheters. With the nonirrigated ablation catheter there was a significant difference in maximum (mean 1.7 W, p = .03) and average power (mean 9.1 W, p = .04) delivery at the PS tricuspid valve, but there were no other differences with the irrigated or nonirrigated catheters. Subjective assessment by the operator revealed a substantial improvement in maneuverability, ability to transfer torque, and stability within the cardiac space. In an in-vivo environment, a novel catheter torque tool subjectively improved catheter manipulation and did not have a significant impact on the integrity of electrophysiologic catheters. Further study including additional catheters and in-vivo human testing is indicated.

Assessment of right atrial strain parameters in half marathon amateur runners

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Endurance training may cause atrial remodeling and atrial arrhythmias in professional athletes. However, there is a lack of data on the right atrial (RA) adaptation to training and half marathon run in amateur runners. Recently introduced atrial deformation strain analysis allows to assess the RA function more precisely. Purpose The study aims to assess the influence of ten-weeks training and half marathon run on the RA strain parameters in non-elite athletes. It also investigates whether these changes affect the runner’s competitive performance. We hypothesized that the training and 21.0975 kilometers run itself cause functional atrial changes in recreational runners. Methods The study group consisted of 45 recreational runners with a mean age of 32.96 ± 5.12 years, 27 men. Two-dimensional, Doppler and speckle tracking echocardiography was performed before the ten-weeks training period (stage 1), 48 hours before (stage 2) and within 48 hours after (stage 3) the half marathon run. We measured RA volumes, ejection fraction and strain during reservoir, conduit and contraction phases at all stages (Figure). Training intensity was expressed in declared kilometers run per week. Results There were no significant changes in RA volumes and RA ejection fraction between stages. We did not notice significant differences in RA strains during reservoir, conduit and contraction phases between stages. Athletes who trained more intensively had significantly higher maximum RA volume at stage 1 (r = 0.32; p = 0.033) and at stage 3 (r = 0.44; p = 0.003). They had also larger RA area at stage 1 (r = 0.32; p = 0.030). Runners whose RA area was larger, achieved significantly better finishing race time (r = -0.49; p = 0.001). Higher RA volume correlated with better half marathon performance (r = -0.32; p = 0.039). Conclusions Ten-weeks training period and participation in half marathon run were not associated with RA dilatation or functional changes based on strain deformation analysis in amateur runners. However, we observed the influence of intensity of physical training on the enlargement of volume and surface area of the right atrium, which resulted in better half marathon finishing time.

Paroxetine induced larva zebrafish cardiotoxicity through inflammation response

Paroxetine (PRX) is a common antidepressant drug which widely existence in natural environment. Numerous studies in the past few decades have focused on the beneficial effects of PRX on depression, however, the toxic properties and the potential mechanisms remain unclear. In this study, zebrafish embryos were exposed to 1.0, 5.0, 10 and 20 mg/L of PRX from 4 to 120-hour-post-fertilization (hpf), and it showed that PRX exposure caused adverse effects in zebrafish embryos, including decreased body length, blood flow velocity, cardiac frequency, cardiac output and increased burst activity and atria area. Meanwhile, the Tg (myl7: EGFP) and Tg (lyz: DsRed) transgenic zebrafish were used to detect the cardiotoxicity and inflammation response of PRX. Moreover, the heart development associated genes (vmhc, amhc, hand2, nkx2.5, ta, tbx6, tbx16 and tbx20) and inflammatory genes (IL-10, IL-1β, IL-8 and TNF-α) were up-regulated after PRX challenge. In addition, Aspirin was used to alleviate the PRX-induced heart development disorder. In conclusion, our study verified the PRX induced inflammatory related cardiotoxicity in larva zebrafish. Meanwhile, the current study shown the toxic effects of PRX in aquatic organism, and provide for the environmental safety of PRX.

The novel left atrial anterior 'seatbelt' line reduces sustained atrial arrhythmia by 72% compared to pulmonary vein isolation alone in a cohort of 400 virtual atria models

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No.860974. Background The success-rate of pulmonary vein isolation (PVI) is modest in persistent atrial fibrillation (AF), but additional empirical ablation, such as posterior wall isolation (PWI), has not been shown to reduce the rate of AF recurrence. The "seatbelt", an anterior linear ablation lesion connecting the right superior pulmonary vein to the mitral annulus, is a novel substrate modification approach that is yet to be tested in a large-scale randomised clinical trial. Purpose To use in-silico trials with human-based modelling and simulation to compare the efficacy of (i) PVI alone, (ii) PVI and PWI (PVI+PWI), or (iii) PVI and seatbelt (PVI+SB) for the prevention of atrial arrhythmia in large populations of virtual patient models. Methods AF was simulated in a cohort of 400 virtual atrial models with anatomical and electrophysiological variability, with AF persisting for &amp;gt;7 seconds defined as sustained. Models which sustained AF were each independently subjected to all three ablation approaches before repeating the AF induction protocol. Results Three hundred forty-four (86%) atrial models developed sustained AF at baseline. After applying the ablation lesions, substantially fewer models sustained atrial arrhythmias in the PVI+SB group (50 [14%] vs. 134 [39%] with PVI+PWI vs. 172 [50%] with PVI). PVI+SB was more effective than PVI and PVI+PWI in preventing both AF and atrial flutter (i.e., presence of a single rotor), since PVI and PVI+PWI led to the formation of anatomical re-entries around the rings of the pulmonary veins and the posterior wall of the left atrium, respectively (Figure). Therefore, PVI+SB restricted atrial flutter mainly to the right atrium (either anatomical, around the inferior cava vein, or functional, meandering throughout the venous portion of the right atrium, Figure). Importantly, in all three ablation strategies, the likelihood of AF recurrence was directly proportional to the surface area of the right atrium (AF probability increased 0.95%/cm², 0.88%/cm² and 0.56%/cm² after PVI+SB, PVI+PWI and PVI, respectively). The role of the right atrial size was less accentuated for PVI alone, since after the ablation the entire left atrial body was still available for rotor anchoring. Moreover, an enlarged left atrium enabled the appearance of micro-re-entries in the anterior and inferior wall of the left atrium, even after applying floor and roof lines. One atrial model additionally presented a rotor in the posterior wall of the left atrium after completely isolating it from the left atrial body. Conclusion(s) In a cohort of 400 virtual atrial models, PVI+SB reduced sustained atrial arrhythmias by 72% compared to PVI alone and by 64% to PVI+PWI, but AF could still originate in an enlarged right atrium.

In Atrial Fibrillation, Omnipolar Voltage Maps More Accurately Delineate Scar Than Bipolar Voltage Maps

BackgroundOptimal method for voltage assessment in AF remains unclear. ObjectivesThis study evaluated different methods for assessing atrial voltage and their accuracy in identifying pulmonary vein reconnection sites (PVRSs) in atrial fibrillation (AF). MethodsPatients with persistent AF undergoing ablation were included. De novo procedures: voltage assessment in AF with omnipolar voltage (OV) and bipolar voltage (BV) methodology and BV assessment in sinus rhythm (SR). Activation vector and fractionation maps were reviewed at voltage discrepancy sites on OV and BV maps in AF. AF voltage maps were compared with SR BV maps. Repeat ablation procedures: OV and BV maps in AF were compared to detect gaps in wide area circumferential ablation (WACA) lines that correlated with PVRS. ResultsForty patients were included: 20 de novo and 20 repeat procedures. De novo procedure: OV vs BV maps in AF; average voltage 0.55 ± 0.18 mV vs 0.38 ± 0.12 mV; P = 0.002, voltage difference of 0.20 ± 0.07 mV; P = 0.003 at coregistered points and proportion of left atrium (LA) area occupied by low-voltage zones (LVZs) was smaller on OV maps (42.4% ± 12.8% OV vs 66.7% ± 12.7% BV; P < 0.001). LVZs identified on BV maps and not on OV maps correlated frequently to wavefront collision and fractionation sites (94.7%). OV AF maps agreed better with BV SR maps (voltage difference at coregistered points 0.09 ± 0.03 mV; P = 0.24) unlike BV AF maps (0.17 ± 0.07 mV, P = 0.002). Repeat ablation procedure: OV was superior in identifying WACA line gaps that correlated with PVRS than BV maps (area under the curve = 0.89, P < 0.001). ConclusionsOV AF maps improve voltage assessment by overcoming the impact of wavefront collision and fractionation. OV AF maps correlate better with BV maps in SR and more accurately delineate gaps on WACA lines at PVRS.