Electromechanical Delay In Patients Research Articles

Evaluation of strain echocardiography and atrial electromechanical delay in patients with idiopathic carpal tunnel syndrome

Aim: Carpal tunnel syndrome (CTS) could be an early marker for amyloidosis before developing of overt symptoms of cardiac amyloidosis (CA). CA characterized with left ventricular (LV) diastolic dysfunction and impairment of LV deformation-based parameters. There is limited data about echocardiographic parameters such as strain value of LV, diastolic parameters and atrial EMD in patients with idiopathic CTS. In this study, we investigated LV strain values, diastolic parameters of LV and atrial EMD in patients with idiopathic CTS. Then, we compared these parameters in CTS patients to control group. Material and Method: Thirty-four patients with idiopathic CTS and twenty-four aged and sex matched volunteers were enrolled to study. Patients with known amyloidosis, heart failure, diabetes mellitus and secondary etiologic states for CTS such as trauma or rheumatologic disease were excluded from the study. ECG and echocardiographic examination of each patient were performed and recorded by cardiology specialist. Conventional and strain imaging echocardiography were performed. Atrial electromechanical delays (EMD) were measured. Results: Baseline characteristics features were not different in groups. Mitral inflow velocities (mitral E and A wave), mitral E wave deceleration time, tissue Doppler velocities (lateral annular E’ and A wave), E/A and E/E’ ratios were similar in two groups. Septal basal strain values increased in CTS group (-21.3±4.83% vs -25.7±2.96%, p<0.001). Septal apical to base ratio (SAB) and relative apical sparing (RELAPS) were increased in CTS group compared to control group (0.94±0.43 vs 0.66±0.12, 0.90±0.31 vs 0.73±0.08, p=0.004, p=0.013, respectively). PA lateral, PA septal, inter-atrial EMD and intra-atrial EMD were significantly higher in CTS group compared to control group (78.2±12.3 ms vs 70.6±9.9 ms, 64.1±8.42 ms vs 58.3±10.1 ms, 25.8±9.09 ms vs 20.7±5.31 ms, 11.68±5.11 ms vs 8.46±3.02 ms, p=0.015, p=0.023, p=0.009 and p=.008, respectively). Conclusion: In CTS group, mean basal strain decreased compared to control group. SAB and RELAPS which associate with CA, decreased in CTS group. Atrial EMD prolonged in CTS group. These changes may associate with increased risk of CA and AF in patients with CTS.

RISK PREDICTION FOR ARRHYTHMIA IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The aim: To evaluate P-wave dispersion (PwD), as an independent predictor of atrial fibrillation, corrected QT interval dispersion (cQTD), the noninvasive marker of ventricular arrhythmia and sudden cardiac death, investigate the atrial electromechanical delay in patients with COPD and assess their relation with the severity of the disease. Materials and methods: We prospectively enrolled consecutive patients with newly diagnosed COPD (n = 53, age 41.2 ± 6.8 years), compared with an age-matched healthy control group (n = 51, age 40.9 ± 6.5 years). A standard 12-lead electrocardiogram of each patient was analyzed for PwD and сQTD. Atrial electromechanical delay was analyzed by echocardiographic tissue Doppler imaging. The difference between PAs-PAl, PAs-PAt, and PAl-PAt were defined as left intra-atrial, right intra-atrial, and interatrial electromechanical delays (EMD), respectively. Results: PwD was higher in COPD patients than in control subjects (39.47 ± 3.12 ms vs. 30.29 ± 3.17 ms, p < 0.05). In comparison between control group and COPD subgroups (mild, moderate and severe), there was a statistically significant difference among these free groups in terms of PwD. Subgroup analyses showed that this difference was mainly due to patients with severe COPD. Regarding cQTD, there was a statistically significant increase in COPD patients 57.92 ± 3.43 ms vs 41.03 ± 5.21 ms, p < 0.05 respectively. PAs, PAl and PAt durations, right intra-atrial and interatrial EMD were also significantly longer in COPD patients (p < 0.05). Furthermore, there were significant negative correlations between FEV1 and PwD (r = – 0.46, p < 0.05), right intra-atrial (r = – 0.39 ms, p < 0.05), interatrial EMD ( r = – 0.35 ms, p < 0.05) and cQTD (r = – 0.32, p < 0.05). Conclusions: Atrial conduction time, such as inter- and intra-atrial EMD intervals, PwD and cQTD were longer than in healthy controls and correlated with the severity of COPD. These parameters offer a non-invasive and cost-effective assessment method for detecting patients at high risk of arrhythmia. Nevertheless, further prospective investigations on this issue are required.

Effects of metformin on epicardial adipose tissue and atrial electromechanical delay of obese children with insulin resistance.

Obesity is usually related to insulin resistance and glucose metabolism disorders. The relationship between insulin resistance and epicardial adipose tissue and atrial electromechanical delay has been described in previous studies. This study aims to demonstrate the effects of metformin on epicardial adipose tissue and electromechanical delay in patients using metformin for insulin resistance. A total of 30 patients using metformin for insulin resistance were included in the study. Pre-treatment and post-treatment epicardial adipose tissue and electromechanical delay were evaluated. There was a statistically significant decrease in epicardial adipose tissue thickness after 3 months of metformin therapy (6.4±2.1 versus 4.7±2.0; p = 0.008). Furthermore, the inter-atrial and intra-atrial electromechanical delay also significantly decreased after 3 months of metformin monotherapy (23.6±8.2 versus 18.1±5.8; p < 0.001, 9.1±2.9 versus 6.3±3.6; p = 0.003, respectively). In this study, we show that metformin monotherapy significantly decreases epicardial adipose tissue thickness and electromechanical delay in obese children.

P-wave dispersion and atrial electromechanical delay in patients with inflammatory bowel disease

Kontext: Nespecifické střevní záněty (inflammatory bowel disease, IBD) představují skupinu zánětlivých onemocnění, k jejichž rozvoji dochází u vnímavých jedinců s nadměrnou imunitní odpovědí na různé antigeny nebo faktory okolního prostředí. Starší studie navrhly jako možný časný marker fibrilace síní parametr elektromechanické zpoždění síní (electromechanical delay, EMD). Cílem této studie bylo zhodnotit elektromechanické vlastnosti síní pacientů s IBD, měřené dopplerovským ultrazvukem a současně elektrokardiograficky (EKG). Materiál a metody: Do studie bylo zařazeno 35 pacientů s IBD a 21 dobrovolníků srovnatelného věku a pohlaví. Elektromechanické vlastnosti síní byly měřeny transthorakální echokardiografií a povrchovým EKG. Vypočítávaly se disperze vlny P (P wave dispersion, PWD), elektromechanické zpoždění (electromechanical delay, EMD) v šíření vzruchu mezi síněmi, EMD v šíření vzruchu v levé síni i EMD v šíření vzruchu v pravé síni. Výsledky: Do studie bylo zařazeno celkem 35 pacientů s IBD (54 % muži; 19 s ulcerózní kolitidou, 16 s Croh- novou chorobou, průměrný věk 43,97 &plusmn; 13,98 roku). Ve skupině pacientů byla ve srovnání s kontrolní skupinou PWD delší a doba trvání vlny P kratší. Trvání EMD mezi síněmi (laterální-trikuspidální-PA) i v rámci levé síně (laterální-septální-PA) bylo ve skupině pacientů delší. Závěr: U pacientů s IBD byly ve srovnání s kontrolní skupinou hodnoty PWD, EMD síní a EMD v levé síni delší. Vzhledem k predispozici jedinců s IBD ke vzniku epizod arytmií síní lze uvedené parametry použít k vyhledávání vysoce rizikových jedinců. &copy; 2019, ČKS.

Atrial electromechanical delay in patients with chronic obstructive pulmonary disease in acute and stable periods

Atrial electromechanical delay in patients with chronic obstructive pulmonary disease in acute and stable periods

Relationship of left atrial mechanics to electrical activity on surface electrocardiography in idiopathic dilated cardiomyopathy

Aim: (1) Assess left atrial (LA) mechanics and electromechanical delay in patients with idiopathic dilated cardiomyopathy (IDCM), and (2) examine the relationship between atrial electromechanical delay and atrial electrical activity [P-wave duration, P-wave dispersion (PWD) and P terminal force (PTF)] on surface ECG.Methods: 73 IDCM patients (age 36 ± 17 years); 63% men,25 age & sex matched healthy subjects were studied. LA atrial electromechanical delay & mechanics (εsys, SRsys, SRe, SRa) were measured with 2D-strain. From 12-lead electrocardiograms, P-wave duration, PWD and PTF calculated.Results: Reservoir, conduit and contractile functions were predominantly reduced compared to control (P < 0.001). Intra-atrial electromechanical delay was 88.9 ± 84.6 in IDCM versus 27.4 ± 16.5 in control (P < 0.0001). In IDCM, PWD (52.89 ± 15), Pmax(98 ± 17.5) and PTF(58.2 ± 36) were significantly increased compared to control (36.20 ± 8.9, 79 ± 9.9, 25.22 ± 8.76) respectively (P < 0.0001). A positive correlation was detected between intra-atrial electromechanical delay and PWD &PTF (r = 0.5, P < 0.0001). By stepwise multiple linear regression analyses, LA reservoir function (LA εsys) [β = 0.754; CI at 95%:0.356–0.780, P < 0.001] and LA volume [β = 0.743; CI 95%:0.423–0.75, P < 0.001], and PWD [β=0.848; CI 95%:0.311–0.644, P < 0.0001], and PTF [β = 0.927; CI 95%: 0.357–0.722, P < 0.0001] are independent predictors for LA electromechanical delay in IDCM.Conclusion: In addition to altered LA mechanics, atrial electromechanical delay gets longer in IDCM and is correlated with PWD and PTF. Atrial electrical dispersion on surface ECG could be early index of LA dysfunction that deserves further study.

Long term evaluation of electromechanical delay in patients with atrial septal defect after transcatheter closure.

Some studies have been showed that electromechanical delay, which may pose an increased tendency to atrial fibrillation, may prolong in patients with various clinical conditions. In addition, the electromechanical delay in patients with secundum type atrial septal defect (ASD) compared to healthy people have been reported previously. Therefore, in the present study, we prospectively evaluated the mid-term and long-term effects of the transcatheter closure of secundum type ASD on the lateral atrial conduction time (PA), septal PA, tricuspid PA, left and right intra-atrial electromechanical delay (ILeft-EMD and IRight-EMD, respectively) and inter-atrial electromechanical delay (IA-EMD) measured by means of Doppler echocardiography. Our prospective study included a total of 45 secundum type ASD patients who undergone percutaneous transcatheter closure from December 2012 to April 2015. All patients underwent transthoracic echocardiography (TTE) before the closure, at sixth and twelfth months after the closure. In comparison of the EMD sixth months after the device closure, there were statistically significant decrease in lateral PA, septal PA, tricuspid PA, ILeft-EMD, IRight-EMD and IA-EMD compared to pre-device closure values. Twelfth months after the device closure, we also observed statistically significant decrease in lateral PA, septal PA, tricuspid PA, ILeft-EMD, IRight-EMD and IA-EMD compared to 6-month post-device closure values. In the present study, we observed that the atrial EMD improves after device closure and continues to improve after twelfth month following post-device closure.

Association between right ventricular systolic function and electromechanical delay in patients with right bundle branch block

BackgroundElevated right ventricle (RV) pressure and/or volume can place stress on the right bundle branch block (RBBB) and its associated Purkinje network, which can affect its electrical properties, resulting in conduction delay or block. We hypothesized that prolonged R′ wave duration in lead V1 would extend the later portion of the QRS complex and can act as an indicator of reduced RV function in patients with RBBB. MethodKosin University Gospel Hospital echocardiography and electrocardiography (ECG) database was reviewed to identify patients with complete RBBB between 2013 and 2015. ECGs recorded closest to the time of the echocardiography were carefully reviewed, and QRS and R′ wave duration were measured. RV systolic dysfunction was defined as an RV fractional area change (FAC) less than 35%, as indicated by echocardiography guidelines. ResultsCompared to patients with normal RV function (n=241), patients with RV dysfunction (n=123) showed prolonged QRS duration (145.3±19.3ms vs. 132.2±13.4ms, p<0.001), predominantly due to R′ prolongation (84.8±13.0ms vs. 102.9±12.0ms, p<0.001). R′ duration was significantly associated with RV FAC (r=−0.609, p<0.001), RV systolic pressure (r=0.142, p=0.008), RV dimension (r=0.193, p<0.001), and RV myocardial performance index (r=0.199, p<0.001). On receiving operator characteristic curve analysis, V1 R′ duration ≥93ms was associated with RV dysfunction with 90% sensitivity and 87% specificity (area under the curve: 0.883, 95% confidence interval=0.845–0.914, p<0.001). ConclusionProlonged R′ wave duration in lead V1 is an indicator of RV dysfunction and pressure and/or volume overload in patients with RBBB.

Atrial electromechanical delay in patients undergoing heart transplantation

BackgroundWe aimed to assess atrial electromechanical delay (AEMD) in patients who had undergone heart transplantation. MethodsA total of 32 patients who underwent biatrial anastomosis heart transplantation (24 men, 8 women; mean age: 42±11 years) and 30 healthy volunteers (20 men, 10 women; mean age: 36±13 years) were included in the study. Atrial electromechanical coupling (PA), intra-AEMD, and inter-AEMD were measured. ResultsPA lateral (68±7 vs. 51±11ms, p<0.01), PA septal (50±5 vs. 42±8ms, p< 0.01) and PA tricuspid (39±6 vs. 36±9ms, p<0.01), inter-AEMD (PA lateral–PA tricuspid) (27±7 vs. 10±4ms, p<0.01), left intra-AEMD (PA lateral–PA septal) (18±7 vs. 10±4ms, p<0.01), right intra-AEMD (PA septal–PA tricuspid) (13±5 vs. 5±3ms, p<0.01) values were higher in patients who underwent heart transplantation than in a control population. ConclusionInter-AEMD and intra-AEMD were prolonged in patients who underwent heart transplantation as compared to a control population. This may explain the increased atrial fibrillation and other atrial arrhythmia incidences associated with the biatrial anastomosis heart transplantation technique and may contribute to the treatment of atrial fibrillation in this special patient group.

Evaluation of the association between stroke/transient ischemic attack and atrial electromechanical delay in patients with paroxysmal atrial fibrillation.

Objective:This study aimed to evaluate the association between the history of stroke/transient ischemic attack (TIA) and inter- and intra-atrial electromechanical delay (EMD) in patients with paroxysmal atrial fibrillation (PAF).Methods:Patients diagnosed with PAF were included in this retrospective study. Patients who had a history of stroke or TIA were defined as the symptomatic group, whereas those who did not have such a history were defined as the asymptomatic group. On the basis of the transthoracic echocardiographic records, atrial electromechanical coupling (time interval from the onset of the P wave on the surface electrocardiogram to the beginning of the A’ wave interval with tissue Doppler echocardiography) and intra- and interatrial EMD were measured.Results:In this study, 160 patients were included, 52 of whom were symptomatic. While the intra-left atrial EMD was 68.2±6.1 ms in the symptomatic group, it was found to be 50.8±6.5 ms in the asymptomatic group (p<0.001). Interatrial EMD was 91.3±5.0 ms in the symptomatic group, whereas it was 71.5±7.0 ms in the asymptomatic group (p<0.001). In multiple logistic regression analysis, intra-left atrial [odds ratio (OR): 1.417, 95% confidence interval (CI): 1.193–1.684, p<0.001] and interatrial EMDs (OR:1.398, 95% CI: 1.177–1.661, p<0.001) were found to be independently associated with the presence of stroke/TIA.Conclusion:Prolonged inter- and intra-left atrial EMDs in patients with PAF is associated with stroke/TIA. Evaluating this parameter in addition to the CHA2DS2-VASc score in patients with PAF may be helpful in identifying patients who are at a high risk of stroke/TIA. (Anatol J Cardiol 2016; 16: 572-8)

Atrial conduction abnormalities in patients with psoriasis vulgaris.

Psoriasis vulgaris is one of the most common chronic inflammatory skin disorders. Patients with psoriasis are at risk of developing atrial fibrillation (AF). The electromechanical delay (EMD) is the time interval from the onset of the P wave on surface electrocardiography (ECG) to the beginning of the A wave. Prolonged atrial EMD is an independent risk factor for the development of AF. This study investigated the intra- and interatrial EMD in patients with psoriasis. This study included 85 adults with psoriasis vulgaris (Group 1) and 46 age- and sex-matched healthy individuals (Group 2). ECGs were obtained from all subjects, and atrial EMD variables were calculated. Results are reported as means ± standard deviations and percentages. Continuous variables were analysed using Student's t-test. A p-value < 0.05 was considered statistically significant. Interatrial electromechanical delay (IA-EMD) and intra-left atrial electromechanical delay (ILA-EMD) were significantly longer in the psoriasis group compared with controls. A correlation analysis between psoriasis severity (PASI score) and the atrial conduction parameters revealed a significant positive correlation between PASI and IA-EMD (r = 0.261, p < 0.001). In addition, there was a positive correlation between high-sensitivity C-reactive protein (hsCRP) and IA-EMD (p = 0.022). The atrial conduction time was longer in patients with psoriasis vulgaris and it correlated with the severity of disease and hsCRP. Since the association between delayed conduction and AF is known, the measurement of intra-atrial conduction times could be a practical tool to estimate the AF risk in these patients.

Assessment of interatrial dyssynchrony by Tissue Doppler Imaging in mitral stenosis: Effect of afterload reduction after balloon mitral valvuloplasty

Abstract Background The predisposition to atrial fibrillation (AF) in mitral stenosis (MS) has been demonstrated with several electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (atrial electromechanical delay). After percutaneous mitral balloon valvuloplasty (PMBV), the improvement in echocardiographic parameters related to AF risk is unknown. We aimed to assess the interatrial electromechanical coupling by Tissue Doppler Imaging (TDI) echocardiography in MS before and after PBMV. Patients and methods This study included 45 patients with moderate to severe MS who underwent successful PMBV without complication at our clinic and 20 healthy volunteers as a control group. We compared the two groups in regard to clinical, electrocardiographic and echocardiographic features. The patients with MS were also evaluated one week after PMBV. Interatrial electromechanical delay (EMD) was measured by TDI before and after PMBV and we compared the results. Results The interatrial EMD (56.4 ± 15.8 vs. 34.6 ± 7.2 ms, p P -max) and P-wave dispersion (PWD) showed significant positive correlation with the interatrial EMD ( r = 0.37, p r = 0.41, p p Conclusion The current study showed significant increase in the interatrial EMD in patients with moderate to severe MS. These changes improved significantly after PMBV.

OP-135 Relationship Between Serum Galectin-3 Levels and Atrial Electromechanical Delay in Patients with Paroxysmal Atrial Fibrillation

OP-135 Relationship Between Serum Galectin-3 Levels and Atrial Electromechanical Delay in Patients with Paroxysmal Atrial Fibrillation

OP-136 Relationship Between Serum Anti-M2- muscarinic Receptor Levels and Atrial Electromechanical Delay in Patients Diagnosed with Paroxysmal Atrial Fibrillation

OP-136 Relationship Between Serum Anti-M2- muscarinic Receptor Levels and Atrial Electromechanical Delay in Patients Diagnosed with Paroxysmal Atrial Fibrillation

The Assessment of Atrial Electromechanical Delay in Patients With Acromegaly

BackgroundWe aimed to evaluate whether atrial electromechanical delay (AEMD) measured by tissue Doppler imaging (TDI), which is an indicator for structural and electrical remodelling of the atria, is prolonged in patients with active or inactive acromegaly, or both, compared with a control group. MethodsA total of 34 patients with acromegaly (18 active/16 inactive) and 35 patients as a control group were enrolled. Both intra- and inter-AEMD were calculated by TDI. The correlation between clinical variables and AEMD were analyzed. ResultsBoth inter-AEMD and right and left intra-AEMD were prolonged in patients with acromegaly compared with the control group (P < 0.001, P < 0.001, and P = 0.004, respectively). Also, patients with active acromegaly showed higher inter-AEMD and right intra-AEMD compared with patients with inactive acromegaly (P < 0.05). There was no significant difference in left intra-AEMD between patients with active acromegaly and those with inactive acromegaly (P = 0.977). The growth hormone and insulin-like growth factor (IGF-1) levels positively correlated with inter-AEMD (r = 0.577; P < 0.001; r = 0.614; P < 0.001, respectively). Additionally, we found that inter-AEMD was significantly and positively correlated with relationship between maximal values of passive mitral inflow (E, PW-Doppler) and lateral early diastolic mitral annular velocities (e′, TDI) (r = 0.316; P = 0.008). Only the serum IGF-1 level was independently associated with inter-AEMD in multivariate linear regression analysis (β = 0.500; P = 0.011). ConclusionsOur study findings showed that both inter- and intra-AEMD are prolonged in patients with acromegaly. Also, AEMD was observed to be more prolonged in patients with active acromegaly than in those with inactive acromegaly. IGF-1 was an independent predictor of inter- AEMD in patients with acromegaly. Being a noninvasive, inexpensive, and simple technique, AEMD may be used as an indicator for atrial electrical and structural remodelling in patients with acromegaly.

P-Wave Dispersion and Atrial Electromechanical Delay in Patients with Preeclampsia

Objectives: To investigate the duration of atrial electromechanical delay (EMD) and left atrial mechanical function in patients with preeclampsia. Materials and Methods: This study included 26 pregnant women with preeclampsia and 24 age-matched pregnant women without preeclampsia (control group). Atrial electromechanical coupling (PA) and intra-atrial and interatrial EMD were measured using tissue Doppler echocardiography. P-wave dispersion (PWD) was measured via 12-lead electrocardiography. All data were analyzed using SPSS v.15.0 for Windows (SPSS, Inc., Chicago, Ill., USA). Differences in continuous variables between groups were examined using a nonparametric Mann-Whitney U test. Correlation analysis was performed using Spearman's coefficient of correlation. Categorical values were compared using a χ² test. Results: PA lateral and PA septal durations were significantly longer in the preeclampsia group than in the control group [74.6 ± 8.1 vs. 62.3 ± 5.3 ms (p < 0.001) and 59.7 ± 5.3 vs. 56.2 ± 4.9 ms (p = 0.005), respectively]. The duration of interatrial EMD and intra-atrial EMD in the preeclampsia group was significantly longer than in the control group [25.4 ± 4.6 vs. 13.2 ± 3.9 ms (p < 0.001) and 10.5 ± 1.9 vs. 7.1 ± 1.2 ms (p < 0.001), respectively]. PWD was significantly higher in patients with preeclampsia (43.1 ± 9.1 ms) than in the controls (37.6 ± 7.9 ms; p = 0.008). There was a significant correlation between PWD and interatrial EMD and intra-atrial EMD [r = 0.46 (p < 0.001) and r = 0.39 (p < 0.001), respectively]. Conclusion: The duration of atrial EMD and PWD was prolonged in patients with preeclampsia.

Assessment of atrial electromechanical delay in patients with acromegaly

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Assessment of atrial electromechanical delay in patients with polycystic ovary syndrome in both lean and obese subjects

Even though polycystic ovary syndrome (PCOS) is characterized by increased inflammatory activity and insulin resistance, there is no clinical data about whether risk of atrial fibrillation are increased in these patients. We aimed to evaluate atrial conduction parameters predicting atrial involvement in this patient group. The study population comprised 50 women 18-40 years of age who had been diagnosed with PCOS. The patients were divided into two groups: lean women (L-PCOS) with a body mass index (BMI) under 25 kg/m² and obese women (O-PCOS) with a BMI greater than 30 kg/m². Twenty-five age-matched lean healthy women were enrolled voluntarily as the control group. Difference between maximum and minimum P-wave duration was calculated and was defined as P-wave dispersion (Pd). Inter- and intra-atrial electromechanical delays (inter-AED, intra-AED, respectively) were measured with tissue Doppler imaging. Inter- and intra-AED parameters were higher in the L-PCOS group when compared with control subjects (anova, P=0.004 and P=0.013, respectively), and were also significantly higher in the O-PCOS group compared with other groups (anova, P<0.001 for both). The regression analyses indicated that Homeostasis Model of Assessment - Insulin Resistance (HOMA-IR) (β=0.603, P<0.001) and BMI (β=0.379, P<0.001) were the independent predictors of inter-AED, HOMA-IR (β=0.835, P<0.001) was an independent predictor of intra-AED, and BMI (β=0.457, P=0.006) and the left atrial diameter (β=0.350, P<0.034) were independent predictors of Pd. Consequently, our findings provide data regarding prolonged atrial conduction parameters in PCOS patients, especially when accompanied by obesity.

Assessment of atrial electromechanical delay in patients with migraine

Evidence suggests that symptoms of migraine are related to the involvement of the autonomic nervous system. Data on atrial conduction system are limited in migraineurs. We aimed to assess atrial electromechanical delay using tissue Doppler imaging (TDI) in patients with migraine. Forty-five migraine patients and age- and sex-matched 26 control subjects were enrolled in the study. All the patients and controls underwent resting surface electrocardiogram (ECG) and TDI. The maximum P-wave duration (Pmax), minimum P-wave duration (Pmin) and P-wave dispersion (Pd) were measured from the 12-lead ECG. Atrial conduction time was determined from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septal), and lateral tricuspid annulus (PA tricuspid) by TDI. Interatrial (PA lateral-PA tricuspid) and intraatrial (PA septal-PA tricuspid) electromechanical delays were calculated. Pd was significantly higher in migraine patients than in controls (p<0.05), whereas Pmax and Pmin were not different between both groups (p>0.05). PA lateral and PA septal durations were significantly higher in migraine patients than in controls (p<0.001 and p<0.05, respectively). However, PA tricuspid duration was similar between the groups (p>0.05). Both interatrial and intraatrial conduction times were delayed in migraineurs as compared to the controls (p<0.001). Interatrial delay and intraatrial delay variables were found as an independent risk factors separately on predicting atrial conduction abnormalities in migraineurs. An interatrial delay of 18ms and an intraatrial delay of 5ms were found to be cutoff values in ROC analysis (p<0.001). This is the first report to provide a hypothetical suggestion that there is an atrial electromechanical delay in patients with migraine.

Determinants of Atrial Electromechanical Delay in Patients with Functional Mitral Regurgitation and Non-ischemic Dilated Cardiomyopathy.

Introduction: Atrial conduction time has important hemodynamic effects on ventricular filling and is accepted as a predictor of atrial fibrillation. In this study we assessed atrial conduction time in patients with non ischemic dilated cardiomyopathy (NIDCMP) and functional mitral regurgitation (MR) and aimed to determine factors predicting atrial conduction time prolongation. Methods: Sixty five patients with non ischemic dilated cardiomyopathy who have moderate to severe MR and 60 control subjects were included in the study. In addition to conventional echocardiographic measures used to asses left ventricle and MR, atrial electromechanical coupling (time interval from the onset of P wave on surface electrocardiogram [ECG] to the beginning of A wave interval with tissue Doppler echocardiography [PA]), intra- and interatrial electromechanical delay (intra and inter AEMD) were measured. Results: The correlations between inter AEMD and left atrial (LA) size, MR volume, isovolumetric relaxation time (IVRT), deceleration time (DT), systolic pulmonary artery pressure (PAPs), E/A ratio and E/e’ were very poor. Similarly, intra AEMD was not correlated to LA size , MR volume, IVRT, DT, PAPs, E/A ratio and E/e’. However, both inter AEMD and intra AEMD had good correlation with left ventricular mass index, tenting area (TA), tenting distance (TD), coaptation septal distance (CSD), sphericity index (SI). Conclusion: Prolongation of inter and intra AEMDs were found to be well correlated with parameters reflecting left ventricular and mitral annular remodeling.