Increase In Left Atrial Diameter Research Articles

The Relationship between Hyperuricemia and Echocardiographic Parameters in Patients with Chronic Atrial Fibrillation.

Purpose Uric acid serves as a marker for cardiovascular risk and is often linked to inflammation and oxidative stress. There is evidence suggesting an association between uric acid and atrial fibrillation (AF), including its severity and occurrence of crises, as well as its involvement in cardiovascular mechanisms. The objective of this study was to assess the correlation between hyperuricemia and echocardiographic features in patients with chronic AF lasting for more than 5 years. Methods This case-control study involved 107 patients diagnosed with chronic non-valvular AF. Uric acid levels were measured in all patients, and they were divided into two groups: the first group consisted of 66 patients with hyperuricemia (>7.2 mg/dL), while the second group included 41 patients with normal uric acid levels. Echocardiography (TTE) was performed to evaluate each patient. Various clinical and echocardiographic parameters, such as left ventricle telediastolic (LVTDD) and telesystolic (LVTSD) diameters, left atrial diameter (LAD), aortic diameter (AoD), ejection fraction (EF), and pulmonary artery pressure (PAP), were analyzed. Results Binary logistic regression analysis revealed a statistically significant relationship between uric acid levels (>7.2 mg/dL) and LAD. For each unit increase in LAD, the probability of having hyperuricemia increased by 9% [odds ratio (OD): 0.91, 95% confidence interval (CI): 0.84-0.99]. A significant relationship was found between uric acid levels (>8 mg/dL) and LVESD (p = 0.045) as well as PAP (p = 0.006). For every unit increase in LVESD, the likelihood of having uric acid levels greater than 8 mg/dL increased by 22% [OD: 0.82, 95% CI: 0.67-0.99, b = -0.2]. Likewise, for each unit increase in PAP, the probability of having uric acid levels greater than 8 mg/dL was 9.4% [OD: 0.91, 95% CI: 0.86-0.97, b = -0.09]. Conclusions This study demonstrates that hyperuricemia has a significant relationship with the development of atrial remodeling, with an important association observed between hyperuricemia and an increase in left atrial diameter. Hyperuricemia is also correlated with an enlargement of the left ventricle end-systolic diameter and pulmonary artery pressure, showing a possible influence that hyperuricemia might have also left ventricle morphology and right ventricle function.

#3897 STRUCTURAL AND FUNCTIONAL CHARACTERISTICS OF THE HEART IN ELDERLY AND OLD PATIENTS WITH CHRONIC KIDNEY DISEASE AND ATRIAL FIBRILLATION

Abstract Background and Aims The study of cardiorenal relationships is an important area in medicine. The presence of chronic kidney disease (CKD) and atrial fibrillation (AF) in elderly and old patients requires a special integrated approach in diagnosis and treatment, taking into account the principles of patient orientation. The aim was to study of structural and functional characteristics of the heart in elderly and old patients with CKD and AF. Method 224 female and 215 male patients of elderly and old age (mean age 72.4±6.8 years) with AF were examined. Among elderly and old patients, the following types of AF were diagnosed: a permanent form was observed in 136 (30.9%), a persistent form - in 117 (26.7%), a long-term persistent form - in 98 (22.3%), a paroxysmal form - in 88 (20.1%). Glomerular filtration rate (GFR) was determined using the CKD-EPI equation. All patients underwent electrocardiography (ECG), echocardiography (EchoCG), and some patients underwent ECG monitoring by Holter with assessment of rhythm variability. Results CKD with GFR<60 ml/min/1.73m2 was diagnosed in 274 (62.4%) patients with AF: stage 3a – in 184 (67.2%), stage 3b – in 82 (29.9%), 4 stage - in 8 (2.9%) patients with CKD. When analyzing the structural and functional parameters of the heart, more than half of elderly and old patients with CKD had concentric left ventricular hypertrophy - 146 (53.3%), 65 (23.7%) patients had eccentric hypertrophy. The types of remodeling in elderly and old patients did not differ depending on the presence of CKD (p>0.05). The ejection fraction (EF) of the left ventricle in elderly and old patients did not differ depending on the presence of CKD (p = 0.5). Preserved left ventricular EF had 194 (70%) intermediate - 60 (21.7%), low - 23 (8.3%) elderly and old patients with CKD. In patients with AF and CKD, compared with patients without CKD, mitral regurgitation (p = 0.006) and aortic regurgitation (p = 0.02) were more frequently observed. Left atrial (LA) diameter, exceeding the norm, was observed in most patients regardless of the presence of CKD: in 191 (69.7%) patients with CKD and 118 (71.5%) without CKD (χ2 = 0.03, p = 0.86). Moderate and pronounced increase in LA diameter was observed in 111 (40.1%) patients with CKD and 63 (38.1%) without CKD (χ2 = 0.17, р = 0.67). When analyzing the LA index, an increase in size was observed significantly more often in patients with CKD than in patients without CKD: 79 (28.8%) and 25 (15.2%), respectively, χ2 = 10.75, p = 0.001. Enlargement of the right ventricle was detected in 94 (34.3%) patients with CKD and 53 (32.1%) without CKD (χ2 = 0.18, p = 0.67), right atrium – 35 (12.8%) patients with CKD and 19 (11.5%) without CKD (χ2 = 0.15, p = 0.7). Attention is drawn to the differences in the spectral analysis of the heart rate in elderly and old patients with CKD compared with patients without CKD: a higher index of centralization (0.55 (0.33-0.86) and 0.36 (0.25-0.48), respectively, p = 0.03) and a lower index of vagosympathetic interaction (1.48 (0.85- 2.32) and 3.16 (2.12- 4.59), p = 0.004). Conclusion When analyzing the structural and functional parameters of the heart in elderly and old patients with AF and CKD, there was an increase in the LА index, more frequent presence of mitral and aortic regurgitation compared to patients without CKD. Elderly and old patients with CKD had a lower index of vagosympathetic interaction compared to patients without CKD.

Normal left atrial diameter is associated with better performance on a cognitive screener among a cohort of ischemic stroke patients.

Cardiac structure is an important determinant of ischemic stroke (IS) etiology; however, whether an association between cardiac structural markers and cognition post-IS exists is not yet established. The aim of this study is to examine the association between LAD and LVEF with cognitive performance among IS patients. IS patients admitted to the Johns Hopkins Hospital (2017-2019) underwent transthoracic echocardiography. IS was classified (TOAST) by a masked reviewer. Left atrial diameter (LAD) was evaluated as a non-linear continuous variable with one spline knot at 4 cm; left ventricle ejection fraction (LVEF) was dichotomized, then further evaluated as a non-linear continuous variable with spline knots at 50% and 70%. Patients were contacted by telephone on average 422 days post-stroke and administered the Six-Item Screener (SIS) to assess for dementia. SIS scores were dichotomized into low and high, imputing low scores for non-answerers. Multivariable logistic regression determined the association of SIS category with LAD or LVEF. A sensitivity analysis re-evaluated the association between SIS category and LAD, excluding participants with atrial fibrillation (AF). Participants (N = 108) were on average 61 years old (range = 18-89 years), 55% male, and 63% Black. Among patients considered to have a normal LAD (≤ 4 cm), a 1 mm larger LAD was associated with 1.20 greater odds (95%CI = 1.05-1.38) of scoring in the high SIS category in the final adjustment model. This association remained significant when excluding participants with prevalent AF. There was no association between a 1 mm larger LAD and SIS category among patients with a LAD >4 cm in both the primary analysis and the sensitivity analysis. There was no association between LVEF and SIS category. In this prospective study, among ischemic stroke patients with a LAD within the normal range, a 1 mm increase in LAD was associated with higher scores on a telephone cognitive battery, without an association found among those with a LAD >4 cm.

Clinical implications of left atrial changes after optimization of medical therapy in patients with heart failure.

Limited data exist regarding the prognostic relevance of changes in left atrial (LA) dimensions in patients with heart failure (HF). We assessed changes in LA dimension and their relation with outcomes after optimization of guideline-directed medical therapy (GDMT) in patients with new-onset or worsening HF. Left atrial diameter was assessed at baseline and 9 months after GDMT optimization in 632 patients (mean age 65.8 ± 12.1 years, 22.3% female) enrolled in BIOSTAT-CHF. LA adverse remodelling (LAAR) was defined as an increase in LA diameter on transthoracic echocardiography between baseline and 9 months. After the 9-month visit, patients were followed for a median of 13 further months. LAAR was observed in 247 patients (39%). Larger baseline LA diameter (odds ratio [OR] 0.90; 95% confidence interval [CI] 0.87-0.93; p < 0.001) and up-titration to higher doses of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEi/ARBs) (OR 0.56; 95% CI 0.34-0.92; p = 0.022) were independently associated with lower likelihood of LAAR. LAAR was associated with an increased risk of the composite of all-cause mortality or HF hospitalization (log-rank p = 0.007 and adjusted hazard ratio 1.73, 95% CI 1.22-2.45, p = 0.002). The association was more pronounced in patients without a history of atrial fibrillation (p for interaction = 0.009). Among patients enrolled in BIOSTAT-CHF, LAAR was associated with an unfavourable outcome and was prevented by ACEi/ARB up-titration. Changes in LA dimension may be a useful marker of response to treatment and improve risk stratification in patients with HF.

P386 OBESITY AND CARDIOMYOPATHY

Abstract Background Obesity cardiomyopathy is a heart failure unexplained by others etiologies that can vary from a subclinical left ventricular dysfunction to overt dilated cardiomyopathy. Aim To evaluate the changes in echocardiogram in both normotensive and hypertensive obese and to evaluate obesity and/or hypertension impact on cardiomyopathy. Methods 383 subjects (236F–147M) were enrolled. They were divided into two groups based on BMI: non–obese subjects (BMI&amp;lt;30kg/m2) and obese subjects (BMI&amp;gt;30kg/m2). The obese subjects were divided in different degrees (groups) of obesity according with obesity classification: group 1= BMI &amp;gt;30&amp;lt;35, 2= BMI &amp;gt;35&amp;lt;40, 3= BMI &amp;gt;40 kg/m2. 208 of 383 enrolled subjects were hypertensive. All subjects underwent to an echocardiogram with evalutation of left atrial diameter (LAD), left ventricular end–diastolic diameter (LVEDD), left ventricular end–systolic diameter (LVESD), ventricular septum, cardiac mass and left ventricular mass index (LVMI). Results Obese subjects showed a progressive increase in left atrial diameter (LAD)(P = 0.000), left ventricular end–diastolic diameter (LVEDD)(P = 0.000), left ventricular end–systolic diameter (LVESD)(P = 0.001), ventricular septum (P = 0.000) and cardiac mass (P = 0.000) according to the degree of obesity. Subjects in the 3° group of obesity showed higher value of LAD and LVESD when compared with subjects in first two groups (P = 0.000; P = 0.032; P = 0.000; P = 0.001, respectively). Similarly, subjects in the 3° group of obesity showed higher value of ventricular septum and cardiac mass when compared with the first two groups of obesity (P = 0.005; P = 0.002; P = 0.000; P = 0.005; respectively). LAD, LVEDD, LVESD, ventricular septum and cardiac mass were positively related with the obesity degree. In order to avoid that echocardiographic modifications were caused by hypertension, data were adjusted for hypertension so linear regression documented that degree of obesity predicts echocardiographic changes (LAD, LVEDD, LVESD) better than hypertension. Conclusions Our data suggested that the in obese subjects the severity of cardiomyopathy is correlated with degree of obesity and that the degree of obesity is a better predictor than hypertension for echocardiographic changes.

Hyperuricemia in patients with chronic atrial fibrillation

Uric acid is a cardiovascular risk marker, often associated with inflammation & oxidative stress. There is evidence that associate it with atrial fibrillation (AF), its severity and crisis and showing its association with mechanisms of heart. The aim of this study was to evaluate the relationship between hyperuricemia & echocardiogaphic features in patients with chronic AF for more than 5 years. This was a case-control study which included 107 patients with chronic non-valvular AF. Uricemia was measured in all patients and they were divided into 2 groups: the first consisted in 66 patients with hyperuricemia (> 7.2 mg/dL) and the second in 41 patients with normal uricemia. Every patient was evaluated through echocardiography (TTE). All clinical data (age, disease duration, sex), echocardiographic parameters left ventricle telediastolic (LVTDD) and telesystolic (LVTSD) diameter, left atrial diameter (LAD), aortic diameter (AoD), ejection fraction (EF) and pulmonary pressure (PAP) were analysed. Through binary logistic regression, in backwards conditional method, it results a casual relationship statistically significant between uricemia (7.2 mg/dL) and LAD: for every elevation of LAD with 1 unit, the probability to have hyperuricemia increases by 9% [OD: 0.91, 95% CI: 0.84–0.99]. It exists a significant casual relation between uricemia (> 8 mg/dL) and TSLVD ( P = 0.045) and PAP ( P = 0.006). For every elevation of TSLVD with 1 unit, the chances of having a uricemia > 8 mg/dL increase with 22% [OD: 0.82, 95% CI: 0.67–0.99, b = −0.2]. For every elevation of PAP with 1 unit, the probability of having a uricemia greater than > 8 mg/dL is 9.4% [OD: 0.91, 95% CI: 0.86–0.97, b = −0.09]. In this study, it resulted that hyperuricemia is an important factor in the development of atrial remodelling, associated casually with an increase in left atrial diameter. Hyperuricemia is related with a greater left ventricle telesystolic diameter and pulmonary artery pressure.

Abstract 15729: Effect of Metformin on Outcomes of Catheter Ablation for Atrial Fibrillation

Background: Diabetes mellitus (DM) and glycemic control are risk factors for atrial fibrillation (AF). Metformin may have antifibrillatory properties by altering atrial metabolism. It is unknown whether metformin has favorable effects on the outcomes of catheter ablation (CA) for AF. Objective: To determine whether metformin use is associated with maintenance of sinus rhythm after CA for AF. Methods and Results: A 1 st CA was performed in 271 consecutive patients with DM and AF (age: 65±9 years, women: 34 %; and paroxysmal AF: 50%). A total of 182 (67%) patients were treated with metformin and 79/182 were also receiving other antidiabetics or insulin. HbA1c and preprocedural fasting blood glucose were similar among the patients treated with and without metformin (7.2±1.4% vs. 7.2±1.3%, P=0.95 and 162± 61 vs. 159±66 mg/dL, P=0.72). At a median of 10 months (IQR: 5-23, mean 15±13 months) after CA, 100/182 patients (55%) on metformin remained in sinus rhythm without concomitant antiarrhythmic drugs (AAD) compared to 36/89 patients (40%) not receiving metformin (P=0.03). On K-M analysis, patients on metformin were more likely to stay in sinus rhythm after CA, with or without AADs (P&lt;0.001, log-rank, Figure). On Cox proportional hazards analysis, adjusted for age, gender, BMI, type of AF(paroxysmal vs. non-paroxysmal), fasting blood glucose, AAD use, obstructive sleep apnea, chronic kidney disease, and left atrial diameter, metformin use was associated with a ~35% lower probability of recurrent atrial arrhythmia(HR: 0.65, ±95% CI: 0.44-0.97, P=0.04). Increase in left atrial diameter (per mm, HR: 1.05, ±95% CI:1.01-1.08, P=0.001) and non-paroxysmal AF (HR: 1.9, ±95% CI: 1.3-2.9, P=0.001) were associated with a higher risk of recurrence after CA of AF. Conclusion: In patients with DM, the use of metformin was associated with a significant reduction in recurrent atrial arrhythmias after CA for AF independent of the other risk factors, including preprocedural glycemic control.

Atrial Cardiopathy in the Absence of Atrial Fibrillation Increases Risk of Ischemic Stroke, Incident Atrial Fibrillation, and Mortality and Improves Stroke Risk Prediction

BackgroundAtrial fibrillation (AF) is a major, often undetected, cardiac cause of stroke. Markers of atrial cardiopathy, including left atrial enlargement (LAE) or excessive atrial ectopy (EAE) increase the risk of AF and have shown associations with stroke. We sought to determine whether these markers improve stroke risk prediction beyond traditional vascular risk factors (eg CHA 2 DS 2‐VASc score).Methods and ResultsRetrospective longitudinal cohort of 32 454 consecutive community‐dwelling adults aged ≥65 years referred for outpatient echocardiogram or Holter in Ontario, Canada (2010–2017). Moderate‐severe LAE was defined as men >47 mm and women >43 mm, and EAE was defined as >30 APBs per hour. Cause‐specific competing risks Cox proportional hazards used to estimate risk of ischemic stroke (primary), incident AF, and death (secondary). C‐statistics, incremental discrimination improvement and net reclassification were used to compare CHA 2 DS 2‐VASc with LAE and EAE to CHA 2 DS 2‐VASc alone. Each 10 mm increase in left atrial diameter increased 2‐ and 5‐year adjusted cause‐specific stroke hazard almost 2‐fold (LAE: 2‐year hazard ratio (HR), 1.72; P=0.007; 5‐year HR, 1.87; P<0.0001), while EAE showed no significant associations with stroke (2‐year HR, 1.00; P=0.99; 5‐year HR, 1.08, P=0.70), adjusting for incident AF. Stroke risk estimation improved significantly at 2 (C‐statistics=0.68–0.75, P=0.008) and 5 years (C‐statistics=0.70–0.76, P=0.003) with LAE and EAE.Conclusions LAE was independently associated with an increased risk of ischemic stroke in the absence of AF and both LAE and EAE improved stroke risk prediction. These findings have implications for stroke risk stratification, AF screening, and stroke prevention before the onset of AF.

Usefulness of Hemodynamic Device-Based Optimization in Heterogeneous Patients Implanted with Cardiac Resynchronization Therapy Defibrillator.

Optimization of the atrioventricular (AV) and interventricular (VV) timings of the CRT is the most supposed correctable variable to improve the rate of CRT responder. The aim of the present study has been to evaluate if there is a specific subgroup of patients who can actually benefit the most from a hemodynamic optimization of AV. This is a prospective, observational single-center study that enrolled consecutive patients with clinical indication for CRT; all patients were implanted with CRT-D devices with SonR technology, able to automatically adjust AV and VV delay on a weekly basis. Among 57 patients, 39 (69%) showed a LVESV reduction > 15%. The SonR was able to modify the pacing parameters, but an increase of left atrial diameter was associated to a reduced AV variability, suggesting that an impaired left atrial function could potentially reduce the ability of the SonR algorithm to adjust the correct timing of pacing. Graphical abstract Patients with respectively a high (A) and low (B) AV timing variability, among several parameters that could potentially influence the AV timing, only left atrial dimensions demonstrated a significant impact. In fact an increase of left atrial diameter was associated to a reduced AV variability, suggesting that an impaired left atrial function could potentially reduce the ability of the SonR algorithm to adjust the correct timing of pacing.

Left ventricular remodeling and dysfunction in obstructive sleep apnea : Systematic review and meta-analysis.

BackgroundObstructive sleep apnea syndrome (OSAS) is associated with cardiovascular mortality and morbidity. Several studies have reported that it affects the left ventricle; however, large randomized controlled trials are lacking. The current study aimed to summarize the association between OSAS and left ventricular (LV) structure and function.MethodsElectronic databases (PubMed, Embase, and Cochrane) and references were searched for articles published until March 2018. A systematic review and meta-analysis were performed to assess LV structure and function in OSAS patients based on echocardiography.ResultsIn total, 17 studies with 747 OSAS patients and 426 control participants were included. Patients with OSAS showed an increase in LV diastolic diameter (weighted mean difference [WMD], 95% CI: 1.24 [0.68, 1.80]; p < 0.001), LV systolic diameter (WMD, 95% CI: 1.14 [0.47, 1.81]; p = 0.001), and LV mass (WMD, 95% CI: 35.34 [20.67, 50.00]; p < 0.001). In addition, left ventricular ejection fraction (LVEF) significantly decreased in the OSAS group compared with the controls (WMD, 95% CIs: −1.82 [−2.76, −0.87]; p < 0.001), and the reduction in LVEF was consistent with the severity of OSAS. The OSAS group also showed an increase in left atrial diameter (WMD, 95% CI: 2.13 [1.48, 2.77]; p < 0.001) and left atrial diameter volume index (WMD, 95% CIs: 3.96 [3.32, 4.61]; p < 0.001).ConclusionObstructive sleep apnea syndrome leads to atrial dilatation, left ventricular hypertrophy, enlargement, mass increase and reduction of systolic function. Treatments for OSAS might be beneficial for the preservation of left cardiac structure and function.Electronic supplementary materialThe online version of this article (10.1007/s00059-019-04850-w) contains supplementary material, which is available to authorized users.

A4252 The effect of left atrial size on the cognitive impairment of patients with atrial fibrillation

Objectives: Left atrial (LA) size is an independent predictor of cardiovascular events.In patients with atrial fibrillation (AF), LA enlargement is also associated with the occurrence and recurrence of AF, but the relationship between LA size and cognitive function in patients with AF has not been reported. Methods: 297 patients with AF were selected from the second hospital of lanzhou university, the age average was 67.6 ± 8.4. According to the tertiles of left atrial diameter (LAD), they were divided into three groups(LAD≤33.8 mm group included 99 patients; LAD 33.9–39.7 mm group included 98 patients; LAD≥39.8 mm group included 100 patients), and then according to the MMSE score they were divided into no cognitive impairment group (n = 213) and cognitive impairment group (n = 84). LAD was obtained by echocardiography. To evaluate the effect of different LAD on cognitive impairment of AF patients by multivariate linear regression. Results: There are 84 patients of cognitive impairment with AF, accounting for 28.3%. With the increase of LAD, the incidence of cognitive impairment increased.When LAD≥39.8 mm, the incidence of cognitive impairment is 39% (P < 0.05). LAD was significantly associated with cognitive impairment (OR = −0.0893, 95%CI: −0.1570∼0.0216, P = 0.01), especially in the LAD≥39.8 mm group and LAD≥35 mm in women or LAD≥38 mm in male, LAD can independently increases the risk of cognitive impairment in patients with AF (OR = −1.3729, 95% CI: 2.4796∼0.2662, P = 0.016; OR = −0.9598, 95% CI: 1.8238∼0.0958, P = 0.03). Conclusion: LAD is an independent risk factor for cognitive impairment in AF patients.The incidence of cognitive impairment in AF patients increased with the enlargement of the LAD, especially language ability, concentration and computing powernd directional ability have been significantly reduce.

Cardiac Remodeling from Middle Age to Senescence

Background: The data on cardiac remodeling outside the scope of myocardial infarction and heart failure are limited.Methods: A cohort of middle-aged hypertensive subjects with age- and gender-matched control subjects without hypertension (n = 1,045, aged 51 ± 6 years) were randomly selected for the OPERA study (Oulu Project Elucidating Risk of Atherosclerosis study). The majority of those who were still alive after more than 20 years of follow-up underwent thorough re-examinations.Results: Left ventricular mass index (LVMI) increased significantly from 106.5 ± 27.1 (mean ± SD) to 114.6 ± 29.1 g/m2 (p < 0.001), the thickness of the left ventricular posterior wall (LVPW) from 10.0 ± 1.8 to 10.6 ± 1.7 mm (p < 0.001), fractional shortening (FS) from 35.0 ± 5.7 to 38.4 ± 7.2 % (p < 0.001), and left atrial diameter (LAD) from 38.8 ± 5.2 to 39.4 ± 6.7 mm (p = 0.028) during the 20-year follow-up. After multivariate adjustments, hypertension treated with antihypertensive medication and male gender predicted a smaller increase in the thickness of LVPW (p = 0.017 to <0.001). Baseline higher fasting plasma insulin level, larger intima media thickness of the carotid artery, greater height and antihypertensive medication (p = 0.046–0.002) predicted a smaller (less favorable) change of FS. The increase of LAD was associated with higher baseline diastolic blood pressure (p = 0.034) and greater height (p = 0.006).Conclusion: Aging from middle age to senescence increases the echocardiographic indexes of LVMI, LVPW thickness, FS and LAD. Several baseline factors are associated with these changes.

Echocardiographic Predictors of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study and Cardiovascular Health Study.

This study assessed the echocardiographic predictors of sudden cardiac death (SCD) within 2 population-based cohorts. Echocardiograms were obtained on 2383 participants (1993-1995) from the ARIC study (Atherosclerosis Risk in Communities; 100% black) and 5366 participants (1987-1989 and 1994-1995) from the CHS (Cardiovascular Health Study). The main outcome was physician-adjudicated SCD. We used Cox proportional-hazards models with incident coronary heart disease and heart failure as time-dependent covariates to assess the association between echocardiographic variables and SCD, adjusting for Framingham risk score variables, coronary heart disease, and renal function. Cohort-specific results were meta-analyzed. During a median follow-up of 7.3 and 13.1 years, 44 ARIC study participants and 275 CHS participants had SCD, respectively. In the meta-analyzed results, the adjusted hazard ratios (95% confidence intervals) for predictors of SCD were 3.07 (2.29-4.11) for reduced left ventricular ejection fraction; 1.85 (1.36-2.52) for mitral annular calcification; 1.64 (1.07-2.51) for mitral E/A >1.5, and 1.52 (1.14-2.02) for mitral E/A <0.7 (versus mitral E/A 0.7-1.5); 1.30 (1.15-1.48) per 1 SD increase in left ventricular mass; and 1.15 (1.02-1.30) per 1 SD increase in left atrial diameter. A receiver-operating characteristic model for prediction of SCD using Framingham risk score variables had a C statistic of 0.61 for ARIC study and 0.67 for CHS; the full multivariable model including all echocardiographic variables had a C statistic of 0.76 for ARIC study and 0.74 for CHS. In addition to reduced left ventricular ejection fraction, we identified other echocardiographic-derived variables predictive for SCD that provided incremental value compared with clinical risk factors.

Early Cardiac Involvement and Risk Factors for the Development of Arrhythmia in Patients With β-Thalassemia Major.

Cardiac iron overload is the most serious complication in thalassemia; even patients treated with intensive chelation suffer at a certain point from cardiomyopathy and arrhythmia. The aim of the study was to identify indicators of cardiac dysfunction in thalassemia as well as risk factors associated with the development of arrhythmia. A total of 45 patients with β-thalassemia major were enrolled in this cross-sectional study. Patients were divided into 2 groups according to the absence (group A) or the presence of arrhythmia (group B). Cardiac parameters in thalassemic groups were evaluated using 24-Holter recording, Stress electrocardiogram, and M-mode echocardiography. Serum ferritin and Cardiac T2* were used to assess the iron status. Group B showed significantly higher values of cardiac T2* and serum ferritin (P<0.05). Group B patients had significantly higher maximum heart rate with significant attacks of bradycardia and ST segment changes. In addition, they achieved a lower percentage of maximum age predicted heart rate and lower values of maximum metabolic equivalents (P<0.05). Significantly higher values of the left atrial diameter, the interventricular septum diameter, and the left-ventricle posterior wall diameter (P<0.05) were identified in group B. The increase in left atrial diameter, interventricular septum diameter, and left-ventricle posterior wall diameter seems to be related to the development of arrhythmia in patients with thalassemia, especially supraventricular arrhythmias.

Abstract 18186: Evaluating the Utility of a Multi-factorial Computational Model and Simplified Multi-factorial Risk Score to Predict Postoperative Atrial Fibrillation Following Cardiothoracic Surgery

Background: Postoperative atrial fibrillation (PAF) is a frequent complication following cardiothoracic surgery and is associated with increased length of stay and increased morbidity. This study develops a novel multi-factorial computational model to predict PAF, as well as a simplified risk score for PAF based on this model. Methods: A multi-factorial computational model to predict PAF was trained on 592 patients in the MIMIC II database undergoing cardiothoracic surgery at the Beth Israel Deaconess Medical Center, using demographic, comorbidity, laboratory, and echocardiographic parameters. Parameters were chosen using LR stepwise-backward elimination applied to routinely collected covariates via logistic regression. A simplified risk score was created using the retained covariates based on the observed odds ratios (OR). Discrimination for both the model and risk score were calculated using the area under the receiver operating characteristic curve (AUC) via leave one out cross validation. Results: The multi-factorial computational model retained the following parameters: age in years (OR 1.06; p&lt;0.001), serum chloride in mEq/L (OR 0.92; p=0.019), and left atrial diameter categorized from 0-3 (OR 1.84; p&lt;0.001). The model achieved a significantly higher level of discrimination relative to any covariate alone (AUC 0.72; p&lt;0.001 relative to all individual covariates). The simplified risk score is calculated as: +2 for age &gt; 67, +1 for serum chloride &lt; 105, +1 for each categorical increase in left atrial diameter (&gt;40mm, &gt;47.5mm, &gt;52.5mm); and achieved comparable performance to the multi-factorial computational model (AUC 0.71; p&lt;0.001) with a graded increase in risk (Figure). Conclusions: Multi-factorial computational modeling may provide a robust basis for discriminating between patients at high or low risk of PAF following cardiothoracic surgery. This model can be delivered as a simplified multi-factorial risk score for broad use by the bedside.

Abstract 12642: Left Atrial Diameter as a Predictor of World Health Organization Group Two Pulmonary Hypertension Severity

Objective: Left atrial (LA) enlargement and dysfunction have poor prognostic significance in heart failure and coronary artery disease. However, the correlation between LA diameter and World Health Organization (WHO) Group 2 pulmonary hypertension (PH) severity has not been well studied. Hypothesis: We hypothesized that LA enlargement as a marker of LA remodeling in response to pressure and volume overload may contribute to higher pulmonary arterial pressures (PAP) in this population, independent of comorbidities and left ventricular ejection fraction (LVEF). Methods: After exclusion for severe left-sided valvular disease, 100 patients with isolated or mixed WHO Group 2 PH defined by right heart catheterization were studied in a cross-sectional retrospective analysis at a single institution. Linear LA anteroposterior diameter was obtained from the parasternal long-axis view on two dimensional TTE. LVEF, LV E/A Ratio, and LV Mass Index were measured according to ASE guidelines. LV E/A and LV Mass Index was recorded in 80 subjects and 79 subjects, respectively. Mean PAP was assessed on RHC. TTE and RHC were performed within one year of each other. Results: LA diameter was significantly associated with mean PAP after adjustment for age, sex, body-mass index, presence of coronary artery disease, hypertension, atrial fibrillation, and LVEF in multivariable linear regression analysis. In this multivariable model, a one centimeter increase in LA diameter predicted an average increase in mean PAP of 2.78 mmHg (95% CI 0.10, 5.46, p = 0.0423). In a subset of this population, LVEF, LV E/A Ratio, and LV Mass Index were not significant predictors of mean PAP. Reduction in cardiac index was noted with increasing LA diameter but this trend did not reach statistical significance. Conclusion: LA enlargement is significantly associated with increased mean PAP in patients with WHO Group 2 PH. LA enlargement may be a proxy for LA dysfunction and our data suggests that increased LA diameter may be a predictor of WHO Group 2 PH severity. Further studies of LA dimension, volume, and function are warranted to further our understanding of the left atrium’s relationship to PH.

Ischemia-Induced Model of Diastolic Dysfunction in Sheep

ABSTRACTBackground: Ischemic heart failure with normal ejection fraction (HFNEF) is an increasingly recognized entity that carries similar morbidity and mortality than low ejection fraction heart failure. Animal models of diastolic dysfunction mimicking this condition are lacking and are essential for the development of therapeutic strategies. Methods and Results: Eight Corriedale sheep, 18 ± 5 months old, were included in the study. Basal echocardiography and myocardial perfusion evaluation (SPECT) was performed. Acute myocardial infarction (AMI) was made by occlusion (90 min) and reperfusion of the second diagonal branch of the anterior descending coronary artery. Two months after AMI, echocardiography and SPECT evaluation were performed prior to sacrifice. Basal and 2 months echocardiography showed similar fractional shortening and ventricular dimensions in each animal except for an increase in left atrial diameter. No mitral regurgitation was evidenced. SPECT imaging and pathology confirmed infarction in the apical, apico-anterior, and apico-septal segments. Conclusion: A novel model of ischemia-induced diastolic dysfunction with preserved ventricular thickness and ejection fraction is described. This model opens the possibility of testing therapeutic options for patients with this condition.

Structural and functional changes of the heart in patients with chronic ischemic heart failure, associated with renal dysfunction

Kidney disease is a frequent complication of congestive heart failure (CHF) and may contribute to the progression of ventricular dysfunction. Regardless of the degree of heart failure, chronic kidney disease (CKD) increases the risk of death and cardiac decompensation. Left ventricular hypertrophy (LVH) is a known parameter of cardiac remodelling and has a higher prevalence and incidence among people with impaired kidney function. LVH is an early subclinical marker of cardiovascular disease and heart failure risk, and is probably an intermediary step in the pathway leading from kidney dysfunction to heart failure and its complications. The effects of CKD on other left ventricular and myocardial parameters, however, have been less characterized. The aim of the study was to examine the structural and functional changes, geometric remodeling of the heart in patients with ischemic chronic heart failure, being hospitalized, according to the presence of renal dysfunction.Materials and methods. The study involved 333 patients with ischemic CHF (277 men and 56 women, mean age 59,3±9,4 years). The functional class of heart failure was assessed on the recommendations of the New York Heart Association (NYHA). The etiology of heart failure in 288 (86.5%) patients had a combination of coronary artery disease and essential hypertension, in 45 (13.5%) – only CAD. 1 FC of heart failure was diagnosed in 9 (2.7%) patients, 2 FC - in 106 (31.8%), 3 FC - in 199 (59.8%) and 4 FC - 19 (5.7%) patients. Diabetes was in 61 (18.3%), myocardial infarction history was in 240 (72.1%) patients. Depending on the glomerular filtration rate, patients were divided into 3 groups: 72 with normal GFR (&gt;90 ml/min/1.73m2), 218 with a slight decrease in GFR (60-90 ml/min/1.73m2) and 43 with moderate reduced GFR (&lt;60 ml/min/1.73m2). Echocardiography was performed using the General Electric VIVID 3 system (General Electric Healthcare, USA) with the 2.5–3.5 MHz transducer and Doppler technique. Descriptive statistics are presented as mean±standard deviation for continuous variables and as percentages for categorical variables. Depending on the distribution of the analyzed parameters used unpaired Student's t-test or U-Mann-Whitney test. Comparisons among all groups for baseline clinical variables were performed with the Pearson χ2 or Fisher exact test for categorical variables. Differences considered reliable for values of p&lt;0,05.Results. In patients with ischemic CHF as far as reduction of GFR, an increase in left atrial diameter (p=0.006), end-diastolic size (p=0.03), end-systolic size (p=0.003) end-diastolic (p=0.03) and end-systolic volumes (p=0.02). Analysis of ejection fraction showed a significant reduction in the progression of renal dysfunction: from 55,1±14,5% in GFR over 90 ml/min/1,73m2 to 46,3±14,6% with a GFR less than 60 ml/min/1.73 m2. LV hypertrophy was registered in 63 (87.5%) with normal renal function, in 202 (92.7%) with mild dysfunction and in 42 (97.7%) patients with moderate renal dysfunction. In the analysis of LV remodeling in patients with heart failure and normal renal function revealed the prevalence of concentric hypertrophy - in 45.8%. In mild decrease GFR stored value for concentric hypertrophy in 50% of cases. However, at lower eGFR less than 60 ml/min/1,73m2 dominated eccentric hypertrophy - in 55.8%, concentric hypertrophy in 41.9% and no patient with normal geometry. After analyzing the distribution of patients by type of violation diastolic function in patients with ischemic CHF, depending on the level of GFR, we can conclude that in normal renal function in 48.6% reported pseudonormal type, 36.1% - a abnormal of relaxation, 4.2% - restrictive type. In patients with mild to moderate decrease in GFR revealed a gradual deterioration in diastolic function as increase the proportion of more serious disorders: pseudonormal (56.9% and 60.5%, respectively) and restrictive type (3.7% and 9.3%, respectively).Conclusion. In patients with ischemic CHF decrease in GFR accompanied by structural adjustment in the form of an increase in the diameter of the left atrium, left ventricle, both in diastole and systole. The presence of renal dysfunction is associated with increased left ventricular myocardium index, the development of maladaptive remodeling of the left ventricle, as increase in patients with eccentric hypertrophy and diastolic function deterioration dominated pseudonormal and restrictive type. Thus, the progressive decrease GFR in patients with ischemic chronic heart failure accompanied geometric and hemodynamic transformation that leads to severe diastolic dysfunction.

Mortality and cerebrovascular events after radiofrequency catheter ablation of atrial fibrillation.

Atrial fibrillation (AF) is associated with a significant increase in the risk of stroke and mortality. It is unclear whether maintaining sinus rhythm (SR) after radiofrequency ablation (RFA) is associated with an improvement in stroke risk and survival. The purpose of this study was to determine whether SR after RFA of AF is associated with an improvement in the risk of cerebrovascular events (CVEs) and mortality during an extended 10-year follow-up. RFA was performed in 3058 patients (age 58 ± 10 years) with paroxysmal (n = 1888) or persistent AF (n = 1170). The effects of time-dependent rhythm status on CVEs and cardiac and all-cause mortality were assessed using multivariable Cox models adjusted for baseline and time-dependent variables during 11,347 patient-years of follow-up. Independent predictors of a higher arrhythmia burden after RFA were age (estimated beta coefficient [β] = 0.017 per 10 years, 95% confidence interval [CI] 0.006-0.029, P = .003), left atrial (LA) diameter (β = 0.044 per 5-mm increase in LA diameter, 95% CI 0.034-0.055, P <.0001), and persistent AF (β = 0.174, 95% CI 0.147-0.201, P <.0001). CVEs and cardiac and all-cause mortality occurred in 71 (2.3%), 33 (1.1%), and 111 (3.6%), respectively. SR after RFA was associated with a significantly lower risk of cardiac mortality (hazard ratio [HR] 0.41, 95% CI 0.20-0.84, P = .015). There was not a significant reduction in all-cause mortality (HR 0.86, 95% CI 0.58-1.29, P = .48) or CVEs (HR 0.79, 95% CI 0.48-1.29, P = .34) in patients who remained in SR after RFA. Maintenance of SR after RFA is associated with a reduction in cardiovascular mortality in patients with AF.

GW24-e3603 Association between high-sensitive troponin T levels and the nonischemia factors in elderly patients without overt coronary heart disease

ObjectivesAnalysis association between high-sensitive troponin T levels and the nonischemia factors in hospitalised elderly patients without overt coronary heart disease (CHD).MethodsA total of 354 hospitalised elderly patients, aged ≥ 65...