Left Atrial Active Ejection Fraction Research Articles

Interaction effect of hypertension and obesity on left atrial phasic function: a three-dimensional echocardiography study.

Hypertension (HT) and obesity often coexist and contribute to left atrial (LA) dysfunction. The present study aimed to compare LA function in hypertensive individuals and control participants with different body mass index (BMI) categories and to explore whether there is an interaction effect between HT and obesity on LA function. In this cross-sectional study, a total of 258 individuals (145 hypertensive and 113 non-hypertensive patients) were prospectively enrolled from Fuwai Central China Cardiovascular Hospital from September 2020 to November 2021. Hypertensive and non-hypertensive patients were both divided into three study subgroups (n=35 per group) according to their BMI: normal weight (BMI 18.5-<25 kg/m2), overweight (BMI 25-<30 kg/m2), and obesity (BMI ≥30 kg/m2) groups. LA volume and strain parameters were obtained using three-dimensional echocardiography. A significant interaction effect between HT and obesity on LA function was observed [PInteraction =0.04, 0.03, 0.005, 0.01, and 0.002 for LA ejection fraction (LAEF), LA passive ejection fraction (LAPEF), LA active ejection fraction (LAAEF), LA reservoir longitudinal strain (LASr), and LA contraction longitudinal strain (LASct), respectively; PInteraction <0.001 for LA conduit longitudinal strain (LAScd)]. Univariate correlation analysis revealed that HT [LASr, r=-0.53, 95% confidence interval (CI): -0.62 to -0.42, P<0.001; LAScd, r=-0.49, 95% CI: -0.58 to -0.39, P<0.001; and LASct, r=-0.46, 95% CI: -0.55 to -0.34, P<0.001] and BMI categories (LASr, r=-0.68, 95% CI: -0.75 to -0.61, P<0.001; LAScd, r=-0.47, 95% CI: -0.57 to -0.35, P<0.001; and LASct, r=-0.73, 95% CI: -0.78 to -0.66, P<0.001) were negatively correlated with LA strains. A generalized linear model further demonstrated that there was an interaction effect between HT and obesity on LA strains after adjusting for confounding factors (Model 2: LASr, βHT*Obesity =-1.91, 95% CI: -3.48 to -0.35, P=0.01; LAScd, βHT*Obesity =-3.26, 95% CI: -4.83 to -1.70, P<0.001; LASct, βHT*Overweight =-1.97, 95% CI: -3.03 to -0.91, P<0.001; βHT*Obesity =-1.54, 95% CI: -2.67 to -0.41, P=0.007). Both HT and increasing BMI category had an adverse effect on LA function. The coexistence of HT and obesity further impaired LA performance in an interaction manner. Weight loss is essential to reduce the incidence of adverse cardiovascular events in hypertensive patients.

Analysis of Left Atrial Function after Percutaneous Intramyocardial Septal Radiofrequency Ablation in Hypertrophic Cardiomyopathy

Introduction: The main goal of our research was to explore the effect of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) on left atrial (LA) phasic function in hypertrophic cardiomyopathy (HCM). Methods: The study included 13 patients who underwent PIMSRA at our hospital. The function of LA including reservoir, conduit, and booster pump was analyzed and compared before and 6 months after PIMSRA in HCM patients. LA reservoir function parameters contain maximal LA volume, minimal LA volume (LAV min), LA ejection fraction (LAEF), LA expansion index (LAEI), and reservoir strain; LA conduit function includes LA volume before atrial systole, LA passive volume, LA passive ejection fraction, and conduit strain; LA booster function involves LA booster volume, LA active ejection fraction, and LA contraction strain. Additionally, 20 healthy controls were selected to compare the LA function of HCM patients. Results: The preoperative LA reservoir and conduit function in HCM patients were significantly impaired compared with the control group, while the change in booster pump function was not obvious. HCM patients at 6 months after PIMSRA had remarkably enhanced reservoir and conduit functions which were manifested by lower LAV min, higher LAEF, LAEI, reservoir, and conduit strain than before the operation, and the differences among these parameters between patients after PIMSRA and the healthy control group were not significant. However, with regard to LA contraction function, there was no significant improvement at 6 months after PIMSRA compared with before operation. Conclusion: PIMSRA is effective in the amelioration of LA reservoir and conduit function in patients with HCM but not in a marked improvement of LA contraction function in these individuals in short term.

Analysis of The Left Atrial Function Using Two-Dimensional Strain in Patients with Recent Diagnosis of Hereditary Hemochromatosis.

Hereditary Hemochromatosis (HH) is a genetic condition associated with a systemic iron overload. Heart failure is an important cause of mortality. It has been demonstrated early stages of systolic and diastolic left ventricular dysfunction in previous studies. The aim of the study is to compare the left atrial (LA) function between asymptomatic HH patients and a control group using 2D speckle tracking. Prospective study. LA strain, LA strain rate and LA volumetric parameters during the reservoir, conduit and contraction phases were studied. The LA Stiffness Index was calculated by the ratio between E/e and LA reservoir strain. 30 patients with HH (90% males, 47 ± 18 years old) and 30 healthy controls (85% males, 45 ± 13 years old) were included. LA volume was similar in both groups. No differences were observed in LA ejection fraction (EF), LA passive EF and LA active ejection fraction between both groups. On the contrary, the HH group had lower LA strain during the reservoir (31.5 ± 6.5% vs 38.3 ± 7.9%; P=0.002), and conduit phases (-18 ± 7% vs -23.3 ± 6.4%; P=0.01) and lower LA conduit strain rate (-1.7 ± 0.7 seg-1 vs -2.1 ± 0.5 seg-1; P=0.02) than controls. The LA stiffness index was significantly higher in the HH group (0.25 ± 0.9 vs 0.19 ± 0.6; P=0.01) Early abnormalities in the LA function could be detected by using 2D speckle tracking study despite no evidence of changes in atrial size or volumetric parameters.

Association of left atrial strain by cardiovascular magnetic resonance with recurrence of atrial fibrillation following catheter ablation

BackgroundAtrial fibrillation (AF) is a progressive condition, which is characterized by inflammation/fibrosis of left atrial (LA) wall, an increase in the LA size/volumes, and decrease in LA function. We sought to investigate the relationship of anatomical and functional parameters obtained by cardiovascular magnetic resonance (CMR), with AF recurrence in paroxysmal AF (pAF) patients after catheter ablation.MethodsWe studied 80 consecutive pAF patients referred for ablation, between January 2014 and December 2019, who underwent pre- and post-ablation CMR while in sinus rhythm. LA volumes were measured using the area–length method and included maximum, minimum, and pre-atrial-contraction volumes. CMR-derived LA reservoir strain (ℇR), conduit strain (ℇCD), and contractile strain (ℇCT) were measured by computer assisted manual planimetry. We used a multivariate logistical regression to estimate the independent predictors of AF recurrence after ablation.ResultsMean age was 58.6 ± 9.4 years, 75% men, mean CHA2DS2-VASc score was 1.7, 36% had prior cardioversion and 51% were taking antiarrhythmic drugs. Patients were followed for a median of 4 years (Q1–Q3 = 2.5–6.2 years). Of the 80 patients, 21 (26.3%) patients had AF recurrence after ablation. There were no significant differences between AF recurrence vs. no recurrence groups in age, gender, CHA2DS2-VASc score, or baseline comorbidities. At baseline, patients with AF recurrence compared to without recurrence had lower LV end systolic volume index (32 ± 7 vs 37 ± 11 mL/m2; p = 0.045) and lower ℇCT (7.1 ± 4.6 vs 9.1 ± 3.7; p = 0.05). Post-ablation, patients with AF recurrence had higher LA minimum volume (68 ± 32 vs 55 ± 23; p = 0.05), right atrial volume index (62 ± 20 vs 52 ± 19 mL/m2; p = 0.04) and lower LA active ejection fraction (24 ± 8 vs 29 ± 11; p = 0.05), LA total ejection fraction (39 ± 14 vs 46 ± 12; p = 0.02), LA expansion index (73.6 ± 37.5 vs 94.7 ± 37.1; p = 0.03) and ℇCT (6.2 ± 2.9 vs 7.3 ± 1.7; p = 0.04). Adjusting for clinical variables in the multivariate logistic regression model, post-ablation minimum LA volume (OR 1.09; CI 1.02–1.16), LA expansion index (OR 0.98; CI 0.96–0.99), and baseline ℇR (OR 0.92; CI 0.85–0.99) were independently associated with AF recurrence.ConclusionSignificant changes in LA volumes and strain parameters occur after AF ablation. CMR derived baseline ℇR, post-ablation minimum LAV, and expansion index are independently associated with AF recurrence.

Observation of changes in left atrial and left ventricular function in patients with hypertensive disorders of pregnancy based on myocardial strain.

To observe the changes of left atrial and left ventricular function in patients with hypertensive disorders of pregnancy (HDP) based on myocardial strain. A total of 66 HDP patients admitted to our hospital were retrospectively analyzed, and 36 normal pregnant admitted during the same period women were selected as the control group. The maximum volume of the left atrium (LAVmax), minimum volume of the left atrium (LAVmin), left atrial active ejection fraction (LAAEF), mitral ratio of peak early to late diastolic filling velocity (E/A), and left ventricular active ejection fraction (LVEF) were measured by conventional echocardiography. The peak systolic strain rate (SRs) of each wall of the left atrium during early systole (SRe) and late diastole (SRa) was detected by speckle-tracking imaging (STI). The longitudinal (LS), radial (RS), and circumferential strain (CS) parameters of each wall of the left ventricle were also measured. The above parameters were compared between the two groups, and the correlation between mean SRa (mSRa) and LAAEF as well as left ventricular global longitudinal strain (GLS) and LVEF in HDP patients was analyzed. LAVmax, LAVmin, and LAAEF in the HDP group were higher than those in the control group, while the E/A ratio was lower than that in control group (all P<0.05). However, there was no significant difference in LVEF between the two groups (P>0.05). In the HDP group, the absolute values of SRs and SRe in each wall of the left atrium were lower than those in the control group, while the absolute values of SRa were higher than those in the control group. In addition, the absolute values of LS, CS, and RS values in each wall of left ventricle in the HDP group were lower than those in the control group (all P<0.05). Pearson correlation analysis showed that mSRa was negatively correlated with LAAEF (r=-0.895, P=0.000) and that left ventricular long-axis GLS was negatively correlated with LVEF (r=-0.646, P=0.000) in HDP patients. According to the STI results, HDP patients experience significant left atrial and left ventricular myocardial strain injury. Therefore, monitoring of cardiac function and early intervention should be strengthened in clinical practice.

Left heart function evaluation of patients with essential hypertension and paroxysmal atrial fibrillation by two-dimensional speckle tracking imaging combined with real-time three-dimensional ultrasound imaging.

BackgroundThis study aims to assess the value of two-dimensional speckle tracking imaging (2D-STI) combined with real-time 3-dimensional echocardiography (RT-3DE) in evaluating left heart function in patients with combined ETH and PAF.MethodsA prospective study was designed, and the research period was from January 2017 to January 2020. A PAF observation group comprised of patients with ETH and PAF, a PAF control group of patients with ETH but without PAF, and a healthy volunteer group referred to as the healthy group, each comprised of 50 patients was established. All patients underwent routine ultrasound imaging examination using 2D-STI and RT-3DE. The interventricular septum thickness (IVST), left and right atrioventricular diameter (LAD), left ventricular posterior wall thickness (PWT), left ventricular ejection fraction (LVEF), the mean left atrium peak strain (mSs, mSe, mSa), strain rate (mSRs, mSRe, mSRa), the left ventricular mass (LVM), left ventricular mass index (LVMI), and left atrial total emptying volume (LATEV), the left atrial volume index (LAVI), left atrial total emptying fraction (LATEF), left atrium expansion index (LAEI), left atrium passive ejection fraction (LAPEF), and left atrial active ejection fraction (LAAEF) were calculated. Patients in the PAF observation group received telmisartan combined with rosuvastatin after diagnosis and 12- and 24-month-follow up visits were conducted. During these visits, 2D-STI combined with RT-3DE was used to evaluate cardiac function and each patient’s blood pressure was monitored.ResultsPatients in the PAF observation group had a significantly longer course of ETH than patients in the PAF control group (13.5±4.4 vs. 10.32±5.6, P=0.002). The comparison of routine 2D-STI and RT-3DE ultrasound indexes among the three groups also showed significant differences (P<0.01). During the 2-year follow-up period, the IVST, LAD, PWT, and LVEF of remaining patients significantly improved as treatment progressed (P<0.05). The LAVI, LATEF, and LAEI also improved significantly as the treatment progressed (P<0.05). After 12 months of treatment, the recurrence rate of atrial fibrillation was 16.33% (8/45) and after 24 months this was 34.21% (13/38).ConclusionsCardiac function could be evaluated comprehensively by 2D-STI combined with RT-3DE in patients with ETH combined with PAF at initial diagnosis and follow-up.

Impaired left atrial mechanical functions as indicators for increased aortic root diameter in hypertensive and diabetic patients.

Previous studies have demonstrated that increased aortic root diameter (ARD) is frequently associated with increased cardiovascular (CV) events and is apredictor of stroke. Two-dimensional speckle tracking echocardiography (2D-STE) provides abetter evaluation of left atrial (LA) functions. Left atrial mechanical dispersion is auseful predictor of new-onset atrial fibrillation (AF) independent of LA enlargement and dysfunction. We aimed to investigate the relationship between ARD and LA mechanical functions. The present study included 93consecutive patients with hypertension and diabetes. The relationships between ARD and LA functions was evaluated. Study population was divided into two groups according to the mean ARD values: group1 (ARD ≤30.03 mm, n = 53) and group2 (ARD >30.03 mm, n = 40). In group2, age, LA maxvolume (vol), LA preA vol, LA min vol, LA emptying fraction, LA active ejection fraction (EF), and LA expansion index were significantly higher compared to group1. S‑LAs and SR-LAs (peak LA strain and strain rate, respectively, during ventricular systole) and S‑LAe and SR-LAe (peak early diastolic LA strain and strain rate, respectively) were significantly lower in group2 compared to group1. Age, LA max vol, LA preA vol, LA min vol, LA emptying fraction, LA active EF, LA expansion index, S‑LAs, S‑LAe, SR-LAs, and SR-LAe were significantly associated with increased ARD. In multivariate logistic regression analysis, age, LA expansion index, and SR-LAe were independent predictors for ARD. Impaired LA mechanical functions determined by speckle tracking methods are related with increased ARD independent of LV diastolic dysfunction.

Left atrial structural and functional remodeling study in type 2 diabetic patients in sub-Saharan Africa: Role of left atrial strain by 2D speckle tracking echocardiography.

To evaluate the role of peak atrial longitudinal strain (PALS) through speckle tracking 2D echocardiography for the assessment of structural and functional left atrial (LA) remodeling in a type 2 diabetes mellitus (T2DM) population. We conducted a cross-sectional study during a 9-month period. T2DM adults aged 18 and above were included. The variables assessed during the study include age and gender of participants, diabetes characteristics, cardiovascular risk factors, clinical anthropometric and hemodynamic parameters, standard echocardiographic parameters, volume-derived LA functions, and 2D PALS. We included a total of 102 patients. The mean age was 58 ± 11.7 years, and the M/F sex ratio was 1:1.5. Coexistent arterial hypertension (HTN) was observed in more than half (59.8%) of the population sample. Mean 2D PALS was 29.2 ± 8.9% with 58.8% (95% CI: 50.0-68.6) of subjects having a reduced LA strain (ie,<32%). Reservoir and pump functions were the most altered LA volumetric phasic functions. Mean indexed LA maximal volume was 22.2 ± 6.8 mL/m2 . There was a significant association between abnormal PALS and age, Body mass index (BMI), indexed LA volume, E/E' ratio, LA active ejection fraction (pump function), and LA expansion index (reservoir function). Left atrial remodeling is a recurrent condition in adult T2DM Cameroonians. The reservoir and pump LA functions were the most affected. Assessment of LA global strain allows early detection of LA remodeling with comparison to LA size standard analyses. Age, BMI, indexed LA volume, E/E' ratio, and reservoir and pump LA functions were associated to 2D LA global strain impairment.

Correlation of serum BNP and ET-1 levels with cardiac pump function and ventricular remodeling in patients with heart failure

This study aimed to explore the correlation of serum brain natriuretic peptide (BNP) and endothelin-1 (ET-1) levels with cardiac pump function and ventricular remodeling in patients with heart failure. Eighty-one patients with chronic heart failure admitted to our hospital from March 2016 to November 2018 were enrolled as the study group, and 80 healthy individuals as the control group. Immunofluorescence was used for the detection of serum BNP, ELISA for serum ET-1, and ultrasound for related indexes of cardiac pump function and ventricular remodeling. Moreover, correlation analysis and prognostic factors analysis were carried out. Both BNP and ET-1 were highly expressed in the serum of patients with heart failure. Cardiac pump function related indexes (left atrial ejection fraction (LAEF), left atrial passive ejection fraction (LAPEF), and left atrial active ejection fraction (LAAEF)) in the study group were significantly lower than those in the control group (P&lt; 0.05). While ventricular remodeling related indexes (left ventricular end-diastolic diameter (LVEDD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPM), and left ventricular mass index (LVMI) in the study group were significantly higher than those in the control group (P&lt; 0.05). BNP and ET-1 were negatively correlated with LAEF, LAPEF and LAAEF (P&lt; 0.05), and were positively correlated with LVEDD, IVST, LVPM and LVMI (P&lt; 0.05). The expressions of serum BNP and ET-1 were higher in patients with cardiovascular events than those without cardiovascular events. Hypertension, hyponatremia, high BNP, high ET-1, NYHA classification, decreased LAEF and increased LVEDD were independent risk factors for cardiovascular adverse events. Serum BNP and ET-1 are closely related to cardiac pump function and ventricular remodeling in patients with heart failure and can be used as important reference indexes for prognosis evaluation.

Assessment of left atrial function in elderly patients with ischemic mitral regurgitation by real-time three-dimensional speckle tracking imaging

Objective To assess left atrial(LA)function by evaluating changes of LA wall movement and volume detected by real-time three-dimensional speckle tracking imaging(RT3D-STI)in elderly patients with ischemic mitral regurgitation(IMR). Methods Eighty-six elderly patients with coronary heart disease(CHD)were enrolled in this study.According to whether or not to have IMR, the patients were divided into the pure CHD group(n=32)and the CHD-induced ischemic mitral regurgitation(IMR)group(n=54, including 20 cases of mild IMR, 18 cases of moderate IMR and 16 cases of severe IMR). Thirty-two healthy elderly volunteers were considered as control group.RT3D-STI was used to evaluate the global atrial longitudinal strain(GLS), global circumferential strain(GCS), global radial strain(GRS)and LA maximal, minimal and pre-systolic volumes(LAVmax, LAVmin, and LAVp). LA ejection fraction(LAEF), LA passive ejection fraction(LApEF)and LA active ejection fraction(LAaEF)were calculated.The relationship of LA volume changes and myocardial strain with LA function was analyzed. Results The left ventricular ejection fraction(LVEF)and LAEF were reduced in CHD group and IMR group as compared with the control group, and were lower in IMR group than in CHD group(P<0.05). Compared with the control group, the LAVmin was increased, and the LAaEF was decreased in the IMR group(P<0.05). Compared with the control group, the GLS, GCS, GRS were declined in the CHD and IMR groups, and were lower in IMR group than in control group(P<0.05). Along with the increased severity of regurgitation, GLS, GCS, and GRS were decreased in varying degrees.The standard deviations of time to peak longitudinal strains(TLS-SD), of time to peak circumferential strains(TCS-SD), and of time to peak radial strain(TRS-SD)rose in the IMR group as compared with the control group(P<0.05). The myocardial motion indicators(GLS, GCS, GRS)had a quite strong correlation with LAEF in the CHD and IMR groups(CHD group: r=-0.745, -0.718 and 0.627, P=0.006, 0.007 and 0.009; IMR group: r=-0.785, -0.781, 0.643, P=0.006, 0.007 and 0.008). The receiver operating characteristic(ROC)curves analysis showed that the sensitivity and specificity of TLS-SD, TCS-SD and TRS-SD were 89.7% and 81.8%, 78.6% and 84.8%, 85.7% and 72.1%, respectively in the evaluation of LA function changes. Conclusions RT3D-STI can precisely and objectively assess the LA function changes by measuring the volume changes and tracing the myocardial motion in elderly IMR patients. Key words: Coronary disease; Mitral valve insufficiency; Echocardiography, three-dimensional; Atrail function, left

Assessment of left atrial function in dilated cardiomyopathy patients using speckle-tracking echocardiography

Background: The available methods to assess left atrial function (LAF) have some limitations as angle dependence and opposite distortion. The objective of the current study was to evaluate LAF in dilated cardiomyopathy (DCM) of ischemic (IDCM) and non-ischemic etiologies (NIDCM) using speckle tracking echocardiography (STE).&#x0D; Methods: 52 patients with systolic heart failure were included in our study; 27 with IDCM and 25 with NIDCM along with 15 healthy controls. All patients underwent conventional echocardiography, tissue doppler imaging, and speckle tracking echocardiography. The later modality was used to compare left atrial function in IDCM and NIDCM groups.&#x0D; Results: We found the left atrial maximum volume and the left atrial total emptying volume to be higher in patients with dilated cardiomyopathy compared to healthy patients (52.19 ± 6.01 vs. 21.87 ± 1.69 cm3/m2; p &lt;0.001 and 28.67 ± 4.34 vs. 15.67 ± 2.02 cm3/m2, respectively). Conversely, left atrial emptying index and left atrial active ejection fraction were lower in patients with DCM compared to healthy controls (9.60 ± 2.29 vs. 8.27 ± 3.01 cm3/m2; p&lt; 0.001 and 23 ± 2.56 vs. 37.47 ± 3.54 %; p&lt;0.001, respectively). When comparing the IDCM group with NIDCM patients, we found no significant difference in left atrial maximum volume and left atrial active emptying volume. However, the NIDCM patients had significantly lower left atrial total emptying volume, and left atrial active ejection fraction (8.93 ± 1.86 vs. 9.60 ± 2.29 cm3/m2 and 23 ± 2.56 vs. 31.19 ± 1.66 %; p&lt;0.001). on comparing strain function, DCM patients had lower systolic (28.22 ± 3.84 vs. 60.87 ± 3.07 %, p&lt;0.001), and left atrial systolic strain rate (-2.66 ± 0.45 vs. -3.81 ± 0.35; p = 0.003) compared to healthy controls. All strains and strain rates were significantly lower in NIDCM patients compared to IDCM patients.&#x0D; &#x0D; Conclusion: STE is a promising method for evaluating LAF in DCM patients. Patients with DCM had significantly lower left atrial systolic and late diastolic strains and strain rates compared to healthy patients. Moreover, NIDCM could be differentiated from IDCM by having more impairment in the LA dynamic reservoir and booster pump function.

Assessment of left atrial function in patients with ischemic and nonischemic dilated cardiomyopathy using speckle-tracking echocardiography

Objective The aim was to assess left atrial (LA) function in patients with ischemic and nonischemic dilated cardiomyopathy using speckle tracking echocardiography. Background LA changes occur in patients with dilated cardiomyopathy and LA enlargement is commonly found by echocardiography. Two-dimensional speckle tracking echocardiography is a tool for the evaluation of LA function. Patients and methods This casecontrol study was conducted on 67 randomly selected individuals who presented to the Cardiology Department of Faculty of Medicine, Menoufia University, Egypt, during the period from January 2017 to December 2017. They included 52 patients with systolic heart failure (HF) and 15 normal individuals. In this study, the LA maximum, minimum volumes, and volume before the atrial systole, and calculated total emptying, active emptying volumes, expansion index, and fraction were measured. Strains and strain rates during left ventricular (LV) systole and late LV diastole using speckle-tracking imaging were measured. Results The study showed no significant differences between the nonischemic dilated cardiomyopathy (NIDCM) and ischemic dilated cardiomyopathy (IDCM) groups in the A peak, DT, septal e′, E/A, E/e′ and LAD, LVEDD. LA maximum volume (LAVmax) and the active emptying volume of LA (LAEV) showed no significant difference between the studied groups, but the total emptying capacity of the LA (LATV), the left atrial expansion index, and the left atrial active ejection fraction (LAAEF) were significantly lower in the NIDCM group. The LA strain and strain rate during LV systole (Ss, SRs) and during late LV diastole (Sa, SRa) representing the reservoir and booster pump function of the LA, respectively, were significantly lower in the NIDCM group. Conclusion LA systolic and late diastolic strains and strain rates were significantly lower in NIDCM patients. The LA dynamic reservoir and booster pump function were more severely impaired in NIDCM.

P605Correlation of left atrial phasic transport function and arrhythmogenic substrate in patients with atrial fibrillation: cardiac magnetic resonance feature tracking and bipolar voltage mapping

Abstract Background Bipolar voltage mapping is a widely accepted approach to identify areas of arrhythmogenic substrate in patients presenting for atrial fibrillation (AF) ablation. However, until now little is known about the correlation of left atrial (LA) bipolar voltage distribution and LA transport function. Purpose To study the impact of LA low voltage zones (LVZ) on LA transport function. Methods 107 consecutive patients presenting for ablation of symptomatic AF (34 paroxysmal AF, 73 persistent AF) were prospectively enrolled. Each patient underwent cardiac magnetic resonance imaging (CMR) within 24 hours prior to the ablation procedure. 59 patients were in sinus rhythm (SR) and 48 in AF. LA phasic indexed volumes (LAVi) and ejection fractions were calculated using biplane area length formula. In addition LA phasic strains and strain rates were analyzed using dedicated software (Figure 1A &amp; B). LA bipolar voltage mapping was performed prior to beginning of ablation in sinus rhythm using a 3-dimensional mapping system and LVZ were defined as areas of bipolar voltage &lt;0.5mV. Results LVZ were present in 47 patients (23 in SR). The area of LVZ was 14.6cm2 (5.3–34.0). For patients in AF at the time of CMR only elevated minimal and maximal LAVi (p=0.001 and p=0.002 respectively) but no LA functional parameter was predictive for the occurrence of LVZ. In contrast for patients in SR all LA phasic volumes (endsystolic, pre atrial contraction and enddiastolic LAVi) and LA function parameters (passive, active and total ejection fraction (EF), reservoir, conduit and booster pump strains and strain rates) were predictive for the occurrence of LVZ. After clustered and pooled multivariate logistic regression only impaired booster pump strain rate was still predictive for occurrence of LVZ (OR 0.974, 95% CI 0.950–0.998, p=0.036). In addition Pearson correlation analysis revealed a strong link between LA booster pump functional parameters and cm2 expansion of LVZ areas: LA active EF, LA booster pump strain and SR (r=−0.42, p=0.044; r=−0.47, p=0.024; r=−0.65, p=0.001 [Figure 1C] respectively). Conclusion For patients in SR LA transport function is closely linked to the occurrence of LA LVZ and outperforms LA volumetric measurements for the prediction of LA LVZ. Furthermore LA booster pump function parameters show robust correlation to the extension of LA LVZ.

Evaluation of left atrial function in patients with iron-deficiency anemia by two-dimensional speckle tracking echocardiography.

BackgroundIron-deficiency anemia (IDA) is a global health problem and a common medical condition that can be seen in everyday clinical practice. And two-dimensional speckle tracking echocardiography (2D-STE) has been reported very useful in evaluating left atrial (LA) function, as well as left ventricular (LV) function. The aim of our study is to evaluate the LA function in patients with IDA by 2D-STE.Methods65 patients with IDA were selected. This group of patients was then divided into two groups according to the degree of hemoglobin: group B (Hb > 90 g/L) and group C (Hb60 ~ 90 g/L). Another 30 healthy people were also selected as control group A. Conventional echocardiography parameters, such as left atrial diameter (LAD), peak E and A of mitralis (E, A), E/A, end-diastolic thickness of ventricular septum (IVST d), end-diastolic thickness of LV posterior wall (PWTd) and left ventricular end-diastolic dimension (LVDd) were obtained from these three groups. Left atrial minimum volume (LAVmin), left atrial pre-atrial contraction volume (LAVp) and left atrial maximum volume (LAVmax) were measured by Simpson’s rule, whereas left atrial active ejection fraction (LAAEF) and left atrial passive ejection fraction (LAPEF) were obtained from calculation. Two-dimensional images were acquired from apical four-chamber view and two-chamber view to store images for offline analysis. The global peak atrial longitudinal strain and strain rate of systolic LV (GLSs, GLSRs) as well as early and late diastolic LV strain rate (GLSRe, GLSRa) curves of LA were acquired in each LA segment from basal segment to top segment of LA by 2D-STE.ResultsCompared with group A, there were no differences between group B and group A (all P > 0.05). The LAAEF and GLSRa were significantly higher in group C compared with those of group A and group B (all P < 0.01). The LAPEF, GLSs, GLSRs and GLSRe were significantly lower in group C compared with those of group A and group B (all P < 0.01).Conclusions2D-STE could evaluate the LA function in patients with IDA.

Effect of acute sleep deprivation on left atrial mechanics assessed by three-dimensional echocardiography.

Although sleep deprivation (SD) affects cardiovascular system in many ways, physio-pathological changes in cardiac chamber volume and function have not been described well. The aim of the present study was to investigate the effect of SD on left atrial (LA) and ventricular function with three-dimensional (3D) echocardiography. Thirty-two healthy individuals (12 females, mean age 33.25 ± 8.18) were evaluated. Echocardiographic examination was performed once after a night of regular sleep and a night of sleep debt. Beside conventional parameters, 3D phasic volumes and function were measured using a commercially available 3D echocardiography system and offline analysis software. Mean sleep duration of the study group was 8.15 ± 2.19 h in the day of regular sleep and 2.56 ± 2.25 h in the day of sleep deprivation. There was a significant prolongation in deceleration time (180.83 ± 15.34 vs. 166.44 ± 26.12; p = 0.044) and increase in E/e' (6.95 ± 1.26 vs. 6.38 ± 0.85; p = 0.005). Among 3D measurements, the difference in left ventricular ejection fraction (EF), LA EF, LA reservoir function and LA active EF were not significant. Mean LA passive EF of the individuals was significantly lower after night shift (24.10 ± 7.66 vs. 31.49 ± 7.75; p = 0.006). Acute SD is associated with a reduction in LA passive emptying function in healthy adults. 3D-derived indices were sufficient to show subclinical diastolic dysfunction according to impairment in passive phase of LA ejection. Prospective large-scale studies are needed to enlighten this issue.

Evaluation of left atrial function in patients with atrial fibrillation after having catheter ablation by real-time three-dimensional echocardiography and speckle tracking imaging

Objective To evaluate left atrial (LA) function by real-time three-dimensional echocardiography (RT-3D) and speckle tracking imaging (STI) after circumferential ablation of pulmonay vein ostia for atrial fibrillation guided by carto mapping system. Methods Thirty patients who had ablation procedure for paroxysmal atrial fibillation were accepted echocardiography to estimate the LA function at pre-operation,3 days and 3 months of post-operation. The LA maximal, minimal and pre-systolic volume (LAVmax, LAVmin and LAVp), LA passive ejection fraction (LAPEF), LA active ejection fraction (LAAEF) were measured by RT-3DE respectively. The strain rate curve was acquired in each LA segment (anterior, posterior, lateral, inferior and septal) by STI. Systolic strain rate (SRs), early diastolic strain (SRe) and late diastolic strain rate(SRa) of each left atrial segments were measured. Results Comparing with preoperative,3 days post-ablation SRs,SRe and SRa decreased significantly in each wall of LA. After 3 months,SRa and SRe in anterior, inferior and septal were significantly improved, however, SRs showed no significant difference. LAVmax and LAVpre were significantly decreased. LAPEF and LAAEF were significantly improved. Conclusions The patients with circumferential pulmonary vein ablation were in a deterioration after three days. The pump function and conduit functions of left atrial were increased after 3 months. Key words: Echocardiography ; Atrial fibillation; Catheter ablation ; Atrial function, left