Left Atrial Area Index Research Articles

Enlarged right atrium predicts pacemaker implantation after atrial fibrillation ablation in patients with tachycardia-bradycardia syndrome

IntroductionAlthough catheter ablation (CA) of tachycardia-bradycardia syndrome (TBS) in patients with atrial fibrillation (AF) is considered to be an effective treatment strategy, pacemaker implantations (PMIs) are often required even after a successful CA. This study aimed to elucidate the clinical predictors of a PMI after CA. MethodsFrom 2011 to 2020, 103 consecutive patients diagnosed with TBS were retrospectively enrolled in the study. Among the 103 patients, 54 underwent a PMI and 49 CA of AF. During 47.4 ± 35.4 months after 1.4 ± 0.6 CA sessions, 37 (75.5%) of 49 patients were free from atrial arrhythmia recurrences. PMIs were performed in 11 patients (PMI group) and the remaining 38 did not receive a PMI (non-PMI group). ResultsWhen comparing the PMI and non-PMI groups, there were no differences in the basic mean heart rate (P = 0.36), maximum pauses detected by 24-hour Holter-monitoring (P = 0.61), and other clinical parameters between the two groups while the right atrial area index was larger (42.1 ± 24.0 vs. 21.8 ± 8.4 cm2/m2 P = 0.002) in the PMI group than non-PMI group. The ROC curve analysis showed that the optimal cutoff point of the ratio of the right atrial area index to the left atrial area index for predicting a PMI following CA was 0.812 (Sensitivity 72.7%, specificity 71.1%, positive predictive value 42.1%, negative predictive value 90.0%, diagnostic accuracy 71.4%, AUC = 0.81). ConclusionRight atrial enlargement prior to CA was considered to be one of the risk factors for a PMI after CA of AF.

Left atrial area index provides the best prediction of atrial fibrillation in ischemic stroke patients: results from the LAETITIA observational study.

Left atrial (LA) enlargement has been repeatedly shown to be associated with the diagnosis of atrial fibrillation (AF). In clinical practice, several parameters are available to determine LA enlargement: LA diameter index (LADI), LA area index (LAAI), or LA volume index (LAVI). We investigated the predictive power of these individual LA parameters for AF in patients with acute ischemic stroke or transient ischemic attack (TIA). LAETITIA is a retrospective observational study that reflects the clinical reality of acute stroke care in Germany. Consecutive patient cases with acute ischemic cerebrovascular event (CVE) in 2019 and 2020 were identified from the Mannheim stroke database. Predictive power of each LA parameter was determined by the area under the curve (AUC) of receiver operating characteristic curves. A cutoff value was determined. A multiple logistic regression analysis was performed to confirm the strongest LA parameter as an independent predictor of AF in patients with acute ischemic CVE. A total of 1,910 patient cases were included. In all, 82.0% of patients had suffered a stroke and 18.0% had a TIA. Patients presented with a distinct cardiovascular risk profile (reflected by a CHA2DS2-VASc score ≥2 prior to hospital admission in 85.3% of patients) and were moderately affected on admission [median NIHSS score 3 (1; 8)]. In total, 19.5% of patients had pre-existing AF, and 8.0% were newly diagnosed with AF. LAAI had the greatest AUC of 0.748, LADI of 0.706, and LAVI of 0.719 (each p < 0.001 vs. diagonal line; AUC-LAAI vs. AUC-LADI p = 0.030, AUC-LAAI vs. AUC-LAVI p = 0.004). LAAI, increasing NIHSS score on admission, and systolic heart failure were identified as independent predictors of AF in patients with acute ischemic CVE. To achieve a clinically relevant specificity of 70%, a cutoff value of ≥10.3 cm2/m2 was determined for LAAI (sensitivity of 69.8%). LAAI revealed the best prediction of AF in patients with acute ischemic CVE and was confirmed as an independent risk factor. An LAAI cutoff value of 10.3 cm2/m2 could serve as an inclusion criterion for intensified AF screening in patients with embolic stroke of undetermined source in subsequent studies.

Pancreatic T2* Magnetic Resonance Imaging for Prediction of Cardiac Arrhythmias in Transfusion-Dependent Thalassemia.

We assessed the value of pancreatic T2* magnetic resonance imaging (MRI) for predicting cardiac events from a large prospective database of transfusion-dependent thalassemia (TDT) patients. We considered 813 TDT patients (36.47 ± 10.71 years, 54.6% females) enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. MRI was used to measure hepatic, pancreatic, and cardiac iron overload (IO), to assess biventricular function and atrial dimensions, and to detect replacement myocardial fibrosis. The mean follow-up was 50.51 ± 19.75 months. Cardiac complications were recorded in 21 (2.6%) patients: one with heart failure (HF) and 20 with arrhythmias. The single patient who developed HF had, at the baseline MRI, a reduced pancreas T2*. Out of the 20 recorded arrhythmias, 17 were supraventricular. Pancreatic T2* values were a significant predictor of future arrhythmia-related events (hazard ratio = 0.89; p = 0.015). Pancreas T2* remained significantly associated with future arrhythmias after adjusting for any other univariate predictor (age and male sex, diabetes, history of previous arrhythmias, or left atrial area index). According to the receiver-operating characteristic curve analysis for arrhythmias, a pancreas T2* < 6.73 ms was the optimal cut-off value. In TDT, pancreatic iron levels had significant prognostic power for arrhythmias. Regular monitoring and the development of targeted interventions to manage pancreatic IO may help improve patient outcomes.

Ethnic and sex-related differences at presentation in apical hypertrophic cardiomyopathy: An observational cross-sectional study

BackgroundWe investigated whether ethnicity and sex are associated with different clinical presentations and cardiovascular magnetic resonance (CMR) findings in individuals with apical hypertrophic cardiomyopathy (ApHCM). MethodsA retrospective observational cohort study of consecutive ApHCM patients from a large tertiary referral center in the United Kingdom (UK). Demographic, clinical, 12‑lead electrocardiogram (ECG) and CMR findings were collected. Participants presented in our clinics between 2010 and 2020. ‘Pure’ ApHCM was defined as isolated apical hypertrophy and ‘mixed’ with both apical and septal hypertrophy but with the apical segments of a greater wall thickness. Deep T-wave inversion was defined as ≥5 mm in any electrocardiogram lead. ResultsA total of 150 consecutive ApHCM patients (75% men, 25% women; 37% White, 25% Black, 24% Asian and 15% of Mixed/Other ethnicity) were included. Females were diagnosed at an older age compared to men, had less prominent ECG changes, had higher left atrial area index, and were more hypertensive. Black patients had higher left ventricular mass index, more hypertension, and more of the ‘mixed’ type of ApHCM. The majority of hypertensive male patients showed the ‘mixed’ phenotype. ConclusionsIndividuals of Black ethnicity and hypertensive male patients are more likely to present with mixed apical and basal hypertrophy, whereas White, Asian and non-hypertensive male patients tend to have hypertrophy limited to the apex. Females present at an older age and are less likely to have deep T wave inversion on ECG.

The left atrial morphologic and functional parameters as predictors of paroxysmal atrial fibrillation in patients after ischemic stroke

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiogenic source of embolism is the most common cause of non-lacunar ischemic stroke (IS). Identifying the patients with undiagnosed paroxysmal atrial fibrillation (PAF) may reduce the risk of recurrent cardiogenic strokes. Reliable predictors of PAF seems to be crucial for selection the patients to prolonged ECG monitoring after IS. Purpose To assess the feasibility of echocardiography in selecting the patients with highest risk of PAF. Methods We present the preliminary data of prospective cohort study of patients after IS or transient ischemic attack of unknown aetiology and possible cardiogenic origin. The examined group comprises of 40 consecutive patients without history of AF, capable to perform ECG recording. All patients included in the study had transthoracic echocardiography (TTE) prior the monitoring period. An offline analysis including left atrial functional and morphologic assessment was performed. Every patient enrolled in the study was equipped for 2 weeks with a mobile, on demand 1-minute single lead ECG recorder and was asked for at least two exams per day. After two weeks all recorded ECGs were checked for AF occurrence. The level of statistical significance was set at p&amp;lt;0.05. Results From 40 patients (aged 64,5 yrs in average) included in the study 45% were males; (n=18). 15% (n=6) of patients were diagnosed with PAF during ECG monitoring and comprised PAF subgroup, the rest of patients formed non PAF subgroup (nPAF). Mean number of ECG records was 56,5 per patient, during the monitoring period. There were no significant differences between PAF/nPAF in age, past medical history, and left ventricular (LV) size or systolic function. Patients from PAF group have statistically significant higher values of left atrial (LA) area and volume see table 1. PAF group has significantly lower (in absolute values) left atrial contraction strain – (LASct). There were no differences in conduit and reservoir LA (LASr) strains nor in LA ejection fraction. The highest PAF diagnosis efficacy according to area under the curve (AUC) of ROC curves was noted for parameters of: LA size: LA atrium volume index (LAVI) in 4 chamber view (AUC=0,82) and LA area index (0,81) LA contraction function: LASct (Avg) (AUC =0,80) LV diastolic function: E/E’ (0,81) For the threshold of 100% sensitivity the highest specificity was found for LA volume before active atrial contraction in 4 chamber view with cut-off value of &amp;gt;=37,6 ml (specificity 64,7%) (Figure 1.) and LASct (Avg) with cut-off value &amp;lt;=17% in absolute values (specificity 47,1%). Conclusions Both functional and morphologic parameters of LA can predict PAF diagnosis during ECG monitoring after IS. TTE after IS can be used to select patients who would benefit the most from prolonged ECG monitoring. High PAF detectability (100% sensitivity) with approximately 1/2 negative results of ECG monitoring can be achieved by both LA volumetric (LAV preA) and strain (LASct) analysis.

Diagnostic accuracy of cardiovascular magnetic resonance strain analysis and atrial size to identify heart failure with preserved ejection fraction.

Heart failure with preserved ejection fraction (HFpEF) continues to be a diagnostic challenge. Cardiac magnetic resonance atrial measurement, feature tracking (CMR-FT), tagging has long been suggested to diagnose HFpEF and potentially complement echocardiography especially when echocardiography is indeterminate. Data supporting the use of CMR atrial measurements, CMR-FT or tagging, are absent. Our aim is to conduct a prospective case-control study assessing the diagnostic accuracy of CMR atrial volume/area, CMR-FT, and tagging to diagnose HFpEF amongst patients suspected of having HFpEF. One hundred and twenty-one suspected HFpEF patients were prospectively recruited from four centres. Patients underwent echocardiography, CMR, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements within 24 h to diagnose HFpEF. Patients without HFpEF diagnosis underwent catheter pressure measurements or stress echocardiography to confirm HFpEF or non-HFpEF. Area under the curve (AUC) was determined by comparing HFpEF with non-HFpEF patients. Fifty-three HFpEF (median age 78 years, interquartile range 74-82 years) and thirty-eight non-HFpEF (median age 70 years, interquartile range 64-76 years) were recruited. Cardiac magnetic resonance left atrial (LA) reservoir strain (ResS), LA area index (LAAi), and LA volume index (LAVi) had the highest diagnostic accuracy (AUCs 0.803, 0.815, and 0.776, respectively). Left atrial ResS, LAAi, and LAVi had significantly better diagnostic accuracy than CMR-FT left ventricle (LV)/right ventricle (RV) parameters and tagging (P < 0.01). Tagging circumferential and radial strain had poor diagnostic accuracy (AUC 0.644 and 0.541, respectively). Cardiac magnetic resonance LA ResS, LAAi, and LAVi have the highest diagnostic accuracy to identify HFpEF patients from non-HFpEF patients amongst clinically suspected HFpEF patients. Cardiac magnetic resonance feature tracking LV/RV parameters and tagging had low diagnostic accuracy to diagnose HFpEF.

Dyspnea in pregnancy might be related to the incomplete physiological adaptation of the heart.

Introduction: Dyspnea is a common complaint in pregnant women with no cardiac and pulmonary diseases. We aimed to assess whether physiological dyspnea of pregnancy was correlated with subtle changes in ventricular systolic and diastolic function. Methods: This cross-sectional study enrolled 40 healthy pregnant women in their second and third trimesters with no complaints of dyspnea and 40 healthy pregnant women in the same trimesters with a complaint of dyspnea. Parameters of echocardiography were compared between the 2 groups. Results: Global left ventricular ejection fraction (59.65±6.44 and 58.49±4.95 P=0.418 in patients without and with dyspnea respectively), and global longitudinal strain were not significantly different (18.72±2.90 and 18.94±3.07, P=0.57 in the same order). Global circumferential strain (GCS) was lower in patients with dyspnea. (20.19±4.86 vs 22.61±4.69, P=0.03). Systolic volume (33.17±8.94 vs 32.63±8.09) and diastolic volume (80.75±18.73 vs 78.37±16.63) and left ventricular end-diastolic diameter (47.5±4.24 vs 46.23±3.21) were not different (P=0.784, 0.560 and 0.146 respectively). Left ventricular end-systolic diameter was significantly lower in the case group (32.52±4.66 vs 29.92±4.05, P=0.011). Left atrial area index in the patients with dyspnea was lower(8.13±1.42 vs 8.94±1.4, P=0.014). Other findings were a high E/E' and high pulmonary artery pressure in the patients with dyspnea. Conclusion: Dyspnea in pregnant women can be a consequence of incomplete physiological adaptation to volume overload in pregnancy. Lower systolic and diastolic diameters of the left ventricle, left atrial area, and left atrial index may lead to increased filling pressure, manifested by a higher E/E' ratio and pulmonary artery pressure.

Left atrial reservoir and pump function after catheter ablation with persistent atrial fibrillation: a two-dimensional speckle tracking imaging study

Objective By using ultrasound strain rate (SR) imaging to evaluate the left atrial (LA) reservoir and pump function after catheter ablation (CA) with persistent atrial fibrillation (PAF). Methods A total of 45 patients with PAF underwent echocardiography examination before and after ablation as well as during 6 months of follow-up. Peak SR was measured at each LA segment (septal, lateral, anterior, inferior and posterior) during systole (LAs) and late diastole (LAa). Results During 6 months after CA, 30 patients were free of atrial fibrillation recurrence (AFR). left atrial area index (LAAI), left atrial maximum volume index (LAVImax), and E/Ea were obviously higher in patients with before CA, left atrial ejection fraction (LAEF), SR-LAs were lower than in normal cases, the SR-LAa was disappeared. Shortly after ablation, SR-LAa was recovered, and SR-LAs was reduced compared to those at baseline. At midterm follow-up, LAEF and SR-LAs were still lower than the control group, and LAAI and LAVImax were higher. SR-LAa was recovered slowly over time, but still lower. Conclusion LA reservoir function was seriously damaged and LA pump function disappeared in patients with PAF. LA reservoir function impairment appeared shortly after ablation, it showed improvement at midterm follow-up, but some degree of damage to the LA reservoir and pump function was still present. Speckle tracking imaging is a feasible technique for the assessment of LA function in patients with PAF, which is a potentially valuable clinical tool to assist in the early detection of atrial remodelling and reverse remodelling.

Prediction of new-onset atrial fibrillation after off-pump coronary artery bypass surgery using left atrial area and area index

Aim: This study aimed to determine preoperative echocardiographic predictors of postoperative atrial fibrillation (POAF) in patients undergoing beating-heart coronary artery bypass grafting (CABG) surgery. Materials and Methods: 84 patients undergoing off-pump isolated CABG were prospectively enrolled. The left atrium area (LAA) was measured from the apical four-chamber projection at the end-ventricular systole, then indexed to BSA for the left atrial area index (LAAI). POAF was detected with continuous telemetry and surface 12 electrocardiograms throughout hospitalization. Results: We observed postoperative atrial fibrillation (AF) in 32 patients (38%, 64.9±10.2 years); of whom 87.5% ( 28 patients) were men. Patients with POAF had significantly larger left atrium (LA) area (18.9 ± 3.7 vs. 21.3 ± 4.9 cm2, p=0.016 ), higher LAAI (10.4 ± 2.0 vs. 12.0 ± 2.6 cm2/m2, p= 0.001), and higher systolic pulmonary artery pressure (30 (2-37) vs. 33 (20-64), p=0.05). In addition, lateral wall Em (9 (3-14) vs. 7 (3-15), p= 0.047), Am (10.8 ± 2.6 vs. 8.3 ± 3.0, p=0.05), and left ventricular ejection fraction (LVEF) (60.5 (23- 78.50) vs. 57.15 (33.10-74.90), p=0.05) were significantly lower in patients with POAF. Based on the backward stepwise model of multivariate analysis, LAAI (p=0.007, 95% CI for OR:1.374 (1.092-1.729)) and LVEF (p=0.039, 95% CI for OR:0.889 (0.796-0.994)) were found to be the strongest independent predictors of POAF. Conclusion: In this study, LAAI and LVEF were independent predictors of POAF development after off-pump CABG surgery. These predictors may be helpful in risk assessment for the possibility of POAF in patients undergoing off-pump CABG surgery.

Impact of right ventricular volume and function assessed by cardiac magnetic resonance imaging on outcomes in patients undergoing MitraClip implantation

Abstract Background Right ventricular (RV) dysfunction is a predictor of poor clinical outcome in patients with heart failure and valvular heart disease. However, in patients undergoing MitraClip implantation, only limited data exist regarding the prognostic role of RV function and dimensions on outcomes. Previous studies suggested that RV dysfunction may be associated with poor clinical outcome following MitraClip, while other studies demonstrated contractionary results. Purpose The purpose of this study was to assess whether cardiac magnetic resonance (CMR) imaging derived RV assessment can facilitate risk stratification among patients undergoing transcatheter mitral valve repair with the MitraClip. Methods Sixty-one patients (mean age 77±9 years; 72% functional MR; logistic EuroScore 24±15) with severe mitral regurgitation (MR) were included and underwent CMR imaging and right heart catheterization prior MitraClip procedure. We divided patients into groups according to the presence of RV systolic dysfunction defined by RV ejection fraction (RVEF) &amp;lt;45%. Similarly, patients were separated into groups according to the presence of RV dilatation. For the assessment of RV dilatation, the RV end-diastolic volume index (RVEDVi) assessed by CMR was matched to age and gender specific reference values for each patient. All-cause mortality was assessed during one-year follow-up. Results Patients with RV systolic dysfunction displayed increased left and right ventricular volumes as well as reduced LVEF (all p&amp;lt;0.05). Patients with RV dilatation showed increased left atrial area index (p=0.012) and had more advanced tricuspid regurgitation (p=0.028). Moreover, we observed a negative correlation between RVEDVi and PAPi (r=−0.231, p=0.087) and a positive correlation between RVEDVi and the ratio of right atrial (RA) pressure/ pulmonary artery wedge pressure (PAWP) (r=0.278, p=0.043). We found an inverse correlation between RVEF and systolic pulmonary artery pressure (r=−0.329, p=0.012) (Figure 3). During 12±1 month follow-up, 15 patients (25%) died. Kaplan-Meier survival analysis for 1-year mortality shows that patients with RV systolic dysfunction (p=0.026) and RV dilatation (p=0.005) had an increased 1-year all-cause mortality. Patients presenting with both, RV systolic dysfunction and RV dilatation, exhibited a very high 1-year mortality of 71% (p&amp;lt;0.001). Conclusion The assessment of RV volumes and function by CMR imaging yields important prognostic information that enable an estimation of heart failure severity and prognosis. In this regard, not only RV systolic dysfunction, but also RV dilatation was associated with increased 1-year mortality, while patients presenting with both exhibit additive high mortality risk. Therefore, current criteria for patient selection that are mainly based on mitral valve characteristics only, should also consider RV volumes and function as can be accurately assessed by CMR. Funding Acknowledgement Type of funding source: None

P5263Genotype and cardiac findings in non transfusion dependent thalassemia patients

Abstract Background In non transfusion dependent thalassemia (NTDT) the lack of a clear genotype-phenotype relationship complicates the already complex and extensive scenario in clinical practice. Purpose Our aim was to detect if the presence of a β°/β° homozygous genotype was associated to different rate of cardiac findings by Cardiovascular Magnetic Resonance (CMR) and cardiac complications. Methods We considered 81 patients with thalassemia intermedia never transfused o who received occasional transfusions (37.7±11.4 years, 39 females) consecutively enrolled in the Myocardial Iron Overload in Thalassemia project. CMR was used to quantify iron overload (T2* technique), biventricular morphological and functional parameters (cine sequences), and the presence of myocardial fibrosis (late gadolinium enhancement-LGE technique). All cardiac complications were classified according to international guidelines. Results Two groups of patients were identified: non homozygous β°/β° genotype (N=61) and homozygous β°/β° genotype (N=20.) No significant differences for sex and age were found between the groups. Patients with homozygous β°/β° genotype had lower mean haemoglobin levels (8.6±1.1g/dl vs 9.2±1.2 g/dl) but the difference did not reach the statistical significance (P=0.060). No patient showed cardiac iron and global heart T2* values were comparable between the two groups. Left atrial area index, left ventricular (LV) end-diastolic, end-systolic and stroke volume indexes, LV mass index, right ventricular end-diastolic and end-systolic volume indexes were significantly higher in the homozygous β°/β° group (see Table). Frequencies of heart failure and arrhythmias were comparable between the groups. Non-β0/β0 homozygous genotype β0/β0 homozygous genotype P Left Atrial Area (cm2/m2) 13.87±2.59 16.63±2.59 0.001 LV EDVI (ml/m2) 94.88±15.59 112.94±21.52 0.003 LV ESVI (ml/m2) 35.22±9.55 41.88±9.70 0.018 LV SVI (ml/m2) 61.98±12.57 69.81±11.20 0.029 LV mass index (g/m2) 61.26±10.15 68.63±15.89 0.030 RV EDVI (ml/m2) 91.27±23.50 107.53±23.87 0.019 RV ESVI (ml/m2) 33.93±17.55 40.81±15.20 0.043 Conclusions Heart remodelling related to a high cardiac output state cardiomyopathy was more pronounced in patients with homozygous β°/β° genotype. These data can support the knowledge of different phenotypic groups in the management of NTDT patients.

P5553Right ventricular involvement in hypertrophic cardiomyopathy: insights from a tertiary centre

Abstract Introduction Hypertrophic cardiomyopathy (HCM) is the main cause of sudden cardiac death in the young and a cause of heart failure (HF) and death at any age. Nevertheless, adverse long-term outcomes are not easy to predict. Objectives To assess the prevalence and prognostic value of right ventricular (RV) involvement in patients (pts) with HCM. Methods Retrospective single-centre study of consecutive pts with HCM evaluated in a specialized consultation. Selected those submitted to cardiac magnetic resonance imaging (CMR) as the gold-standard for RV assessment. The primary endpoint (PE) was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, ventricular arrhythmias with hemodynamic instability and unplanned HF admission. Results Of a total of 181 pts, 104 fulfilled the inclusion criteria (mean age at first consultation 62.1±9.7 years, 63.5% male). Septal asymmetric phenotype was the most frequent (73.1%) and 24 pts (23.1%) had rest LV outflow tract obstruction. Mean value of maximum wall thickness was 18.8±4.6 mm. Regarding CMR parameters (Fig A), 5.8% had RV dysfunction and 2.9% RV free wall hypertrophy; no patient presented RV dilation. Late gadolinium enhancement (LGE) of joint points was observed in 47.1%. During follow-up (FU, mean 56.6±29.5 months), survival free of RV dysfunction was 94.3%. Only 5 pts developed RV compromise assessed by echocardiographic parameters: TAPSE 12.0±3.4 mm and pulsed tissue Doppler systolic annular velocity (tricuspid S') wave 7.3±0.9 cm/s. These pts were significantly older (p&lt;0.01) and had higher values of average tissue doppler E/E' ratio at diagnosis (p&lt;0.01). Global RV involvement (at diagnosis or during FU) were associated with increased values of indexed left atrial area (p&lt;0.01), LV dysfunction (p=0.01), LGE of joint points (p=0.01) and higher values of NT-proBNP (p=0.01). In multivariate logistic regression, left atrial enlargement was the only independent predictor of global RV dysfunction (OR 1.9, 95% CI 1.1–3.2, p=0.01) and average E/E' ratio an independent predictor of RV dysfunction during FU (OR 1.3, 95% CI 1.1–1.5, p&lt;0.01). PE rate was 10.6%. It was significantly higher in pts with global RV involvement and there was a significant difference in survival analysis (Fig B). Average E/E' ratio (OR 1.5, 95% CI 1.1–1.9, p=0.01) and RV ejection fraction (OR 0.8, 95% CI 0.7–0.9, p=0.01) were independent predictors of the outcome. Conclusions Although not common, RV dysfunction was associated with a higher rate of cardiovascular events. Average E/E' ratio, as a measure of left ventricular filling pressure, was a risk factor for both RV dysfunction and PE. Higher values of RV ejection fraction were protective of adverse events occurrence. Together, these results support a potential role of RV function in the risk stratification of HCM pts.

Left Atrium Dilatation and Left Ventricular Hypertrophy Predispose to Atrial Fibrillation in Patients With Community-Acquired Pneumonia

Atrial fibrillation (AF) is one of the most common cardiovascular complications in patients hospitalized with community-acquired pneumonia (CAP). However, predisposing clinical factors associated with AF in CAP patients have not been fully elucidated. We enrolled 545 patients consecutively hospitalized for CAP. Data on demographic characteristics and co-morbidities were collected and all patients underwent ECG, echocardiography, and laboratory measurements. During the in-hospital stay, 9.5% of patients experienced a new episode of AF within 24 to 72 hours from admission. CAP patients who experienced AF had a higher indexed left atrial area (LAAi) and a higher proportion of concentric left ventricular hypertrophy than those not presenting AF. Univariate logistic regression analysis showed that hypertension, history of coronary heart disease, high Pneumonia Severity Index classes, history of paroxysmal AF, systolic heart failure, concentric left ventricular hypertrophy, and an enlarged LAAi were associated with a new episode of AF. A multivariable logistic analysis showed that history of paroxysmal AF (odds ratio [OR] 11.7; 95% confidence interval [CI] 5.8 to 23.7; p <0.001), enlarged LAAi (OR 5.4; 95% CI 2.5 to 11.9; p <0.001), and concentric left ventricular hypertrophy (OR 2.2; 95 CI 1.1 to 4.6; p = 0.034) remained independently associated with AF occurrence. In conclusion, in this large cohort of CAP patients, history of paroxysmal AF, enlarged LAAi, and concentric left ventricular hypertrophy are independent predictors of AF occurrence during the early stages of pneumonia.

Right atrium enlargement predicts clinically significant supraventricular arrhythmia in patients with pulmonary arterial hypertension

BackgroundRight atrial (RA) enlargement is a common finding in patients with pulmonary arterial hypertension (PAH) and an important predictor of mortality, however its relation to the risk of atrial arrhythmias has not been assessed. ObjectivesTo assess whether RA enlargement is associated with supraventricular arrhythmias (SVA) and whether it predicts new clinically significant SVA (csSVA). MethodsPatients with PAH were recruited between January 2010 and December 2014 and followed until January 2017. csSVA was diagnosed if it resulted in hospitalization. To assess predictors of new csSVA, only patients without a history of SVA at baseline were analyzed. ResultsAmong 97 patients, any SVA was observed in 45 (46.4%) and included permanent atrial fibrillation(AF, n = 8), paroxysmal AF (n = 10), permanent atrial flutter (AFl, n = 1), paroxysmal AFl (n = 2) or other types of supraventricular tachycardia (n = 24). Patients with SVA as compared to patients without SVA were characterized by older age, lower distance in a 6-minute test, higher NT-proBNP, higher RA area index (RAai), left atrial area index, mean right atrial pressure (mRAP) and were more commonly treated with β-blocker. Eighty five patients who were in sinus rhythm at baseline assessment and had no history of significant SVA were observed for 37 ± 19.9 months. During that time csSVA occurred in 15.3%. In univariate models, the occurrence of csSVA were predicted by age, right ventricular ejection fraction, right ventricular end diastolic index, RAai and mRAP, but in multivariate model only RAai remained significant predictor for csSVA (HR of 1.23, 95%CI: 1.11–1.36, p < 0.001). The optimal threshold for RA enlargement as discriminator of csSVA was 21.7 cm2/m2. ConclusionsIn PAH patients RA enlargement is associated with increased prevalence of SVA. RAai is an independent predictor of hospitalization due to csSVA.

Left atrial area index predicts adverse cardiovascular events in patients with unstable angina pectoris.

BackgroundThe left atrial size has been considered as a useful marker of adverse cardiovascular outcomes. However, it is not well known whether left atrial area index (LAAI) has predictive value for prognosis in patients with unstable angina pectoris (UAP). This study was aimed to assess the association between LAAI and outcomes in UAP patients.MethodsWe enrolled a total of 391 in-hospital patients diagnosed as UAP. Clinical and echocardiographic data at baseline were collected. The patients were followed for the development of adverse cardiovascular (CV) events, including hospital readmission for angina pectoris, acute myocardial infarction (AMI), congestive heart failure (CHF), stroke and all-cause mortality.ResultsDuring a mean follow-up time of 26.3 ± 8.6 months, 98 adverse CV events occurred (84 hospital readmission for angina pectoris, four AMI, four CHF, one stroke and five all-cause mortality). In a multivariate Cox model, LAAI [OR: 1.140, 95% CI: 1.016–1.279, P = 0.026], diastolic blood pressure (OR: 0.976, 95% CI: 0.956–0.996, P = 0.020) and pulse pressure (OR: 1.020, 95% CI: 1.007–1.034, P = 0.004) were independent predictors for adverse CV events in UAP patients.ConclusionsLAAI is a predictor of adverse CV events independent of clinical and other echocardiographic parameters in UAP patients.

T1 mapping across the ejection fraction spectrum

Methods 242 consecutive consenting patients referred for CMR between December 2014 and June 2015 were scanned on a 1.5T Magnetom Avanto (Siemens Healthcare, Erlangen) using a MOLLI (WIP#448, 5:3:3 acquisition scheme, motion correction and automatically generated T1 map). In all cases on the basal short axis slice, a single, slender ROI was placed in the mid wall of the septum with meticulous attention to avoid partial volume of blood/and or scar areas to derive the native T1 in msec. The patients were grouped by ejection fraction: 55%. 15 healthy volunteers were also used as a control group. Ejection fraction (EF), LV volumes, LV mass and BSA indexed left atrial area (LAAi) were also acquired. Comparison was performed using ANOVA and linear regression with adjustment for demographic variables that were found to vary between groups (age and BSAi LV mass).

Diastolic Dysfunction Is a Contributing Factor to Exercise Intolerance in COPD

Right ventricular (RV) systolic failure is rare in patients with COPD, but they often develop RV diastolic dysfunction. Left ventricular (LV) diastolic dysfunction is also common in this population. Nevertheless, data are scarce regarding the effect of diastolic dysfunction on the functional capacity in patients with COPD. We investigated the correlation between echocardiographic parameters of RV and LV diastolic function and the exercise capacity in COPD, by using conventional echocardiographic methods and tissue Doppler imaging. 65 patients with COPD (61 ± 9 years) in stages GOLD II-IV were investigated. Functional capacity was measured with 6-minute walk test (6MWT). Right (RA) and left atrial (LA) area index were measured; collapsibility index inferior vena cava was calculated. Parameters of the mitral and tricuspid inflow (E, A) as well as annular systolic (S), early- (e’) and late- (a’) diastolic myocardial longitudinal velocities were measured. E/A, E/e’ and e’/a’ ratios were calculated. 6MWT distance was 330 ± 76 m. LV diastolic dysfunction was found in 48 (74%) patients. LV and RV filling pressures were elevated in 28 (43%) and in 29 (45%) patients, respectively. In the left heart, LA area index showed significant correlation with the functional capacity (r = -0.319; p = 0.011). In stepwise multiple linear regression analysis tricuspid e’/a’ (r = 0.611; p = 0.000), collapsibility index (r = 0.505; p = 0.000), RA area index (r = -0.445; p = 0.000) and body surface area (r = 0.314; p = 0.011) were independent predictors of 6MWT distance. Right ventricular diastolic function and filling pressure have strong influence on the functional capacity in patients with COPD.

Prevalence and determinants of the early repolarisation pattern in a group of young high endurance rowers.

The prevalence and significance of the early repolarisation (ER) pattern in the general population has raised a number of questions. Even less data are available on athletes. To determine the prevalence and determinants of ER in a group of young high endurance athletes. We studied 117 rowers (46% women, mean age 17.5 ± 1.5 years, mean training duration 4.3 ± 1.8 years). On 12-lead electrocardiogram (ECG), we evaluated inferolateral leads for the presence of the ER pattern, defined as at least 0.1 mV elevation of the QRS-ST junction (J point) from the baseline in at least two leads. All subjects underwent detailed echocardiographic study, cardiopulmonary exercise test with evaluation of VO₂max (mean 57.1 ± 8.4 mL/kg/min), and evaluation of complete blood count and biometric parameters (fat tissue, body mass index, body surface area). We identified 35 subjects with ER in the inferior and/or lateral leads. The phenomenon was more frequent in males (n = 25, 21.36% of the overall study population) than in females (n = 10, 8.54%, p = 0.01). The training duration in both groups (with or without ER) was similar (4.4 ± 1.5 vs. 4.3 ± 1.8 years, p > 0.05). Athletes with the ER pattern had significantly higher VO₂max (58.8 ± 7.8 vs. 55.3 ± 8.2 mL/kg/min, p = 0.03), lower resting heart rate (58.7 ± 11.3 vs. 65.4 ± 11.9 bpm, p < 0.01), higher haemoglobin level (15.2 ± 0.8 vs. 14.6 ± 1.2 g/dL, p < 0.01), higher red blood cell count (5.31 ± 0.3 vs. 4.98 ± 0.4 million/μL, p = 0.04), and lower fat tissue mass (12.1 ± 4.4 vs. 14.9 ± 6.0 kg, p < 0.01). Compared with the others, the ER group was characterised by a higher left atrial area index (12.2 ± 1.3 vs. 11.5 ± 1.6 cm²/m², p = 0.01), right atrial area index (9.9 ± 1.3 vs. 9.0 ± 1.4 cm²/m², p < 0.01), and right ventricular basal diameter index (2.0 ± 0.2 vs. 1.9 ± 0.2 cm/m², p = 0.04). We found no significant differences in any other cardiac size and function parameters. ER pattern in the inferior and/or lateral leads is a frequent finding in the population of young high endurance rowers. The presence of ER pattern is associated with gender and a number of parameters reflecting the general level of fitness and may be considered an electrophysiological sign of the athlete's heart. The significance of these alterations should be evaluated in prospective follow-up studies.

Impact of Serial B-Type Natriuretic Peptide Changes for Predicting Outcome in Asymptomatic Patients With Aortic Stenosis

BackgroundThe aim of this study was to determine the impact on the outcome of serial B-type natriuretic peptide (BNP) changes during follow-up in asymptomatic patients with ≥ moderate aortic stenosis (AS) and preserved left ventricular ejection fraction. MethodsWe prospectively screened 69 patients who underwent comprehensive transthoracic echocardiography, BNP level measurement at baseline and after every 6 or 12 months. Annualized BNP changes were calculated as the difference between the last and baseline BNP measurements divided by the duration of follow-up. The primary endpoint was the occurrence of symptoms, aortic valve replacement, or cardiovascular death. ResultsDuring a follow-up of 30 ± 19 months, 43 patients experienced a cardiac event. These patients were significantly older (73 ± 9 vs 65 ± 16 years; P = 0.010), had more often dyslipidemia (79% vs 42%; P = 0.038), more severe AS (peak velocity: 3.9 ± 0.6 vs 3.5 ± 0.6 m/s; P = 0.002), larger indexed left atrial area (10.2 ± 2.5 vs 8.7 ± 1.9 cm2/m2; P = 0.006), and a higher increase in annualized BNP (+90 ± 155 vs +7 ± 49 pg/mL/y; P = 0.010). Patients with higher annualized BNP changes (> 20 pg/mL/y) had a significantly lower cardiac event-free survival (1 year: 63 ± 8% vs 97 ± 3%; 3 years: 31 ± 8% vs 68 ± 8%; P < 0.001). Using the multivariate Cox proportional hazards model, higher annualized BNP changes were significantly associated with increased risk of cardiac events (hazard ratio: 2.73, 95% confidence interval: 1.27-5.86; P = 0.010) after adjustment for age, dyslipidemia, and echocardiographic parameters. ConclusionsIn asymptomatic patients with AS and preserved left ventricular ejection fraction, the use of serial BNP changes may help to anticipate development of class I indication for aortic valve replacement.

Evaluating of left atrial remodeling and predicting the efficacy of radiofrequency catheter ablation with atrial fibrillation by speckle tracking imaging

Objective To evaluate left atrial function dynamic changes before and after radiofrequency catheter ablation (CA) with persistent atrial fibrillation (AF) and predict the maintain sinus rhythm of postoperative atrial fibrillation by speckle tracking imaging. Methods The study was including 45 cases underwent CA with persistent AF(preoperative 1 week, postoperative 24 hours, 3 months, 6 months) and 25 normal cases. Left atrial function and strain rate were analysed. These index were measured and calculated: the left atrial diameter index(LADI), left atrial area index(LAAI), left atrial maximum volume index(LAVImax) and left atrial ejection fraction(LAEF), left atrial wall strain rate of left ventricular systolie (SRs), left atrial wall strain rate of left ventricular early diastolie (SRe), left atrial systolic strain rate(SRa) and the average of left atrial wall each phase strain rate. Results ①LADI, LAAI, LAVImax were significantly increased; LAEF, SRs, SRe were decreased significantly; SRa were disappeared with AF compared with the control group. ②LADI, LAAI, LAVImax decreased gradually, LAEF, SRs, SRe, SRa were gradually increased with the extension of the follow-up time. ③Left atrial average SRs predicted maintenance of sinus rhythm with atrial fibrillation after operation of CA(odds ratio=0.607, 95% CI=0.417-0.819, correction of P=0.017) was an independent predictor. Conclusions Speckle tracking imaging can quantitative evaluate left atrial function with persistent AF after CA. Left atrial global reservoir function predicts the efficacy of CA. Key words: Echocardiography; Atrial fibrillation; Atrial function, left; Speckle tracking imaging