Left Atrial Dysfunction In Patients Research Articles

The Association of Age and Left Atrial Dysfunction in Patients With Atrial Fibrillation

The Association of Age and Left Atrial Dysfunction in Patients With Atrial Fibrillation

Kiosk 1R-TA-01 - Association of Visceral Adipose Tissue with Left Ventricular Concentric Remodeling and Left Atrial Dysfunction in Patients with Known or Suspected Coronary Artery Disease

Kiosk 1R-TA-01 - Association of Visceral Adipose Tissue with Left Ventricular Concentric Remodeling and Left Atrial Dysfunction in Patients with Known or Suspected Coronary Artery Disease

Rest and Stress Left Atrial Dysfunction in Patients with Atrial Fibrillation.

Left atrial (LA) myopathy with paroxysmal and permanent atrial fibrillation (AF) is frequent in chronic coronary syndromes (CCS) but sometimes occult at rest and elicited by stress. This study sought to assess LA volume and function at rest and during stress across the spectrum of AF. In a prospective, multicenter, observational study design, we enrolled 3042 patients [age = 64 ± 12; 63.8% male] with known or suspected CCS: 2749 were in sinus rhythm (SR, Group 1); 191 in SR with a history of paroxysmal AF (Group 2); and 102 were in permanent AF (Group 3). All patients underwent stress echocardiography (SE). We measured left atrial volume index (LAVI) in all patients and LA Strain reservoir phase (LASr) in a subset of 486 patients. LAVI increased from Group 1 to 3, both at rest (Group 1 = 27.6 ± 12.2, Group 2 = 31.6 ± 12.9, Group 3 = 43.3 ± 19.7 mL/m2, p < 0.001) and at peak stress (Group 1 = 26.2 ± 12.0, Group 2 = 31.2 ± 12.2, Group 3 = 43.9 ± 19.4 mL/m2, p < 0.001). LASr progressively decreased from Group 1 to 3, both at rest (Group 1 = 26.0 ± 8.5%, Group 2 = 23.2 ± 11.2%, Group 3 = 8.5 ± 6.5%, p < 0.001) and at peak stress (Group 1 = 26.9 ± 10.1, Group 2 = 23.8 ± 11.0 Group 3 = 10.7 ± 8.1%, p < 0.001). Stress B-lines (≥2) were more frequent in AF (Group 1 = 29.7% vs. Group 2 = 35.5% vs. Group 3 = 57.4%, p < 0.001). Inducible ischemia was less frequent in SR (Group 1 = 16.1% vs. Group 2 = 24.7% vs. Group 3 = 24.5%, p = 0.001). In CCS, rest and stress LA dilation and reservoir dysfunction are often present in paroxysmal and, more so, in permanent AF and are associated with more frequent inducible ischemia and pulmonary congestion during stress.

Prevalence, Determinants, and Prognostic Value of Left Atrial Dysfunction in Patients With Chronic Coronary Syndrome and Normal Left Ventricular Ejection Fraction

Patients with chronic coronary syndrome (CCS), even when they have complete revascularization and normal left ventricular (LV) systolic function, experience subsequent cardiovascular disease (CVD), highlighting the importance of surrogate markers to prevent adverse consequences. Speckle-tracking echocardiography-derived left atrial (LA) reservoir strain has emerged as a sensitive marker for CVD in various clinical settings. The present study investigated the prevalence, determinants, and prognostic value of LA dysfunction in CCS. We included 278 consecutive patients with CCS with completed percutaneous coronary intervention and preserved LV ejection fraction who underwent follow-up echocardiography. Speckle-tracking analysis was performed to assess LA reservoir strain, and LA dysfunction was defined as LA reservoir strain ≤24%. The primary outcome comprised new-onset atrial fibrillation, heart failure hospitalization, acute coronary syndrome, stroke, or all-cause death. At baseline, 28 patients (10.1%) had LA dysfunction. Multivariable analysis identified age, hypertension, LV ejection fraction, and multivessel disease as independent determinants of LA reservoir strain (all p <0.05). During a median follow-up of 4.8 years, the primary outcome occurred in 60 patients (21.6%). LA dysfunction carried a significant risk for primary outcome independent of traditional risk factors, LV parameters, and LA size (adjusted hazard ratio 3.10, p=0.003); the risk increase remained significant even after excluding atrial fibrillation from the primary outcome (adjusted hazard ratio 2.27, p=0.043). In conclusion, approximately 10% of patients with CCS with normal LV ejection fraction had LA dysfunction associated with adverse cardiovascular outcomes. Further studies are needed to explore whether therapeutic interventions affecting LA remodeling may help prevent CVD events.

Left Atrial Dysfunction in Patients with Coronary Slow Flow

The coronary slow flow phenomenon (CSFP) is relatively common in patients scheduled for coronary angiography, characterized by delayed distal vessel opacification of contrast in the absence of significant epicardial coronary stenosis.

Incremental value of P-wave indices for predicting left atrial dysfunction in patients with primary mitral regurgitation using speckle tracking echocardiography.

The correlation of P wave indices on surface ECG and phasic LA dysfunction in patients with significant primary mitral regurgitation (MR) due to the adverse LA adaptive structural and functional changes needs to be more studied. This study aims to investigate the diagnostic value of P wave indices to predict LA function assessed both by volumetric analysis using 3-dimensional (3D)echocardiography, and by strain analysis using speckle tracking echocardiography. (STE). The study included 107 subjects, we measured maximum P-duration (Pmax), P dispersion (PD), and V1 negative terminal force (V1-NTF) (negative duration x negative amplitude) on surface ECG. Both Basic and Dynamic LA volumes (LAV) during reservoir, conduit, and contractile phases were measured. The global LA strain and strain rate parameters were calculated By STE. LA ejection fraction (LAEF) and ejection force were also calculated.V1-NTF showed a significant positive correlation while P-max a significant negative correlation with global peak atrial longitudinal strain (GPALS) (r = 0.75; P < 0.001 and r = - 0.72; P < 0.001 respectively). Using ROC curve analysis, Pmax > 110ms, 1-NTF ≥ 4ms.mV and P notching > 40ms had a sensitivity of 90%, 95% and 50% and a specificity of 87.4%, 94.3% and 100% respectively in predicting GPALS ≤ 30%. P notching > 40ms was associated with severe LA dysfunction. ECG P wave indices represent a simple bedside tool that could have an incremental role in predicting LA dysfunction as well as size in patients with significant primary MR.

Left atrial dysfunction in patients with obstructive sleep apnea: a combined assessment by speckle tracking and real-time three-dimensional echocardiography.

At present, little research concerning the assessment of left atrial (LA) dysfunction in patients with obstructive sleep apnea (OSA) using a combined assessment by speckle tracking (STE) and real-time three-dimensional echocardiography (RT3DE) is available. The objective of this study was to evaluate the LA volume and function by STE and RT3DE in patients with OSA. In our cohort study, ninety-two OSA patients and 50 healthy individuals were enrolled. According to the apnea hypopnea index (AHI), patients (AHI >15/h) classified as having moderate and severe OSA were included. The patients were divided into 2 subgroups according to the left ventricular mass index (LVMI): the left ventricular hypertrophy (LVH) group in which patients had LVH (n=30), and the nonLVH group in which patients did not have LVH (n=62). All subjects underwent LA function assessment by conventional techniques and the combination of STE and RT3DE. OSA patients showed impaired LA global longitudinal strain during early diastole (LA S-E) and systole (LA S-S) but increased LA global longitudinal strain during late diastole (LA S-A) compared with controls (all P<0.05). In addition, OSA patients with LVH had lower LA S-S and LA S-E than patients without LVH (all P<0.05). With regard to parameters obtained from RT3DE, indexed LA maximum, minimum, and preatrial contraction volumes (LAVi-max, LAVi-min, LAVi-preA) and the LA active emptying fraction (LAAEF) were significantly higher, whereas the LA passive emptying fraction (LVPEF) was significantly lower in OSA patients in comparison with controls (all P<0.05). The LA total emptying fraction (LVTEF) and the LA expansion index were significantly lower in OSA patients with LVH than in controls (all P<0.05). Additionally, OSA patients with LVH had higher LAVi-min, LAVi-preA and LAAEVi but lower LAPEF than patients without LVH (all P<0.05). OSA is associated with LA remodeling and dysfunction that occurs in the subclinical stage before the development of LVH and left ventricular diastolic dysfunction, and it will be further aggravated along with the development of LVH and OSA severity. The process can be detected with a detailed evaluation of active and passive functions of the LA using the STE and RT3DE method.

Left atrial dysfunction in patients with prosthesis-patient mismatch after transcatheter aortic valve replacement

Abstract Funding Acknowledgements Type of funding sources: None. Background. Transcatheter aortic valve replacement (TAVR) prostheses have better hemodynamics compared to surgical prostheses, with lower incidence of prosthesis-patient mismatch (PPM). Nonetheless, this complication is neither rare nor benign in the expanding population of TAVR patients (pts). Data regarding the effect of TAVR PPM on cardiac function is scarce. Our aim was to determine the short-term impact of PPM on left atrium (LA) function in patients undergoing transfemoral TAVR. Methods. One hundred forty-three consecutive pts (76.3 ± 7.5 yrs, 74 men) considered to be at high risk for SAVR were enrolled and examined before and 30 days after TAVR. All pts underwent a comprehensive echocardiogram, including speckle tracking echocardiography (STE) for LA and left ventricular (LV) strain analysis. Longitudinal LA strain parameters were assessed from the apical 4-chamber view. Peak values of global longitudinal LA strain (LAε) and LA systolic strain rate (SSr, reservoir function) and early diastolic strain rate (ESr, conduit function) were measured in all. Contractile LA function (late diastolic strain rate, ASr) was assessed in patients in sinus rhythm (106 pts). Results. Fifty-five pts (38%) had PPM (defined as an indexed effective orifice area, EOA ≤0.85 cm2/m2). Most of these pts (71%) had moderate PPM (indexed EOA between 0.65 and 0.85 cm2/m2). No significant differences in age (76.4 ± 8.1 vs 76.3 ± 7.2 yrs, p = 0.9), gender (p = 0.2), body surface area (p = 0.8), body mass index (p = 0.2) and the presence of cardiovascular risk factors (p &amp;gt; 0.2 for all) were observed between pts with and without PPM. The severity of post-TAVR aortic regurgitation was mild in 92 pts (64%) and moderate in 12 pts (8%) without any significant difference between pts with and without PPM. The post-TAVR prevalence of ³moderate mitral regurgitation was not different between the two groups (p = 0.40). After TAVR, there were no significant differences in terms of indexed LV mass, volumes, ejection fraction (p &amp;gt; 0.5 for all). LV global longitudinal strain was also similar between groups (-13.7 ± 4.3 vs -14 ± 3.6%, p = 0.7). Although LA volumes were similar between patients with and without PPM (47.8 ± 12.4 vs 49.3 ± 20.3 ml/m2, p = 0.6), in the mismatch-group we found a significantly reduced systolic global LA strain (12.7 ± 6.2 vs 15.9 ± 7.9%, p = 0.009) and impaired LA contractile function (ASr: -1.0 ± 0.4 vs -1.2 ± 0.5, p = 0.03). Parameters of LV diastolic function were also worse in the mismatch-group, with an E/e’sep ratio of 22 ± 10 vs 17 ± 7, p = 0.01. Conclusions. In our study group TAVR was associated with an incidence of PPM of 38%. The short-term follow-up of these patients revealed a significantly impaired LA function and increased LV filling pressure in patients with PPM compared to those without PPM. To our knowledge, this is the first report about the effect of PPM on the LA global and contractile function.

Simple and additive diagnostic modalities for the screening of heart failure with preserved ejection fraction

Abstract Background Nearly half of all patients with heart failure (HF) symptoms have an EF that is preserved (HFpEF). The prevalence of HFpEF is rising, with high morbidity, mortality. The diagnosis of HFpEF is particularly challenging. Lung ultrasound (LUS) and left atrial strain are promising screening and diagnostic tools to assess pulmonary congestion and left atrial dysfunction in patients with suspected HFpEF. Aim To evaluate the relationship between patients symptoms, pro-BNP level with LUS and left atrial strain, as well to assess the diagnostic power of B-lines in HFpEF population. Methods 82 consecutive patients (57 women, mean age 70±6 years) with clinical signs of heart failure were prospectively enrolled. Exclusion criteria were: ejection fraction &amp;lt;55%, more than mild mitral and/or aortic valve disease, pulmonary disease, pulmonary arterial hypertension. Within one hour all patients underwent comprehensive echocardiographic evaluation including left atrial strain analysis (peak atrial longitudinal strain-LASr), lung ultrasound assessment of B-lines on the anterolateral and posterior chest wall, and NT-proBNP levels. Results In 45 patients (54%) a significant number of B-lines (≥15) were observed. We found a positive correlation between the number of B-lines and NT-proBNP levels (p&amp;lt;0.0001, r=0.67), left atrial volume (p&amp;lt;0.0001, r=0.45), and LASr (p&amp;lt;0.005, r=−0.4). We also found week correlation between the number of B-lines and E/e' ratio (p&amp;lt;0.003, r=0.3), and between E/e' ratio and NT-proBNP level (p&amp;lt;0.05, r=0.2). We also assessed the diagnostic ability of B-lines to predict markedly elevated pro-BNP level (≥125pg/ml), AUC was 0.85, with specificity of 64% and sensitivity of 85% (Figure 1). The number of B lines also correlated with the H2FPEF score (p&amp;lt;0.001, r=0.4). Conclusion LUS is a simple, feasible tool to detect pulmonary congestion in HFpEF and it has an adequate diagnostic power to predict elevated NTpro-BNP level. LASr is promising too, which better reflects pulmonary congestion and elevated NT-proBNP values than the conventional echocardiographic parameters. Figure 1. ROC curve Blines predict high NTproBNP Funding Acknowledgement Type of funding source: None

Functional mitral regurgitation and left atrial myopathy in heart failure with preserved ejection fraction

Mild to moderate functional mitral regurgitation (MR) is common in patients with heart failure and preserved ejection fraction (HFpEF) where it is usually considered as an innocent bystander. We hypothesized that MR in HFpEF reflects greater left atrial (LA) myopathy, leading to more adverse haemodynamics and poorer exercise reserve. Patients with HFpEF (n= 280) with and without MR underwent echocardiography, invasive haemodynamic exercise testing, and expired gas analysis. As compared to non-MR-HFpEF (n= 163), patients with MR-HFpEF (n= 117; 78 mild and 39 moderate, central jet in 90%) were older, more likely female, with lower body mass and higher prevalence of atrial fibrillation (AF). HFpEF patients with MR displayed greater LA volume, reduced LA strain and compliance, and greater mitral annular dilatation, which was strongly correlated with LA dilatation (r=0.63, P< 0.0001) but was only weakly related to left ventricular remodelling (r=0.37). Patients with MR-HFpEF displayed worse biventricular function, more adverse pulmonary haemodynamics, impaired pulmonary vasodilatation, blunted right ventricular reserve, and reduced cardiac output with exercise as compared to non-MR-HFpEF. Importantly, these findings were maintained after excluding patients with HFpEF and AF, suggesting a role for LA myopathy in contributing to MR in HFpEF, independent of rhythm. Functional MR in patients with HFpEF reflects LA myopathy, even in the absence of AF, and is associated with greater haemodynamic severity of disease and poorer functional capacity. Further study is required to better define causal mechanisms and potential treatments for MR and LA dysfunction in patients with HFpEF.

P1358 New insights into cardiac dysfunction assessed by left atrial function in patients with type 1 diabetes mellitus

Abstract BACKGROUND There have been many reports of heart failure due to diabetic cardiomyopathy and decreased left ventricular (LV) function with increasing age in patients with type 1 diabetes mellitus (T1DM). Recently, although left atrial (LA) function has been occasionally reported to be a more useful prognostic indicator than LV function in acquired heart diseases, LA function in patients with T1DM has not yet been studied. PURPOSE To investigate LA dysfunction in patients with T1DM. METHODS Fifty patients with T1DM were recruited (age, 5–41 years). We excluded patients who had a history of heart disease, hypertension, and those taking cardioprotective agents. The patients and 50 age-matched controls were classified into 3 age groups (D1, C1, 5–14 years; D2, C2, 15–29 years; D3, C3, 30–41 years). The LA phasic function serving as the reservoir, conduit, and pump strains; the LA strain rate (SR) in the systole, early diastole, and late diastole; and the LV global longitudinal strain (LV-LS) as determined via 2-dimensional speckle tracking imaging were measured from the apical four- and two-chamber views. We also calculated the LA stiffness index as the ratio of E/e’ to the LA reservoir strain. RESULTS There was no significant difference in left ventricular ejection fraction in each age group. The LA reservoir strains in D2 and D3 were significantly lower than those in C2 (40.8 ± 5.7% vs. 47.2 ± 5.5%, p = 0.005) and C3 (39.2 ± 5.5% vs. 47.3 ± 5.7%, p = 0.004), respectively. The LA conduit strain in D2 was significantly lower than that in C2 (28.9 ± 5.8% vs. 35.0 ± 5.0%, p = 0.006). The LA pump strain and the three phases of LA SR were not significantly different among the age groups. The LA stiffness index in D3 increased significantly compared to that in N3 (0.18 ± 0.05 vs. 0.13 ± 0.01, p &amp;lt;0.001). The LV-LS in D2 and D3 was significantly lower than that in C2 (-15.7 ± 1.7% vs. -18.7 ± 2.1%, p &amp;lt;0.001) and C3 (-15.3 ± 1.8% vs. -19.3 ± 2.0%, p &amp;lt;0.001), respectively. The LA reservoir strain significantly correlated with LV-LS (r = -0.468, p &amp;lt; 0.001). Both the LA reservoir strain and LV-LS in patients with T1DM decreased significantly (p = 0.028, p &amp;lt; 0.042, respectively) and correlated with increasing age (r = -0.323, r = 0.286, respectively). The LV stiffness index did not correlate with age or LV-LS. CONCLUSIONS The LA reservoir strain might be as useful as LV-LS as an early marker of cardiac dysfunction in patients with T1DM. The correlation coefficient between the LA reservoir strain and LV-LS was not strong. Therefore, although LV-LS might affect the LA reservoir strain, it might represent other aspects of cardiac dysfunction. The increase of LA stiffness might represent the changes in LA wall properties and could be another useful indicator of cardiac dysfunction during long-term follow-ups, which is independent of LV-LS. Overall, these findings provide new insights into cardiac dysfunction in patients with T1DM.

P1586 Lung ultrasound and left atrial deformation analysis: a promising methods for the diagnosis of heart failure with preserved ejection fraction

Abstract Background Heart Failure with Preserved Ejection Fraction (HFpEF) is a growing healthcare burden and its prevalence is increasing. Diagnosing HFpEF is challenging. Lung ultrasound (LUS) and left atrial strain are promising screening tools to assess pulmonary congestion and left atrial dysfunction in patients with suspected HFpEF. Aim To evaluate the relationship between LUS, left atrial strain and NT-proBNP level in patients with HFpEF. Also to assess the diagnostic power of B-lines in HFpEF population. Methods Forty-seven consecutive patients (24 women, mean age 69 ± 11 years) with clinical signs of heart failure were prospectively enrolled. Exclusion criteria were: ejection fraction &amp;lt;55%, more than mild mitral and/or aortic valve disease, pulmonary disease, pulmonary arterial hypertension. Within one hour all patients underwent comprehensive echocardiographic evaluation including left atrial strain analysis (peak atrial longitudinal strain-PALS), lung ultrasound assessment of B-lines on the antero-lateral and posterior chest wall, and NT-proBNP levels. Results In 34 patients (72%) a significant number of B-lines (≥15) were observed. We found a positive correlation between the number of B-lines and NT-proBNP levels (p &amp;lt; 0,0001, r = 0,74, Figure 1.), left atrial volume (p &amp;lt; 0,05, r = 0,45), and PALS (p &amp;lt; 0,02, r = 0,4 ). We didn’t found any correlation between the number of B-lines and E/e’ ratio (p = 0,1, r = 0,28), or between E/e’ ratio and NT-proBNP level (p = 0,1, r = 0,2). We also assessed the diagnostic ability of ≥15 B-lines to predict markedly elevated pro-BNP level (≥ 220pg/ml), AUC was 0.89. If the total number of B-lines was greater or equal to 28, the sensitivity was 68% with the specificity of 100%, but if we changed the cut-off value to 12, the sensitivity grew to 89% with the specificity of 71%. (Figure 2.). Conclusion LUS is a simple, feasible tool to detect pulmonary congestion in HFpEF and it has a strong diagnostic power to predict elevated NTpro-BNP level. B-lines correlate with parameters of left atrial dysfunction. PALS is promising too, which better reflects pulmonary congestion and elevated NT-proBNP values than the conventional echocardiographic parameter E/e’. Abstract P1586 Figure. NT-pBNP vs B-lines, AUC of Blines

Effects of atrial electromechanical delay and ventriculoatrial conduction over the atrial functions in patients with frequent extrasystole and preserved ejection fraction.

The deterioration of left atrial and ventricular functions was demonstrated in patients with frequent ventricular extrasystole (fVES). The exact pathophysiology of left atrial dysfunction in patients with fVES is unclear. Retrograde ventriculoatrial conduction (VAC) often accompanies fVES, which may contribute to atrial dysfunction. We investigated whether atrial electromechanical delay and VAC are related to these atrial functions in patients with frequent right ventricular outflow tract (RVOT) VES and preserved ejection fraction (pEF). This study included 21 patients with pEF (eight males, 48±11 years), who had experienced more than 10000 RVOT-VES during 24-h Holter monitoring and had undergone electrophysiological study/ablation. The study also included 20 healthy age- and sex-matched control subjects. Transthoracic echocardiography was performed on all of the subjects. Atrial conduction time was obtained by using tissue Doppler imaging. Strain analysis was performed with two-dimensional speckle tracking echocardiography. The peak atrial longitudinal strain was significantly impaired in patients with fVES (P=0.01). In addition, although the interatrial and left atrial conduction delay times were significantly different between each group (P<0.001, P<0.001), the right atrial conduction delay times were similar. When patients with fVES were divided into groups depending on the existence of retrograde VAC, atrial deformation parameters and conduction delay time did not significantly differ between either group. Frequent RVOT-VES causes left atrial dysfunction. This information is obtained through strain analyses and recordings of left atrial conduction times in patients with pEF. Regardless, retrograde VAC is not related to atrial dysfunction.

P5800Magnetocardiography detects left atrial dysfunction in patients with paroxysmal atrial fibrillation: comparison with healthy subjects

P5800Magnetocardiography detects left atrial dysfunction in patients with paroxysmal atrial fibrillation: comparison with healthy subjects

Assessment of left atrial function in patients with hypertrophic cardiomyopathy using two-dimensional strain: a comparison with volume-derived values.

Hypertrophic cardiomyopathy (HCM) is a common heart disease. Left atrial (LA) function plays an important role in the diastolic function in patients with HCM. In this study, two-dimensional speckle tracking imaging (2D-STI) was used to assess left atrial (LA) function in patients with HCM. Thirty-four patients with HCM and thirty-four age- and gender-matched normal subjects were studied. The LA Volume-Derived Index was measured using 2D ultrasonic images. The LA strain (S-reservoir, S-conduit, S-booster pump) and the strain rate (SR-reservoir, SR-conduit, SR-booster pump), representing the reservoir, conduit and booster pump functions, respectively, were measured. The LA reservoir, conduit and booster pump functions were significantly different between patients with HCM and normal subjects. The values in patients with HCM were less than those in normal subjects. In patients with HCM, S-reservoir and SR-reservoir were significantly correlated with the total LA ejection fraction (LAEF), LA Expansion Index and left ventricular (LV) global longitudinal strain. S-conduit and SR-conduit were significantly correlated with e' and LV global longitudinal strain. S-booster pump and SR-booster pump were significantly correlated with the A, a', active LAEF and LA Expansion Index. S-booster pump was significantly correlated with the LV global longitudinal strain. 2D-STI conveniently demonstrated the LA dysfunction in patients with HCM by detecting the LA strain and strain rate. The accurate assessment of LA function could have potential clinical value for the treatment of patients with HCM.

On The Nature of Transient Left Atrial Dysfunction in Patients with Takotsubo Syndrome

On The Nature of Transient Left Atrial Dysfunction in Patients with Takotsubo Syndrome

OP-076 The Importance of Speckle Tracking Echocardiography in the Detection of Left Atrial Dysfunction in Patients with Coronary Artery Diseases

OP-076 The Importance of Speckle Tracking Echocardiography in the Detection of Left Atrial Dysfunction in Patients with Coronary Artery Diseases

Complex evaluation of left atrial dysfunction in patients with type 1 diabetes mellitus by three-dimensional speckle tracking echocardiography: results from the MAGYAR-Path Study.

Objective:Changes in left atrial (LA) function can be observed in type 1 diabetes mellitus (T1DM). Three-dimensional (3-D) speckle tracking echocardiography (STE) seems to be a promising tool for volumetric and functional evaluation of LA. The objective of the present study was to compare 3DSTE-derived LA volumetric and strain parameters between T1DM patients and matched healthy controls.Methods:This prospective study consists of 17 subcutaneous insulin pump-treated non-obese patients with T1DM (mean age: 33.5±8.2 years, 8 males). To exclude possible cardiovascular disease, patients with complaints of chest pain, dyspnea, or signs of cerebrovascular disease or peripheral artery disease were not included. Their results were compared with 20 age-matched and gender-matched healthy controls (mean age: 36.9±11.0 years, 9 males). Independent sample Student t-test and Fisher’s exact test were used for comparisons. Bland–Altman method was used for evaluating intraobserver and interobserver correlations.Results:Anemia and impaired renal function were not confirmed in T1DM patients. Calculated LA maximum and minimum volumes and LA volume before atrial contraction were significantly increased in T1DM patients. Total atrial stroke volume was increased (23.6±6.9 mL vs. 19.6±4.6 mL, p=0.04), whereas mean segmental circumferential peak strain was decreased (28.9%±11.4% vs. 37.3%±12.5%, p=0.04). Segmental basal longitudinal and area strains were increased, whereas segmental superior circumferential and area strains and midatrial 3-D strain were decreased in T1DM.Conclusion:Both 3DSTE-derived volumetric and strain analysis confirmed alterations in LA function, suggesting early LA remodeling in patients with T1DM. (Anatol J Cardiol 2016; 16: 587-93)

Abstract 15760: Left Atrial Dysfunction in Patients With Anderson - Fabrys Disease Using Magnetic Resonance Imaging Derived Left Atrial Phasic Function

Background: Anderson-Fabrys disease (AFD) is an x-linked lysosomal storage disease caused by deficiency of the enzyme alpha-galactosidase. This results in accumulation of globotriaosylceramide in various organs. The hallmark of cardiac involvement is left ventricular hypertrophy (LVH). However, autopsy studies have demonstrated involvement of the left atrium (LA) as well. There is currently limited data on left atrial volumes and function in patients with AFD. We sought to assess LA phasic volumes and function in patients with AFD using cardiac MRI (CMR) cine data. Method and Results: This was a retrospective study. Consecutive patients with clinically indicated CMR at our center were included. CMR acquired 2 and 4 chamber steady state free precession (SSFP) cine data were used to measure LA volume and phasic function with commercially available off-line software (eSieVVI, Siemens Medical System). We included 37 patients with AFD (18 males, mean age 48±13 yrs) and 22 age balanced healthy volunteers (8 males, mean age of 40±14 yrs). LA maximal and conduit volumes were not different between AFD and controls, but the LA minimal was larger (Table). Volume derived reservoir, conduit, and pump function were significantly reduced in AFD (Table). Strain measured reservoir and pump function were also significantly reduced in AFD. An inverse correlation was seen between LA reservoir strain and left ventricular (LV) mass (r=-0.53) and myocardial late gadolinium enhancement (LGE) measured using the 4 (r=-0.67) and 6 (r=-0.67) standard deviation thresholds. Conclusion: This is the first study to demonstrate abnormal LA function in patients with AFD using both volumetric and strain techniques. Patients with AFD had reduced LA reservoir and pump function with modest correlation with disease severity based on the burden of LV LGE and LV mass. Further studies are needed to assess the relationship between LA function and prognosis including the development of atrial arrhythmia.

Assessment of left atrial volume and function in patients with psoriasis by using real time three-dimensional echocardiography.

Left atrial (LA) volume has been identified as a predictor of adverse cardiovascular outcomes, both in the general population and in selected clinical conditions. The aim of this study was to evaluate the effect of psoriasis on LA volume and mechanical function. A total of 40 consecutive normotensive psoriasis patients free of any cardiovascular disease and 39 healthy volunteers were included. All participants underwent comprehensive transthoracic echocardiographic examination. LA volume and mechanical function were evaluated using real-time three-dimensional echocardiography (RT3DE). There were no significant differences between psoriasis and control groups with regard to conventional echocardiographic parameters. Individuals with psoriasis had a higher incidence of left ventricular diastolic dysfunction (LVDD) than the controls; nine people with psoriasis (23%) and three control individuals (8%) had LVDD (p = 0.06). With regard to the parameters obtained from RT3DE, LA maximum, LA minimum, passive stroke volume, and passive emptying fraction were significantly higher; whereas LA active emptying fraction, LA total emptying fraction, LA expansion index, and active stroke volume values were significantly lower in individuals with psoriasis compared with controls. Disease duration and Psoriasis Area of Severity Index (PASI) score correlated with the majority of volume parameters. Individuals with psoriasis had higher LA phasic volumes and impaired LA mechanical function compared with healthy controls. LA volume and functional analysis with RT3DE may facilitate recognition of subtle LA dysfunction in patients with psoriasis.