Left Atrial Enlargement Research Articles

Correlation between Obesity and Left Atrial Enlargement in Patients Using Cardiac Magnetic Resonance

Objective: The correlation between left atrial (LA) enlargement and obesity has been previously reported. However, most studies primarily evaluated LA diameter using echocardiography, which is less accurate and reliable than assessing LA volume with cardiac magnetic resonance (CMR). This study aimed to explore the correlation between obesity and LA volume by using CMR imaging. Materials and Methods: We prospectively enrolled consecutive eligible patients aged 18 years or older who underwent CMR at a tertiary academic hospital. Clinical variables, including body mass index (BMI), were collected from the medical records. LA volume classification was based on the current guideline recommendations. Results: A total of 140 patients (41% men), with a mean age of 66.5 ± 10.5 years, were studied. The mean BMI was 25.7 ± 4.2 kg/m2. CMR parameters revealed an LA volume of 75.7 ± 22.5 mL, a left ventricular (LV) ejection fraction of 71.1 ± 9.5%, and an LV mass index of 46.1 ± 27.4 g/m2. Univariable analysis indicated that the factors affecting LA volume included BMI (r = 0.3, p < 0.001), LV mass index (r = 0.3, p = 0.001), waist circumference (r = 0.3, p < 0.001), male sex (p = 0.01), and hypertension (p = 0.01). In stepwise multivariable analysis, BMI (p < 0.001), LV mass index (p = 0.02), and male sex (p = 0.03) were independently associated with LA volume. Conclusion: Obesity, as represented by BMI, was independently associated with LA enlargement. Other independent factors correlated with LA volume included the LV mass index and male sex.

Abstract WP272: Cancer and Left Atrial Enlargement in Patients with Ischemic Stroke

Abstract WP272: Cancer and Left Atrial Enlargement in Patients with Ischemic Stroke

The Clinical Trajectory of NYHAFunctional Class I Patients With Obstructive Hypertrophic Cardiomyopathy.

An improved understanding of the natural history in NYHA functional class I patients with obstructive hypertrophic cardiomyopathy (oHCM) is needed. Using a multicenter registry (SHaRe [Sarcomeric Human Cardiomyopathy Registry]), this study described the natural history in patients with oHCM who were classified as NYHA functional class I at the initial visit compared with patients classified as NYHA functional class II and reported baseline characteristics associated with incident clinical events. Incident events assessed included a composite of NYHA functional class III to IV symptoms, left ventricular ejection fraction<50%, atrial fibrillation, stroke, ventricular arrhythmias, septal reduction therapy, ventricular assist device or transplantation, or death. Factors associated with incident events were determined using Kaplan-Meier, Cox proportional hazards, and restricted cubic spline models. Of 7,964 patients with HCM in SHaRe, 1,239 patients with oHCM met inclusion criteria; 598 were in NYHA functional class I at the initial visit (age 48 ± 17 years; 31.1% female; peak gradient, 75 ± 40mmHg). At 5-year follow-up, the composite event rate of NYHA functional class I patients was 28% compared with 44% (P< 0.001) in 641 NYHA functional class II patients with oHCM (age 54 ± 16 years; 46.5% female; peak gradient, 83 ± 39mmHg). Left atrial (LA) diameter≥45mm (HR: 1.56 [95%CI: 1.14-2.12]; P = 0.005), female sex (HR: 1.61 [95%CI: 1.16-2.24]; P = 0.003), and older age (HR: 1.21 per 10 years [95%CI: 1.09-1.34]; P< 0.001), but not the magnitude of left ventricular outflow tract obstruction, were associated with a higher risk of the composite outcome in NYHA functional class I patients. Although NYHA functional class I patients with oHCM fared better than NYHA functional class II patients, more than one-fourth experienced adverse events over 5-year follow-up, especially if they were older, female, and/or had LA enlargement. Strategies to reduce the rate of clinical outcomes in NYHA functional class I patients warrant further study.

The monocyte-to-HDL-cholesterol ratio predicts new-onset atrial fibrillation in patients with acute STEMI.

Newly diagnosed AF (NOAF) associated with acute STEMI holds significant relevance in clinical practice. This study seeks to assess the role of the monocyte to HDL-C ratio (MHR) in predicting NOAF in these patients. Between July 2017 and May 2018, 663 patients who underwent primary PCI for STEMI were retrospectively analyzed. NOAF was identified in 34 patients (5.1%), and this group was compared with those without AF. The NOAF group experienced a longer hospitalization duration and a higher mortality rate (11.8 vs. 4.3%, p = 0.044) compared to the non-AF group. In a multivariable analysis, increased MHR (OR: 1.413, 95% CI: 1.203-1.657, p = 0.005), advanced age, decreased LVEF, Killip class 2-4, diabetes mellitus, hypertension, and left atrial enlargement emerged as independent predictors for the development of NOAF in STEMI. ROC curve analysis revealed that MHR values exceeding 26.54 strongly predict NOAF, achieving sensitivity and specificity above 70% (AUC: 0.768, 95%CI: 0.734-0.801, p < 0.001). The present study revealed that increased MHR robust indicator for NOAF in STEMI patients and can be easily assessed in clinical practice. Incorporating MHR alongside established traditional risk factors may enhance the identification of patients at risk for AF in those with STEMI.

Atrial strain assessment in elite athletes: unveiling physiologic adaptation

Abstract Background Left atrial (LA) strain, measured by speckle-tracking echocardiography, provides insights into cardiac function beyond traditional volumetric assessments. In athletes, the effects of chronic exercise on LA strain are unclear, with conflicting findings on whether it reflects physiological adaptation or potential dysfunction. Aims This study aimed to comprehensively assess LA remodeling and function in professional soccer players compared to controls. We hypothesized that while athletes would exhibit LA enlargement, their atrial function would remain preserved due to the physiological nature of cardiac remodeling in this population. Methods A retrospective analysis of echocardiographic parameters, namely left atrial strain, was carried out in a group of professional male athletes compared to a control group of healthy male individuals. A GE Vivid E95 echocardiographic ultrasound system and EchoPAC V.206 software (GE Vingmed Ultrasound AS, Horten, Norway) were used. Shapiro-Wilk test was used to test data distribution, ANOVA and t-test were used as a parametric tests, and Man-Whitney as a non-parametric Test (SPSS v.27). Results The study analyzed 111 athletes with a median age of 24 (21-31) years and 70 healthy male individuals from the control group with a median age of 27 (23-32) years. Athletes had a significantly higher indexed left atrial end-systolic volume compared to the control group (41 ± 9 ml/m² vs. 31 ± 7 ml/m², p&amp;lt;0.001). Despite the difference in volume, the early and late diastolic tissue velocities were similar in both groups and E/E’ was lower (4.4 ± 0.9 vs. 5.0 (4.5-5.8), p&amp;lt;0.001). There were no significant differences between athletes and the control group in Left Atrial Reservoir Strain (LASr) and Left Atrial Conduit Strain (LAScd). The active contraction of the left atrium during atrial systole is reduced in athletes, which had a significantly lower left atrial contraction strain compared to the control group (-9 (-11 – -8)% vs. -12 ± 4%, p&amp;lt;0.001). Conclusion The data suggests that athletes' hearts have undergone specific adaptations, particularly in terms of increased left atrial size and altered contraction patterns. Maintaining atrial reservoir strain (the most validated parameter for normality) and atrial conduit strain within normal ranges may indicate that morphological changes are merely normal adaptations to the high cardiac output demands during exercise. Descriptive analysis LA strain example

Prevalence and predictors of left atrial thrombus in patients with rheumatic atrial fibrillation undergoing cardiac surgery: a cross-sectional study

BackgroundUnlike non-rheumatic atrial fibrillation (AF), where left atrial thrombus (LAT) is predominantly confined to the left atrial appendage (LAA), a significant proportion of LAT in rheumatic AF occurs within the left atrial cavity (LAC). However, LAC thrombosis in rheumatic AF has not been extensively studied. This study aimed to evaluate the prevalence of LAT and its subtypes and identify potential predictors of LAT.MethodsThis retrospective study included adult patients with rheumatic AF who underwent open-heart surgery for mitral valvular abnormalities between January 2019 and December 2020. LAT was identified through intraoperative inspection and categorized as either LAC thrombus or LAA thrombus. The prevalence of LAT and its subtypes was calculated, and logistic regression analysis was performed to identify predictors of LAT.ResultsA total of 530 patients (mean age: 59.7 ± 9.5 years; male: 29.8%) with a predominance of mitral stenosis (59.6%) were included. LAT was identified in 82 patients (15.5%), including 44 (8.3%) with LAA thrombus and 38 (7.2%) with LAC thrombus. In the multivariable logistic regression model, coronary artery disease (OR: 6.35, 95% CI: 2.79–14.46, p < 0.001), larger left atrial diameter (OR: 1.31 per 10 mm increase, 95% CI: 1.02–1.68, p = 0.03), and moderate-to-severe mitral stenosis (OR: 1.77, 95% CI: 1.00–3.13, p = 0.05) were independently associated with an increased risk of LAT, whereas moderate-to-severe mitral regurgitation was independently associated with a decreased risk of LAT (OR: 0.21, 95% CI: 0.11–0.43, p < 0.001).ConclusionIn patients with rheumatic AF undergoing open-heart mitral valve surgery, LAT can be located in either the LAA or LAC. The presence of LAT was independently associated with coronary artery disease, left atrial enlargement, and mitral valvular abnormalities. Timely screening and management of LAT are crucial to mitigate potentially fatal thromboembolic events.

Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source

BackgroundDetection of atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS) is important for the secondary prevention of stroke. We investigated the factors associated with the detection of newly diagnosed AF in ESUS patients during follow-up.MethodsPatients with acute ischemic stroke classified as ESUS were included. All patients underwent transthoracic echocardiography and Holter to detect the source of embolism. Structural, electrophysiological markers of left atrial cardiopathy (i.e., left atrial enlargement [LAE], non-sustained tachycardia [NSAT]) as well as lesion patterns of ischemic stroke were examined. Implantable loop recorder (ILR) was implanted in selective patients. Sensitivity and positive predictive value analysis was used to assess the predictive value for AF detection.ResultsAmong 312 patients with ESUS, AF was detected in 24 (7.7%) patients during follow-up. Patients with AF had a higher prevalence of LAE, NSAT, and the imaging pattern of confluent plus additional lesions in a single vascular territory. Multivariable analysis showed that ILR implantation (hazards ratio 11.497 [95% confidence interval 3.795–34.818]), LAE (3.204 [1.096–9.370]), NSAT (4.070 [1.378–12.018]), and confluent plus additional lesions (4.977 [1.649–15.019]) were independent predictors of AF detection. The sensitivity of detecting AF in those with LAE, NSAT, or confluent plus additional lesions pattern was 91.7%. The positive predictive value of detecting AF in those with LAE, NSAT and confluent plus additional lesions pattern was 40.0%.ConclusionIn conclusion, patients with LAE, NSAT, or confluent plus additional lesions may benefit from ILR monitoring detecting new AF.

Clinical, Imaging, and Atrial Cardiopathy Markers in Ischemic Stroke Subtypes - Clues to a Cardioembolic Source.

Cryptogenic strokes account for 20%-25% of all ischemic strokes. Although atrial cardiopathy markers are more prevalent in the cryptogenic embolic stroke of undetermined source (ESUS) subgroup than in the nonembolic stroke subgroup, the utility of individual parameters in predicting cardioembolic sources needs to be studied further. We studied the clinical, imaging, and atrial cardiopathy markers in three ischemic stroke subtypes - large artery atherosclerosis (LAA), cardioembolism (CE), and cryptogenic ESUS - and their role in predicting the source of CE. This was a prospective observational study of ischemic stroke patients at Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum from April 2021 to December 2022. Clinical and risk factor profiles, imaging details, atrial cardiopathy marker (N-terminal pro-brain natriuretic peptide [NT-pro-BNP]) levels, electrocardiogram (ECG) parameters (P terminal force of V1 [PTFV1], P wave duration, the PR interval), and transthoracic echo parameters (left atrial [LA] diameter and LA volume) were collected. Associations were made between clinical, imaging, and atrial cardiopathy markers and etiological subtypes. We had 255 participants (LAA- 98, CE- 41, and ESUS- 139) with a mean age of 63.53 years. Among the atrial cardiopathy markers, the most prevalent was elevated NT-pro-BNP (43.95%), followed by the ECG markers P wave duration (30.92%) and PTFV1 (28.74%), and LA diameter greater than 37 mm (24.27%) and LA volume greater than 34 ml/m2 (20.31%). Among the atrial cardiopathy markers, NT-pro-BNP and LA enlargement were strongly predictive of CE etiology, when compared to LAA. Chronic non-lacunar infarcts on imaging and elevated NT-pro-BNP showed a strong association with CE, when compared to cryptogenic strokes. The atrial cardiopathy biomarker NT-pro-BNP and chronic non-lacunar infarcts can serve as useful tools for recognizing cardioembolic sources among patients with embolic strokes.

New risk score for predicting postoperative atrial fibrillation after cardiac surgery

Introduction: Postoperative atrial fibrillation is the most common sustained arrhythmia after cardiac surgeries that occurs in approximately 30-50% of patients postoperatively. Because of the substantial evidence recommending prophylactic treatment and the lack of clear indications for commencing treatment, this study aimed to develop a new predictive score for atrial fibrillation after cardiac surgery that represents well the pathophysiology of the disease. Methods: This is a retrospective cohort study, involving two public teaching hospitals. The study included 989 adult patients who underwent cardiac surgery, except for heart transplantation or the implantation of a ventricular assist device. Patients with previous atrial fibrillation or those requiring amiodarone were excluded. The variables (age ≥60 years, echocardiographic LA enlargement, inotrope use within 24 hours of surgery, and the need for reoperation) were subjected to univariate analysis of the occurrence of postoperative atrial fibrillation and multivariate analysis using logistic regression. This was then used for developing a risk score. Results: Statistically significant variables in the multivariate analysis were age ≥60 years (P&lt;.001), left atrial enlargement based on echocardiography (P=.025), inotrope use within 24 hours after surgery (P=.002), and the need for reoperation within 24 hours after surgery (P=.016). The score comprises these four variables and has an accuracy of 77% for predicting outcomes. Scores ≥3 were related to a 34% risk of postoperative atrial fibrillation. Conclusions: The proposed score represents the disease pathophysiology well and has good accuracy for predicting the main outcome.

Evaluation of Radiographic Methods for Detecting Left Atrial Enlargement in Dogs with Mitral Valve Disease

Evaluation of Radiographic Methods for Detecting Left Atrial Enlargement in Dogs with Mitral Valve Disease

Clinical, Electrocardiographic and Echocardiographic Profiles of Elderly Hypertensive Patients in Gabon

Introduction: Hypertension in the elderly is an independent risk factor for cardiovascular disease. Our objectives were to describe the clinical, electrocardiographic, and echocardiographic features of hypertension in elderly patients. Methods: We conducted a descriptive and cross-sectional study from January to September 2023. Elderly hypertensive patients aged 60 years and older, who were followed in the outpatient cardiology service at HIAOBO Hospital in Libreville, Gabon, were included. Statistical data were analyzed using Epi Info 7 software, and a p-value of &lt; 0.05 was considered statistically significant. Results: A total of 210 patients were included. The average age was 60 years with a female predominance (sex ratio of 0.85). The average blood pressure was 162/90 mmHg. Hypertension was controlled in 13% of cases. Electrocardiogram results showed rhythm disturbances (17.78%), left atrial enlargement (45.19%), left ventricular hypertrophy (28.85%), and two cases of complete atrioventricular block. The Holter ECG revealed four cases of non-sustained ventricular tachycardia (Lown stage IVb), six cases of paroxysmal atrial fibrillation, and one case of paroxysmal atrial flutter. Echocardiography, performed in 140 patients, revealed left ventricular hypertrophy (LVH), predominantly concentric, in 25 patients, more frequent in males (p = 0.04), and left atrial dilation in 56.42% of cases, more common in older patients (p = 0.01). Conclusion: Electrocardiographic and echocardiographic features in the elderly hypertensive population are characterized by left ventricular hypertrophy, particularly concentric hypertrophy, and the frequent occurrence of arrhythmias, sometimes detected by long-term electrocardiographic monitoring.

Impact of Anxiety-Depressive Disorders in COPD Patients

Introduction: Hypertension in the elderly is an independent risk factor for cardiovascular disease. Our objectives were to describe the clinical, electrocardiographic, and echocardiographic features of hypertension in elderly patients. Methods: We conducted a descriptive and cross-sectional study from January to September 2023. Elderly hypertensive patients aged 60 years and older, who were followed in the outpatient cardiology service at HIAOBO Hospital in Libreville, Gabon, were included. Statistical data were analyzed using Epi Info 7 software, and a p-value of &lt; 0.05 was considered statistically significant. Results: A total of 210 patients were included. The average age was 60 years with a female predominance (sex ratio of 0.85). The average blood pressure was 162/90 mmHg. Hypertension was controlled in 13% of cases. Electrocardiogram results showed rhythm disturbances (17.78%), left atrial enlargement (45.19%), left ventricular hypertrophy (28.85%), and two cases of complete atrioventricular block. The Holter ECG revealed four cases of non-sustained ventricular tachycardia (Lown stage IVb), six cases of paroxysmal atrial fibrillation, and one case of paroxysmal atrial flutter. Echocardiography, performed in 140 patients, revealed left ventricular hypertrophy (LVH), predominantly concentric, in 25 patients, more frequent in males (p = 0.04), and left atrial dilation in 56.42% of cases, more common in older patients (p = 0.01). Conclusion: Electrocardiographic and echocardiographic features in the elderly hypertensive population are characterized by left ventricular hypertrophy, particularly concentric hypertrophy, and the frequent occurrence of arrhythmias, sometimes detected by long-term electrocardiographic monitoring.

Bradyarrhythmias in patients with embolic stroke of undetermined source: a tight relationship with atrial cardiomyopathy.

Implantable loop recorders (ILRs) have been shown to significantly improve the detection of atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS). The incidence and characterization of bradyarrhythmias in this subset of patients is still unknown. All consecutive patients who received ILRs, after an ESUS, between March 2015 and December 2022 in our Center were retrospectively enrolled and analyzed. Bradyarrhythmias were defined as: (1) sinus node dysfunction defined as sinus bradycardia, pause or arrest, exit block; (2) second-degree heart block or complete atrioventricular block. The primary endpoint was to analyze the incidence and characterization of bradyarrhythmias; the secondary endpoint was the detection of possible risk factors for bradyarrythmias. All patients were followed through the remote monitoring. A total of 150 consecutive patients (mean age 70.4 ± 10.3 years old, 52.7% males) were analyzed. Bradyarrythmias were identified in 13 patients (8.7%). On multivariable analysis the presence of AF and first degree AV block were independently associated with the occurrence of bradyarrhythmias (respectively, OR 4.95, 95% CI 1.12-21.89, p = 0.0.03 and OR 3.77, 95% CI 1.08-13.14, p = 0.04). The incidence of bradyarrhythmias detected by ILRs in patients with ESUS was 8.7%. Atrial fibrillation, left atrial enlargement and first degree AV block due to prolonged P wave duration were associated with the occurrence of bradyarrhythmias during the follow up.

Enhancing Thromboembolic Risk Prediction in Non-valvular Atrial Fibrillation: The Critical Role of Transesophageal Echocardiography (TEE).

Introduction Atrial fibrillation (AF), the most common cardiac arrhythmia, poses challenges in predicting thromboembolic risk. While the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years (doubled), type 2 diabetes mellitus, previous stroke, transient ischemic attack, or thromboembolism (doubled), vascular disease, age 65-74 years, and sex category) scoreremains essential, its limitations include failure to identify left atrial (LA) thrombus in some patients. Transesophageal echocardiography (TEE) provides superior detection of LAthrombi and thrombogenic factors compared to transthoracic echocardiography (TTE), improving risk stratification, especially in intermediate-risk groups. Our study highlights the value of TEE in addressing gaps left by clinical scoring systems in certain subgroups of patients. Purpose and methodology This descriptive, prospective study aims to evaluate the role of transthoracic and transesophageal echocardiography in stratifying thromboembolic risk in patients with non-valvular AF. A total of 100 patients, from two hospitals in Morocco, were included. Data were collected through clinical and paraclinical assessments, with echocardiography examining morphological and functional atrial parameters. Results Among the 100 patients, 73% were male, with a mean age of 67 years. AF was permanent in 84.8% of cases, with dyspnea and palpitations being the most common symptoms. Hypertension was the leading underlying cause. Echocardiographic findings showed a correlation between LA enlargement, reduced left atrial appendage (LAA) emptying velocities, and increased thromboembolic risk. In patients with low clinical scores, 30.7% exhibited echocardiographic signs of a thrombogenic environment, while protrusive aortic atheroma was more prevalent in those with higher clinical risk scores. Discussion The findings confirm the utility of echocardiography, particularly transesophageal, in detecting parameters associated with heightened thromboembolic risk, including LAA emptying velocities, spontaneous contrast, and aortic abnormalities. These echocardiographic markers, combined with clinical scores, may enhance the precision of risk stratification and allow for more targeted anticoagulation therapy. Conclusion Atrial fibrillation remains a common and potentially serious arrhythmia. Echocardiography provides valuable information that complements clinical risk stratification, especially for patients at moderate thromboembolic risk. This study highlights the benefit of incorporating echocardiographic parameters into risk assessment to optimize strategies for preventing thromboembolic events in patients with AF.

Preprocedural Screening Tool to Guide Nonpulmonary Vein Trigger Testing in First-Time Atrial Fibrillation Ablation.

Patients undergoing first-time atrial fibrillation (AF) ablation can benefit from targeting non-pulmonary vein (PV) triggers. Preprocedural identification of high-risk individuals can guide planning of ablation strategy. This study aimed to create a preprocedural screening tool to identify patients at risk of non-PV triggers during first-time AF ablation. All patients who underwent first-time AF ablation at the Hospital of the University of Pennsylvania between 2018 and 2022 were identified. Those who underwent non-PV trigger provocative maneuvers or had spontaneous non-PV trigger firing were included. Non-PV triggers were defined as non-PV ectopic beats triggering AF or sustained focal atrial tachycardia that occurred spontaneously, after AF cardioversion, or after standard provocative maneuvers. The provocative maneuvers included incremental isoproterenol infusion (3, 6, 12, and 20-30 µg/min) and an atrial burst pacing protocol. Risk factors associated with non-PV triggers in a stepwise multivariable logistic regression model with backward elimination were used to create a risk score. In all, 163 (8.0%) of 2038 patients had non-PV triggers during first-time AF ablation. Based on the multivariable model, we created a risk score using female sex (1 point; odds ratio [OR], 1.90 [95% CI, 1.36-2.67]), sinus node dysfunction (1 point; OR, 1.84 [95% CI, 1.04-3.24]), prior cardiac surgery (1 point; OR, 2.26 [95% CI, 1.45-3.53]), moderate to severe left atrial enlargement (2 points; OR, 3.43 [95% CI, 2.46-4.79]), and cardiac sarcoidosis/amyloidosis (4 points; OR, 7.24 [95% CI, 3.03-17.33]). Internal validation using bootstrap resampling showed an optimism-adjusted C statistic of 0.715 (95% CI, 0.678-0.751). Among all first-time AF ablations, 68.1% of procedures were low-risk for non-PV triggers (scores 0-1, 4.3% risk), 17.8% were intermediate-risk (score 2, 10.5% risk), and 14.1% were high-risk (score ≥3, 22.6% risk). A preprocedural screening tool can classify patients based on their risk of non-PV triggers during first-time AF ablation. This risk score can guide operators to identify patients who would benefit most from adjunctive non-PV trigger testing. However, further validation is needed to confirm these findings.

Atypical Presentation of Andersen-Tawil Syndrome: Heart Failure with Reduced Ejection without Periodic Paralysis or Dysmorphic Features.

Andersen-Tawil syndrome (ATS) is a rare autosomal dominant disorder caused by variants in the KCNJ2 gene. It is associated with periodic paralysis, dysmorphic features and cardiac arrhythmias. The syndrome exhibits incomplete penetrance, leading to a broad spectrum of clinical manifestations, making diagnosis challenging. A male in his mid-20s with class 3 obesity presented to the emergency department with a week-long history of worsening chest pain, orthopnoea and fatigue. His family history was significant for sudden cardiac death affecting both his mother and brother, with his father having died from complications of Wolff-Parkinson-White syndrome. Cardiovascular examination revealed an S3 heart sound and elevated brain natriuretic peptide levels at 875 pg/ml, with undetectable troponins; potassium level on admission was 3.6 mEq/l. An electrocardiogram showed normal sinus rhythm, first-degree heart block, left atrial enlargement, left bundle branch block and a prolonged QTc of 486 ms. A transthoracic echocardiogram demonstrated a 15-20% reduction in ejection fraction with global left ventricular hypokinesis and left atrial enlargement. Ultimately, he was diagnosed with non-ischaemic dilated cardiomyopathy and referred for genetic testing, which revealed a KCNJ2 variant. Shortly after discharge, he experienced a 55-second run of ventricular tachycardia, necessitating the placement of a single-chamber ICD. Currently, the patient remains on guideline-directed medical therapy and is listed for a heart transplant. Dilated cardiomyopathy, although a rare manifestation in ATS, can profoundly increase the risk of fatal arrythmias, necessitating the need for a low threshold of suspicion, to ensure timely diagnosis and management. Andersen-Tawil syndrome (ATS) can present with heart failure with reduced ejection fraction, even without the typical triad of periodic paralysis, dysmorphic features and arrhythmias. Early genetic testing is essential for confirming ATS, especially in atypical cases with unexplained heart failure or arrhythmias.ATS has incomplete penetrance so it may present without the typical features, making diagnosis challenging and requiring a high suspicion in cases with unexplained arrhythmias or family history of sudden cardiac death.

Metabolic Syndrome Nonalcoholic Steatohepatitis Male Mouse With Adeno-Associated Viral Renin as a Novel Model for Heart Failure With Preserved Ejection Fraction.

Heart failure with preserved ejection fraction (HFpEF) currently accounts for more than half of patients with HF, with limited approved evidence-based therapies. HFpEF is a complex multifactorial disease associated with hypertension, obesity, diabetes, and renal dysfunction. In addition to our limited understanding of HFpEF pathophysiology, the development of new therapies is partially hindered by the existing translationally relevant preclinical HFpEF models. Here, we report the development of a novel 2-hit HFpEF male mouse model through adding hypertensive stress from the activation of the renin-angiotensin-aldosterone system with adeno-associated viral-renin (AAV-renin), to the metabolic syndrome nonalcoholic steatohepatitis (MSNASH, formerly FATZO) mouse (MSNASH+AAV-renin). To further demonstrate model translatability, MSNASH+AAV-renin mice were then treated with approved HFpEF therapies sacubitril/valsartan or a combination of sacubitril/valsartan and empagliflozin. We found that the MSNASH+AAV-renin mouse model demonstrates clinically relevant features of human HFpEF, including preserved ejection fraction, cardiac hypertrophy, left atrial enlargement, diastolic dysfunction, elevated natriuretic peptides, inflammation, and low exercise capacity. We also demonstrate that treatment with approved HFpEF therapies sacubitril/valsartan and the combination of sacubitril/valsartan with empagliflozin improves the cardiac phenotypes of HFpEF in this model. The MSNASH+AAV-renin model faithfully represents a severe cardiometabolic HFpEF phenogroup that can be used as a new tool for HFpEF preclinical research and drug discovery.

Atrial and ventricular functional mitral regurgitation: prevalence, characteristics, outcomes, and disease progression.

Limited data exist on the natural history of functional mitral regurgitation (FMR), including atrial (AFMR), ventricular (VFMR), and dual FMR. This study examined the prevalence, characteristics, outcomes, and progression of these FMR subtypes. Consecutive patients with ≥mild to moderate FMR were included and classified as AFMR, VFMR, or dual FMR. AFMR is characterized by left atrial enlargement, while VFMR involves left ventricular enlargement or reduced left ventricular ejection fraction. Dual FMR combines features of both. Clinical outcome was all-cause mortality and heart failure (HF) hospitalization. Echocardiographic outcome was the progression from mild-moderate/moderate to severe FMR and from AFMR/VFMR to dual FMR. Of 22 814 patients, AFMR, VFMR, and dual FMR were identified in 39%, 14%, and 47%, respectively. Most (84%) had mild-moderate to moderate FMR. Over a median clinical follow-up of 4.7 years, dual FMR has the highest risk of all-cause mortality and HF hospitalization. Compared with AFMR, patients with VFMR have a higher incidence of all-cause mortality (adjusted HR = 1.73, 95%CI 1.54-1.94, P < 0.001) and HF hospitalization (adjusted HR = 1.23, 95%CI 1.15-1.32, P < 0.001). In the serial cohort with 2.4 (1.0-4.9) years echocardiogram follow-up, VFMR was associated with a 1.51-fold and 3.08-fold increase in the risk of progressing to severe FMR and dual FMR than AFMR (both P < 0.001). Sensitivity analyses did not change these findings. AFMR and VFMR have significant differences in survival and disease progression. Dual FMR is a common and distinct disease process that occurs in the progression of AFMR or VFMR and is associated with a poor prognosis.

The Relationship Between BigET-1 and Cardiac Remodeling in Patients with Hypertrophic Obstructive Cardiomyopathy.

To explore the relationship between BigET-1 and cardiac remodeling in hypertrophic obstructive cardiomyopathy (HOCM). A retrospective analysis was conducted on the data of 150 HOCM patients in a hospital from September 2021 to August 2023. According to the 2015 American Ultrasound Society's recommended standards for quantifying adult UGG cardiac lumen, left atrial enlargement is defined as having a left atrial diameter greater than 40mm in males and greater than 38mm in females. 150 HOCM patients were divided into a left atrial normal group (n = 97) and a left atrial enlargement group (n = 53). Comprehensive patient data were collected, including BigET-1in plasma, N-Terminalpro-B-TypeNatriureticPeptide (NT-pro-BNP), and High-sensitive C-reactive protein (Hs-CRP), as well as cardiac magnetic resonance imaging (CMR) imaging data. The relationship between BigET-1 levels and cardiac remodeling was analyzed. The two groups had no statistical difference in gender, age, heart rate, dyspnea, angina pectoris, etc. (P > 0.05). The χ2-test showed that patients in the left atrial enlargement group had an increased proportion of atrial fibrillation compared to those in the left atrial normal group (P < 0.05). Non parametric tests showed that the Big ET-1 and NT-pro-BNP in the left atrial enlargement group were significantly higher than those in the left atrial normal group (P < 0.05). The t-test results showed that there were statistical differences in Hs-CRP, left atrial anteroposterior diameter, interventricular septum thickness, and LVEDV between the left atrial enlargement group and the left atrial normal group (P < 0.05). Pearson correlation analysis showed that Big ET-1 was positively correlated withNT-pro-BNP, Hs-CRP, left atrial anteroposterior diameter, and interventricular septum thickness (P < 0.05). The multiple linear regression analysis showed that Big ET-1 was positively correlated with NT-pro-BNP and LADap (P < 0.05). In HOCM patients with atrial enlargement, the Big ET-1 is significantly elevated. Cardiac remodeling is more pronounced, indicating that Big ET-1 plays a role in cardiac remodeling in HOCM patients.

Initial Real-World Experiences of Pulmonary Vein Isolation and Ablation of Non-Pulmonary Vein Sites Using a Novel Circular Array Pulsed Field Ablation Catheter.

Background and Aims: Various pulsed field ablation (PFA) systems are currently being developed. Recently, a novel CE-approved circular array PFA catheter (PulseSelect™ PFA System, Medtronic, Minneapolis, MN, USA) was introduced. Data on this commercially available system are sparse. The aim was to elucidate real-world data assessing the feasibility, safety, and acute efficacy of pulmonary vein isolation (PVI) and ablation beyond PVI with this novel ablation system. Methods: Consecutive patients with paroxysmal and persistent atrial fibrillation (AF) undergoing first-time ablation with the circular PFA catheter were enrolled in this study. In patients with persistent AF and left atrial (LA) enlargement (LA area > 20 cm2), additional left atrial roof ablation (LARA) was performed. Those with concomitant typical atrial flutter received adjunctive cavo-tricuspid isthmus (CTI) ablation. Results: A total of 100 AF patients were included (29% female, 50% persistent AF). Of these, 33 patients (33%) underwent adjunctive LARA, 1 patient (1%) received posterior wall isolation, and 6 patients (6%) required additional CTI ablation. The skin-to-skin procedural time averaged 66.3 ± 13.8 min, while the fluoroscopy time and dose area product were 13.7 ± 4.7 min and 6.8 ± 4.9 Gycm2, respectively. Acute PVI was achieved in 100% of pulmonary veins. A bidirectional conduction block of the LARA and CTI lines was confirmed in all patients, and no major adverse events were reported. Conclusions: These real-world data demonstrate the feasibility, safety, and acute efficacy of PVI and ablation beyond PVI using a novel circular array PFA catheter in patients with atrial fibrillation and flutter. The system can easily be integrated with standard PVI workflows. Further and larger studies are warranted to assess the clinical long-term effectiveness and safety of this PFA system.