Left Atrium Strain Rate Research Articles

Abstract 14837: Increase in Left Atrial Pressure After Cryoballoon Ablation Indicates Worse Atrial Function: Evidence From APPEARANCE-AF Trial

Introduction: Left atrial pressure (LAP) is a direct reflection of left atrial function, while LAP could fluctuate following left atrial procedure. The pattern of LAP change in response to pulmonary vein isolation (PVI) and its significance remain to be explored. Hypothesis: The change of LAP before and after PVI could indicate atrial function and predict adverse events. Methods: 28 patients from APPEARANCE-AF trial underwent PVI using cryoballoon ablation were included. Pre-ablation and post-ablation LAP were directly measured via catheter. The correlation of LAP change with demographics, biochemical measurements, and speckle traced echocardiographic indexes of left atrium (LA) were investigated. Results: The included cohort has a mean age of 73.8±8.4 years old, with 12 male (42.9%). Instant PVI was achieved in all patients without complications. The average mean LAP (mLAP) measured before and after PVI was 8.2±4.5 mmHg (pre mLAP) and 14.0±6.5 mmHg (post mLAP), with a significant increment (ΔmLAP: 5.8±4.5 mmHg, P<0.001). In the evaluation of the association of LAP with LA function, the change in LAP significantly correlated with LA strain rate in reservoir (LASr, r=-0.58, P=0.001) and conduit phase (LAScd, r=0.63, P<0.001) and LA ejection fraction (r=-0.48, P=0.014). Furthermore, we divided the cohort into group with significant increment of LAP (inc-mLAP, increment of mLAP > 5 mmHg, n=14) and group with non-significant increment of LAP (ninc-mLAP, mLAP ≤ 5 mmHg, n=14). Correspondingly, patients with larger LAP increment presented significant worse atrial function indicated by LASr (17.3%±5.6% ninc-mLAP vs 11.5%±7.3% inc-mLAP, P=0.030), LAScd (-9.6%±2.2% ninc-mLAP vs -5.7%±3.6% inc-mLAP, P=0.003). Conclusions: PVI could significantly increase LAP, and a higher change of LAP could indicate worse atrial function. Measuring the change of LAP might be valuable in predicting the prognosis of PVI.

A SIGNIFICANT INCREMENT IN LEFT ATRIAL PRESSURE AFTER CRYOBALLOON ABLATION INDICATE WORSE ATRIAL FUNCTION: EVIDENCE FROM APPEARANCE-AF TRIAL

Objective: Left atrial pressure (LAP) is a direct reflection of left atrial function, while LAP could fluctuate following left atrial procedure. The pattern of LAP change in response to pulmonary vein isolation (PVI) and its significance remain to be explored. This study aimed to investigate the pattern of LAP change before and after PVI, and its correlation with other clinical profiles. Design and method: 28 patients underwent PVI using cryoballoon ablation were included (from APPEARANCE-AF trial). Pre-ablation and post-ablation LAP were directly measured via catheter. The correlation of LAP change with demographics, biochemical measurements, and speckle traced echocardiographic indexes of left atrium (LA) were investigated. Results: The included cohort has a mean age of 73.8±8.4 years old, with 12 male (42.9%). Instant PVI was achieved in all patients without complications. The average mean LAP (mLAP) measured before and after PVI was 8.2±4.5 mmHg (pre mLAP) and 14.0±6.5 mmHg (post mLAP), with a significant increment (↗mLAP: 5.8±4.5 mmHg, P<0.001). The change in LAP significantly correlated with LA strain rate in reservoir (LASr, r = -0.58, P = 0.001) and conduit phase (LAScd, r = 0.63, P<0.001) and LA ejection fraction (r = -0.48, P = 0.014). Correspondingly, patients with larger LAP increment (inc-mLAP, increment of mLAP>5 mmHg, n = 14) presented significant worse atrial function indicated by LASr (17.3%±5.6% ninc-mLAP vs 11.5%±7.3% inc-mLAP, P = 0.030), LAScd (-9.6%±2.2% ninc-mLAP vs -5.7%±3.6% inc-mLAP, P = 0.003). Conclusions: PVI could significantly increase LAP, and a higher change of LAP might indicate worse atrial function. The prognostic value of LAP change necessitates further follow-up evaluation.

Reduced left atrial contractile strain with speckle tracking analysis predicts abnormal plasma NTproBNP in an asymptomatic community population

BackgroundThe left atrium (LA) is closely related to left ventricular diastolic function. Two-dimensional speckle tracking strain and strain rate (SR) imaging has been applied in the study of LA function. We intended to explore the relationship between global LA deformation parameters and plasma NTproBNP levels in asymptomatic community residents with normal ejection fraction and normal LA volume.MethodsA cross-sectional sample of Beijing residents underwent comprehensive Doppler echocardiography and medical record review in 2009. Global LA longitudinal strain and SR indexes were obtained in the apical four-chamber view. LA stiffness index (LASI) was calculated as the ratio of early diastolic velocity of transmitral flow/early diastolic mitral annular motion velocity (E/E') to LA reservoir strain.ResultsA total of 620 individuals (mean age = 65.8 years, left ventricular ejection fraction = 70.8%, LA volume index = 17.9 ml/m2) were investigated in our study. 117 individuals had increased plasma NTproBNP (≥ 125 pg/ml). LA reservoir and contractile function by LA strain and SR indexes were significantly reduced in the abnormal NTproBNP group compared with the normal NTproBNP group. Multiple regression analysis indicated that LA contractile strain was a negative predictor of plasma NTproBNP in addition to indexed LA volume and E/E'. LASI was higher in the abnormal NTproBNP group and was significantly correlated with NTproBNP (r = 0.342, P < 0.001). The area under ROC analysis for LASI in predicting elevated plasma NTproBNP was 0.690, similar with LA contractile strain, E/E’ and LAVI. The cut-off value of LASI was 0.612.ConclusionsLA reservoir and contractile functions demonstrated by LA strain and SR were significantly impaired in the community-based population with increased plasma NTproBNP levels. LA contractile strain adds incremental information in predicting abnormal NTproBNP levels. As a single index, LASI showed similar diagnostic value with LAVI and E/E’ in predicting abnormal NTproBNP.

Mechanical function of the left atrium within 28 days after restoration of sinus rhythm in patients with paroxysmal atrial fibrillation

Objective: Atrial fibrillation is a strong independent risk factor for cardioembolic stroke, with a significant impact on morbidity, mortality and healthcare costs. The aim of our study is to investigate left atrial mechanical function in healthy subjects and patients with atrial fibrillation paroxysms less than 48 hours with low risk of thromboembolic complications at 1 and 28 days after restoration of sinus rhythm. Methods: Thirty-six healthy controls and patients with paroxysms of non-valvular atrial fibrillation less than 48 hours (n=25) with low-risk CHA2DS2VASc score were included in the study. The mechanical function of the left atrium (LA) was investigated by the 2D speckle tracking program. Transthoracic echocardiography was performed on the 1st and 28th days after restoration of sinus rhythm by pharmacological cardioversion. Results: Despite the absence of differences in left ventricular systolic function and LA size between the groups, there was a significant decrease in LA deformation and strain rate on day 1 immediately after sinus rhythm recovery in the patients. In the pump phase, the decrease was about 3%, reservoir phase – 10%, and conduit phase – 7% compared to the control group. The strain rate also decreased in the patient group: -1.5 s-1 versus control: -2.14 s-1 (p&amp;lt;0.0001). On the 28th day after restoration of sinus rhythm, there were significant changes in reservoir and conduit functions in patients group in comparison with control group. Global longitudinal LA strain (reservoir phase) decreased to 7%, conduit phase decreased to 11% compared with the control group. In patients group we can see the dynamics during 28 days: pump phase and strain rate were significantly improved, however reservoir and conduit did not significantly change and were lower than in healthy. Conclusion: Mechanical function of the LA in patients with non-valvular atrial fibrillation and low risk of thromboembolic complications, studied with speckle tracking on the first day was significantly impaired compared with the control group (reservoir phase and strain rate). By day 28, mechanical function improved compared to day 1, but reservoir phase remained significantly lower than normal.

Left Atrial Dysfunction in Children with Repaired Pulmonary Artery Atresia with Ventricular Septal Defect: A Cardiovascular Magnetic Resonance Imaging Study.

(1) Background: The left atrium (LA) is much more than a reservoir for left ventricular filling. The aim of this study was to assess the LA volume and function in patients with repaired pulmonary artery atresia with ventricular septal defect (rPA/VSD) using CMR. (2) Methods: 31 pediatric patients with rPA/VSD and 30 healthy controls were prospectively recruited. Left atrial ejection fraction (EF), strain and strain rate of three phases (reservoir, conduit, and pump) and left atrial volume were measured with cardiac function analysis software. (3) Results: Patients with rPA/VSD had decreased maximal volume index (p = 0.008). Compared to controls, LA reservoir strain and strain rate, conduit strain and strain rate, booster pump strain rate, total EF and passive EF were significantly lower (p = 0.001, p < 0.001, p = 0.001, p = 0.02, p = 0.03, p < 0.001, p < 0.001); the patients with preserved but lower RVEF(<50%) had lower reservoir strain, reservoir strain rate and pump strain rate (p = 0.01, p = 0.02, p = 0.04, respectively) than the patients with higher RVEF (≥50%). (4) Conclusions: In patients with rPA/VSD, LA function was altered when biventricular EF was preserved, which may provide an early indication of left ventricular diastolic dysfunction. CMR can detect LA dysfunction at an early stage, even before LA enlargement.

DISSOCIATION BETWEEN LEFT ATRIAL AND LEFT VENTRICULAR CHANGES IN HYPERTENSIVE PATIENTS WITH ATRIAL CARDIOMYOPATHY

Objective: Arterial hypertension (AH) is most important cardiovascular risk factor, associated with adverse left ventricular (LV) remodeling. In according to concept of atrial cardiomyopathy (ACMP) left atrium (LA) may be a more sensitive to pressure and volume overload than LV. We tried to delineate atrial and ventricular remodeling in hypertensive patients (pts) with and without ACMP. Design and method: Conventional and speckle tracking echocardiography was performed on 426 hypertensive patients [mean age 63 yrs, 51% men] with LV ejection fraction &gt; 45%. Global peak LA longitudinal strain (PALS) and strain rate (PALSR) in the reservoir © and contractile © phase were assessed. ACMP was defined as P-wave terminal force in lead V1 &gt; 4000 V × ms and/or LA size &gt; 4,3 sm for women and &gt; 4,7 sm for men. Results: Pts with ACMP (n = 214) were significantly younger to compare with non-ACMP pts (n = 212) [60 (51; 69) vs 66 (61; 73) yrs, p &lt; 0,001] and were less likely to have CAD [87 (41%) vs 174 (82%) pts, p &lt; 0,001], type 2 diabetes mellitus [18 (8%) vs 47 (22%) pts, p = 0,001]. Frequency of atrial fibrillation and anamnesis of previous heart failure hospitalization did not differ between comparing groups. Pts with ACMP had significantly higher LA diameter [3,9 (3,6; 4,5) vs 3,8 (3,5; 4,0) sm, p &lt; 0,001], LA volume index [34 (27; 42) vs 28 (22; 34) ml/m2, p &lt; 0,001] and lower PALSr [11,7 (10,4; 14,3) vs 14,7 (11,9; 16,4) %, p = 0,003], PALSc [-12,5 (-14,9; -9,5) vs -13,9 (-15,5; -11,2) %, p = 0,04] as well as PALSRr [1,85 (1,45; 1,95) vs 2,15 (1,78; 2,31) 1/s, p = 0,01] and PALSRc [-1,75 (-2,00; -1,38) vs -1,96 (-2,20; -1,81) 1/s, p = 0,009] than non-ACMP pts. Along with that pts with ACMP had significantly lower LV end-diastolic diameter [4,8 (4,5; 5,2) vs 4,9 (4,5; 5,4) sm, p = 0,006], A [0,60 (0,53; 0,70) vs 0,62 (0,55; 0,77) m/s, p = 0,04], E/É [6,6 (5,3; 9,6) vs 7,2 (6,2; 10,5), p = 0,01] and greater LV ejection fraction [62 (58; 67) vs 58 (51; 62), p &lt; 0,001]. Conclusions: In hypertensive pts with ACMP more prominent LA changes were accompanied by less obvious LV abnormalities.

Left atrium phasic impairments in paroxysmal atrial fibrillation patients assessed by cardiovascular magnetic resonance feature tracking

Atrial fibrillation (AF) is an abnormal and irregular heartbeat caused by uncoordinated electrical impulses in the left atrium (LA), which could induce lasting changes in the heart tissue or could be a consequence of underlying cardiac disease. This study aimed to assess the left atrial phasic function and deformation in paroxysmal AF (PAF) patients—who had not received radiofrequency ablation and had no signs of permanent AF—using the cardiovascular magnetic resonance (CMR) feature-tracking (FT) technique. Fifty subjects (27 PAF patients and 23 controls) were included and examined with CMR. Their LA volume, LA function, LA longitudinal strain (LS) and LA strain rate were assessed in the LA reservoir, conduit, and contractile phases. PAF patients exhibited higher LA volumes than controls, while their LA emptying fraction and LA LS was significantly lower in all three phases. In contrast, the corresponding emptying volumes (total, passive and active) were similar in both groups. The LA volumetric rates from CMR-derived volume curves differed significantly in PAF patients vs controls in the reservoir and contractile phases. In contrast, the equivalent LV volumetric rates were similar. This study suggests that assessing the LA phasic function could offer insight into early LA impairments for PAF patients.

Atrial Impairment as a Marker in Discriminating Between Takotsubo and Acute Myocarditis Using Cardiac Magnetic Resonance.

The purpose of this study was to comprehensively compare the left and right atrium strain and strain rate (SR) parameters by cardiac magnetic resonance (CMR) between patients with Takotsubo (TS) and patients with acute myocarditis (AM). We retrospectively enrolled 3 groups of patients: TS (n=18), AM (n=14), and 11 healthy subjects. All the patients had complete CMR data for features tracking assessment.Differences in reservoir, conduit strain (εe), conduit strain rate (SRe), and booster phase of biatrial strain were analyzed between the groups using analysis of variance and multivariate analysis of covariance analyses. Intraobserver and interobserver reproducibility was assessed for all strain and SR parameters using intraclass correlation coefficients and Bland-Altman analysis. Atrial strain was feasible in all patients and controls. In TS, left atrium (LA) reservoir strain (εs), reservoir SR, εe, and SRe were significantly lower compared with the other groups (P=0,001 for all). multivariate analysis of covariance analysis showed association of these parameters after correction for age and sex, while LA booster deformation (εa and SRa) strain parameters were preserved. LA SRe proved to have excellent sensitivity in differentiating patients with TS from those with AM (areas under the curves of 0.903, 95% confidence interval: 0.81-0.99).Biatrial strain and SR parameters showed good (excellent) intraobserver and interobserver reproducibility (ranged between 0.61 to 0.96 and 0.50 to 0.90, respectively). Compared with AM, patients with TS showed significantly decreased LA reservoir, conduit strain, and SR parameters. Therefore, LA strain assessment may have a role in discriminating between TS and AM.

Assessment of atria function after percutaneous closure of atrial septal defect using 2D speckle tracking echocardiography.

Percutaneous occlusion of atrial septal defect (ASD) has recently become a standard therapeutic strategy, but little is known about atria function thereafter. Strain analysis by two-dimensional speckle tracking echocardiography (2D-STE) is considered to be a new tool to assess myocardial function. This study aimed to evaluate atria function by quantifying longitudinal strain in patients with chronic RV volume overload due to ASD before and after percutaneous closure using 2D-STE. 28 consecutive patients underwent percutaneous closure of ASD (18 female, 10 male) were examined, clinical and echocardiographic evaluation one day before, 1day, and one month after percutaneous closure of ASD. Peak longitudinal systolic strain and strain rate of both atria were analyzed by 2D-STE. Mean age of the patients was 15.07 ± 8.39years; mean diameter of ASD was 16.01 ± 2.78mm; left atrium (LA) diameter significantly increased after ASD closure; and peak longitudinal strain of RA increased significantly one day and one month after ASD closure (48. 77 ± 4.40, vs.55.36 ± 3.70 and, vs. 62.13 ± 3.81%, p = 0.001). LA longitudinal strain significantly decreased after ASD closure (42.55 ± 4.57, vs. 34.79 ± 3.20%, p = 0.001). Furthermore, negative correlation was found between the size of the ASD and delta LA systolic strain and strain rate. 2D-STE can be considered a feasible and simple technique for assessment of atrial deformation in ASD patients, and it useful to assess the effect of percutaneous ASD closure on atrial reservoir function by measuring peak atrial longitudinal strain.

Left atrial function in patients with coronary artery disease: Role of 2D strain. État d’avancement du travail

Left ventricular (LV) dysfunction in patients with coronary artery disease (CAD) is shown by strain and strain rate imaging. However, left atrium (LA) function in such patients has been little studied by this method and impairment of atrial function in CAD due to ischemia has not been clearly evaluated. We aimed to evaluate left atrial function in patients with CAD and to determine whether 2D strain can be helpful to detect CAD in these patients. Seventy patients with CAD, with normal-size LA (LA diameter ≤ 4.0 cm, volume max index < 34 ml/m 2 ) (CAD group), fifty age-and-sex matched healthy subjects as a control group were included. Echocardiography was performed in patients in the two groups to evaluate left ventricular (LV) diastolic and systolic function, LA volume, and LA function. Two-dimensional strain echocardiographic imaging (2DSE) was performed. Both conventional parameters, strain and strain rate parameters, such as LA peak systolic strain and strain rate (LAs S/SR), early diastolic strain rate (LAe SR) and late diastolic strain and strain rate (LAa S/SR), were measured. Clinical and conventional echocardiographic parameters, including Doppler measurements, did not differ significantly between the two groups. LAs S/SR and LAe SR were lower in patients than in healthy subjects ( P < 0.05). No differences were found between the two groups regarding LAa S/SR. A significant correlation was observed between LAs S/SR and LA emptying fraction ( r = 0.63, P < 0.05; r = 0.49, P < 0.05, respectively). LAa S/SR were correlated to LA ejection fraction ( r = 0.71, P < 0.05; r = 0.51, P < 0.05, respectively). LAs SR was most reliable in identifying CAD patients from controls (AUC = 0.74) ( Fig. 1 ). Our results suggest that LAs S/SR may be a usuful parameter to identify patients with CAD.

EARLY AND CONTINUOUS DETECTION OF LEFT ATRIAL PHASIC DYSFUNCTION IN THE PROGRESSION OF HYPERTENSIVE CARDIAC REMODELING

Objective: Objective: The left atrium (LA) modulates left ventricular (LV) filling and cardiovascular performance with its reservoir, conduit, and booster pump functions. We used two dimensional speckle tracking echocardiography (2DSTE)-based strain and strain rate to evaluate LA mechanics in hypertensive patients with or without LA/LV structural remodeling. Design and method: Design and Method: We enrolled 30 healthy controls (Group I) and 302 HT patients, and we divided HT patients according to LV and LA structural remodeling. Group II (n = 101), HT without LVH and LA volume index (LAVI) &lt; 28 mL/m2; Group III (n = 82), HT without LVH and LAVI &gt; 28 mL/m2; Group IV (n = 98), HT with LVH and E/e‘ &lt; 13; Group V (n = 21), HT with LVH and E/e‘ &gt; 13. The strain and strain rate images were studied, and the following parameters were measured: LA reservoir strain and strain rate (LAS-S, LASR-S), LA conduit strain and strain rate (LAS-E and LASR-E), LA booster strain and strain rate (LAS-A and LASR-A). LA stiffness index (LASI) was defined as the ratio of E/e‘ to LAS-S. Results: Results: LASI was significantly higher in Group II than Group I (p &lt; 0.05), and further increased in Group III and IV. LASI is the highest in Group V (p &lt; 0.001 vs Group I and II, p &lt; 0.05 vs Group III and IV). Generally, All strain and strain rate parameters, including LAS-S, LASR-S, LAS-E, LASR-E, LAS-A and LASR-A, gradually and significantly decreased from Group I to Group V. We also explored the correlation between LASI and cardiovascular risk factors as well as the other markers of TOD in HT. LASI was correlated with age, diabetes, hemoglobin A1c, systolic blood pressure, BMI, LVMI, Ma/Cre, carotid IMT, PWV, Triglycerides and eGFR. Multivariate regression analysis revealed that age, BMI, PWV and Ma/Cre were independent factors related to LASI. Conclusions: Conclusions: The abnormality of LA mechanics precedes LA enlargement and LVH in HT, and strain-derived LA phasic function declined further along with LA and LV remodeling and diastolic dysfunction. LASI can be identified as a detective biomarker of left cardiac remodeling and diastolic dysfunction in HT.

Analysis of the left atrial function using two dimensional strain in patients with recent diagnosis of hereditary hemochromatosis

Abstract Funding Acknowledgements Type of funding sources: None. Background. Hereditary hemochromatosis (HH) is a genetic condition associated with a systemic iron overload caused by a reduction in the concentration of the iron regulatory hormone hepcidin or the hepcidin-ferroportin complex activity. Heart failure is the leading cause of death. It has been demonstrated early stages of systolic and diastolic left ventricular dysfunction in previous studies. The main function of the left atrium (LA) is to modulate the left ventricular filling through the reservoir, conduct and bump phases. Purpose. To compare the LA function between asymptomatic and recently diagnosed HH patients and a control group using two-dimensional speckle tracking. Methods. In this prospective study, 30 patients with HH (90% males, 47 ± 18 years old) and 30 healthy controls with a normal echo stress test (85% males, 45 ± 13 years old) were included. A conventional echocardiogram was performed. LA strain, LA strain rate and LA volumetric parameters during the reservoir, conduit and bump phases were studied according to the current recommendations. The LA stiffness index was calculated by using the ratio between E/e´ ratio and LA strain during the reservoir phase. Results. LA volume was similar in both groups (36,5 ± 10 ml vs 32,3 ± 6,5 ml; p = 0.09). No differences were observed in LA ejection fraction (EF) (57.5 ± 10% vs 60 ± 5%; p = 0.32), LA passive EF (35 ± 12% vs 36 ± 9%; p = 0.82) or LA bump function (34 ± 11% vs 36 ± 9.9%; p = 0.41) between both groups. On the contrary, the HH group had lower LA reservoir strain (31.5 ± 6.5% vs 38.3 ± 7.9%; p = 0.002) and during the conduct phase (18 ± 7% vs 23.3 ± 6.4%; p = 0.01) than the control group. The LA stiffness index was significantly higher in the HH group (25.5 ± 9.1 vs 19.5 ± 6.4; p = 0.01). Conclusion. Early abnormalities in the LA function could be detected by using two-dimensional speckle tracking study despite no evidence of changes in atrial size or volumetric parameters. Abstract Figure.

Left Atrial Strain in Patients With Systemic Lupus Erythematosus.

In patients with systemic lupus erythematosus (SLE), left ventricle diastolic dysfunction (LVDD) may be the only manifestation of cardiac involvement in anticipation of systolic dysfunction. It has been seen that myocardial deformation of the left atrium (LA), through the LA global longitudinal strain (LAGLS), may be useful in assessing diastolic function. To evaluate LA function through myocardial deformation in patients with LES, and compare the LA strain in patients with active, inactive and controls. Fifty patients with SLE were included and compared with 50 healthy controls paired by age and gender. Myocardial deformation was measured by transthoracic echocardiogram, to investigate the LAGLS, the strain of the three phases of the LA cycle and the strain rate. The differences between groups were compared in univariate analysis. LAGLS in SLE patients was less than in the controls (41.6% vs. 50.5%; p=.02), and in the 3 phases of the LA cycle. There were no differences in the LA strain rate in both groups (SLE 2.5s-1 vs. controls 2.75s-1; p=.1). It was also found that the LAGLS was lesser in active patients than controls and inactive. SLE patients have lower myocardial deformation of the LA, which is expressed as a lower diastolic function correlating with early subclinical myocardial damage.

Left atrial strain in patients with systemic lupus erythematosus

BackgroundIn patients with systemic lupus erythematosus (SLE), left ventricle diastolic dysfunction (LVDD) may be the only manifestation of cardiac involvement in anticipation of systolic dysfunction. It has been seen that myocardial deformation of the left atrium (LA), through the LA global longitudinal strain (LAGLS), may be useful in assessing diastolic function. ObjectiveTo evaluate LA function through myocardial deformation in patients with LES, and compare the LA strain in patients with active, inactive and controls. MethodsFifty patients with SLE were included and compared with 50 healthy controls paired by age and gender. Myocardial deformation was measured by transthoracic echocardiogram, to investigate the LAGLS, the strain of the three phases of the LA cycle and the strain rate. The differences between groups were compared in univariate analysis. ResultsLAGLS in SLE patients was less than in the controls (41.6% vs 50.5%; p?=?.02), and in the 3 phases of the LA cycle. There were no differences in the LA strain rate in both groups (SLE 2.5 s-1 vs controls 2.75 s-1; p?=?.1). It was also found that the LAGLS was lesser in active patients than controls and inactive. ConclusionsSLE patients have lower myocardial deformation of the LA, which is expressed as a lower diastolic function correlating with early subclinical myocardial damage.

Echo after Transcatheter aortic valve implantation (TAVI) in Medina Cardiac Centre

Introduction In patients (pts) with aortic valve stenosis (AS), it has been demonstrated that left atrium (LA) mechanics assessed by speckle tracking echocardiography (STE) were reduced compared with controls. LA strain and strain rate parameters are more affected in AS than in pts with hypertension, despite a similar extent of left ventricle (LV) hypertrophy and LA dilatation. Reverse remodeling process of LA post aortic valve replacement was observed in many studies. The aim of this study was to assess LA remodeling and LV diastolic functions after Transcatheter Aortic Valve Implantation (TAVI). Methodology All patients who had TAVI in the period of 2013 and 2016 at Medina Cardiac Centre were included. LA functions were assessed by STE using TOMTEC software before and 12 ± 3 months after TAVI. In apical 2 chamber view, the average Peak negative strain of left wall of LA, right wall of LA and LA roof were determined. LA volumes and LV diastolic parameters were measured. Results Eighty patients with severe symptomatic AS were retrospectively enrolled (79.5 ± 4Y, aortic valve area 0.73 ± 0.4cm2 and Logistic Euro score 15.0 ± 13.9. At 12 ± 3 months post TAVI LA diastolic volume index decreased from 36.1 ± 5.3 mL/m2 to 33.9 ± 4.6 mL/m2 (P = 0.2), LA systolic volume index decreased from 24.7 ± 4.5 mL/m2 to 20.7 ± 3.9 mL/m2 (p = 0.3) and LA fraction improved from 20.5 ± 3.1% to 24 ± 3.5% (P = 0.5).The average peak negative LA strain was low at −8.2 ± 7.1% and improved to −13.1 ± 6.8% (P = 0.02). LA strain rate improved from −0.79 ± 0.48 s-1 to −1.12 ± 0.36 s-1 (P = 0.05). The Diastolic parameters including E/A ratio, deceleration time and E/ e- are significantly improved. E/A ratio improved from 1.68 ± 0.5 to 1.2 ± 0.4 (P Conclusion Significant improvement of LA mechanical parameters assessed by STE reflects improvement of LA remodeling and recovery of LV diastolic function post TAVI.

Left atrial function, inflammation, and prothrombotic response after radiofrequency ablation for atrial fibrillation

BackgroundThe conversion of atrial fibrillation (AF) to sinus rhythm is associated with transient dysfunction of the left atrium (LA). This study aimed to investigate the time course of LA function and inflammation after radiofrequency (RF) ablation for paroxysmal AF. MethodsFifty-three patients with paroxysmal AF undergoing RF ablation were recruited. White blood cells were counted and high-sensitivity C-reactive protein (hs-CRP), fibrinogen, and D-dimer levels were measured. LA emptying fraction, strain, and strain rate were evaluated before RF ablation and at 1, 2, 3, and 4 weeks and 2 and 3 months after ablation using conventional Doppler echocardiography and two-dimensional speckle-tracking echocardiography. ResultsLA emptying fraction sharply decreased at day 7 after ablation and then slowly increased (p < 0.05) and returned to the baseline value at day 28. LA strain and strain rate values sharply decreased at day 7 after the procedure and then slowly increased (p < 0.05). A significant correlation between hs-CRP level and LA emptying fraction was found at day 7. ConclusionReduced LA function and increased prothrombotic tendency were found at ∼1 week after AF ablation for paroxysmal AF. Therefore, monitoring the time and degree of anticoagulation after ablation for paroxysmal AF might effectively prevent thromboembolic events and reduce anticoagulant cost and bleeding risk.

Impact of the MitraClip Procedure on Left Atrial Strain and Strain Rate.

Although reverse remodeling of the left atrium (LA) has been shown after MitraClip placement in degenerative mitral regurgitation (MR), changes in LA strain and strain rate have not been evaluated in these patients or compared with surgical mitral valve repair. We included 87 subjects (mean age 59.7±12.3 years) with degenerative MR enrolled in the randomized EVEREST II trial (Endovascular Valve Edge-to-Edge Repair Study II). Baseline peak positive LA strain (ε) and strain rates along with longitudinal left ventricular strain (LV ε) were compared with 12-month follow-up measures. At 12 months, all 38 mitral valve repair subjects had ≤2+ MR, and 31 of the 49 MitraClip had ≤2+ MR. Baseline LA strain and strain rate values were similar in MitraClip and mitral valve repair groups. Of the strain rate measures, only peak early diastolic strain rate was consistently decreased in all treatment arms. In patients with reduced baseline LA ε, no significant change in LA ε occurred in either the MitraClip or mitral valve repair group despite significant MR and LA volume reduction. However, in patients with normal or high baseline ε, successful MR reduction by either method resulted in return of LA ε to normative values. There was a significant correlation between LA ε, LV ε values, and change in LA ε and LV ε over time. Changes seen in LA ε seem to depend on baseline LA and LV function. Changes in LA ε after MR reduction may reflect a decrease in LA expansion but may also be influenced by the degree of pre-existing LA dysfunction. URL: https://www.clinicaltrials.gov. Unique identifier: NCT00209274.

PP.14.15] ASSOCIATION BETWEEN VENTRICULAR-ARTERIAL COUPLING PARAMETERS AND LEFT ATRIAL REMODELING WITH ATRIAL FIBRILLATION RECURRENCES IN PATIENTS WITH DIASTOLIC DYSFUNCTION

Objective: Left ventricular diastolic dysfunction (DD) is one of the main mechanisms of structural and functional changes of the left atrium (LA). It can be caused by impaired ventricular-arterial coupling (VAC). The relationships between VAC, LA remodeling and atrial fibrillation (AF), however, remain unclear. We tried to evaluate VAC parameters with LA remodeling and their predictive value for AF recurrence during a 3-month follow-up period in patients with recurrent AF and mild to moderate left ventricular DD. Design and method: Sixty patients [45% male, median age 65 (61; 72) years] with recurrent non-valvular AF and mild to moderate DD were enrolled in the study and treated with amiodarone 200 mg + metoprolol 50 mg daily (n = 30) or sotalol 160 mg daily (n = 30). All the patients underwent conventional and speckle tracking echocardiography. Global peak LA longitudinal strain (PALS) and strain rate (PALSR) in the reservoir (r) and contractile (c) phases were assessed using 6 segments in the 4-chamber and 2-chamber views. To assess VAC EaI, EesI, Ea/Ees, systemic vascular resistance index and total arterial compliance (TAC) were calculated. Follow-up period was 3 months. Results: EaI was significantly associated with LA size (r = −0.38, p = 0.003), LA end diastolic volume (r = −0.33, p = 0.009) and PALSc (r = −0.31, p = 0.02). EesI correlated with E/A (r = −0.3, p = 0.02). Ea/Ees was related to E/E’ (r = 0.4, p = 0.002). Thirty-five (58%) patients (group 1) had complete antiarrhythmic response, whereas 25 (42%) patients (group 2) experienced at least one AF recurrence. Despite having comparable E/E’, E’ and LA volume index, the patients of group 1 had significantly higher PALSr (15.7 vs 12.6, p = 0.004), PALSc (−16.2 vs -13.9, p = 0.008), PALSRr (2.44 vs 1.76, p < 0,001), PALSRc (−2.4 vs −1.66, p < 0.001), E (0.87 vs 0.69, p < 0.001), IVRT (90 vs 89, p = 0.04) and TAC (1.26 vs 1.08, p = 0.04), whereas Ees corrected by afterload was higher in group 2 (619 vs 803, p = 0,004). Stepwise multiple regression analysis revealed that PALSRc was linked to AF recurrence (β = 0.38, p = 0.04). Conclusions: VAC parameters were significantly related to LA remodeling and DD but had no prognostic value in recurrence of AF. Only PALSRc was independently associated with complete antiarrhythmic effect.

The Role of Left Atrium

Left atrium (LA) contributes 20-30% of cardiac output. LA volume and function measured by 2D biplane area length and real-time 3D echocardiography have been well-validated and widely used. LA function consists of 3 components, including reservoir, conduit, and active contractile phases. The most frequently used echocardiographic method for evaluation of phasic function of LA is volumetric method. LA volume measured by biplane area-length method and corrected by body surface area is a useful index for studying LA remodeling, and early LA remodeling has been proven to have prognostic significance in heart failure after myocardial infarction. Phasic changes of LA volume can be measured in different phases of cardiac cycle. Volumetric measurements are useful in evaluation of LA, however, volumetric changes can not reflect changes of the LA wall itself. Tissue Doppler imaging has been applied for the assessment of cardiac function, including atrial function. Atrial deformation evaluated by tissue Doppler derived strain or strain rate imaging can be used for assessment of LA wall directly. Newly developed speckle tracking echocardiography is useful in assessment of left ventricular strain and strain rate. This non-Doppler two-dimensional strain imaging avoids effects of Doppler angle and ventricular tethering. Speckle tracking echocardiography was recently used for assessment of LA function after resynchronization therapy. The feasibility of LA longitudinal strain and strain rate measured by speckle tracking echocardiography has been verified in healthy subjects, and adequate tracking can be performed in 94% of subjects or in 97% of segments. Early changes of LA function can be documented by speckle tracking echocardiography. We have found the phasic LA function changed in untreated hypertension subjects and correlated with left ventricular diastolic function. LA strain also has prognostic implications such in primary mitral regurgitation or in atrial fibrillation.

Left atrial myocardial deformation characteristics in patients presenting with ST elevation myocardial infarction

Abstract Background The left atrium (LA) plays an important role in left ventricular (LV) function, we investigated the LA myocardial deformation characteristics in patients presenting with acute ST segment elevation myocardial infarction (STEMI). Methods Forty STEMI patients (aged 54.78 ± 6.7, 92.5% men) and twenty healthy matched control (aged 50.7 ± 7.4 years, 90% men) were included. All patients had conventional echocardiography and tissue Doppler imaging (TDI), with measurement of LA volumes (LA maximum volume index, LA minimum volume index, and LA reservoir volume index), the early transmitral inflow velocity (E) to early diastolic mitral annular velocity (Ea) ratio, and the LA global longitudinal strain and strain rate were also measured using TDI, and the following parameters were measured: the global [peak systolic strain (PSS), peak systolic strain rate (PSSR), early diastolic strain rate (ESR), and late diastolic strain rate (ASR)]. Results All the measured LA volumes were significantly increased in patients compared to control. The LA global longitudinal strain (%) and strain rate ( S −1 ) parameters were significantly reduced in patients compared to control, the PSS (11.69 ± 4.25 vs 22.43 ± 3.74, p = 0.0001), the PSSR (1.04 ± 0.37 vs 1.81 ± 0.28, p = 0.0001), the ESR (−0.84 ± 0.44 vs −1.98 ± 0.60, p = 0.0001), and the ASR (−1.43 ± 0.29 vs −1.62 ± 0.37, p = 0.034), and we found that the global PSS had a significant negative correlation to E /Ea ( r = −0.457, P = 0.0001) and significant positive correlation to left ventricular ejection fraction ( r = 0.338, P = 0.033) in patients with STEMI. Conclusion Our study concluded that the LA reservoir, conduit and booster pump functions studied by TDI strain were reduced in STEMI patients, and the global peak systolic strain was significantly correlated with the LV systolic and diastolic dysfunction.