Peak Atrial Contraction Strain Research Articles

Measures of left atrial structure and function predict cardiovascular death in patients with heart failure with reduced ejection fraction

Abstract Background The role of the left atrium (LA) is increasingly recognized as a predictor of cardiovascular health outcomes. This study aimed to investigate the prognostic value of LA strain in relation to cardiovascular (CV) death in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Methods In this retrospective cohort analysis, patients diagnosed with stable HFrEF and free from atrial fibrillation at baseline were included. All patients had a Left Ventricular Ejection Fraction (LVEF) of 45% or below at the time of referral. Baseline clinical and echocardiographic parameters were collected from the database of the HF outpatient clinic, and data on CV death was gathered through the Danish National Patient Registry. LA function was assessed by means of LA emptying fraction (LAEF), peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and LA conduit strain (LACS). Uni- and multivariable Cox regression models adjusted for clinical and echocardiographic baseline characteristics were used to determine the association between LA parameters and CV death. Cubic splines were used to identify cutoff values for LA parameters corresponding to a HR of 1. Results The study population consisted of 495 patients (mean age 66 ±11.5 years, 71% males). During a follow-up of 10.9 years [IQR: 6.2; 13.4], 134 (27%) patients reached the outcome of CV death. At baseline, patients who died of CV death were generally older (70.7±9.7 years vs. 64.2±11.7, p<0.001), had a higher prevalence of diabetes (25.4% vs. 13.9%, p=0.004), and a higher prevalence of moderate or severe valve disease (11.2% vs. 3.9%, p=0.004), as well as a lower LVEF (25.1%±8.5 vs. 29.4±8.9, p<0.001). Among LA parameters, the patients who met the outcome had a significantly lower LAEF (30.5% [IQR: 18.0; 42.0] vs. 38.9% [IQR: 29.0; 49.3], p<0.001), PALS (18.2% [IQR: 12.7; 24.4] vs. 23.0% [IQR: 18.3; 29.9], p<0.001), PACS (7.7% [IQR: 2.9; 13.6] vs. 11.7% [IQR: 7.9; 16.4], p<0.001), and LACS (9.4% [IQR: 7.2 ; 12.4] vs. 11.9% [IQR: 8.8; 15.0], p<0.001). Lower levels of all LA parameters were associated with an increased risk of CV death in univariable analysis (p<0.0001 for all parameters). However, in multivariable analysis, only LAEF (HR 0.99 per 1% increase, 95% CI 0.973-0.999, p=0.039), PALS (HR 0.96 per 1% increase, 95% CI 0.931–0.991, p=0.011), and PACS (HR 0.94 per 1% increase, 95% CI 0.90–0.98, p=0.002) remained significant. Splines for LAEF, PALS, and PACS were constructed with identified cutoff points for higher CV death risk (Figure 1), which were utilized to generate Kaplan-Meier curves (Figure 2). Conclusion Lower LA parameters, including LAEF, PALS, and PACS, are associated with increased risk of CV death in patients with HFrEF.Spline curves for LAEF, PALS, and PACS.Kaplan-Meier survival estimates for CVD

Quantitative Analysis of Right Atrial Functions by 2D-Speckle Tracking Echocardiography During Healthy Pregnancy.

The role of speckle tracking in the assessment of right atrial (RA) deformation parameters has not been investigated yet. The purpose of this article is to establish the effects of normal pregnancy on RA mechanical changes obtained by 2-dimensional speckle-tracking echocardiography. A total of 49 healthy pregnant women were included in the study. All participants were followed for each trimester and postpartum period, encompassing standard assessments of both RA and ventricular functions, as well as measurements of RA global peak atrial longitudinal strain (RA-Global-PALS) and RA global peak atrial contraction strain (RA-Global-PACS). Additionally, the RA segments were individually evaluated with respect to strain parameters. During pregnancy, the increased volume load resulted in elevated RA reservoir function, as indicated by RA-Global-PALS, and increased contraction parameter, as indicated by RA-Global-PACS. These changes were within physiological limits and reversible. Segmental analysis of the right atrium showed similar findings for regional PACS and PALS parameters. In this study, we established normal RA deformation parameters for healthy pregnancies. These data will aid in discerning various measures of RA phasic function in cardiovascular and systemic conditions among normal pregnant women. Moreover, they may offer insights into potential cardiac pathologies that may arise during the pregnancy.

Diagnostic Value of Left Atrial Strain in Heart Failure with Preserved Ejection Fraction

Introduction: Despite different ultrasound parameters, left ventricular filling pressures (LVFP) assessment remains inconclusive in some cases. We aimed to determine the contribution of left atrial strain (LAS) in estimating of LVFP in patients suspected of having heart failure with preserved ejection fraction (HFpEF). Methods: This was a monocentric study, carried out in the cardiology department of the Interior Security Forces Hospital of Marsa, between October 2021 and March 2022. Patients had a physical examination, a biological assessment and an ultrasound examination at rest and, if necessary, during exercise. We investigated the performance of LAS components (Peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS) and conduit function (FnC) in predicting LVFP rising. Results: We enrolled 73 patients. The mean age was 61 ± 12 years old with a female predominance (57.5%). The median PALS was 29.3% [21.4-32.4]. The mean PACS and FnC values were 13.4% ± 4.9 and 13.7% ± 4.7, respectively. Patients were categorized into two finals groups according to LVFP: Group A= high LVFP at rest or during exercise (25 = 34%) and Group B = not-high LVFP at rest and during exercise (48 = 66%). Patients with high LVFP had lower LAS parameters and higher NT-Pro BNP levels. LAS had negative correlations with E/e' ratio and NT-Pro BNP. PALS was an independent predictor of LVFP raising (HR = 0.711; 95% CI: 0.513 - 0.986; p = 0.041). Conclusion: LAS is a simple, reproducible and sensitive ultrasound parameter for the diagnosis of HFpEF

Changes in left atrial function following two regimens of combined exercise training in patients with ischemic cardiomyopathy: a pilot study.

Left atrial dysfunction has shown to play a prognostic role in patients with ischemic cardiomyopathy (ICM) and is becoming a therapeutic target for pharmacological and non-pharmacological interventions. The effects of exercise training on the atrial function in patients with ICM have been poorly investigated. In the present study, we assessed the effects of a 12-week combined training (CT) program on the left atrial function in patients with ICM. We enlisted a total of 45 clinically stable patients and randomly assigned them to one of the following three groups: 15 to a supervised CT with low-frequency sessions (twice per week) (CTLF); 15 to a supervised CT with high-frequency sessions (thrice per week) (CTHF); and 15 to a control group following contemporary preventive exercise guidelines at home. At baseline and 12 weeks, all patients underwent a symptom-limited exercise test and echocardiography. The training included aerobic continuous exercise and resistance exercise. The analysis of variance (ANOVA) was used to compare within- and inter-group changes. At 12 weeks, the CTLF and CTHF groups showed a similar increase in the duration of the ergometric test compared with the control (ANOVA p < 0.001). The peak atrial longitudinal strain significantly increased in the CTHF group, while it was unchanged in the CTLF and control groups (ANOVA p = 0.003). The peak atrial contraction strain presented a significant improvement in the CTHF group compared with the CTLF and control groups. The left ventricular global longitudinal strain significantly increased in both the CTHF and the CTLF groups compared with the control group (ANOVA p = 0.017). The systolic blood pressure decreased in the CTHF and CTLF groups, while it was unchanged in the control group. There were no side effects causing the discontinuation of the training. We demonstrated that a CT program effectively improved atrial function in patients with ICM in a dose-effect manner. This result can help with programming exercise training in this population.

Atrial Strain and Strain Rate in a General Population: Do These Measures Improve the Assessment of Elevated NT‐proBNP Levels?

Background. Noninvasive assessment of elevated filling pressure in the left ventricle (LV) remains an unresolved problem. Of the many echocardiographic parameters used to evaluate diastolic pressure, the left atrial strain and strain rate (LA S/SR) have shown promise in clinical settings. However, only a few previous studies have evaluated LA S/SR in larger populations. Methods. A total of 2033 participants from Norwegian (Tromsø 7) and Russian (Know Your Heart) population studies, equally distributed by age and sex, underwent echocardiography, including atrial and ventricular S/SR and NT‐proBNP measurements. Of these, 1069 were identified as healthy (without hypertension (HT), atrial fibrillation (AF), or structural cardiac disease) and were used to define the age‐ and sex‐adjusted normal ranges of LA S/SR. Furthermore, the total study population was divided into groups according to ejection fraction (EF) ≥50%, EF &lt;50%, and AF. In each group, uni‐ and multiple regression and receiver operating characteristic curve analyses were performed to test LA and LV functional parameters as potential indicators of NT‐proBNP levels above 250 ng/ml. Results. The mean LA S/SR values in this study were higher than those in previous large studies, whereas the lower references were comparable. In normal hearts, atrial total strain (ATS) and mitral valve E deceleration time (MV DT) were independent factors indicating elevated NT‐proBNP levels, whereas in hearts with reduced EFs, the independent indicators were peak atrial contraction strain (PACS) and LV stroke volume. The areas under the curve for these significant indicators to discriminate elevated NT‐proBNP levels were 0.639 (95% confidence interval (CI): 0.577–0.701) for normal EF and 0.805 (CI: 0.675–0.935) for reduced EF. Conclusion. The results confirm good intrastudy reproducibility, with mean values in the upper range of previous meta‐analyses. In the future, automated border‐detection algorithms may be able to generate highly reproducible normal values. Furthermore, the study showed atrial S/SR as an additional indicator of elevated NT‐proBNP levels in the general population, demonstrating the incremental value of both ATS and PACS in addition to conventional and ventricular strain echocardiography. Thus, the LA S/SR may be regarded as an important addition to the multiparametric approach used for evaluating LV filling.

Contribution of TNF-R1 to reduced exercise capacity in hypertensive heart disease. Mediating role of left atrial mechanical function reserve

Abstract Background Tumor necrosis factor alpha (TNF-alpha) plays a relevant pathophysiological role in cardiovascular disorders, including hypertensive heart disease (HHD) – a clinical condition frequently contributing to the development of heart failure with preserved ejection fraction (HFpEF). TNF receptor 1 (TNF-R1) has been found to mediate proinflammatory and proapoptotic effects of TNF-alpha, and its soluble circulating form proved to be effective in predicting incident HF. Existing evidence indicates the association between TNF pathways activation and cardiac dysfunction, but exact mechanisms mediating this link are unclear. Objectives We sought to investigate the association of TNF-R1 with exercise capacity, and left ventricular (LV) and left atrial (LA) function reserve in asymptomatic patients with HHD. Methods We enrolled 80 (55±12 yo) patients with HHD and normal exercise tolerance (stage A and B HF). Echocardiography (including LA and LV strain assessment) was performed at rest and immediately post exercise test. Blood samples for TNF-R1 were drawn in fasting conditions. Exercise reserve of cardiac function parameters was calculated by subtracting resting value from exercise value. Results The study population was categorized into 2 subsets using a median value of exercise capacity (9.2 METs). Patients with higher exercise capacity were characterized by lower TNF-R1 concentrations and higher LA reservoir and LA contractile strain reserves (Table). No significant intergroup differences were found for exercise reserves in LV ejection fraction (LVEF), LV global longitudinal strain and diastolic parameters (e’ and E/e’). TNF-R1 significantly correlated with peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) reserves (r=-0.27; p&amp;lt;0.02 and r=-0.24; p&amp;lt;0.04, respectively), but not with LVEF, global longitudinal strain (GLS), e’ and E/e’ reserves. Regression-based mediation analysis revealed that the relationships between TNF-R1 and exercise capacity were mediated by PALS and PACS reserve, as evidenced by the reduction in variance of exercise capacity (METs) explained by TNF-R1 after the inclusion of PALS and PACS reserve to the models (decrease in beta coefficient from -0.24 to -0.19 for PALS, and to -0.20 for PACS, Figure). Conclusions In patients with HHD, higher TNF-R1 is associated with lower exercise capacity, and this relationship may be mediated by lower LA strain reserve. This finding may contribute to elucidating the mechanisms behind the involvement of the left atrium in HF progression.Mediation analysis

Post-transplant left atrial function depends on the technique used for orthotopic heart transplantation

Abstract Background Even short episodes of post-transplant atrial fibrillation (AF) have been shown to increase the risk of adverse outcomes, including thromboembolic events, graft failure, and increased mortality. Of the two most commonly used heart transplantation techniques - bicaval and total orthotopic heart transplantation (OHTx), the former approach combines the donor and recipient atria, and may predispose to supraventricular arrhythmias, especially atrial fibrillation, as well as lead to a higher incidence of atrioventricular valve incompetence. Existing data relate mainly to the more non-physiological left atrial (LA) size and geometry after bicaval OHTx, while little is known about differences in LA function between patients treated with both techniques. Aim To compare LA functional and morphological characteristics between patients after bicaval and total OHTx. Methods The study group consisted of 28 patients who underwent OHTx between May 2021 and December 2022: 14 consecutive patients after total OHTx and 14 subjects after bicaval OHTx matched by age and time from heart transplant. Echocardiographic examination included standard measurements and left ventricle (LV) and LA longitudinal deformation assessment by speckle tracking technique. Results All enrollees were male. There were no differences between the groups after total and bicaval OHTx in anthropometric and laboratory parameters. Routine endomyocardial biopsies performed during follow-up after OHTx in all patients did not show severe graft rejection. No significant differences were found in LV dimensions, ejection fraction and stroke volume, Doppler velocities of mitral inflow and mitral annulus, as well as LV global longitudinal strain. In contrast to LV measures, significant between-group differences were demonstrated for LA parameters: LA volume index was significantly higher, and peak atrial longitudinal strain (PALS) corresponding to LA early diastole in the reservoir phase and peak atrial contraction strain (PACS) corresponding to LA systole were significantly higher in the total OHTx group than in the bicaval OHTx group (Table). Conclusions Total OHTx technique is associated with a more favorable LA morphology and function, which may explain the lower prevalence of atrial fibrillation reported in the literature in patients treated with this method. The clinical significance of reduced LA contribution to LV filling in patients subjected to bicaval OHTx needs further exploration.

Abstract 18784: Impaired Left Atrial Strain is a Risk Factor for New-Onset Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting millions of individuals. Left atrial (LA) strain, a measure of LA function and remodeling, holds potential as a prognostic indicator for AF development. We aimed to examine whether LA strain is associated with new onset AF. Methods: We performed a nested case-control study within an electronic health record-based longitudinal cohort of primary care patients from a multi-institutional healthcare system spanning 2001 to 2018. Cases included patients who developed new-onset AF during a follow-up period of 7.3 years and had undergone transthoracic echocardiography (TTE) within three years of the follow-up start. Several LA strain parameters were compared between the case and control groups, including Peak Atrial Longitudinal Strain (PALS), Left Atrial Conduit Strain (LACS), and Peak Atrial Contraction Strain (PACS). Results: The study included 216 patients who developed AF during follow-up each matched with a corresponding age- and sex-matched control without AF. The AF group had significantly lower PALS (25.9 ± 8.9 vs. 34.3 ± 10.4, p&lt;0.001) and LACS (13.6 ± 5.2 vs. 19.9 ± 7.6, p&lt;0.001) compared to the non-AF group. Subgroup analyses of AF patients, stratified by the time to AF development, revealed more substantial differences between the AF and non-AF groups when the initial TTE was conducted closer to the onset of AF. Specifically, when the TTE was performed within 2 years prior to AF onset, the disparities in LA strain parameters were more pronounced compared to TTEs conducted between 2-5 years prior or beyond 5 years prior to AF onset. Conclusions: Impaired left atrial strain is strongly associated with new-onset AF, particularly when measured 2 years prior to AF onset, indicating a higher risk of developing AF in the near future. Incorporating LA strain assessment into clinical decision-making can enhance the evaluation of individuals at risk for AF.

Acute Changes on Left Atrial Function during Incremental Exercise in Patients with Heart Failure with Mildly Reduced Ejection Fraction: A Case-Control Study.

the aim of this study was to assess acute changes in left atrial (LA) function during incremental aerobic exercise in patients with heart failure with mildly reduced ejection fraction (HFmrEF) in comparison to healthy subjects (HS). twenty patients with established HFmrEF were compared with 10 HS, age-matched controls. All subjects performed a stepwise exercise test on a cycle ergometer. Echocardiography was performed at baseline, during submaximal effort, at peak of exercise, and after 5 min of recovery. HS obtained a higher value of METs at peak exercise than HFmrEF (7.4 vs. 5.6; between group p = 0.002). Heart rate and systolic blood pressure presented a greater increase in the HS group than in HFmrEF (between groups p = 0.006 and 0.003, respectively). In the HFmrEF group, peak atrial longitudinal strain (PALS) and conduit strain were both increased at submaximal exercise (p < 0.05 for both versus baseline) and remained constant at peak exercise. Peak atrial contraction strain (PACS) did not show significant changes during the exercise. In the HS group, PALS and PACS increased significantly at submaximal level (p < 0.05 for both versus baseline), but PALS returned near baseline values at peak exercise; conduit strain decreased progressively during the exercise in HS. Stroke volume (SV) increased in both groups at submaximal exercise; at peak exercise, SV remained constant in the HFmrEF, while it decreased in controls (between groups p = 0.002). patients with HFmrEF show a proper increase in LA reservoir function during incremental aerobic exercise that contributes to maintain SV throughout the physical effort.

The Improvement of Left Atrial Function after Twelve Weeks of Supervised Concurrent Training in Patients with Heart Failure with Mid-Range Ejection Fraction: A Pilot Study.

Left atrial dysfunction is associated with exercise intolerance and poor prognosis in heart failure (HF). The effects of exercise training on atrial function in patients with HF with mid-range ejection fraction (HFmrEF) are unknown. The purpose of the present study was to assess the effects of a supervised concurrent training (SCT) program, lasting 12 weeks, on left atrial function of patients with HFmrEF. The study included 70 stable patients, who were randomly assigned into two groups: SCT with (three sessions/week) or a control (CON) group directed to follow contemporary exercise preventive guidelines at home. Before starting the training program and at 12 weeks, all patients performed an ergometric test, a 6 min walk test, and echocardiography. Between-group comparisons were made by analysis of variance (ANOVA). At 12 weeks, the duration of the ergometric test and distance walked at 6 min walk test presented a significant greater increase in SCT compared to the control (between-group p 0.0001 and p 0.004 respectively). Peak atrial longitudinal strain and conduit strain presented an increase of 29% and 34%, respectively, in the SCT, and were unchanged in CON (between-group p 0.008 and p 0.001, respectively). Peak atrial contraction strain increased by 21% in SCT, with no changes in CON (between-group p 0.002). Left ventricular global longitudinal strain increased significantly in SCT compared to control (between-groups p 0.03). In conclusions, SCT improved left atrial and left ventricular function in HFmrEF. Further studies are needed in order to verify whether these favourable effects of SCT on LA function are sustained and whether they will translate into clinical benefits for patients with HFmrEF.

Predictive value of left and right atrial strain for the detection of atrial fibrillation in patients with cryptogenic stroke and implant of loop recorder

Abstract Funding Acknowledgements Type of funding sources: None. Background Structural and functional remodeling of left and right atrium (LA-RA) are predictors of the risk of hospitalization and mortality. These are chronic and complex processes, dependent on an adaptive response implemented by the atrial myocytes against stressors of an electrical, mechanical and metabolic nature. Atrial fibrillation (AF) is the most common condition associated with remodeling of both atria, of which it can be cause and effect at the same time: atrial enlargement, interstitial fibrosis and myocardial distension. Often the first manifestation of AF is cryptogenic stroke (CS) which is associated with a high rate of recurrence and adverse long-term follow-up outcomes, mainly due to its unknown etiology often leading to secondary prevention ineffective. Asymptomatic (AF) may play an important pathophysiological role to detect CS. Evidence has demonstrated the efficacy of AF ablation in restoring the structure of the LA and, consequently, in favoring the maintenance of sinus rhythm. However, little is known regarding the evaluation of RA remodeling and its variation over time in patients with FA. Aim of the study Evaluate the relationship between echocardiographic parameters of LA and RA function, and the occurrence of AF revealed by continuous ECG monitoring through insertable cardiac monitors (ICM) implant in a cohort of patients with CS Methods Single-center retrospective study. A total of 204 patients who suffered from cryptogenic stroke underwent ICM between May 2013 and July 2022. All detected AF episodes lasting more than 30 seconds were considered, according to Guidelines. All patients underwent to Transthoracic Echocardiography (TTE) to study on LA and RA function, including both standard and longitudinal strain-derived parameters. Transesophageal Echocardiography (TEE) was also performed to exclude embolic sources. Results During a median follow-up period of 15.3 months (interquartile range, 7.4 / 23.5), continuous ECG monitoring revealed AF in 96 patients (47.0%). Many echocardiographic parameters, such as LA maximum and minimal volume were significantly associated with the occurrence of AF, suggesting the worst atrial function in the AF group. Furthermore, multivariable regression analysis revealed that peak atrial contraction strain of both atria were independently associated with AF (p &amp;lt; 0.001,respectively). Conclusion In patients with cryptogenic CS, LA and RA strain analysis are strong and independent predictors of the occurrence of AF despite clinical and morpho-functional echocardiographic parameters.

Ocena funkcji prawego przedsionka za pomocą echokardiografii metodą śledzenia markerów akustycznych

Introduction. Speckle tracking echocardiography (STE) is a well-established tool to assess cardiac function parameters, however, the value of this tool in the assessment of right atrial (RA) function is still largely unknown. The aim of the study is to investigate the feasibility of RA function assessment by STE and the relationship between right ventricular (RV) deformation and the function of the RA. Material and methods. 94 patients with various cardiovascular pathologies have been included in the study group. All patients underwent transthoracic echocardiography with subsequent off-line analysis using speckle tracking technique and measurement of numerous RA deformation parameters, including peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS), as well as established indices of RV function, such as tricuspid annular peak systolic excursion (TAPSE) and global longitudinal strain (GLS). Results. RA function assessment by STE was feasible in all patients. A statistically significant correlation was observed between RA strain (PACS and PALS) and RV parameters. RV-GLS showed weak correlation with PALS (r = –0.38; p = 0.0015) and PACS (r = –0.30; p = 0.013). Similarly, TAPSE correlated with PALS and PACS (r = 0.34; p = 0.02) and (r = 0.23; p = 0.04) respectively. Conclusion. RA function assessment by STE is feasible. The RA deformation parameters weakly correlate with RV function indices, indicating that other factors significantly influence RA function. Therefore, the RA function cannot be regarded as a direct barometer of the RV function.

Left Atrial Functional Remodeling in Patients with Chronic Heart Failure Treated with Sacubitril/Valsartan.

(1) Background: Previous studies showed left ventricular (LV) and left atrial (LA) improvement and reverse remodeling after therapy with Sacubitril/Valsartan (S/V) in patients affected by heart failure with reduced ejection fraction (HFrEF). Therefore, we sought to investigate predictors of LA structural and functional reverse remodeling (LARR) in this setting of patients after therapy with S/V, focusing on left atrial strain parameters, such as peak atrial longitudinal strain (PALS). (2) Methods: Patients with HFrEF underwent clinical and echocardiographic evaluation at baseline and after six months of therapy with S/V. Measures of LA structure (LA volume index, LAVi) and function (LA emptying fraction (LAEF), PALS, LA conduit strain and peak atrial contraction strain (PACS) were also analyzed. Patients were divided in two groups, those with a LARR (relative reduction in LAVi > 15%, LARR+) and those without (LARR-). (3) Results: A total of 47 consecutive patients (66 ± 8 years, 85% male, mean LVEF 28 ± 6%) were enrolled in the study and followed up. A significant increase of LAEF (46 ± 13 vs. 37 ± 11%, p < 0.001) and a significant reduction of LAVi (42 ± 15 vs. 45 ± 15 mL/m2, p = 0.008) were found after 6 months of S/V therapy; 47% of the population showed LA reverse remodeling. LA strain parameters, PALS (19 ± 8 vs. 15 ± 7 %, p < 0.001) and LA conduit (-9.7 ± 5.2% vs. -7.6 ± 4.1%, p = 0.007) significantly improved after 6 months of S/V therapy. At multivariable stepwise regression analysis, changes in LV End Diastolic Volume (LVEDV) and PALS were significantly proportional to changes in LAVi values. (4) Conclusions: Six months of treatment with S/V in patients with HFrEF was associated with an improvement in LA functional reverse remodeling in a real-world scenario. LARR was not significantly correlated to baseline echocardiographic variables, but was proportional to changes in LV volumes and LA strain parameters. Finally, after S/V therapy, a strict connection between LA and LV reverse remodeling and between LA anatomical and functional reverse remodeling seems to be outlined.

The loss of left atrial contractile function predicts a worse outcome in HFrEF patients.

In chronic heart failure, high intracardiac pressures induce a progressive remodeling of small pulmonary arteries up to pulmonary hypertension. At the end of left atrial conduit function, pulmonary and left heart end-systolic pressures equalization might affect left atrial systole. In this single-center prospective study, we aimed to investigate whether peak atrial contraction strain (PACS), measured by speckle tracking echocardiography, was independently associated with prognosis in heart failure with reduced ejection fraction (HFrEF). Outpatients with HFrEF and sinus rhythm referred to our echo-labs were enrolled. After clinical and echocardiographic evaluation, off-line speckle tracking echocardiography analysis was performed. Primary and secondary endpoint were cardiovascular death and heart failure hospitalization, respectively. Spline knotted survival model identified the optimal prognostic cut-off for PACS. The 152 patients were stratified based on PACS <8% (n = 76) or PACS ≥8% (n = 76). Patients with PACS <8% had lower left ventricle and left atrial reservoir strain and higher New York Heart Association (NYHA) class and left atrial volume index (LAVI). Over a mean follow-up of 3.4 ± 2 years, 117 events (51 cardiovascular death, 66 heart failure hospitalizations) were collected. By univariate and multivariate Cox analysis, PACS emerged as a strong and independent predictor of cardiovascular death and heart failure hospitalization, after adjusting for age, sex, left ventricle strain, and E/e', LAVI (HR 0.6 per 5 unit-decrease in PACS). Kaplan-Meier curves showed a sustained divergence in event-free survival rates for the two groups. The reduction of PACS significantly and independently affects cardiovascular outcome in HFrEF. Therefore, its assessment, although limited to patients with sinus rhythm, could offer additive prognostic information for HFrEF patients.

563 THE ROLE OF ECHOCARDIOGRAPHY FOR MANAGEMENT OF IBRUTINIB RELATED ATRIAL FIBRILLATION: ONE MORE SUPPORT OVER CLINICAL EVALUATION

Abstract Background Ibrutinib is a Bruton tyrosine kinase inhibitor, approved in the last few years for treatment as primary option for all subsets of chronic lymphocytic leukemia (CLL). Its use is associated with increased incidence of atrial fibrillation (AF). Objectives Aim of this study is to determine whether there are echocardiographic parameters that could identify patients at major risk of developing ibrutinib-related atrial fibrillation (IRAF). Methods We performed a retrospective review of 26 patients (mean age 70,34 ± 11,69; 27% females), admitted at our EchoLab in the last year, who underwent echocardiogram prior to Ibrutinib treatment. Echo-Doppler assessment was realized according to the standards of the European Association of Cardiovascular Imaging (EACVI) standardization of the echo report. Left atrial (LA) strain was measured with EchoPAC, obtaining peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) on 4-chambers and 2-chambers views. Continuous normally distributed variables were compared by using the Student t-test. A probability value &amp;lt; 0,05 was considered statistically significant. Analyses were performed with SPSS version 25 (IBM Corporation, Somers, New York). Results Six patients developed IRAF (23%). There weren't differences of clinical characteristics between the two groups (age, body mass index, arterial blood pressure, heart rate and diabetes, hypertension and cardiovascular diseases prevalence). It was noticed that IRAF's group had lower ejection fraction (EF) (54,67 ± 1,96 vs 60,90 ± 4,35, p-value &amp;lt; 0,0001), higher left atrium volume index (48,95 ± 16,31 vs 34,18 ± 9,07, p-value: 0,009), higher pulmonary arterial pressure values (PAPs) (44,16 ± 11,26 vs 32,89 ± 8,44, p-value: 0,015). Furthermore, it was noticed that peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) were reduced in patients who developed IRAF (PALS 4Ch: 18,89 ± 6,90 vs 29,40 ± 9,79, p-value 0,06; PACS 4Ch: 10,56 ± 5,66 vs 14,31 ± 5,72, p-value: 0,25; PALS 2Ch: 23,36 ± 5,02 vs 32,88 ± 16,57, p-value: 0,28; PACS 2Ch: 13,61 ± 8,16 vs 18,33 ± 9,87, p-value: 0,39), but not statistically significant, probably due to the sample size. Conclusions This is a preliminary pilot study which confirms the data already present in the literature. The importance of baseline evaluation by echocardiogram including measurement of atrial strain of patients before starting treatment with Ibrutinib is emphasized since, given the same anthropometric characteristics and risk factors, there are echocardiographic parameters that help us to identify patients at major risk of developing IRAF. Pharmacological intervention tailored on this type of basal echocardiographic evaluation could allow the reduction of IRAF's onset and improve patient outcomes in the long term. Certainly, further follow-up studies will be needed to confirm this hypothesis.

6 EVALUATION OF ECHOCARDIOGRAPHIC PARAMETERS IN PATIENTS WITH MICROVASCULAR DYSFUNCTION: A PROSPECTIVE STUDY.

Abstract Background The prevalence of microvascular angina is underestimated in the general population because it is often difficult to detect. Microvascular dysfunction is defined by parameters of reduced coronary flow reserve (CFR &amp;lt;2) without epicardial stenosis and/or increased index of microvascular resistance (IMR&amp;gt; 25). Purpose The aim of this study was to evaluate the echocardiographic parameters in patients with symptoms of myocardial ischemia without evident coronary epicardial obstruction. Primary endpoint was to analyze the global longitudinal strain of the left ventricle and the left atria strain in patients with microvascular angina. Secondary endpoint was to analyze echocardiographic parameters to evaluate the diastolic function of the left ventricle, the prevalence of cardiovascular risk factors and the blood tests values. Methods Between 1st February 2019 and 1st May 2022, subjects with angina and not functionally significant epicardial stenosis (Resting Full-cycle Ratio &amp;gt; 0.91, Fractional flow reserve &amp;gt;0.80), underwent assessment of microvascular function and were divided into 2 cohorts. All patients had sinus rhythm, preserved left ventricular ejection fraction (LVEF&amp;gt; 55%), no severe left ventricular hypertrophy (interventricular septum &amp;lt;13 mm) or structural heart disease. For each patient we analyzed the left ventricular global longitudinal strain in the three apical views (4 chamber, 2 chamber and 3 chamber) and the left atria strain, PALS (peak atrial longitudinal strain) and PACS (peak atrial contraction strain), in two apical views (4 chamber and 2 chamber). We also measured the diastolic function indices (E/e’, isovolumic relaxation time, deceleration time), the left atrial area and pulmonary artery systolic pressure (PASP) evaluated on echocardiography. Results A total of 132 patients were enrolled. Of those, 47 had evidence of microvascular dysfunction and 85 had normal CFR/IMR. Primary Endpoint: patients with microvascular dysfunction had reduced values of left ventricular global longitudinal strain and reduced values of left atrial strain compared to controls (p&amp;lt;0,001). Secondary Endpoint: a higher prevalence of diabetic and obese women was associated with microvascular dysfunction. However, there were no significant differences in age, prevalence of hypertension, dyslipidemia, smoking and dysthyroidism. Numerically higher values of NTproB-type Natriuretic Peptide (NTproBNP) and C-reactive protein were seen in patients with microvascular dysfunction, while there were no significant differences in hemoglobin, white bold cells, platelets, cholesterol, creatinine and troponin values. Left ventricular isovolumic relaxation time, left atrium area, and pulmonary artery systolic pressure as well as E/e' values were significantly increased in patients with microvascular dysfunction. Furthermore, there was a significant reduction in deceleration time values. Conclusion Patient with microvascular dysfunction are frequently diabetic and obese women. Echocardiographic parameters show left ventricular diastolic dysfunction and possibly subsequent left atrial remodeling. Furthermore, the analysis of the global longitudinal strain of the left ventricle could reveal alterations in cardiac contractile mechanics that are difficult to identify with conventional echocardiography. NTproBNP values were not significantly higher, demonstrating that patients with microvascular dysfunction have an early diastolic dysfunction that is not clinically evident.

Effect of mitral valve transcatheter edge-to-edge repair on indices of left atrial performance in chronic mitral regurgitation.

Effect of transcatheter edge-to-edge repair (TEER) using MitraClip in patients with mitral regurgitation (MR) on left atrial (LA) kinetic energy (LAKE), an index of LA work, and LA strain, a measure of LA performance, have not been well defined. Patients with chronic primary or secondary 3+ or 4+ MR were analyzed pre- and post-TEER using MitraClip. LAKE was determined by echocardiography using LA stroke volume and A-wave velocity. Peak atrial longitudinal strain (PALS), peak atrial strain in early diastole, and peak atrial contraction strain (PACS) were obtained by speckle tracking echocardiography. Thirty-nine patients undergoing TEER with MitraClip were screened, 12 met criteria for analysis (9 primary and 3 secondary MR). Compared to pre-TEER, there was a significant increase post-TEER in LAKE (71.0±64.1vs. 177.5±167.9 dyne·cm·103 , respectively; p=.008) and Doppler transmitral A-wave velocity (87.8±41.4vs. 138.5±43.7cm/s, respectively; p<.001); LA stroke volume did not change significantly. Mitral valve mean gradient significantly increased post-TEER compared to pre-TEER (5.7±2.1vs. 3.3±2.1mmHg, respectively; p=.01). There was a trend toward decrease in PALS post-TEER compared to pre-TEER (16.2±4.8vs. 20.7±9.9%, respectively; p=.05). Peak atrial strain in early diastole significantly decreased post-TEER compared to pre-TEER (7.2±3.0vs. 14.1±7.2%; respectively, p<.001), while PACS did not significantly change (9.1±3.5vs. 6.7±5.2%, respectively; p=.07). In patients with chronic MR, LAKE increases after TEER with MitraClip driven by an increase in LA emptying velocities. Changes were also seen in LA strain with MitraClip. These procedurally induced changes due to mild mitral stenosis may have clinical implications.

Left atrial strain predicts heart failure in the general population

Abstract Background Left atrial (LA) function has shown to be a significant predictor of cardiovascular outcomes. We sought to determine the prognostic value of LA strain in relation to incident heart failure (HF) in the general population. Methods The present study includes 3,540 participants from the general population without prevalent atrial fibrillation or HF. All participants underwent health examinations and echocardiography including measures of LA function by means of peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and LA strain during the conduit phase (LACS). Cox proportional hazards regressions were utilised to access the association between incident HF and LA strain parameters. Results Median age of the study population was 57 years (interquartile range: 40, 69) and 2,015 (57%) were female. During follow-up (median 5.4 years), 66 (2%) participants were diagnosed with HF. Participants who developed HF had lower PALS (26.4% vs. 36.6%, p&amp;lt;0.001), PACS (15.6% vs. 16.5%, p=0.016), and LACS (11.4% vs. 19.3%, p&amp;lt;0.001) at baseline. Lower values of all three LA strain parameters were associated with a higher risk of developing HF in univariable analysis (Figure 1 &amp; 2). After multivariable adjustments for Framingham Risk Score and global longitudinal strain, PALS (HR=1.06, 95% CI [1.03; 1.09], p&amp;lt;0.001, per 1% decrease), PACS (HR=1.07, 95% CI [1.02; 1.12], p=0.003, per 1% decrease), and LACS (HR=1.05, 95% CI [1.01; 1.10], p=0.016, per 1% decrease) remained significantly associated with incident HF. However, in participants with normal-sized LA (LA volume index &amp;lt;34 ml/m2) and no ischemic heart disease (n=3,046), only PALS and PACS remained independent predictors of HF (Figure 2). Conclusion LA strain provides independent prognostic value regarding the risk of incident HF in the general population. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The Danish Heart Foundation and The Metropolitan Region of Denmark

Could echocardiographic left atrial characterization have additive value for detecting risks of atrial arrhythmias and stroke in patients with hypertrophic cardiomyopathy?

Abstract Background Atrial arrhythmia (AA) is considered a turning point for prognosis in hypertrophic cardiomyopathy (HCM) patients. Prediction of AA and associated stroke risk in patients with HCM is an important clinical challenge as these events can occur in young subjects and significantly impact their quality of life. (1) (2) Purpose We sought to assess whether an echocardiographic evaluation focused on the left atrial (LA) characterization could estimate the occurrence of AA and stroke in HCM patients. Methods 216 HCM-patients (52±16 years old) were enrolled between 2016 and 2019. All patients underwent transthoracic echocardiography for the evaluation of left atrial volume (LAV), left ventricular global longitudinal strain (LV-GLS), peak left atrial strain (PLAS) and peak atrial contraction strain (PACS) by speckle-tracking imaging. A composite endpoint was defined as a history of AA and/or a history of stroke or peripheral embolism and/or occurrence of AA. Results The patients were followed for 2.9 years. Among the 216 patients, 78 (36%) met the composite endpoint. These patients were older (50.3±16.7 vs. 57.1±14.4 years, p=0.0035), had a higher prevalence of arterial hypertension (42.3% vs. 62.3%; p=0.005) and had higher NT-proBNP levels. LAV (37.2±15.7 vs. 47±20 ml/m2, p=0.0001) was significantly higher in patients who met the composite endpoint, whereas PLAS and PACS were significantly impaired (26.6±9.12 vs. 19.3±9.54%; p&amp;lt;0.0001 and 13.1±6.3% vs. 8.8±6.5%; p&amp;lt;0.0001, respectively). After adjustment, PLAS and PACS remained independently associated with events with an odds ratio (OR) of 0.42 for PLAS (95% CI, [0.29–0.61]; p&amp;lt;0.0001). Stroke occurred in 67% of the patients without any clinical AA. PLAS with a cut-off of under 15.5% provided event detection with 91% specificity and demonstrated a predictive value for new-onset of AA. Although there was a high correlation between PLAS and LV-GLS, LV-GLS was not associated with the events. Conclusion The impairment of LA function assessed by 2D speckle-tracking echocardiography was strongly associated with AA and the risk of stroke, even in patients without any documented AA. Its value for guiding the management of HCM-patients requires further investigation. Funding Acknowledgement Type of funding sources: None.

Could echocardiographic left atrial characterization have additive value for detecting risks of atrial arrhythmias and stroke in patients with hypertrophic cardiomyopathy?

Atrial arrhythmia (AA) is considered a turning point for prognosis in patients with hypertrophic cardiomyopathy (HCM). We sought to assess whether the occurrence of AA and stroke could be estimated by an echocardiographic evaluation. A total of 216 patients with HCM (52 ± 16 years old) were analysed. All patients underwent transthoracic echocardiography for the evaluation of left atrial volume (LAV), peak left atrial strain (PLAS), and peak atrial contraction strain. The patients were followed for 2.9 years for the occurrence of a composite endpoint including AA and/or stroke and peripheral embolism. Among the 216 patients, 78 (36%) met the composite endpoint. These patients were older (57.1 ± 14.4 vs. 50.3 ± 16.7 years; P = 0.0035), had a higher prevalence of arterial hypertension (62.3 vs. 42.3%; P = 0.005), and had higher NT-proBNP. The LAV (47 ± 20 vs. 37.2 ± 15.7 mL/m²; P = 0.0001) was significantly higher in patients who met the composite endpoint, whereas PLAS was significantly impaired (19.3 ± 9.54 vs. 26.6 ± 9.12%; P < 0.0001). After adjustment, PLAS was independently associated with events with an odds ratio of 0.42 (95% confidence interval 0.29-0.61; P < 0.0001). Stroke occurred in 67% of the patients without any clinical AA. The PLAS with a cut-off of under 15.5% provided event prediction with 91% specificity. Using a 15% cut-off, PLAS also demonstrated a predictive value for new-onset of AA. The decrease in PLAS was strongly associated with the risk of stroke, even in patients without any documented AA. Its value for guiding the management of patients with HCM requires further investigation.