Right Atrium In Patients Research Articles

Value of 2D speckle tracking technique combined with real-time 3-dimensional echocardiography in the evaluation of the right atrial function in patients with 3-branch coronary artery disease without myocardial infarction.

To evaluate the right atrial function in patients with 3-branch coronary artery disease (TBCAD) without myocardial infarction by 2D speckle tracking echocardiography (2D-STE) combined with real-time 3-dimensional echocardiography (RT-3DE). Fifty-six patients admitted to our hospital without myocardial infarction with TBCAD were selected. We divided them into 2 groups according to the coronary angiography results: 28 patients in group B (the rate of stenosis is 50% ~< 75%); 28 patients in group C (the rate of stenosis is ≥75%); in addition, 30 healthy volunteers were screened as group A. All subjects underwent RT-3DE to obtain the right atrial volume (RAVmax, RAVmin, and RAVp), and then we calculated the right atrial passive and active ejection fraction (RAPEF, RAAEF), and maximum volume index (RAVImax). In addition, to measure the strain rates (RASRs, RASRe, RASRa) of the right atrium during systole, early diastole, and late diastole, 2D-STE was applied. Correlations between the 2D-STE parameters and the results of N-terminal pro-brain natriuretic peptide (NT-proBNP) and Gensini scores were analyzed by Pearson linear analysis. Compared with group A, RAPEF and RASRe were reduced, while RAAEF and RASRa were elevated in group B (P < .05). RAPEF, RASRs, RASRe, and RASRa were decreased compared with groups A and B, while RAVmax, RAVmin, RAVp, RAVImax, and RAAEF were increased in group C (P < .05). There was a significant correlation between 2D-STE parameters and the results of NT-proBNP and Gensini scores (P < .05). The storage, conduit, and pump functions of the right atrium are reduced in patients with 3-branch coronary artery disease without myocardial infarction; 2D-STE combined with RT-3DE is valuable in the evaluation of the right atrium in patients with coronary artery disease.

Multiple thrombi mimicking metastases in the right atrium of patients with non-Hodgkin’s lymphoma diagnosed by multimodal cardiac imaging: one case report

BackgroundRight-side heart mass can be found incidentally on routine transthoracic echocardiography (TTE). Accurate diagnosis of cardiac mass often requires more than one imaging method. We present a mid-age woman with non-Hodgkin lymphoma who was found to have multiple right atrial masses mimicking metastases on routine TTE, which were finally diagnosed as thrombi by multimodal cardiac imaging.Case presentationA 52-year-old woman was diagnosed with primary mediastinal diffuse large B cell lymphoma (DLBCL) almost six months prior. The TTE revealed multiple masses in the right atrium with normal cardiac function when she was being evaluated for the next chemotherapy. On arrival, she was hemodynamically stable and asymptomatic. Physical examination was no remarkable. Laboratory findings showed leukocytosis of 17,900 cells/mm3, hemoglobin of 7.5 mg/dL, and a normal D-dimer level. The suspicious diagnosis of right atrial metastasis was made by TEE. However, the diagnosis of right atrial thrombi was made by contrast CMR. Finally, the 18 F-FDG PET-CT demonstrated no metabolic activity in the right atrium, which further supported the diagnosis of thrombi. Eventually, the masses were removed by cardiopulmonary bypass thoracotomy because of a high risk of pulmonary embolism. Histopathology confirmed the diagnosis of thrombi.ConclusionsThis case highlights the importance of multimodality cardiac imaging in the appropriate diagnosis of a RA masses in patient of lymphoma. Diagnosis of RA masses can be made using multimodal cardiac imaging like TTE, TEE and CMR, even PET. Echocardiography is the most commonly used on multimodal imaging in cardiac thrombus. CMR has high specificity in differentiating a tumor from thrombus, while 18 F-FDG PET has good sensitivity to determine the nature of the masses.

Visualisation and Evaluation Study of Some Patients Arteriosclerosis Microvessel with Coronary Artery Disease at Coronary Artery Bypass Grafting

Visualization of coronary microvessel at ischemic disease still remains actual. There is necessity for additional study of arteriosclerosis microvessels. The byoptates of auricular right atria of patients with coronary artery disease were taken at coronary artery bypass grafting. The epoxy slices were obtained from material treated by the method of transmission electron microscopy and fixed in epoxy resins with further staining by Azur II and viewed under light optical microscope. Analysis of the images obtained during this study identified different arteriosclerotic damages, with negative phenomena of convolute formation in the walls of arteriolas and formation of de Novo arteriolas from previous one, by intussusception type that could also lead to ischemia. Evaluation on 5-degree scale of pathological growth of vessels microcirculatory bed as well as provided 1-2 images could help during analyze of arteriosclerotic damages, identification of pathological process direction in each patient case. This will improve medical treatment of such patients in postsurgical period.

Stiff substrates inhibit collagen accumulation via integrin α2β1, FAK and Src kinases in human atrial fibroblast and myofibroblast cultures derived from patients with aortal stenosis

The aim of the study was to confirm whether cell substrate stiffness may participate in the regulation of fibrosis. The involvement of integrin α2β1, focal adhesion kinase (FAK) and Src kinase in signal transmission was investigated. Human atrial fibroblasts and myofibroblasts were cultured in both soft (2.23 ± 0.8 kPa) and stiff (8.28 ± 1.06 kPa) polyacrylamide gels. The cells were derived from the right atrium of patients with aortal stenosis undergoing surgery. The isolated cells, identified as fibroblasts or myofibroblasts, were stained positively with α smooth muscle actin, vimentin and desmin. The cultures settled on stiff gel demonstrated lower intracellular collagen and collagen type I telopeptide (PICP) levels; however, no changes in α1 chain of procollagen type I and III expression were noted. Inhibition of α2β1 integrin by TC-I 15 (10−7 and 10−8 M) or α2 integrin subunit silencing augmented intracellular collagen level. Moreover, FAK or Src kinase inhibitors increased collagen content within the culture. Lower TIMP4 secretion was reported within the stiff gel cultures but neither MMP 2 nor TIMP-1, 2 or 3 release was altered. The stiff substrate cultures also demonstrated lower interleukin-6 release. Substrate stiffness modified collagen deposition within the atrial fibroblast and myofibroblast cultures. The elasticity of the cellular environment exerts a regulatory influence on both synthesis and breakdown of collagen. Integrin α2β1, FAK and Src kinase activity participates in signal transmission, which may influence fibrosis in the atria of the human heart.

Long-term results of one-and-a-half ventricle repair with open azygos vein.

The one-and-a-half ventricle repair (1.5VR) is an option for definitive surgery of cardiac defects with hypoplastic right ventricle (RV). The 1.5VR with open azygos vein was reported to provide a theoretical advantage of decompressing the supra vena cava (SVC) or the right atrium in patients with SVC hypertension or severe RV dysfunction. The aim of this study is to review and evaluate our experience with this procedure in the long-term period. Medical records of the patient undergoing 1.5VR with open azygos vein between January 2000 and December 2019 were reviewed retrospective. Pre- and postoperative echocardiography and cardiac catheterization data were also analyzed. 4 patients underwent the 1.5VR with open azygos vein. The median age at time of surgery was 2.2years, and the median weight was 9.8kg. The median tricuspid valve (TV) Z-score was - 3.5, the median right ventricular end-diastolic volume (RVEDV) was 54.0% of normal. There were no operative death and early adverse events. Median follow-up time was 17.1years. There were no late death and re-operation during the follow-up. The postoperative TV diameter and RVEDV were larger than preoperative data in 3 of 4 patients. The 1.5VR with open azygos vein is a good surgical option for congenital heart disease with hypoplastic RV. The TV and RVEDV may grow and biventricular conversion may be possible.

Abstract 10604: Rs11091046-a Increases the Expression of Angiotensin Ii Receptor 2 Gene by Mir-208a

Introduction: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. The mechanism of AF still remains unknown. In case - control study, we found that rs11091046 located in 3' - UTR of angiotensin II receptor 2 (AGTR2) gene was related to non - familial AF in Chinese Han population. It is necessary to figure out the mechanism of rs11091046 in non - familial AF. Methods: We predicted cohesion change between rs11091046 and miR-208a by RNAhybrid software and confirmed the prediction of cohesion change between rs11091046 and miR-208a by double luciferase reporter system. We detected the expression of AGTR2 gene in right atrium of patients with AF and subjects with sinus rhythm by quantitative real-time PCR. Results: RNAhybrid software showed that the cohesion between 3' - UTR of AGTR2 gene and seed region of miR - 208a was reduced because of the polymorphism of rs11091046 (wide type C mfe: -16.4kcal/mol, mutant type A mfe: -13.7kcal/mol). We also observed that the luciferase activity of transfected cells with miR - 208a and wild - type rs11091046 - C was significantly decreased by 59% while it was relatively enhanced by 22% with miR - 208a and mutant - type rs11091046 - A (Figure 1 up panel). The mRNA level of AGTR2 gene in right atrium of patients with AF was significantly increased compared with subjects with sinus rhythm. The mRNA level of AGTR2 gene in cardiomyocyte transfected by miR - 208a mimic was higher than cardiomyocyte transfected by miR - 208a (Figure 1 down panel). Conclusion: The polymorphism of rs11091046 in AGTR2 gene reduced the cohesion between 3 '- UTR of AGTR2 gene and seed region of miR - 208a, which increased the expression level of AGTR2 gene leading to occurrence of AF. Figure 1 Up panel The relative luciferase activity of transfected cells with wild - type rs11091046 - C and mutant - type rs11091046 - A (BK389: pmirGLO - rs11091046 - C, BK390: pmirGLO - rs11091046 - A). ** P &lt; 0.01. Down panel The mRNA level of AGTR2 gene in cardiomyocyte transfected by miR - 208a mimic and miR - 208a. * P &lt; 0.05.

Chemoembolization for Hepatocellular Carcinoma in Patients With Inferior Vena Caval/Right Atrial Tumor Thrombi Without Hepatic Vein Invasion.

To clarify the clinical and radiological features of isolated tumor thrombi in the inferior vena cava (IVC)/right atrium in patients with hepatocellular carcinoma (HCC) without hepatic vein invasion. In this retrospective study, from January 2007 to December 2019, a total of 35,163 chemoembolization sessions were performed in 7,704 patients with HCC. Among them, 10 (0.13%) patients had tumor thrombi in the IVC/right atrium without definitive hepatic vein invasion. Computed tomographic (CT) scans, digital subtraction angiograms, and cone-beam CT images were retrospectively reviewed and interpreted. The tumor thrombi were supplied by the right inferior phrenic artery (n=8) or the right internal mammary artery (n=2). Follow-up CT scans in eight patients showed linear accumulation of iodized oil along the diaphragm, which was presumed to be a thrombosis of the phrenic vein. Retrospective review of formal radiological reports of pre-procedural CT scans revealed that a correct diagnosis of tumor thrombi of the IVC/right atrium was made in only three cases. HCC invading the phrenic vein may have tumor thrombi in the IVC/right atrium without hepatic vein invasion.

Cardiac Microvascular Endothelial Cells in Pressure Overload-Induced Heart Disease.

Chronic pressure overload predisposes to heart failure, but the pathogenic role of microvascular endothelial cells (MiVEC) remains unknown. We characterized transcriptional, metabolic, and functional adaptation of cardiac MiVEC to pressure overload in mice and patients with aortic stenosis (AS). In Tie2-Gfp mice subjected to transverse aortic constriction or sham surgery, we performed RNA sequencing of isolated cardiac Gfp+-MiVEC and validated the signature in freshly isolated MiVEC from left ventricle outflow tract and right atrium of patients with AS. We next compared their angiogenic and metabolic profiles and finally correlated molecular and pathological signatures with clinical phenotypes of 42 patients with AS (50% women). In mice, transverse aortic constriction induced progressive systolic dysfunction, fibrosis, and reduced microvascular density. After 10 weeks, 25 genes predominantly involved in matrix-regulation were >2-fold upregulated in isolated MiVEC. Increased transcript levels of Cartilage Intermediate Layer Protein (Cilp), Thrombospondin-4, Adamtsl-2, and Collagen1a1 were confirmed by quantitative reverse transcription polymerase chain reaction and recapitulated in left ventricle outflow tract-derived MiVEC of AS (P<0.05 versus right atrium-MiVEC). Fatty acid oxidation increased >2-fold in left ventricle outflow tract-MiVEC, proline content by 130% (median, IQR, 58%-474%; P=0.008) and procollagen secretion by 85% (mean [95% CI, 16%-154%]; P<0.05 versus right atrium-MiVEC for all). The altered transcriptome in left ventricle outflow tract-MiVEC was associated with impaired 2-dimensional-vascular network formation and 3-dimensional-spheroid sprouting (P<0.05 versus right atrium-MiVEC), profibrotic ultrastructural changes, and impaired diastolic left ventricle function, capillary density and functional status, especially in female AS. Pressure overload induces major transcriptional and metabolic adaptations in cardiac MiVEC resulting in excess interstitial fibrosis and impaired angiogenesis. Molecular rewiring of MiVEC is worse in women, compromises functional status, and identifies novel targets for intervention.

A MicroRNA Signature in Acute Coronary Syndrome Patients and Modulation by Colchicine

Circulating microRNAs (miRNAs) may play a pathogenic role in acute coronary syndromes (ACS). It is not yet known if miRNAs dysregulated in ACS are modulated by colchicine. We profiled miRNAs in plasma samples simultaneously collected from the aorta, coronary sinus, and right atrium in patients with ACS. A total of 396 of 754 miRNAs were detected by TaqMan real-time polymerase chain reaction from EDTA-plasma in a discovery cohort of 15 patients (n = 3 controls, n = 6 ACS standard therapy, n = 6 ACS standard therapy plus colchicine). Fifty-one significantly different miRNAs were then measured in a verification cohort of 92 patients (n = 13 controls, n = 40 ACS standard therapy, n = 39 ACS standard therapy plus colchicine). Samples were simultaneously obtained from the coronary sinus, aortic root, and right atrium. Circulating levels of 30 of 51 measured miRNAs were higher in ACS standard therapy patients compared to controls. In patients with ACS, levels of 12 miRNAs (miR-17, -106b-3p, -191, -106a, -146a, -130a, -223, -484, -889, -425-3p, -629, -142-5p) were lower with colchicine treatment. Levels of 7 of these 12 miRNA were higher in ACS standard therapy patients compared to controls and returned to levels seen in control individuals after colchicine treatment. Three miRNAs suppressed by colchicine (miR-146a, miR-17, miR-130a) were identified as regulators of inflammatory pathways. MicroRNAs were comparable across sampling sites with select differences in the transcoronary gradient of 4 miRNA. The levels of specific miRNAs elevated in ACS returned to levels similar to control individuals following colchicine. These miRNAs may mediate ACS (via inflammatory pathways) or increase post-ACS risk, and could be potentially used as biomarkers of treatment efficacy.

P280 Evaluation of right atrium in patients with gestational hypertension

Abstract Introduction Some authors have confirmed changes in function of the right hearth in different conditions with endothelial dissfunction, such as systemic hypertension and metabolic syndrome. During gestational hypertension (GH), endothelial disfunction is one of the main pathogenic causes of vasoconstriction and placental insuficiety and following intrauterine growth restriction. Few authors evaluated function of the right ventricle during gestational hypertension, but to our knoledge, there are no studies about right atrial function during gestational hypertension. Purpose We hypothesized that there are changes in right atrial function durig gestational hypertension, and wondered if they are reversible. Methods Study included 45 pregnant women. 25 with GH (defined as blood pressure ≥140/90mmHg that appeared after 20th week of gestation and disappeared within six weeks postpartum) and 20 normotensivewomen,as control. Function of right atrium and right ventricle was evaluated according to the last guidelines for chamber quantification. Additionally, right atrial function was assessed with p-p cycle speckle tracking. Echo was performed in the third trimester of pregnancy and 6 weeks after delivery. Results Parameters showed impairment of RV diastolic function. Women with gestational hypertension had E/e" over the normal value and higher than healthy pregnants, althow difference was not significant. ( 6.46 +- 4.7 vs 5.16 +- 1.9, p =0.66). TDI derived E" from lateral tricuspid annulus was significantly lower in hypertensive group (0.11 +- 0.03 vs 0.14 +- 0.03 p= 0.023). Atv – right ventricle late filling velocity was significantly higher in patients with GH (0.61 +- 0.1 vs 0.51+-0.12, p= 0.08) . All pregnant women had normal values of RA dimensions, RA endsystolic area, RA endsystolic volume (RAVs). RAVs was significantly larger in GH group (34.64 +-12 vs 27.9+- 9.89, p= 0.041) comparing to the controls, but when we indexed it to the BSA, difference disappeared. Peak longitudinal strain was signfificantly higher in hypertensive group (33.49+- 2.48 vs 28.05+- 4.52, p= 0.001). After Pearson correlation of peak longitudinal strain with parameters of right ventricle diastolic function was done, there was possitive correlation between peak longitudinal strain and Etv (right ventricle early filling velocity) in hypertensive group (r 0.646, p 0.017). Also RAVs positively correlated with LAVsI (r= 0.577, p= 0.019), and RAVsI positively correlated with LAVsI (r= 0.690, p = 0.019). After delivery all changes disappeared. Conclusion Our study indicates that right atrium accommodates to the hemodynamic and functional changes during gestational hypertension. It changes because of modified right ventricle diastolic function and probably in the same mode as left atrium. RA peak longitudinal strain is high, so function of the right atrium is preserved, and we assume that short time of mentioned changes during pregnancy, is the reason why.

P3673Electroanatomical mapping of right atrium in patients with pulmonary hypertension

Abstract Introduction Atrial fibrillation (AF) and related atrial tachycardia (AT), including cavotricuspid isthmus dependent atrial flutter (AFL), are a known complication of pulmonary hypertension (PH). Catheter ablation is an established method of treatment of selected patients with heart rhythm disorders. The aim of the work was to evaluate arrhythmogenic substrate in the right atrium (RA) of the group of patients who underwent catheter ablation with electroanatomical mapping. Methods The findings in electroanatomical mapping with contact force of RA were evaluated in a group of 22 patients (16 men, median and scattering age 73, range 45–87 years) indicated for catheterization ablation for AFL or other right-sided AT. During electroanatomical mapping, 8 patients had sinus rhythm and 14 patients had AF or AT (all AT with cycle length under 350 ms). Areas with reduced atrial electrogram voltages (AEGM) &lt;0.1 mV in sinus rhythm or &lt;0.04 in AF or AT, existence of double and fragmented potentials were identified. Results Out of the 22 patients, 3 patients had hypoxic PH, 13 individuals had chronic thromboembolic PH (7 undergoing surgical treatment) 4 patients had idiopathic PH and 2 patients had combined PH. The median mean pulmonary arterial pressure was 44 (range 22 - 72) mmHg. The median RA CARTO volume was 225 (range 151–383) ml. Out of all patients, 2 subjects manifested scattering of the surface proportion RA with a defined reduced voltage over 10% (maximum 15%). Six subjects had surface proportion with defined reduced voltage in interval 1–9% and 14 subjects had scattering below 1% of total surface area of RA. The predominant localizations of pathological AEGMs was the area adjacent to the vena cava superior and posterior portion of RA between caval veins. Regular finding in patients following surgical treatment of thromboembolic PH was a scar after atriotomy. Arrhythmogenic substrate in right atrium Conclusion Dilatation of RA is present in all PH patients. However, the proportion of tissue with reduced AEGM voltage in RA does not appear to be extensively high in this population.

Feasibility and Accuracy of Two-and Three-Dimensional Transthoracic Echocardiography in patients with Right Atrial Dilatation using the Right Parasternal Approach

Background: Echocardiography increasingly used for diagnosis of right atrial dilatation. Three dimensional is superior than two dimensional echocardiography. However, advances and new windows continues to emerge to increase its accuracyAim of the work: to show the feasibility and accuracy of right parasternal approach and its usefulness in qualitative and quantitative assessments of right atrium in patients with right atrial dilatation in comparison with transesophageal approach.Patients and Methods: The study included thirty patients with right atrial dilatation. All patients underwent full history taking, clinical, 12-lead electro-cardiography and echocardiography. Transesophageal Echocardio-graphy was used as a gold standard for the accuracy of the right parasternal approach.Results: The study includes 30 patients with right atrial dilatation the right parasternal (RPS) view obtained in 18 patients (60%), and not obtained in 12 patients (40%). There was significant decrease of SVC anteroposterior minimal diameter (Min AP), crista terminalis (CT) width, CT length, right atrial appendage (RAA) base Maximum diameter and RAA base Minimum diameter, in 2D Echocardiography when compared to 3D Echocardiography. On the other side, there was no statistically significant difference in Right parasternal approach (3D) and Transesophageal approach.Conclusions: Parasternal approach is feasible in imaging right heart structures. In addition, three dimensional TTE had an incremental value over two dimensional TTE in the assessment of these structures

P15118F-FDG uptake in the right atrium in patients with heart failure

P15118F-FDG uptake in the right atrium in patients with heart failure

Пухлинний тромбоз нижньої порожнистої вени та правого передсердя у хворих на нирково-клітинний рак: 25-річний досвід хірурґічного лікування

Aim. To improve the results of surgical treatment of tumor thrombosis of the inferior vena cava and right atrium in patients with renal cell carcinoma. Materials and Methods. The results of clinical examination, laboratory, instrumental, intraoperative observations and morphological studies were analyzed in 83 patients with renal cell carcinoma, complicated with tumor venous thrombosis, who were hospitalized to the vascular surgery department of Lviv regional clinical hospital for the period from 1993 to 2018. For a comparative analysis, all patients were divided into two groups: the first, main, group included 61 patients (39 men and 20 women, mean age 58,1±2,7 years old; two children, 5 and 9 years old) with renal cell carcinoma, complicated with tumor thrombosis of inferior vena cava and right atrium. The second, control, group included 22 patients (19 men and 3 women, mean age 58,3±4,3 years old) with renal cell carcinoma and renal vein invasion. Thepatients’ examination included laboratory and instrumental methods: ultrasound; computer or magnetic resonance imaging with intravenous contrast enhancement of the abdominal and chest cavity;excretory urography; echo-cardiography; veno-cavagraphy according to indications. Kaplan-Meier method was used to evaluate the long-term survival of patients with renal cell carcinoma, complicated with tumor venous thrombosis. Results and Discussions. Surgical treatment included radical nephrectomy in combination with thrombectomy from the inferior vena cava and right atrium. The using of Cell-Saver system has significantly reduced the need for donor blood. Despite the significant volume and trauma of surgical interventions in patients of the first group, the risk of most postoperative complications did not predominate in eithergroup. Survival indicators were evaluated among 76 patients with renal cell carcinoma, complicated with venous invasion - in 55 patients of the first and 21 patients of the second group. The median follow-up was 53,2 months. The median survival rate for patients in the first group was 33,3 months; for patients in the second group - 118,2 months. The cumulative 2-, 5-, and 10-year survival rates for patients in the second group (80,0%, 59,1%, 52,5%) were significantly higher compared to the first group (57,8%, 38,5%, 23,4%) (p 0,2). Regarding the level of the tumor thrombus of the inferior vena cava, there was no significant difference in survival as well (p>0,29). Conclusions. A detailed preoperative assessment of the prevalence of neoprocess, the improvement of surgical procedure, an effective prevention of thromboembolic and hemorrhagic complications allow providing acceptable long-term survival rates of patients with renal cell carcinoma with venous invasion.

Assessment of right atrium dysfunction in patients with obstructive sleep apnea syndrome using velocity vector imaging

Background and ObjectivesThis study aimed to assess the changes of RA function in patients with obstructive sleep apnea syndrome (OSAS) using velocity vector imaging (VVI) and to evaluate the application of VVI technology.MethodsAccording to the apnea–hypopnea index (AHI), 71 patients with OSAS were divided into three groups: mild, moderate, and severe. A total of 30 cases of healthy subjects were enrolled as the control group. Digital images of apex four-chamber views were acquired to measure the right atrium (RA) linear dimensions and volume parameters including RA longitudinal diameter (RAL), transverse diameter (RAT), RA maximum volume (Vmax), RA minimum volume (Vmin), right atrial volume before contraction (Vpre). Right atrial volume parameters were corrected by body surface area (VImax, VImin, VIpre). The total right atrial emptying fraction (RATEF), right atrial passive emptying fraction (RAPEF), right atrial active contraction emptying fraction (RAAEF) were calculated. The VVI data measuring right atrial global strain (RA-GLS), right atrial strain rate in ventricular systolic phase (RA-SRs), right atrial strain rate in ventricular early diastolic phase (RA-SRe), right atrial strain rate in ventricular late diastolic phase (RA-SRa).ResultsRA linear dimensions and volume parameters in severe OSAS were higher than those of control group. RAPEF in severe group was lower than control group and mild OSAS group (t = 2.681, P = 0.021; t = 2.985, P = 0.011; respectively). RAAEF in OSAS moderate group was higher than that of control group (t = 3.006, P = 0.02), and without statistical difference (P > 0.05) in the severe OSAS group and the control group.RA-GLS in moderate OSAS group was significantly lower than that of control group (t = 2.333, P = 0.040) and reduced more obvious in the severe OSAS group (vs control, t = 3.25, P = 0.008, vs mild; t = 3.011, P = 0.012; respectively). RA-SRe in moderate and severe OSAS groups were lower than control group (t = 2.466, P = 0.031; t = 3.547, P = 0.005; respectively). RA-SRs of OSAS in severe group was lower than that of control and mild groups (t = 3.665, P = 0.004; t = 3.204, P = 0.008; respectively). RA-SRa in severe OSAS group was lower than that of control group (t = 2.425, P = 0.034).Multivariate regression analysis showed that RA-GLS and RA-SRe were independently correlated with AHI (t = − 2.738, P = 0.010; t = − 2.191, P = 0.036; respectively).ConclusionRA function was impaired in patients with OSAS. On hemodynamics, the change of RA function performed increased of reserve function, reduced pipeline function and increased of contraction function. However, the strain and strain rate reduced in different degree. RA-GLS and RA-SRe decreased the earliest, which suggested that strain and strain rate were the parameters which can reflect myocardial function damage earliest. VVI can more earlier and accurately detect myocardial dysfunction of right atrium in patients with OSAS, which is expected to be a worthy technique for early clinical therapy in patients with OSAS.

Epicardial connection between the right-sided pulmonary venous carina and the right atrium in patients with atrial fibrillation: A possible mechanism for preclusion of pulmonary vein isolation without carina ablation

Ablation of the pulmonary venous carina is occasionally required for pulmonary vein isolation (PVI) despite its nonessential role in ipsilateral PVI from the anatomical (endocardial) viewpoint. Although the Bachmann bundle (BB) is a common and main interatrial band, local variations in small tongues of muscular fibers were frequently found in autopsy studies. We sought to clarify the effect of the electrical conduction pattern from the right atrium (RA) to the left atrium (LA) during sinus rhythm on the necessity of performing right-sided pulmonary venous carina ablation to achieve PVI. Study subjects comprised 37 consecutive patients undergoing initial catheter ablation of lone atrial fibrillation. During sinus rhythm, RA and LA activation maps were acquired using an electroanatomical mapping system. LA breakthroughs were classified into 3 sites: BB, fossa ovalis (FO), and right-sided pulmonary venous carina. Patients were divided into the carina-ABL (ablation) or non-carina-ABL group on the basis of the necessity of pulmonary venous carina ablation to achieve PVI. Patients were classified in the non-carina-ABL group (n= 26 [70%]) and carina-ABL group (n = 8 [22%]) after excluding 3 patients (8%) because of their complex ablation lesion sets. Breakthrough occurred in the BB (n = 21 patients [62%]), FO (n= 7 [21%]), carina (n = 1 [3%]), carina and BB (n = 3 [9%]), and carina and FO (n = 2 [6%]). Carina breakthrough occurred in 6 patients (75%) in the carina-ABL group but in no patients in the non-carina-ABL group (P < .0001). PVI was not achievable without carina ablation in one-fifth of patients, probably because of epicardial connections present between the right-sided pulmonary venous carina and the RA.

PW009 Expression of Kv1.5 Channel in Right Atria of Patients with Rheumatic Heart Disease and Atrial Fibrillation

The authors synthesized a fluorine-containing Ir(III) complex Ir(PTZ)2(HFD) and the corresponding composite electrospinning fibers [email protected](PTZ)2(HFD), where PTZ, HFD and PVP stood for 2-phenylbenzo[d]thiazole, 1,1,1,5,5,5-hexafluoropentane-2,4-dione and poly(vinylpyrrolidone), respectively. The molecular structure of the Ir(III) complex was confirmed by its single crystal analysis, which suggested that Ir(PTZ)2(HFD) molecules crystallized as monoclinic system with two molecules in each unit cell. Density functional theory calculation on the crystal revealed that the onset electronic transitions possessed a mixed character of metal-to-ligand-charge-transfer (MLCT) and ligand-to-ligand-charge-transfer (LLCT). Ir(PTZ)2(HFD) was then doped into electrospinning fibers so that the photophysical comparison between bulk Ir(PTZ)2(HFD) and composite samples could be performed. It was found that both face-to-face π–π attraction in crystal and the immobilization in PVP host could improve photoluminescence performance by restraining the geometric relaxation of MLCT excited state, showing emission blue shift, longer excited state lifetime and improved photostability.

Do Atrial Differences in Endothelial Damage, Leukocyte and Platelet Activation, or Tissue Factor Activity Contribute to Chamber‐Specific Thrombogenic Status in Patients with Atrial Fibrillation?

Thrombi form mainly in the left rather than the right atria of patients with atrial fibrillation (AF), the reason of this predilection being unknown. The purpose of this study was to investigate whether atrial-specific differences in endothelial damage, leukocyte activation, platelet stimulation, and tissue factor activity occur in patients with AF. Twenty-two patients (16 men, 6 women; age 56 ± 8 years; 16 paroxysmal AF, 6 persistent AF) with AF undergoing pulmonary vein isolation were investigated. Blood samples from the left and the right atrium were obtained at the start of the procedure. Microparticles (MPs) released by apoptotic/stimulated cells were measured by capture assays. Their procoagulant abilities were quantified by functional prothrombinase and tissue factor assays and their cellular origin were determined (endothelium, platelet, leukocyte). Platelet reactivity was evaluated by whole blood flow cytometry for expression of platelet P-selectin (CD62P), active glycoprotein IIb/IIIa receptor (PAC-1). Platelet aggregation was evaluated using ADP, TRAP and collagen-induced whole blood aggregometry. There were no atrial-specific differences in the levels of total procoagulant MPs, leukocyte-derived-MPs or platelet-derived MPs. Conversely, endothelial-derived MPs and tissue factor activity and collagen-induced platelet aggregation were slightly elevated in the right atrium (P < 0.05). Our data show no evidence for increased thrombogenic status in the left atrium that would account for its greater propensity for thrombus formation in patients with AF.

2D speckle tracking analysis of right atrium in patients with pulmonary hypertension

2D speckle tracking analysis of right atrium in patients with pulmonary hypertension

Right Atrial Scar Detection after Catheter Ablation: Comparison of 2D and High Spatial Resolution 3D-late Enhancement Magnetic Resonance Imaging

To prospectively compare the diagnostic performance of two-dimensional (2D) and high spatial resolution three-dimensional (3D) late enhancement magnetic resonance imaging (MRI) for the detection of scar tissue caused by catheter ablation of the right atrium in patients with atrial flutter. Forty-seven patients were enrolled. In 16 patients, imaging of the cavotricuspid isthmus was performed before and after catheter ablation, 16 subjects were imaged before, and 15 after catheter ablation, resulting in a total of 63 examinations. MRI included a standard 2D breathhold and a high-resolution navigator-gated 3D T1-weighted gradient-echo inversion-recovery sequence in right and left anterior oblique views. Two readers assessed the subjective image quality on a 4-point scale (1 = excellent) and the presence of late enhancement (blinded/ in consensus). The average image quality was 1.6 for both imaging approaches. In consensus reading, the sensitivity was 83% versus 100%, specificity 97% versus 89%, accuracy 90% versus 94%, positive predictive value 96% versus 89%, negative predictive value 86% versus 100% for 2D and 3D, respectively. The interobserver agreement was 0.86 for 2D and 0.78 for 3D imaging. For the noninvasive identification of scars in the cavotricuspid isthmus after right atrial flutter, ablation 2D imaging was more consistent, whereas 3D sequences showed superior sensitivity for the depiction of late enhancement.