Value Of Left Atrial Function Research Articles

The Prognostic Value of Left Atrial Function in Patients with Acute Myocardial Infarction.

The prognostic value of left atrial (LA) volume is well-established in acute myocardial infarction (AMI) patients. LA strain provides further patophysological insights. In the present study, we evaluated LA volume and LA strain in AMI patients including those with atrial fibrillation (AF). The aim of the study was to determine if LA strain provide additional prognostic value. Patients with AMI underwent two-dimensional echocardiography within 72 h of admission. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular events. Cox regression analyses were performed. We included 501 patients and during follow-up, 132 patients (26.4%) met the primary outcome. Left ventricular (LV) global longitudinal strain (GLS) (HR 0.94 [95% CI 0.88-0.99], p = 0.029), indexed LA volume (LAVi) (HR 1.02 [95% CI 1.00-1.04], p = 0.015), and LA reservoir strain (HR 0.96 [95% CI 0.93-0.99], p = 0.017) were all independently associated with the primary outcome. A univariate Cox model conducted on the AF patients (n = 32) revealed that LA reservoir strain remained significantly associated with the primary outcome, while LV GLS and LAVi were not significant. The prognostic value of LA reservoir strain was comparable to LA volume and LV GLS, and might even be better in AF patients.

Cardiac magnetic resonance imaging in patients with history of COVID-19

BACKGROUND: Myocarditis is among the most common complications arising from coronavirus infection (COVID-19).
 AIM: This study aims to find the differences in the patterns of myocardial injury between patients who had COVID-19 and those from the pre-pandemic period, as determined by contrast-enhanced cardiac magnetic resonance imaging.
 MATERIALS AND METHODS: The study encompassed a retrospective analysis of 47 patients who underwent contrast-enhanced cardiac magnetic resonance imaging to rule out acute myocarditis. Group 1 comprised 34 patients with a confirmed history of COVID-19 through PCR testing (nasal and/or throat swabs), while Group 2 comprised 13 individuals who underwent contrast-enhanced cardiac magnetic resonance imaging in 2017 prior to the onset of the COVID-19 pandemic. All patients enrolled in the study had clinical manifestation of cardiac injury without signs of coronary artery disease as an underlying cause of condition.
 RESULTS: The mean time from the onset of heart symptoms to the administration of contrast-enhanced cardiac magnetic resonance imaging was 166 days. In group 1, a decrease in exercise tolerance was observed in 77% of patients, and 14 (42%), 30 (88%), and 28 (85%) of patients complained of chest pain, shortness of breath, and heart palpitations, respectively. In group 2, four patients (30%) had dyspnea, nine patients (69%) complained of chest pain, and six patients (46%) had heart palpitations and/or feeling of arrhythmia. Myocardial injury in group 1 was more generalized. The third of them had displayed preserved increased pulmonary vascularity and pleural effusion. Within group 1, men had significantly lower left ventricular ejection fraction, lower values of global longitudinal deformation, and higher values of left atrial function compared with the corresponding parameters in women. Differences in women were found only in the number of the affected segments in the left ventricular myocardium.
 CONCLUSION: SARS-CoV-2 virus caused extended myocardial injury, affecting a significant number of myocardial segments. Men had more frequent postinflammatory complications, characterized by abnormal function of the left ventricle and left atrium. Obtained results require continuous efforts for further assessment of long-term consequences of previous COVID-19 to the cardiovascular system. In this regard, contrast-enhanced cardiac magnetic resonance imaging may represent a sensitive imaging tool for the assessment of cardiac injury severity.

Diagnostic and Prognostic Value of Left Atrial Function in Identification of Cardioembolism and Prediction of Outcomes in Patients with Cryptogenic Stroke

Stroke of undetermined source, commonly termed cryptogenic stroke (CS), accounts for a significant proportion of ischemic stroke etiology and have high rates of stroke recurrence. The heterogeneous etiology of CS makes decisions regarding treatment for such patients challenging. The aim of this study was to evaluate the diagnostic and prognostic value of left atrial (LA) function in the identification of cardioembolism and prediction of outcomes in patients with CS. Consecutive patients admitted to a tertiary institution with ischemic stroke or transient ischemic attack (TIA) who underwent transthoracic echocardiography were recruited, with comprehensive evaluation of LA metrics including LA strain. Ischemic strokes and TIAs were classified as noncardioembolic, cryptogenic, or cardioembolic. A total of 709 patients (mean age, 66.0±15.1years; 55% men) were recruited. Two hundred ninety-one patients had CS, 189 had noncardioembolic stroke, and 229 had cardioembolic stroke. Patients with CS were followed for 20.0±13.8months for recurrent ischemic stroke or TIA. Receiver operating characteristic curves showed LA reservoir and contractile strain to be strong discriminators of cardioembolic strokes, and log-rank tests showed both measures to be significantly associated with the distribution of time to recurrent ischemic stroke or TIA in patients with CS. Multivariable hazard models showed LA reservoir and contractile strain to be independent predictors of recurrent ischemic stroke or TIA in patients with CS, in addition to estimated glomerular filtration rate and active smoking. LA reservoir and contractile strain were strong discriminators of cardioembolic stroke and independently predicted recurrent ischemic stroke or TIA in patients with CS. Use of LA strain may improve risk stratification and decision-making in patients with CS, with particular regard to prolonged ambulatory heart rhythm monitoring and/or empiric anticoagulation.

Prognostic value of left atrial function in patients with severe primary mitral regurgitation undergoing mitral valve repair

Abstract Background Timing of mitral valve surgery for primary mitral regurgitation (MR) remains challenging. Since MR has a significant hemodynamic impact on the left atrium (LA), assessment of LA function may have prognostic value in these patients which is incremental to LA volume and left ventricular (LV) remodeling parameters. Purpose This study sought to investigate whether preoperative assessment of LA reservoir strain (LASr) by speckle tracking echocardiography is associated with long-term outcome in patients undergoing mitral valve repair for severe primary MR. Methods Echocardiography was performed prior to mitral valve surgery in 566 patients (age 64±12 years, 66% men) with severe primary MR. Complete clinical information was collected and the endpoint was all-cause mortality after operation. The study population was divided based on a cut-off value of LASr (22%) derived from a spline curve analysis (hazard ratio for all-cause mortality >1). Results Patients with LASr ≤22% (n=277) were significantly older, had more impaired renal function and were more symptomatic (NYHA functional class III to IV) compared to patients with LASr >22% (n=289). In terms of echocardiographic data, patients with LASr ≤22% had significantly lower LV ejection fraction and LV global longitudinal strain (LV-GLS) and significantly higher systolic pulmonary artery pressures and LA volume index compared with patients with LASr >22%. During a median follow-up of 95 (56 – 147) months, 129 patients (22.8%) died. Patients with LASr ≤22% experienced significantly higher mortality rates compared to patients with LASr >22% (log rank chi-square 35.1; p<0.001) (Figure). On multivariable analysis, age (hazard ratio (HR): 1.06; 95% confidence interval (CI): 1.03 to 1.09; p<0.001), LV-GLS (HR: 1.08; 95% CI: 1.02 to 1.15; p=0.014) and LASr (HR: 0.96; 95% CI: 0.93 to 0.99; p=0.014) were independently associated with all-cause mortality. The addition of LASr to a clinical model (including: age, coronary artery disease, estimated glomerular filtration rate, NYHA class III-IV, atrial fibrillation, LV end-diastolic volume index, LV ejection fraction, LV-GLS, LA volume index and systolic pulmonary artery pressure) showed a significant increase in the chi-square value (chi-square differences = 6.9; p=0.011), demonstrating the incremental prognostic value of LASr in patients with primary MR. Conclusions Preoperative LASr is independently associated with all-cause mortality in patients undergoing mitral valve repair for primary MR, has incremental prognostic value over LA volume and LVEF and might therefore be helpful to guide surgical timing. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Jan Stassen has received an ESC training grant (Appehab724.011364741) Association of LASr and outcome

The impact of left atrial strain parameters on systolic and diastolic improvement following TAVI

Abstract Introduction Transcatheter aortic valve implantation (TAVI) can improve left ventricular (LV) mechanics and has been shown to improve long term survival. Data on the prognostic value of left atrial (LA) strain following TAVI are scarce. LA strain – a surrogate of LV filling pressure - can aid the early detection of diastolic dysfunction and correlates with the extent of fibrosis in atrial remodelling. Purpose In this multimodality study, we aimed to evaluate the prognostic value of LA function measured before hospital discharge following TAVI and to further elucidate its association with LV and LA reverse remodelling. Methods In this prospective single center study, we investigated 90 patients (mean age 78.5 years, 46.7% female) with severe, symptomatic aortic stenosis (AS) who underwent transthoracic echocardiography immediately after TAVI and 6 months later. LA and LV global longitudinal strain parameters were obtained by speckle tracking echocardiography. CT angiography (CTA) was performed for pre-TAVI planning and repeated at 6 months follow-up. LV mass values were derived from the serial CTA images. We defined LV reverse remodelling as reduction of myocardial mass quantified on CTA and as an improvement of LV global longitudinal strain (GLS). LA reverse remodelling was assessed based on the peak reservoir strain values (LAGS). The association of LA and LV global strain parameters, LA stiffness, systolic and diastolic functional parameters and LV mass based reverse remodelling were analysed using Pearson correlation coefficient and linear regression models. Results The mean LAGS and LVGLS values were 17.7% and 15.3% at discharge and 20.2% and 16.6% at follow-up, respectively (p=0.024, p<0.001). LA and LV strain values improved in 60.6% and 74.5% of all patients. Reduced LAGS (<20%) was found in 66.7% of all patients at baseline. LA strain at discharge correlated significantly with diastolic parameters (E wave, E/e', LAVI, all p<0.05). Atrial reverse remodelling based on LAGS change correlated with LVGLS change (p<0.01, standardized β=0.53) and LAGS at discharge (p=0.012, standardized β=−0.30). LAGS correlated with the extent of morphological LV remodelling based on LV mass reduction (p=0.002, coeff: 0.36). Elevated LA stiffness at discharge (upper tercile) leads to substantially lower LAGS at 6 months versus patients with lower LA stiffness value (1. and 2. tercile): 16.4±10.0 vs 21.9±9.8, p=0.042. Conclusion Patients with reduced LAGS immediately after TAVI showed a larger extent of LV reverse remodelling during follow up. On the other hand, increased LA stiffness at discharge was consistent with irreversible LA damage as demonstrated by a lack of improvement in LA function. Funding Acknowledgement Type of funding sources: None.

Predictive value of left atrial function for latent paroxysmal atrial fibrillation as the cause of embolic stroke of undetermined source

BackgroundIn patients with embolic stroke of undetermined source (ESUS), paroxysmal atrial fibrillation (AF) is often diagnosed, however, the risk of paroxysmal AF in ESUS has not been well described. Several studies have suggested a linkage between left atrial (LA) functional parameters and risk of AF in stroke patients. The aim of this study was to assess the role of LA functional parameters as predictors of latent paroxysmal AF in ESUS on admission. MethodsBetween January 2015 and December 2019, consecutive stroke patients with suspected ESUS at admission were prospectively included in this study. They were under hospital electrocardiographic monitoring for detection of new-onset AF. Various echocardiographic parameters including left atrial strain were assessed for association with new-onset AF. ResultsWe gathered 1082 consecutive patients with ischemic stroke. After exclusions, 121 patients with suspected ESUS at admission formed the study cohort. New-onset AF was detected in 46 (38%) patients during hospital electrocardiographic monitoring (median follow-up: 18 days). LA pump and reservoir strains were significantly and independently associated with new-onset AF. Receiver operating characteristic analysis for the association with new-onset AF showed that the areas under the curve (AUCs) of clinical parameters plus one of each strain (LA pump strain: AUC: 0.86±0.04 and LA reservoir strain: AUC: 0.76±0.05) models were significantly better than plus LA volume index (AUC: 0.68±0.04, compared p-values <0.05). ConclusionsLA strain was significantly associated with new development of AF. Patients with impaired LA function at admission should be carefully monitored to find AF.

P2728Prognostic impact of left atrial function in patients with cardiac amyloidosis: a cardiac magnetic resonance study

Abstract Background Left atrial function (AEF) is a parameter of paramount importance that has a prognostic value in a number of heart conditions. Cardiac involvement in both light-chain and transthyretin amyloidosis is the main driver of prognosis and influences treatment strategies. Cardiac magnetic resonance (CMR) provides high quality images of the left and right atria using high temporal resolution steady state free precession (SSFP) cine sequences. Purpose The aim of our study was to assess by CMR left atrial function and his correlation with prognosis in patients with cardiac amyloidosis. Method We enrolled 80 consecutive patients with diagnosis of cardiac amyloidosis: 38 patients (47%) with light-chain and 42 patients (53%) with transthyretin one. CMR was performed using a 1.5-T scanner. In all subjects, the study of atria was obtained by acquiring cine steady-state free precession (SSFP). Left Atrial function was evaluated by the ratio between the maximum and the minimum LA volume. A median follow up of 937 days was performed and 36 patients (44%) died of cardiac causes. We evaluated cardiac death as endpoint. We split out all the patient in 4 different quartiles depending on left atrial function: in the first quartile patients with AEF≤14% that reflects severe atrial dysfunction, in the second quartile patients with AEF between 14 and 19%, in the third quartile patients with AEF between 19 and 36% and in the last one patients with AEF≥36% that represent patients with normal value of left atrial function. Results We found that CMR assessed left atrial function allowed to individuate and stratify the prognosis in patients with cardiac amyloidosis. The most effective parameter to evaluate cardiac death was left atrial function with a cut off ≤14% that could predict cardiac related mortality with the same accuracy in both light-chain and transthyretin amyloidosis patients. Kaplan Meier analysis showed that patients with AEF≤14% had a worse prognosis as compared to patient with AEF≥14% (log rank p. 0001). Furthermore patients with AEF≤14% have a cardiac death risk of 32% at 1 year and 61% at 3 years. Kaplan Meier analysis Conclusion Cardiac magnetic resonance is an imaging modality that allows to individuate with great accuracy left atrial function in patients with various heart conditions and especially cardiac amyloidosis. CMR left atrial function assessment clearly identifies a subgroup of cardiac amyloid patients with an increased risk of death.

P2457Left atrial strain parameters predict clinical outcomes in patients with HFmrEF and HFpEF

Abstract Background Heart failure with preserved ejection fraction (HFpEF) and with mid-range ejection fraction (HFmrEF) are conditions sharing similar diagnostic criteria and symptoms. Left ventricular (LV) diastolic dysfunction has often been considered central to the pathophysiology of both, as determined by current conventional echocardiographic measures of elevated filling pressure and/or an increased in left atrial (LA) volume. However, the independent prognostic importance of LA function, beyond clinical predictors and LV features, in those groups remains unclear. Aims To evaluate the prognostic value of LA function measured by speckle tracking echocardiography in patients with new diagnosis of HFpEF and HFmrEF. Methods A total of 171 consecutive patients diagnosed with HFpEF with an Ejection Fraction (EF) ≥50%, or HFmrEF with an EF of 40–49% were prospectively enrolled and followed up. Follow-up was completed in 134 patients with HFpEF (n=100) and HFmrEF (n=34) for a median period of 57 months. Baseline characteristic and comorbidities were recorded, as well as conventional resting echocardiographic parameters of systolic and diastolic function. Left atrial phasic function was analysed using 2D-Specle Tracking. Peak-atrial longitudinal strain (PALS) and peak-atrial contraction strain (PACS) were measured, reflecting LA reservoir and pump function respectively. We looked at the relationship of traditional parameters of systolic and diastolic function and LA strain, with the following cardiovascular (CV) events: acute coronary syndromes, new atrial fibrillation, cerebrovascular events, HF-related admissions and cardiac deaths. Results During a median follow up period of 57 months (range 11.10), of 134 patients, 42 (31%) had at least one CV event, 10 (8%) out of whom had at least one HF-related hospitalization and 5 (4%) had cardiac death. 92 patients (69%) remained event-free. In univariate analysis, lower PALS and PACS were associated with increased risk for the composite endpoint of all CV-events (PALS OR=0.92 p&lt;0.01 and PACS OR=0.92 p&lt;0.05), but only PALS predicted HF admissions (PALS OR=0.86 p&lt;0.05). In multivariate analysis after adjusting for LV EF, E/e' and LAVi, PALS remained significant at predicting CV-events (OR=0.91 p&lt;0.05) and HF admissions (OR=0.85 p&lt;0.05), but PACS did not. Amongst all echocardiographic parameters measured, PALS had the greatest Area Under the Curve at Receiver Operating Characteristics analysis (AUC=0.78 p&lt;0.05) and a PALS value of &lt;23% best predicted future HF-related admissions (sensitivity 0.9, specificity 0.6). Conclusion LA dysfunction in HFpEF and HFmrEF is associated with a higher risk of CV events and HF hospitalizations. The association of LA strain with HF hospitalization remained significant after adjustment for systolic and diastolic parameters.

Prognostic value of left atrial function by cardiovascular magnetic resonance feature tracking in hypertrophic cardiomyopathy.

Left atrium (LA) size has an important role in determining prognosis and risk stratification in hypertrophic cardiomyopathy (HCM). Cardiovascular magnetic resonance myocardial feature tracking (CMR-FT) is a novel technique for the quantification of LA function. Our aim was first to evaluate LA function by CMR-FT and volumetric analysis in patients with HCM; and secondly we sought to determine the association of LA-longitudinal strain (LA-LS) with major cardiovascular outcomes, particularly all cause mortality and heart failure. 75 patients with HCM and 75 control subjects underwent a conventional CMR study including assessment of LA function by CMR-FT (LA-LS) and volumetric analysis. A primary endpoint of all-cause mortality and secondary combined endpoint of hospital admission related to heart failure, lethal ventricular arrhythmias or cardiovascular death were defined. Compared to controls, LA-LS and all volumetric indices of LA function were significantly impaired in HCM even in patients with normal LA volume and normal LV filling pressures. LA-LS showed moderate-high correlation with LA-emptying fraction (total, active and passive LA-EF, r = 0.68, r = 0.67, r = 0.31, p < 0.001 for all) and with parameters of diastolic function (E/é, r = 0.4, p < 0.001). The age, minimum LA volume and % of LGE were independent predictors of LA-LS (p < 0.01 for all). During a mean follow-up of 3.3 ± 1.2years LA-LS was associated with the primary (HR: 0.85 (0.73-0.98), p = 0.02) and the secondary end-point (HR: 0.88 (0.82-0.96), p = 0.003). LA-LS by CMR-FT provides accurate measurements of LA function in HCM patients. LA-LS may become a novel potential predictor of poor cardiac outcomes, particularly cardiovascular mortality and HF.

Prognostic Value of Left Atrial Function Following Myocardial Infarction

Background: Left atrium (LA) maximum volume index (LAVImax) is a known predictor of adverse cardiovascular outcomes in a range of patient groups, including the post–myocardial infarction (MI) population. However, measures of LA function may be a more powerful prognostic marker. At present, there are minimal data on the prognostic impact of LA function following MI.

The prognostic value of left atrial function assessed by TDI after myocardial infarction (comparison between ST and non ST segment elevation myocardial infarction)

The prognostic value of left atrial function assessed by TDI after myocardial infarction (comparison between ST and non ST segment elevation myocardial infarction)

Independent Echocardiographic Markers of Cardiovascular Involvement in Chronic Kidney Disease: The Value of Left Atrial Function and Volume

Chronic kidney disease (CKD) is associated with increased cardiovascular mortality and morbidity, particularly ischemic heart disease and cardiomyopathy. Newer echocardiographic techniques such as myocardial strain analysis provides the opportunity to detect early myocardial dysfunction. The aim of this study was to examine echocardiographic parameters, in particular left atrial (LA) function and volume, in patients with CKD. A further aim was to determine echocardiographic parameters that are sensitive to detect cardiovascular involvement in early CKD. Seventy-six patients with stage 3 CKD (estimated glomerular filtration rate, 30-59mL/min/1.73m(2)) with hypertension and/or diabetes mellitus, without any previous cardiac illness, were prospectively recruited. These patients were compared with subjects matched for age, sex, and risk factors (hypertension and/or diabetes mellitus) with normal renal function and 76 healthy age-matched control subjects. Two-dimensional strain analyses of the left atrium and left ventricle were performed. Comprehensive echocardiographic examinations were performed in all participants, and traditional echocardiographic parameters including indexed LA volume (LAVI) and two-dimensional strain analysis of the left ventricle and left atrium were performed in all participants. Differences among the three groups on demographic, clinical, and echocardiographic parameters were examined. LA systolic strain (20.9±6.3% vs 27.4±7.9%, P<.0001) and systolic and late diastolic strain rates were altered in the CKD group, while early diastolic strain rate was similar to that in the risk factor-matched group. LAVI was significantly larger in the CKD group compared with the risk factor-matched group and healthy control subjects (38.5±10 vs 31.2±9 vs 22.3±5mL/m(2), P<.0001). LV strain as well as LV systolic and early diastolic strain rates were similar in the CKD and risk factor-matched groups. LV late diastolic strain rate, a surrogate measure of LA contractile function, was, however, reduced in the CKD group. Forward logistic regression analysis showed LA global strain to be the most sensitive predictor for the presence of CKD, followed by LAVI; though LV late diastolic strain rate was reduced in the CKD group, it was not an independent predictor. Furthermore, the addition of LA strain to traditional echocardiographic parameters significantly increased the predictive power to detect cardiovascular involvement (C statistic=0.65 vs C statistic=0.84, P<.0001). Increased LAVI, reduced left ventricular global strain, and the presence of CKD were independent predictors of LA strain, while left ventricular mass index, E/e' ratio, and the presence of CKD were predictors of LAVI. LA strain and LAVI are more sensitive parameters than traditional echocardiographic parameters as well as left ventricular strain in patients with early CKD. LA strain and LAVI may be useful to detect myocardial involvement in stage 3 CKD, and LA alterations may be consequent to increased activation of the renin-angiotensin-aldosterone pathway, causing myocardial fibrosis in CKD.

Independent prognostic value of left atrial function by two-dimensional speckle tracking imaging in patients with non -ST-segment-elevation acute myocardial infarction.

BackgroundThe objective of this study is to evaluate left atrial(LA) function and its prognostic value by two-dimensional speckle tracking echocardiography (STE) in patients with non-ST-segment-elevation acute myocardial infarction (NSTEAMI).MethodsGlobal longitudinal LA S/SR data obtained by 2D speckle imaging with automated software (Echo PAC, GE Medical).ResultsClinical variables and angiographic, echocardiographic, and STE parameters were studied in 65 patients with NSTEAMI (51 males and 14 females; mean age of 60.7 ± 9.8 years) who underwent elective PCI. The final study population consisted of 51 individuals (43 males and 8 females; mean age of 62.9 ± 11.1 years) and a 12 ± 3 months follow-up was performed. A total of 22 combined cardiovascular events(20 patients) occurred. With the use of Univariable Cox regression, all parameters were evaluated in the prediction of cardiac events, ischemic events, and/or cardiac death. According to ROC analysis, baseline mean global left atrial SRs (ROC area 0.82, p = 0.001) and baseline mean global left atrial SRe (ROC area 0.68, p = 0.036) were the only predictive variables.ConclusionsIn patients with NSTEAMI, we found that the novel global strain parameter of left atrial function is a valuable predictor of combined cardiovascular events over conventional echocardiography and may therefore be an important clinical tool for risk stratification in the acute phase of NSTEAMI.

Left atrial contractile strain is the independent predictor of LV remodeling after ST-segment elevation myocardial infarction

Background There is growing evidence on the value of left atrial function assessment in cardiac magnetic resonance (CMR) in patients with heart failure. However, there is paucity of data regarding the value of left atrial function in CMR to predict left ventricular remodeling in patients with STsegment elevation myocardial infarction (STEMI). Methods One hundred one (79 males, 22 females, mean age 58.3±11.5 years) patients, who underwent CMR 3-5 days and 6 months after first STEMI treated with primary percutaneous coronary intervention, were enrolled. Cine, T2-weighted STIR and late gadolinium enhancement (LGE) CMR images were assessed off-line using dedicated software (QMass 7.5, Medis, Leiden, The Netherlands). Feature tracking cine-sequence based left atrial strain were measured using Diogenes CMR (TomTec Imaging Systems, Munich, Germany) in 2- and 4-chamber views. Segmental strain values were averaged from two views to obtain average reservoir, conduit and contractile strain. Logistic regression analysis was performed in stepwise forward fashion to determine CMR predictors of LV remodeling. The outcomes were expressed by odds ratio (OR) with corresponding 95% confidence interval (CI). Results 52 subjects had anterior and 49 inferior STEMI. LV remodeling (increase in LV end-systolic volume by 15% in 6 months after STEMI) was present in 29 subjects. Comparing subjects with and without LV remodeling the former tended to have larger extent of LVLGE (27.9±14.3 versus 22.2±13.8% of LV myocardium; p=0.07), larger extent of microvascular obstruction (MO) within LGE (4.3±5.3 versus 2.2±3.1% of LV myocardium; p=0.02), higher maximal levels of troponin I(147.1±122.1 versus 91.2±72.4 ng/ml; p=0.006), CPK-MB (691±407 versus 363±237 U/l; p<0.001), CPK (4943±2968 versus 2733±1936 U/l; p<0.001), and had lower values of average left atrial reservoir strain (14.6±5.3 versus 25.1±10.0%; p<0.001), left atrial conduit strain (6.3±4.3 versus 9.1±5.4%; p=0.02) and left atrial contractile strain (8.3±2.8 versus 16.0±6.2%; p<0.001). The univariative predictors of LV remodeling were the extent of MO within LGE (OR=1.14; 95%CI:1.011.27; p=0.02), maximal levels of troponin I (OR=1.006; 95%CI:1.002-1.011; p=0.007), CPK-MB (OR=1.004; 95% CI:1.002-1.010; p<0.001), CPK (OR=1.0004; 95%CI:1.00021.0006; p<0.001), and average left atrial reservoir strain (OR=0.80; 95%CI:0.72-0.88; p<0.001), left atrial conduit strain (OR=0.86; 95%CI:0.77-0.98; p=0.01) and left atrial contractile strain (OR=0.62; 95%CI:0.50-0.77; p<0.001). Of those in multivariative analysis the independent predictors were CPK (OR=1.0003; 95%CI:1.0000-1.0006; p=0.048) and left atrial contractile strain (OR=0.65; 95% CI:0.53-0.80; p<0.001).

Abstract 11521: Prognostic Value of Left Atrial Function in Normal Exercise Stress Echocardiography

Background: The association between poor left atrial (LA) function and adverse outcomes in subjects following an acute myocardial infarction is recognized. On the other hand, prognostic value of LA function in low risk subjects is not well characterized. The purpose of this study was to assess the prognostic value of LA function in subjects who have exercise stress echocardiography negative for ischemia. Methods: Subjects who underwent exercise stress echocardiography for exclusion of coronary artery disease (CAD) between January to April 2010 were included. Subjects were excluded if they were in atrial fibrillation/flutter at the time of exercise, left ventricular ejection fraction (LVEF) &lt; 45%, moderate or severe valvular disease, echocardiographic evidence of exercise-induced myocardial ischemia, or had known CAD. Maximum metabolic equivalents (METs), LA total strain (analyzed offline with Siemens Syngo VVI), LV E/e’, LA volume index (LAVI) were measured for all subjects. Diagnosis of major adverse cardiac events (MACE: myocardial infarction, coronary revascularization, cardiovascular mortality) and coronary artery disease (CAD: angina, unstable angina) were recorded. Results: Of 672 subjects identified, 486 subjects remained after exclusion. The mean follow up time was 51.6 ± 1.2 months, and the mean LVEF was 56 ± 5%. Following the index stress test, 25 (5%) subjects had MACE and 35 (7%) subjects had CAD. With MACE, maximum METs was a strong prognostic factor, with worse outcome when METs &lt; 9 (median = 9). None of the echocardiographic parameters reached statistical significance. For CAD, none of the variables reached statistical significance including METs. Conclusions: In subjects who have negative exercise stress test for ischemia, reduced METs was strongly associated with adverse outcomes. In this low risk population, none of the tested LA echocardiographic parameters appeared to be associated with adverse outcomes.

Prognostic value of left atrial function in dogs with chronic mitral valvular heart disease.

BackgroundA strong correlation between left atrial (LA) dysfunction and the severity of cardiac disease has been described in human patients with various cardiac diseases. The role of LA dysfunction in dogs with chronic mitral valvular heart disease (CMVHD) has not been addressed.ObjectivesTo investigate the correlation between LA function and the prognosis of dogs with CMVHD.AnimalsThirty‐eight client‐owned dogs with CMVHD.MethodsProspective clinical cohort study. Dogs were divided into 2 groups (survivors and nonsurvivors) based on the onset of cardiac‐related death within 1 year. Physical examination and echocardiographic variables were compared between the groups. For the assessment of the comparative accuracy in identifying patients with cardiac‐related death, receiver operating characteristic (ROC) curves and multivariate logistic analysis were used.ResultsThe highest accuracy was obtained for the LA active fractional area change (LA‐FAC act), with an area under the ROC curve (AUC) of 0.95, followed by the left atrial to aortic root ratio (LA/Ao), with an AUC of 0.94; peak early diastolic mitral inflow velocity (E), with an AUC of 0.85; and LA total fractional area change (LA‐FAC total), with an AUC of 0.85. In the multivariate logistic regression analysis, LA‐FAC act emerged as the only independent correlate of cardiac‐related death within 1 year (odds ratio = 1.401, P = .002).Conclusions and Clinical ImportanceRegarding both the size and function, the LA has a strong correlation with the prognosis of dogs with CMVHD. The most significant independent predictor of mortality in this study was LA‐FAC act.

SHA 103. Value of left atrial function in predicting effort capacity in patients with left ventricular systolic dysfunction

Introduction: Left atrial (LA) function shares in left ventricular diastolic filling and, therefore, cardiac output during rest and exercise. However, there is scanty data about the relation between LA function and exercise performance in left ventricular systolic dysfunction patients (LVSD). Methods and results: This was a prospective, cross sectional study conducted on 25 patients with LVSD (EF < 40%) in sinus rhythm. LA volumes were measured using monoplane Simpson’s method. The measured LA volumes were the largest LA volume (Vmax), the smallest LA volume (Vmin), and the LA volume measured at the peak of P wave (Vp) of simultaneous ECG. Then, LA total emptying (Vmax Vmin), passive emptying (Vmax Vp) and active emptying (Vp Vmin) volumes were calculated. Then LA total emptying fraction (Vmax Vmin/Vmax), passive emptying fraction (Vmax Vp/Vmax), active emptying fraction (Vp Vmin/ Vp) were calculated. Patients were exercised using modified Bruce protocol, to determine their exercise capacity. The selected patient subdivided into two groups: group 1 with functional capacity <7 metabolic equivalent (METS) [17 patients] and group 2 with functional capacity P7 METS [8 patients]. There was a significant difference between the two groups regarding LA total emptying fraction (P 0.0006), LA active emptying fraction (P 0.045) and LA passive emptying fraction (P 0.004). Conclusion: Left atrial emptying fraction which can be easily obtained by routine echocardiography, is useful as a predictor of exercise capacity in LVSD patients.

&lt;b&gt;Value of Left Atrial Function in Predicting Exercise Capacity in Heart Failure With Moderate to Severe Left Ventricular Systolic Dysfunction&lt;/b&gt;

Left atrial (LA) function is associated with left ventricular (LV) diastolic filling and cardiac output response to exercise. But the relation between LA function and exercise performance has not been adequately evaluated. The aim of this study was to investigate the relation between LA function and exercise capacity in dilated cardiomyopathy (DCM) with cardiopulmonary exercise testing. Forty-four patients with a left ventricular end-diastolic dimension (LVDd) > or = 60 mm and an ejection fraction (EF) < or = 40%, and in normal sinus rhythm were included in this study. Patients were divided into group 1 and group 2 according to their exercise peak oxygen uptake (VO2) (group 1: peak VO2 >14 mL/kg/min, group 2: peak VO2 < or = 14 mL/ kg/min). LA function indices were defined as follows: LA end-systolic diameter (LASd), end-diastolic diameter (LADd), LA systolic volume (LASV), LA diastolic volume (LADV), LA ejection volume (LAEV), and LA ejection fraction (LAEF). LASd, LADd, LASV, and LADV were significantly increased in group 2 (P < 0.001, P < 0.001, P < 0.05, P < 0.005). Group 1 had significantly higher LAEF (P < 0.001 ) and LVEF (P < 0.05). Group 2 had significantly shorter exercise duration, and decreased anaerobic threshold levels and minute ventilation volumes (P < 0.001, P < 0.001, P < 0.005 ). There was a positive correlation between peak VO2 and LVEF (r = 0.46, P = 0.002), and LAEF (r = 0.61, P < 0.001), peak A wave velocity (r = 0.39, P = 0.009), E wave deceleration time (r = 0.56, P < 0.001), and isovolumic relaxation time (IVRT) (r = 0.35, P = 0.04). There was a negative correlation between peak VO2 and LASd (r = -0.53, P < 0.001) LADd (r = -0.59, P < 0.001), LASVI (r = -0.34, P = 0.027), LADVI (r = -0.37, P = 0.001), and the E/A ratio (r = -0.41, P = 0.006), Decreased LAEF and increased LA sizes were associated with decreased peak VO2. The results clearly demonstrate that LA functions at rest are related to exercise performance in patients with heart failure.