scholarly journals Electrocardiographic diagnosis of atrial cardiomyopathy to predict atrial contractile dysfunction, thrombogenesis and adverse cardiovascular outcomes

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Björn Müller-Edenborn ◽  
Jan Minners ◽  
Cornelius Keyl ◽  
Martin Eichenlaub ◽  
Nikolaus Jander ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Atrial ◽  
Contractile Function ◽  
Multivariable Analysis ◽  
Cardiovascular Outcomes ◽  
P Wave ◽  
Contractile Dysfunction ◽  
Thromboembolic Risk ◽  
Endocardial Mapping ◽  
Control Study

AbstractThromboembolism and stroke are dreaded complications in atrial fibrillation (AF). Established risk stratification models identify susceptible patients, but their discriminative properties are poor. Atrial cardiomyopathy (ACM) is associated to thromboembolism and stroke in smaller studies, but the modalities used for ACM-diagnosis (MRI and endocardial mapping) are unsuitable for widespread population screening. We aimed to investigate an ECG-based diagnosis of ACM using amplified p-wave analysis (APWA) for stratification of thromboembolic risk and cardiovascular outcome. In this case–control study, ACM-staging was performed using APWA on digital 12-lead sinus rhythm-ECGs in patients with LAA-thrombus and a propensity-score-matched control-cohort. Left atrial contractile function and thrombi were evaluated by transesophageal echocardiography (TEE). Outcome for MACCE including death was assessed using official registries and structured phone interviews. Left-atrial appendage [LAA]-thrombi and appropriate sinus rhythm-ECGs for ACM-staging were found in 109 of 4086 patients that were matched 1:1 to control patients without thrombus (218 patients in total). Both cohorts were comparable regarding cardiovascular risk factors, anticoagulants and CHA2DS2-VASC-score. ACM-stages 1 to 3 (equivalent to no, moderate and extensive ACM) were found in 63 (57.8%), 36 (33.0%) and 10 (9.2%) of patients without and 3 (2.8%), 23 (21.1%) and 83 (76.1%) of patients with LAA-thrombi. Atrial contractile function decreased from ACM-stages 1 to 3 (LAA-flow velocities 38 ± 16 cm/s, 31 ± 15 cm/s and 21 ± 12 cm/s; p < 0.0001), while the likelihood for LAA-thrombus increased (2.8%, 21.1% and 76.1%, p < 0.001). Multivariable analysis confirmed an independent odds ratio for LAA-thrombus of 24.6 (p < 0.001) per ACM-stage. Two-year survival free of stroke/TIA, hospitalization for heart failure, myocardial infarction or all-cause death was strongly reduced in ACM-stage 3 (53.8%) compared to no or moderate ACM (82.8% and 84.7%, respectively; p < 0.0001). Electrocardiographic diagnosis of ACM identifies patients with atrial contractile dysfunction and atrial thrombi at risk for adverse cardiovascular outcomes and death.

Abstract 16058: Abnormal P Wave Morphology is Associated With Decreased Left Atrial Appendage Ejection Velocity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nathaniel D Mcconkey ◽  
Peter Malamas ◽  
Jovan Plamenac ◽  
Robert Park ◽  
Frank Weigel ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
P Wave ◽  
Atrial Appendage ◽  
Volume Index ◽  
Complex Congenital Heart Disease ◽  
Ejection Velocity ◽  
Odds Ratios ◽  
History Of

Introduction: P-wave abnormalities measured during periods of sinus rhythm have been associated stroke in people with atrial fibrillation (AF). The majority of AF-related strokes occur from left atrial appendage (LAA) thromboembolism. Electrical and mechanical dysfunction of the left atrium (LA) and left atrial appendage (LAA) can lower the threshold for thromboembolism and stroke. Hypothesis: We aimed to determine whether P-wave abnormalities are associated with decreased LAA ejection velocity (LAAV) on transesophageal echocardiography (TEE). Methods: We conducted a retrospective cross-sectional study. We reviewed patients at a tertiary care medical center who had underwent TEE in sinus rhythm and had an interpretable sinus rhythm ECG within 12 months of TEE. Participants were excluded for history of complex congenital heart disease, age<18, cardiac transplantation, and atrial pacing. Logistic regression analysis was used to estimate the odds ratios of LAAV<40 cm/s for P-wave abnormalities—advanced interatrial block (aIAB), abnormal P-wave terminal force in V1 (aPTFV1), prolonged P-wave duration (PPWD), and abnormal P-wave axis (aPWA). Results: In our final cohort of 169 patients, the odds ratios of aIAB and aPTFV1 for LAAV<40 cm/s after adjustment for CHA 2 DS 2 VASc variables, heart rate during TEE, history of atrial arrhythmias, and left atrial volume index were 2.81 (1.07-7.53) and 2.48 (1.13-5.60), respectively. Conclusions: P-wave abnormalities are independently associated with low LAAV, which may explain their association with AF-related stroke. Further research is needed to determine if incorporation of P-wave analysis will aid AF-related stroke prediction algorithms.

scholarly journals 772 Incidence of stroke in patients with hypertrophic cardiomyopathy implanted with a cardiac implantable electronic device

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Carlo Fumagalli ◽  
Chiara Zocchi ◽  
Francesca Bonanni ◽  
Luigi Tassetti ◽  
Matteo Beltrami ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
De Novo ◽  
Multivariable Analysis ◽  
Unmet Need ◽  
Prior History ◽  
Advanced Stage ◽  
History Of

Abstract Aims Incidence of stroke in patients with an advanced stage hypertrophic cardiomyopathy (HCM) is associated with adverse outcome, impaired quality of life and loss of productivity. Still today, however, the real burden of stroke in both patients with and without atrial fibrillation (AF) is unresolved. To assess the prevalence and incidence of AF and stroke in patients with an advanced stage HCM implanted with cardiac implantable electronic devices (CIEDs) at our institution, a long-standing high flow referral centre for cardiomyopathies. Methods and results Clinical and instrumental data of HCM patients implanted with CIEDs [either pacemakers (PM) or implantable cardioverter defibrillator (ICD)] from 1998 to 2019 were retrospectively reviewed. Inclusion criteria were site-designated diagnosis of HCM, age at diagnosis &gt;18 years, Follow-up &gt;1 year. HCM phenocopies (e.g. Fabry disease) were carefully excluded. Patients were divided into three categories according to presence of AF (‘AF prior to CIED implantation’ vs. ‘AF after CIED implantation’ vs. ‘sinus rhythm’). Outcome was measured against incidence of thromboembolic events [stroke or transient ischaemic attack (TIA)] at Follow-up. Patients were also stratified by left atrial diameter (LAD) in two groups (&lt;47 vs.  &gt; 48mm). Of 1861 patients followed at our Unit, a total of 185 (9.9%) patients implanted with a CIED were included (57% men, mean age at implantation 54 ± 17 years). At baseline, AF was present in 72 (36%) patients. Mean CHA2DS2VASc was 1.7 + 1.3 with no differences among patients with or without AF. Patients with AF at baseline had a more pronounced LAD dilation (51 ± 7 vs. 44 ± 8, P &lt; 0.001) and a lower ejection fraction (55 ± 11 vs. 64 ± 12, P &lt; 0.001). After 5.0 ± 3.8 years from CIED implantation, de novo AF was detected in 24 (21%) individuals, resulting in an annual incidence rate of 4.1%/year. Overall, 89 (48%) of patients remained is sinus rhythm. Stroke/TIAs were reported in 19 (10.3%) patients: seven (37%, 1.1%/year) occurred in patients with prior history of AF, three (16%, 2.2%/year) in patients with de novo AF, and nine (63%, 2.3%/year) in patients with no history of arrhythmias documented at CIED interrogation. Among patients in sinus rhythm, those with a LAD &gt; 48 mm had the greatest risk of stroke (4.8%/year vs. 0.5%/year, P &lt; 0.01, for LAD &gt; 48 vs. LAD &lt; 47, respectively). At multivariable analysis, after adjustment for CHA2DS2VASc, AF, and obstructive physiology, only LAD was associated with a higher risk for stroke (HR: 1.09, 95% CI: 1.03–1.11, P &lt; 0.001). Conclusions In a large cohort of consecutive high risk HCM patients referred to CIED implantation, the incidence of stroke was high, with 1-in-10 patients experiencing at least one event. Among patients in sinus rhythm, those with a marked left atrial dilatation were at highest risk of ischaemic stroke, suggesting the existence of an unmet need to stratify risk of stroke even in patients with no detected arrhythmias.

scholarly journals Evaluation of p-wave Dispersion and Left Atrium Ejection Fraction in Patients with Cardioembolic Ischemic Stroke

2021 ◽  
Vol 10 (6) ◽  
pp. e2810615301
Author(s):  
Flávio Henrique Amaral Pires Véras ◽  
Eduardo Pereira de Azevedo ◽  
Eudes Euler de Souza Lucena ◽  
Francisco Irochima Pinheiro ◽  
José Rodolfo Lopes de Paiva ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Wave Dispersion ◽  
P Wave ◽  
Similar Distribution ◽  
P Wave Dispersion ◽  
Mean Values ◽  
Left Atrial Ejection Fraction

Introduction: Studies show that p-wave dispersion and left atrial ejection fraction are predictors of cardiovascular events. Purpose: To verify the association of p-wave dispersion and left atrial ejection fraction with cardioembolic ischemic stroke. Methods: This is an observational, cross-sectional, case-control study with 61 patients, mean age of 65.6, with sinus rhythm ischemic stroke who underwent clinical evaluation with CHA2DS2-VASc score, electrocardiogram, echocardiogram and ultrasonography with Doppler of both carotid and vertebral arteries. The groups were divided into cardioembolic (cases) and non-cardioembolic (controls). The p-wave dispersion was obtained with a 12-lead electrocardiographic tracing at 50 mm/s by subtracting the largest p-wave by the smallest one. Left atrial ejection fraction was obtained using the modified biplane Simpson method. This study was approved by the UERN Research Ethics Committee (# 2,536,483). Results: Mean values for p-wave dispersion were 62.5 ms for cases and 49 ms for controls (p = 0.025). For left atrial ejection fraction, the cases presented a mean of 42.9% and the controls a mean of 55.8% (p = 0.003). For the CHA2DS2-VASc score, the mean values were 3.6 and 3.1 for cases and controls, respectively (p = 0.35). Cardiovascular risk factors showed similar distribution in both groups. Conclusion: p-wave dispersion and left atrial ejection fraction were associated with the cardioembolic patients with sinus rhythm that have gone through ischemic stroke.

scholarly journals The loss of left atrial contractile function predicts worse outcome in HFrEF: a speckle tracking study

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
GE Mandoli ◽  
MC Pastore ◽  
G Benfari ◽  
M Setti ◽  
L Maritan ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Contractile Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Volume Index ◽  
Systolic Pulmonary Artery Pressure ◽  
Atrial Contraction

Abstract Funding Acknowledgements Type of funding sources: None. Background in chronic heart failure (HF), high cardiac pressure induces a progressive remodeling of small pulmonary arteries up to pulmonary hypertension development. At the end of left atrial (LA) conduit function, pulmonary and left heart end-systolic pressures equalize. This might affect LA systole. Purpose we investigated whether peak atrial contraction strain (PACS), measured by speckle tracking echocardiography (STE), was independently associated with outcome in HF with reduced ejection fraction(HFrEF). Methods 168 outpatients with HFrEF and sinus-rhythm referred to our echo-labs were prospectively enrolled. After clinical and echocardiographic evaluation, off-line STE analysis was performed. The endpoints were cardiovascular (CV) death and HF hospitalization respectively. Spline knotted survival model identified the optimal cut-off value for PACS. Results The 152 included patients were stratified based on PACS &lt; 8%(n = 76) or PACS≥8%(n = 76). Mean age was 61 ± 12, mean EF was 30 ± 9%. Characteristics of the two groups are presented in Table 1. Over a mean follow-up of 3.41 ± 1.9 years, 117 events (51 CV death, 66 HF hospitalizations) were collected. By univariate and multivariate Cox analysis, global PACS emerged as a strong and independent predictor of CV death and HF hospitalization, even after adjusting for age, sex, LV strain, E/e’, LA volume index (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 (Fig.1). Conclusions The reduction of PACS significantly and independently affects CV outcome in HFrEF. Although limited to patients with sinus rhythm, it could offer additive prognostic information for HFrEF patients. Table 1 Variable PACS &lt; 8 PACS ≥ 8 P value Age 61.5± 11.4 61.8 ± 12.7 0.4 NYHA class &gt;2 26% (n = 39) 11% (n = 17) &lt;0.0001 NT pro BNP 2293.7 ± 1636 1335 ± 242 0.04 E/E’ ratio 16.1 ± 9.09 12.1 ± 7.09 0.0015 LV GLS -7.28 ± 3.4 -10.17 ± 3.2 &lt;0.001 sPAP 40.5 ± 13.7 30.3 ± 9.3 &lt;0.0001 LAVI 64.4 ± 20.4 45.5 ± 15.8 &lt;0.0001 PALS 9.8 ± 4.9 20.2 ± 7 &lt;0.0001 E, peak early diastolic “E” wave; E’, medium velocity of early mitral annulus descent; GLS, global longitudinal strain; LAVI, left atrial volume index; LV, left ventricular; PACS, peak atrial contraction strain; PALS, peak atrial longitudinal strain; sPAP, systolic pulmonary artery pressure. Abstract Figure. Fig.1

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