scholarly journals The predictive value of left atrial expansion index and left atrial contractile strain in younger hypertensive patients with atrial fibrillation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
N Georgieva ◽  
E Kinova ◽  
A Borizanova - Petkova ◽  
B Krastev ◽  
A Goudev
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Social Impact ◽  
Contractile Function ◽  
Global Longitudinal Strain ◽  
Concomitant Disease ◽  
Hypertensive Patients ◽  
Functional Changes

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND   Arterial hypertension (HTN) is the most prevalent risk factor for Atrial fibrillation (AF) through structural and functional changes of the left atrium. Paroxysmal AF is mainly asymptomatic and silent forms in patients with HTN are associated with thromboembolic complications. However, prompt identification of HTN patients at risk for AF may be strategic for preventing purposes.  PURPOSE To assess sensitive and  predictive parameters for AF onset in HTN patients using two-dimensional (2D) conventional and speckle tracking echocardiography of the left atrium (LA) and left ventricle (LV).  METHODS A total of 165 consecutive patients were screened for participation in the study.  Only 80 patients met the inclusion criteria ( age below 60 years; with well controlled HTN or HTN with AF; without concomitant disease or other risk factors for AF).They were separated in two groups: 43 with HTN and 37 patients with AF and HTN. All patients underwent standard 2D echocardiography with volumetric and Speckle tracking analysis for assessment of: LV global longitudinal strain; LA total ( LATEF), passive ( LAPEF), active (LAAEF) emptying fractions; LA stiffness and expansion index; LA - reservoir (LASr), conduit (LAScd) and contractile (LASct) strain.  RESULTS There were statistically significant differences between patents with HTN and  HTN with AF group in: LASr (30.88 ± 3.99% vs. 27.89 ± 8.21 %, p= 0.049), LASct (-17.64 ± 2.04% vs. -14.4 ± 6.74 %, p= 0.007) and LA expansion index (122 ± 42% vs. 174 ± 115%; p = 0.014). There were no significant differences in other LV and LA structural and functional indices. Multiple regression analysis demonstrated that  LASct ( B= - 0.043’ p= 0.001; 95%CI -0.063- -0.023) and expansion index (B= 0.023; p= 0.001, 95%CI 0.117- 0.349)  are independent predictors of AF in hypertensive patients.  Conclusion Preserved LA compliance and contractile function are essential for maintenance of sinus rhythm in younger HTN patients. These findings could be used for  prediction of cardiovascular events and preventing AF onset in younger hypertensive population with a huge social impact.

scholarly journals Relationship between left atrial strain and left atrial bipolar voltage in patients undergoing catheter ablation for atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Takahashi ◽  
T Kitai ◽  
T Watanabe ◽  
T Fujita
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Low Voltage ◽  
Pulmonary Veins ◽  
Global Longitudinal Strain ◽  
Inferior Wall ◽  
Bipolar Voltage ◽  
Global Mean

Abstract Background Low-voltage zone (LVZ) in the left atrium (LA) seems to represent fibrosis. LA longitudinal strain assessed by speckle tracking method is known to correlate with the extent of fibrosis in patients with mitral valve disease. Purpose We sought to identify the relationship between LA longitudinal strain and LA bipolar voltage in patients with atrial fibrillation (AF). We tested the hypothesis that LA strain can predict LA bipolar voltage. Methods A total of 96 consecutive patients undergoing initial AF ablation were analyzed. All patients underwent transthoracic echocardiography including 2D speckle tracking measurement on the day before ablation during sinus rhythm (SR group, N=54) or during AF (AF group, N=42). LA longitudinal strain was measured at basal, mid, and roof level of septal, lateral, anterior, and inferior wall in apical 4- and 2-chamber view. Global longitudinal strain (GLS) was defined as an average value of the 12 segments. LA voltage map was created using EnSite system, and global mean voltage was defined as a mean of bipolar voltage of the whole LA excluding pulmonary veins and left atrial appendage. LVZ was defined as less than 1.0 mV. Results There was a significantly positive correlation between GLS and global mean voltage (r=0.708, p<0.001). Multivariate regression analysis showed that GLS and age were independent predictors of global mean voltage. There was a significant negative correlation between global mean voltage and LVZ areas. Conclusions There was a strong correlation between LA longitudinal strain and LA mean voltage. GLS can independently predict LA mean voltage, subsequently LVZ areas in patients with AF. Funding Acknowledgement Type of funding source: None

Atrioventricular Longitudinal Mechanics Using Novel Speckle-Tracking Improved Risk Stratification Beyond Baseline Thyroid Hormone in Asymptomatic Subclinical Hypothyroidism

2021 ◽  
Vol 14 (11) ◽  
Author(s):  
Wen-Hung Huang ◽  
Kuo-Tzu Sung ◽  
Jen-Yuan Kuo ◽  
Ying-Ju Chen ◽  
Chun-Ta Huang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Subclinical Hypothyroidism ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Cox Regression ◽  
Global Longitudinal Strain ◽  
Risk Reclassification ◽  
Strain Peak

Background: Hypothyroidism is reportedly associated with increased cardiovascular risk and heart failure. We aimed to elucidate the mechanistic influence of atrio-ventricular deformations and their prognostic utilizations in asymptomatic subclinical hypothyroidism (SCH). Methods: We assessed speckle-tracking of deformations among 4173 population-based asymptomatic individuals classified as euthyroid (0.25< thyroid-stimulating hormone [TSH] ≤4.0 μIU/mL, n=3799) or having mild (4< TSH ≤10.0 μIU/mL, n=349) or marked (TSH >10 μIU/mL, n=25) SCH. We further related deformational indices to outcomes of atrial fibrillation and heart failure. Results: Despite borderline differences in indexed left ventricular mass and left atrial volume ( P =0.054 and 0.051), those classified as mild and marked SCH presented with modest but significant reductions of global longitudinal strain, and showed elevated E/tissue Doppler imaging (TDI)-e′, markedly diminished peak atrial longitudinal strain and higher left atrial stiffness (all P <0.05) when compared with euthyroid subjects. A higher TSH level was independently associated with reduced TDI-s′/TDI-e′, worse global atrio-ventricular strains (global longitudinal strain/peak atrial longitudinal strain), elevated E/TDI-e′, and worsened left atrial strain rate components (all P <0.05). Over a median 5.6 years (interquartile range, 4.7–6.5 years) follow-up, myocardial deformations yielded independent risk prediction using Cox regression in models adjusted for baseline covariates, N-terminal pro-brain natriuretic peptide, E/e′, and treatment effect. Incorporation of global atrio-ventricular strain (global longitudinal strain/peak atrial longitudinal strain) and strain rates further showed improved risk reclassification when added to the baseline TSH strata (classified as euthyroid and mild and marked SCH; all P <0.05). Cox regression models remained significant with improved risk reclassification beyond TSH-based strata by using slightly different deformational cutoffs after excluding marked SCH group. Conclusions: Hypothyroidism, even when asymptomatic, may widely influence subclinical atrio-ventricular mechanical functions that may lead to higher heart failure and atrial fibrillation risk. We proposed the potential usefulness and prognostic utilization of myocardial strains in such population.

Atorvastatin can ameliorate left atrial stunning induced by radiofrequency ablation for atrial fibrillation

2017 ◽  
Vol 95 (9) ◽  
pp. 985-992
Author(s):  
Ruiqin Xie ◽  
Yingtao Yang ◽  
Wei Cui ◽  
Hongning Yin ◽  
Hongmei Zheng ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Left Atrium ◽  
Left Atrial ◽  
Conventional Treatment ◽  
Imaging System ◽  
Left Atrial Strain ◽  
Functional Changes ◽  
Atorvastatin Group ◽  
Atrial Strain

The objective of this study was to study the functional changes of the left atrium after radiofrequency ablation treatment for atrial fibrillation and the therapeutic effect of atorvastatin. Fifty-eight patients undergoing radiofrequency ablation for atrial fibrillation were randomly divided into non-atorvastatin group and atorvastatin group. Patients in the atorvastatin group were treated with atorvastatin 20 mg p.o. per night in addition to the conventional treatment of atrial fibrillation; patients in the non-atorvastatin group received conventional treatment of atrial fibrillation only. Echocardiography was performed before radiofrequency ablation operation and 1 week, 2 weeks, 3 weeks, and 4 weeks after operation. Two-dimensional ultrasound speckle tracking imaging system was used to measure the structural indexes of the left atrium. Results indicated that there was no significant change for indexes representing the structural status of the left atrium within a month after radiofrequency ablation (P > 0.05); however, there were significant changes for indexes representing the functional status of the left atrium. There were also significant changes in indexes reflecting left atrial strain status: the S and SRs of atorvastatin group were higher than those of non-atorvastatin group (P < 0.05). In summary, atorvastatin could improve left atrial function and shorten the duration of atrial stunning after radiofrequency ablation of atrial fibrillation.

scholarly journals Utility of Speckle-Tracking Echocardiography For Predicting Atrial Fibrillation Following Ischemic Stroke: A Systematic Review And Meta-Analysis

2021 ◽  
Author(s):  
Qinggele Gao ◽  
Peng Liu ◽  
Tingting Lv ◽  
Ying Yang ◽  
Ping Zhang
Keyword(s):  
Atrial Fibrillation ◽  
Strain Rate ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Global Longitudinal Strain ◽  
Cryptogenic Stroke ◽  
Atrial Remodeling

Abstract Purpose: Undiagnosed atrial fibrillation (AF) is one of the main sources of cryptogenic stroke. And strain indices measured by speckle-tracking echocardiography are associated with atrial remodeling supposed to be the substrate of AF. Therefore, there is a strong need for evaluating the utility of speckle-tracking echocardiography to predict the likelihood of AF in patients with cryptogenic stroke.Methods: PubMed, Embase and Cochrane Database were searched for studies. The random-effects model was used to calculate the pooled results, and summary receiver operating characteristic curve (SROC) analysis was performed to show the overall predictive value.Results: There were 1483 patients with cryptogenic stroke from 8 studies. Meta-analysis showed that strain indices including global longitudinal strain (GLS) (mean difference [SMD]: -0.22, 95% confidence interval [95% CI]: -0.40 to -0.04) , left atrial reservoir strain (εR), (SMD: -0.87, 95% CI: -1.26 to -0.48, conduit strain (εCD) (SMD: -0.56, 95% CI: -0.81 to -0.30), contractile strain (εCT) (SMD: -1.00, 95% CI: -1.39 to -0.61), and left atrial reservoir strain rate (SRe) (SMD: -0.54, 95% CI: -0.80 to -0.28) measured at the period of cryptogenic stroke was significantly decreased in patients with AF occurrence compared to without. SROC analysis suggested an acceptable predictive efficiency of εR for AF occurrence (AUC = 0.799).Conclusion: For patients after cryptogenic stroke, GLS, εR, εCD, εCT and SRe were significantly decreased in AF occurrence compared with non-occurrence. But there was no value in left atrial reservoir strain rate (SRs) and contractile strain rate (SRa) for predicting AF.

Is insulin resistance play a role in left atrium dysfunction in young hypertensive patients?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I.A Khomova ◽  
E.A Bazdyreva ◽  
A.I Khramkova ◽  
N.E Ezhova ◽  
E Shavarova ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Uric Acid ◽  
Waist Circumference ◽  
Left Atrium ◽  
Body Mass ◽  
Left Atrial ◽  
Stepwise Regression ◽  
Global Longitudinal Strain ◽  
Insulin Level ◽  
Hypertensive Patients

Abstract   Insulin resistance with normoglycemia could lead to subclinical inflammation, left atrium enlargement and ventricular systolic and diastolic dysfunction. The aim of our study was to analyzed associations between markers of insulin resistance and parameters of left atrium function in young hypertensive patients. Methods 965 young people were screened, among which 64 (6.6%) had high normal blood pressure and 57 (5.9%) had arterial hypertension. 121 patients with uncomplicated arterial hypertension grade 1–2 were included to the study (81% male, mean age 25.6 (7.3) years, 22 (18%) had obesity, 51 (42%) were smokers). All patients undergone clinical and laboratory evaluation, 24-h blood pressure monitoring, echocardiography. LA function were evaluated by 2D-speckle tracking echocardiography with left atrial reservoir strain (LASr), left atrial booster strain (LASb), left atrial conduit strain (LACs). Insulin level, serum glucose, was measured by using overnight fasting blood sampling between 7 am and 9 am. Insulin resistance was evaluated by HOMA-IR. Results Mean office systolic BP was 132 [122; 138]; diastolic BP – 70 [63; 76]. LAVI was 23 [19; 27] ml/m2. Mean insulin was 8.1 [5.4; 12.3] mIU/l, HOMA-IR – 1.9 [1.2; 2.8]. Correlations between LASr and body mass, waist circumference, insulin level, uric acid, HOMA-IR, E/e', LASb and insulin, HOMA-IR, uric acid, LASc and body mass, waist circumference, insulin level were revealed (p&lt;0.05). Independent association LASc with BMI (B −0.22, p=0.02), LASb with insulin level (B −0.37, p=0.02), LASr with insulin (B −0.37, p=0.02) and with left ventricular (LV) global longitudinal strain (B −0.32, p=0.046) were confirmed in multiple stepwise regression model. Associations between endomyocardial LASb and insulin, HOMA-IR, endomyocardial LASr and body mass, waist circumference, insulin, uric acid, HOMA-IR, E/e', LASra and insulin and HOMA-IR, LASre with body mass, waist circumference, insulin, uric acid, HOMA-IR (p&lt;0.05) were found during correlation analysis. Multiple stepwise regression showed independent associations endomyocardial LASb with HOMA-IR (B −0.44, p=0.005), endomyocardial LASr with HOMA-IR (B −0.46, p=0.003) and with LV global longitudinal strain (B −0.31, p=0.04), LASra with HOMA-IR (B −0.46, p=0.008), LASre with body mass (B −0.48, p=0.036) and with insulin (B −0.38, p=0.001). Conclusion Left atrium reservoir function is load dependent and influenced by LV function. For subclinical left atrium remodeling assessment booster function should be analized along with reservoir function. In young hypertensive patients insulin level were independently associated with left atrial dysfunction. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Project 5-100

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

scholarly journals Clinical implication of disturbed left atrial phasic functions in the heterogeneous population associated with hypertension or atrial fibrillation

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Mengruo Zhu ◽  
Haiyan Chen ◽  
Yang Liu ◽  
Xianhong Shu
Keyword(s):  
Atrial Fibrillation ◽  
Differential Diagnosis ◽  
Healthy Subjects ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Heterogeneous Population ◽  
Two Dimensional ◽  
Hypertensive Patients

Abstract Background To evaluate left atrial (LA) phasic functions in patients with hypertension and/or paroxysmal atrial fibrillation (PAF) and its clinical significance. Methods LA strain was studied in 77 patients (25 hypertension, 24 lone AF, and 28 with both hypertension and PAF) and 28 controls using two-dimensional speckle-tracking echocardiography (2D STE). The following indexes during atrial reservoir, conduit and pump phase were analyzed respectively: (1) peak atrial longitudinal strain (PALS) and strain rate (PALSR), (2) the standard deviation of time to PALS and PALSR of all LA segments (TpS-SD% and TpSR-SD%). Results Compared with controls, PALSres, PALScond and PALSRcond were significantly reduced in patients with isolated hypertension (all P < 0.01) but no significant differences were observed in PALSpump, PALSRpump and TpSpump-SD% between them (all P > 0.05). PALSpump, PALSRpump and PALSRres were significantly lower in patients with both hypertension and PAF than in those with isolated hypertension (all P < 0.05). PALS and PALSR were significantly decreased, and TpS-SD% was significantly increased during each phase in lone AF patients than in controls (all P < 0.05), and PALSRpump was further depressed in patients with both hypertension and PAF (P = 0.029). PALSRcond ≤ 1.475 s− 1 combined with TpSpump-SD% ≥ 3.25% (sensitivity, 85%; specificity, 71%; AUC = 0.845, P < 0.001) could distinguish lone AF from healthy subjects effectively, while in hypertensive patients, PALSpump ≤ 14.2% was found to be an independent differentiator for occurrence of AF or not with sensitivity of 81% and specificity of 84% (AUC = 0.838, P < 0.001). LAVI≥29.3 mL/m2 was an independent characteristic for reflecting different LA remodeling in lone AF or hypertension with AF. Conclusions The impairment of LA phasic functions was varied in patients with hypertension and/or AF. The disturbed LA phasic functions were proved to have independent abilities of differential diagnosis in this heterogeneous population associated with hypertension or AF.

P660The effect of hypertension and metabolic syndrome on left atrial function in patients with paroxysmal atrial fibrillation undergoing catheter ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Katbeh ◽  
T De Potter ◽  
P Geelen ◽  
Z Balogh ◽  
E Stefanidis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Metabolic Syndrome ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Contractile Function ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Hypertensive Patients ◽  
History Of

Abstract Background Hypertension and metabolic risk factors are associated with increased risk of atrial fibrillation (AF) and heart failure. Previous studies assessing the efficacy of catheter ablation in patients with metabolic syndrome have shown conflicting data. Purpose We thought to assess the impact of hypertension and other metabolic risk factors on left atrial (LA) phasic function in patients with paroxysmal AF undergoing the first catheter ablation. Methods We prospectively enrolled 112 consecutive patients (age: 63±21 years; 32% female) with symptomatic paroxysmal AF and preserved left ventricular ejection fraction (≥50%) undergoing the first catheter ablation during sinus rhythm, and 23 healthy controls. Patients with valvular AF or in AF at the time of ablation were excluded. All patients underwent comprehensive echocardiography at one day pre and at one day post ablation, and after three months. The LA reservoir, conduit and contractile strain and strain rate (SR) were assessed using the two-dimensional speckle tracking echocardiography as average of segmental values in apical views. Results A total of 51 (45.5%) patients had history of treated hypertension while 61 (54.5%) patients had normal arterial blood pressure, and 27 (24.1%) patients of hypertensive group and 17 (15.1%) patients of normotensive group have dyslipidemia and/or diabetes. All groups of patients had been adjusted by age and sex. Pre-ablation, hypertensive patients with metabolic risk factors showed significantly lower magnitude of reservoir and contractile strain and SR compared with other groups of patients (all p<0.05). Hypertensive patients compared with normotensive patients had significantly increase in LA volume index (39±1% vs. 34±7%, p: 0.01) and decrease in LA emptying fraction (49.5±11% vs. 54.8±9.8%, p: 0.02). Post-ablation, LA strain and SR significantly decreased in all patients regardless of the history of hypertension or other metabolic risk factors (all p<0.05). At three-month follow-up, LA strain and SR showed almost complete recovery to pre-ablation values in both groups of patients. Yet, LA function in groups of patients with metabolic risk factors remained lower compared with individuals without risk factors. Of note, hypertensive individuals showed similar improvement of LA contractile function to normotensive patients (p: 0.4) but LA reservoir function remained to be lower (p<0.05) (figure 1,2). The intra- and the inter-observer variability for the LAS and LASR assessment were below 5% and significantly lower (p<0.05) than that of the conventional LA indices. Conclusion Both reservoir and contractile LA strain are simultaneously affected by dyslipidemia and/or diabetes. LA reservoir function is affected earlier in hypertensive patients than contractile function. Reservoir LA strain appears to be the most useful parameter to monitor LA function in hypertensive patients with/without metabolic risk factors.

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