1227 Risk stratification of patients with asymptomatic moderate mitral regurgitation: the prognostic value of left atrial strain

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Cameli ◽  
M C Pastore ◽  
F M Righini ◽  
G E Mandoli ◽  
F D"ascenzi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Mitral Regurgitation ◽  
Risk Stratification ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Event Free Survival ◽  
Free Survival

Abstract Background In asymptomatic moderate mitral regurgitation (MR), the criteria for risk stratification are still uncertain. Therefore, in these patients, optimal time of surgery remains controversial. Purpose Our aim was to compare left atrial (LA) strain to other echocardiographic parameters for the prediction of cardiovascular (CV) events in patients with asymptomatic moderate MR. Methods 401 patients with primary degenerative asymptomatic moderate MR was enrolled and prospectively followed for the development of CV events (i.e. atrial fibrillation, stroke/transient ischemic attack, acute heart failure, CV death). Patients with history of atrial fibrillation, myocardial infarction, heart failure, cardiac surgery or heart transplantation, severe MR, mitral valve surgery during follow-up were excluded. Results During a mean follow up of 3.4 ± 2 years, of the 326 patients eligible (mean age 65 ± 9 years), 122 patients had 149 new events. There were no significative differences in mean age and sex, clinical and therapeutic characteristics between the two groups. The event-group presented reduced global peak atrial longitudinal strain (PALS), LA emptying fraction, LV strain at baseline, and larger LA volume indexed (p <0.0001). Receiver operating characteristics curves proved the greatest predictive performance for global PALS < 35% (AUC 0.88). Bland-Altman analysis demonstrated good intra- and inter-observer agreement and Kaplan Meier analysis showed a graded association between PALS and event-free-survival. Conclusions Speckle tracking echocardiography could provide a useful index, global PALS, to estimate LA function in patients with asymptomatic moderate MR in order to optimize surgical timing before the development of irreversible myocardial dysfunction. Echo-data of our study population Variable No CV events (n = 204) CV events (n = 122) LV ejection fraction (%) 59 ± 9 58 ± 10 LV global longitudinal strain (%) - 18.5 ± 3.4 -17.6 ± 3.6* LA volume indexed (ml/m2) 32.5 ± 6.7 36.4 ± 7.1* LA emptying fraction (%) 68 ± 13 62 ± 15* Mitral E/A ratio 0.94 ± 0.14 0.95 ± 0.16 Mitral E/E’ ratio 11.2 ± 6.5 12.4 ± 7.1 Mitral regurgitant fraction (%) 38.9 ± 8.1 39.1 ± 9.4 End regurgitation orifice area (cm2) 0.34 ± 0.05 0.34 ± 0.06 Global PALS (%) 32.5 ± 8.5 19.7 ± 8.1* *Significative variation between groups. Cardiovascular, CV; Left atrial, LA; Left ventricular, LV; Peak atrial longitudinal strain, PALS Abstract 1227 Figure. Event-free survival according to PALS

scholarly journals P1288 Male gender and left atrial volume index predict non valvular atrial fibrillation recurrence. The NeAfi echo registry

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Sorrentino ◽  
V Capone ◽  
L Esposito ◽  
F Lo Iudice ◽  
A M De Roberto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Male Gender ◽  
Volume Index ◽  
Significant Information ◽  
Af Recurrence

Abstract Background In non-valvular atrial fibrillation (AF) patients, risk stratification scores such as CHA2DS2VASc and HASBLED allow the prediction of thromboembolic and bleeding risks, respectively. However, no risk score for the prediction of AF recurrence has been yet validated. Purpose To evaluate the mayor anthropometric and echocardiographic determinants of AF recurrence in non-valvular paroxysmal AF patients at 1 year follow-up. Methods Among 395 consecutive adult patients with non valvular AF enrolled in the Neapolitan Atrial Fibrillation (NeAfi) Echo registry, 177 (F/M = 87/90, age = 66.5± 11.9 years) had paroxismal AF and underwent 1-year follow-up. Fifteen patients had AF recurrence. Anthropometric parameters and blood pressure (BP) were recorded and CHA2DS2VASc and HASBLED scores were calculated. At baseline, patients underwent a comprehensive echo-Doppler exam, including quantification of left atrial (LA) size measurements, peak atrial longitudinal strain (PALS) and left ventricular (LV) global longitudinal strain (GLS). Binary logistic regression analysis was used to establish a mathematical model of the relationship between the variables and AF recurrence. The covariates for regression analysis were chosen as potential confounding factors based on their significance in independent T test analyses for continuous variables of chi-square for dichotomous variables, or on their biological plausibility. Results AF recurrence was higher in male than in female patients (14.4 vs 2.3%, p = 0.008). Patients with AF recurrence had similar body mass index, systolic and diastolic BP and heart rate compared to those without. The two groups were similar for LV end-systolic and end-diastolic volumes, ejection fraction, LV mass index, diastolic indexes, pulmonary artery systolic pressure and GLS. LA diameter (p = 0.235) and PALS (p = 0.375) were also similar between the two groups, whereas LA volume index (LAVi) was greater in patients experiencing AF recurrence (45.5 ± 15.7 vs. 36.7 ± 10.4 ml/m², p = 0.003). Binomial multiple regression analysis model explained 25% (Nagelkerke R²) of the variance in AF recurrence and correctly classified 95.0% of cases. Males were 8.9 times more likely to exhibit AF recurrence than females (p = 0.04). Greater LAVi was associated with an increased likelihood of exhibiting AF recurrence (OR = 1.07, p = 0.03), whereas CHA2DS2VASc >1 in men and >2 in women, HASBLED >3 and greater LA diameter or lower PALS did not add significant information to the model. Conclusions Male gender and, with a lower extent, LAVi appear to be major determinants of AF recurrence in non-valvular paroxysmal AF. The quantification of PALS does not seem to add valuable information in the prediction of recurrent AF.

scholarly journals A prognostic nomogram for event-free survival in patients with atrial fibrillation before cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Cai ◽  
W Hua ◽  
S.W Yang ◽  
N.X Zhang ◽  
Y.R Hu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
High Risk ◽  
Risk Stratification ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Concordance Index ◽  
Resynchronization Therapy ◽  
Event Free Survival ◽  
Free Survival

Abstract Background Atrial fibrillation (AF), one of the most common comorbidities with heart failure (HF), is associated with worse prognosis in HF patients receiving cardiac resynchronization therapy (CRT). However, there is still no convenient tool to evaluate and identify patients with high risk of mortality and hospitalization due to heart failure in CRT candidates with AF. Methods We included 152 consecutive patients with AF for CRT in our hospital from January 2009 to July 2019. Multivariate Cox regression was applied to derive a nomogram, using multiple imputation for missing values and backward stepwise regression for variable selection. Results Five predictors were incorporated in the nomogram, including N-terminal pro brain natriuretic protein (NTproBNP) >1745pg/mL, history of syncope, previous pulmonary hypertension (PHP), moderate or severe tricuspid regurgitation (TR), thyroid stimulating hormone (TSH) >4mIU/L. Concordance index (0.70, 95% CI 0.62–0.77), corrected concordance index (0.67, 95% CI 0.59–0.74) and calibration curve showed optimal discrimination and calibration of the established nomogram. Significant difference of overall event-free survival was recognized by the nomogram-derived scores in patients with high risk (>50 points), intermediate risk (21–50 points) and low risk (0–20 points) before CRT. Conclusion Our nomogram may be an applicable tool for early risk stratification among CRT candidates with AF. Nomogram and risk stratification Funding Acknowledgement Type of funding source: None

scholarly journals Sacubitril/Valsartan Induces Global Cardiac Reverse Remodeling in Long-Lasting Heart Failure with Reduced Ejection Fraction: Standard and Advanced Echocardiographic Evidences

2020 ◽  
Vol 9 (4) ◽  
pp. 906 ◽  
Author(s):  
Matteo Castrichini ◽  
Paolo Manca ◽  
Vincenzo Nuzzi ◽  
Giulia Barbati ◽  
Antonio De Luca ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Prognostic Impact ◽  
Reduced Ejection Fraction

Sacubitril/valsartan reduces mortality in heart failure with reduced ejection fraction (HFrEF) patients, partially due to cardiac reverse remodeling (RR). Little is known about the RR rate in long-lasting HFrEF and the evolution of advanced echocardiographic parameters, despite their known prognostic impact in this setting. We sought to evaluate the rates of left ventricle (LV) and left atrial (LA) RR through standard and advanced echocardiographic imaging in a cohort of HFrEF patients, after the introduction of sacubitril/valsartan. A multi-parametric standard and advanced echocardiographic evaluation was performed at the moment of introduction of sacubitril/valsartan and at 3 to 18 months subsequent follow-up. LVRR was defined as an increase in the LV ejection fraction ≥10 points associated with a decrease ≥10% in indexed LV end-diastolic diameter; LARR was defined as a decrease >15% in the left atrium end-systolic volume. We analyzed 77 patients (65 ± 11 years old, 78% males, 40% ischemic etiology) with 76 (28–165) months since HFrEF diagnosis. After a median follow-up of 9 (interquartile range 6–14) months from the beginning of sacubitril/valsartan, LVRR occurred in 20 patients (26%) and LARR in 33 patients (43%). Moreover, left ventricular global longitudinal strain (LVGLS) improved from −8.3 ± 4% to −12 ± 4.7% (p < 0.001), total left atrial emptying fraction (TLAEF) from 28.2 ± 14.4% to 32.6 ± 13.7% (p = 0.01) and peak atrial longitudinal strain (PALS) from 10.3 ± 6.9% to 13.7 ± 7.6% (p < 0.001). In HFrEF patients, despite a long history of the disease, the introduction of sacubitril/valsartan provides a rapid global (i.e., LV and LA) RR in >25% of cases, both at standard and advanced echocardiographic evaluations.

scholarly journals P905 Value of global longitudinal strain (GLS) in the short term prognosis of geriatric patients with asymptomatic severe aortic stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Ramos Sanchez ◽  
M Quezada ◽  
A Garcia ◽  
R Ayala ◽  
C Herrera ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Stenosis ◽  
Longitudinal Strain ◽  
Geriatric Patients ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Event Free Survival ◽  
Short Term ◽  
Free Survival ◽  
Global Population

Abstract Funding Acknowledgements VII Convocatoria del Banco de Santander and Alfonso X el Sabio University. Background Detection of symptoms in geriatric population with aortic stenosis (AS) is challenging, especially when they associate other comorbidities or frailty. Left ventricular global longitudinal strain (GLS) occurs before left ventricular ejection fraction impairment and could be useful for risk stratification and management of these patients. Purpose We sought to analyze the usefulness of GLS for predicting major cardiovascular adverse events (MACEs) in geriatric patients with asymptomatic severe AS. Material and Methods: Prospective study on 54 patients older than 70 years old with severe asymptomatic AS. Patient evaluation included biochemistry tests, electrocardiogram and echocardiography. We use a GLS cut-off point of 18% to dichotomize patients. Outcomes were defined as the composite of MACEs – occurrence of death from any cause, hospitalization for heart failure, appearance of symptoms or change in treatment. Results The mean age was 83.2 ± 7.1, with 60.4% of women. 24.5% showed atrial fibrillation. At 6 months of follow-up, 33% of patients reached the endpoint: 5.6% CHF, 11.1% death, 3.7% symptoms without changes in management and 13% were referred to an invasive treatment. The event-free survival rate at 6 months for the global population was 83%. 41.5 % of the subjects had GLS &lt; 18%. Kaplan Meier analysis showed that the probability of freedom from MACEs was not significant in patients with lower GLS (Log Rank p = 0.39). In the multivariate analysis only AVA was an inverse predictor of events (AVA) HR 0.05 (95% CI 0.007- 0.471, p &lt; 0.05). Conclusions The value of GLS was not a predictor of short term events in geriatric patients. Only assessment of AVA was an independent marker of MACES and in this kind of subjects. Charasteristics of the global population Global N = 53 (%) GLS ≥ 18 N = 31 (58.5%) GLS &lt; 18 N = 22 (41.5%) (p) HBP 42 (79.2) 27 (87.1) 19 (82.6) 0.09 Atrial fibrillation 13 (24.5) 6 (19.4) 7 (31.8) 0.29 CVD 6 (11.3) 1 (3.2) 5 (22.7) 0.02 LVEF: Normal &gt;50% 48 (92) 31 (100) 17 (77.2) 0.05 Peak velocity 3.72 ± 0.72 3.81 ± 0.71 3.60 ± 0.74 0.315 Mean gradient 34.01 ± 14.06 35.61 ± 13.54 32.09 ± 15.07 0.29 Integral ratio 0.25 ± 0.08 0.26 ± 0.09 0.25 ± 0.08 0.83 AVA 0.8 ± 0.26 0.78 ± 0.27 0.83 ± 0.26 0.651 Indexed AVA 0.48 ± 0.16 0.48 ± 0.17 0.48 ± 0.16 0.9 AVA Aortic valve area; CVD: cerebro vascular disease; HBP: High blood presure; LVEF: left ventricule ejection fraction. Abstract P905 Figure. Kapplan-Meier event-free survival curves

scholarly journals Catheter ablation of nonparoxysmal atrial fibrillation in patients with heart failure with reduced ejection fraction and functional mitral regurgitation

2020 ◽  
Author(s):  
Teng Li ◽  
Jun Huang ◽  
Jian Liang ◽  
Wenjie Peng ◽  
Ligang Ding ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Reduced Ejection Fraction

Abstract Background The optimal treatment for patients with nonparoxysmal atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) has been a subject of debate for years. We aimed to evaluate the efficacy and safety of catheter ablation (CA) of nonparoxysmal AF in patients with HFrEF and functional mitral regurgitation (MR). Methods This single-center, retrospective, and observational study enrolled 21 consecutive patients with nonparoxysmal AF, HFrEF and functional MR underwent CA༎The ablation strategy consisted of bilateral circumferential pulmonary vein isolation and empirical linear ablations. Results After a mean follow-up of 18.2 ± 8.5 months, stable sinus rhythm (SR) was achieved in 15 patients (71.4%) after the initial procedure and 17 patients (81%) after the final procedure. The NYHA class improved from 2.7 ± 0.7 before ablation to 1.2 ± 0.4 during follow-up (p < 0.001). Left ventricular ejection fraction increased from 36.5 ± 6.3% to 54.9 ± 6.6% (p < 0.001). Among 17 patients in continuous SR after the final procedure, MR severity decreased to mild or none,and 10 patients with decreased ventricular wall motion was completely restored to normal after the procedure. No serious complications occurred. Conclusion CA may be a safe and effective method for treating nonparoxysmal AF in patients with HFrEF and functional MR. It can significantly improve HF symptoms, functional MR and left ventricular function..

scholarly journals POSTERS (2)96CONTINUOUS VERSUS INTERMITTENT MONITORING FOR DETECTION OF SUBCLINICAL ATRIAL FIBRILLATION IN HIGH-RISK PATIENTS97HIGH DAY-TO-DAY INTRA-INDIVIDUAL REPRODUCIBILITY OF THE HEART RATE RESPONSE TO EXERCISE IN THE UK BIOBANK DATA98USE OF NOVEL GLOBAL ULTRASOUND IMAGING AND CONTINUEOUS DIPOLE DENSITY MAPPING TO GUIDE ABLATION IN MACRO-REENTRANT TACHYCARDIAS99ANTICOAGULATION AND THE RISK OF COMPLICATIONS IN PATIENTS UNDERGOING VT AND PVC ABLATION100NON-SUSTAINED VENTRICULAR TACHYCARDIA FREQUENTLY PRECEDES CARDIAC ARREST IN PATIENTS WITH BRUGADA SYNDROME101USING HIGH PRECISION HAEMODYNAMIC MEASUREMENTS TO ASSESS DIFFERENCES IN AV OPTIMUM BETWEEN DIFFERENT LEFT VENTRICULAR LEAD POSITIONS IN BIVENTRICULAR PACING102CAN WE PREDICT MEDIUM TERM MORTALITY FROM TRANSVENOUS LEAD EXTRACTION PRE-OPERATIVELY?103PREVENTION OF UNECESSARY ADMISSIONS IN ATRIAL FIBRILLATION104EPICARDIAL CATHETER ABLATION FOR VENTRICULAR TACHYCARDIA ON UNINTERRUPTED WARFARIN: A SAFE APPROACH?105HOW WELL DOES THE NATIONAL INSTITUTE OF CLINICAL EXCELLENCE (NICE) GUIDENCE ON TRANSIENT LOSS OF CONSCIOUSNESS (T-LoC) WORK IN A REAL WORLD? AN AUDIT OF THE SECOND STAGE SPECIALIST CARDIOVASCULAT ASSESSMENT AND DIAGNOSIS106DETECTION OF ATRIAL FIBRILLATION IN COMMUNITY LOCATIONS USING NOVEL TECHNOLOGY'S AS A METHOD OF STROKE PREVENTION IN THE OVER 65'S ASYMPTOMATIC POPULATION - SHOULD IT BECOME STANDARD PRACTISE?107HIGH-DOSE ISOPRENALINE INFUSION AS A METHOD OF INDUCTION OF ATRIAL FIBRILLATION: A MULTI-CENTRE, PLACEBO CONTROLLED CLINICAL TRIAL IN PATIENTS WITH VARYING ARRHYTHMIC RISK108PACEMAKER COMPLICATIONS IN A DISTRICT GENERAL HOSPITAL109CARDIAC RESYNCHRONISATION THERAPY: A TRADE-OFF BETWEEN LEFT VENTRICULAR VOLTAGE OUTPUT AND EJECTION FRACTION?110RAPID DETERIORATION IN LEFT VENTRICULAR FUNCTION AND ACUTE HEART FAILURE AFTER DUAL CHAMBER PACEMAKER INSERTION WITH RESOLUTION FOLLOWING BIVENTRICULAR PACING111LOCALLY PERSONALISED ATRIAL ELECTROPHYSIOLOGY MODELS FROM PENTARAY CATHETER MEASUREMENTS112EVALUATION OF SUBCUTANEOUS ICD VERSUS TRANSVENOUS ICD- A PROPENSITY MATCHED COST-EFFICACY ANALYSIS OF COMPLICATIONS & OUTCOMES113LOCALISING DRIVERS USING ORGANISATIONAL INDEX IN CONTACT MAPPING OF HUMAN PERSISTENT ATRIAL FIBRILLATION114RISK FACTORS FOR SUDDEN CARDIAC DEATH IN PAEDIATRIC HYPERTROPHIC CARDIOMYOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS115EFFECT OF CATHETER STABILITY AND CONTACT FORCE ON VISITAG DENSITY DURING PULMONARY VEIN ISOLATION116HEPATIC CAPSULE ENHANCEMENT IS COMMONLY SEEN DURING MR-GUIDED ABLATION OF ATRIAL FLUTTER: A MECHANISTIC INSIGHT INTO PROCEDURAL PAIN117DOES HIGHER CONTACT FORCE IMPAIR LESION FORMATION AT THE CAVOTRICUSPID ISTHMUS? INSIGHTS FROM MR-GUIDED ABLATION OF ATRIAL FLUTTER118CLINICAL CHARACTERISATION OF A MALIGNANT SCN5A MUTATION IN CHILDHOOD119RADIOFREQUENCY ASSOCIATED VENTRICULAR FIBRILLATION120CONTRACTILE RESERVE EXPRESSED AS SYSTOLIC VELOCITY DOES NOT PREDICT RESPONSE TO CRT121DAY-CASE DEVICES - A RETROSPECTIVE STUDY USING PATIENT CODING DATA122PATIENTS UNDERGOING SVT ABLATION HAVE A HIGH INCIDENCE OF SECONDARY ARRHYTHMIA ON FOLLOW UP: IMPLICATIONS FOR PRE-PROCEDURE COUNSELLING123PROGNOSTIC ROLE OF HAEMOGLOBINN AND RED BLOOD CELL DITRIBUTION WIDTH IN PATIENTS WITH HEART FAILURE UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY124REMOTE MONITORING AND FOLLOW UP DEVICES125A 20-YEAR, SINGLE-CENTRE EXPERIENCE OF IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD) IN CHILDREN: TIME TO CONSIDER THE SUBCUTANEOUS ICD?126EXPERIENCE OF MAGNETIC REASONANCE IMAGING (MEI) IN PATIENTS WITH MRI CONDITIONAL DEVICES127THE SINUS BRADYCARDIA SEEN IN ATHLETES IS NOT CAUSED BY ENHANCED VAGAL TONE BUT INSTEAD REFLECTS INTRINSIC CHANGES IN THE SINUS NODE REVEALED BY I (F) BLOCKADE128SUCCESSFUL DAY-CASE PACEMAKER IMPLANTATION - AN EIGHT YEAR SINGLE-CENTRE EXPERIENCE129LEFT VENTRICULAR INDEX MASS ASSOCIATED WITH ESC HYPERTROPHIC CARDIOMYOPATHY RISK SCORE IN PATIENTS WITH ICDs: A TERTIARY CENTRE HCM REGISTRY130A DGH EXPERIENCE OF DAY-CASE CARDIAC PACEMAKER IMPLANTATION131IS PRE-PROCEDURAL FASTING A NECESSITY FOR SAFE PACEMAKER IMPLANTATION?

EP Europace ◽  
2016 ◽  
Vol 18 (suppl 2) ◽  
pp. ii36-ii47
Author(s):  
T. Philippsen ◽  
M. Orini ◽  
C.A. Martin ◽  
E. Volkova ◽  
J.O.M. Ormerod ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ventricular Tachycardia ◽  
Hypertrophic Cardiomyopathy ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Day Case ◽  
Single Centre ◽  
Subcutaneous Icd

Early change in left atrial and left ventricular strain predicts sinus rhythm maintenance after cardioversion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kupczynska ◽  
D Miskowiec ◽  
B Michalski ◽  
L Szyda ◽  
K Wierzbowska-Drabik ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Recurrence Risk ◽  
Left Ventricular ◽  
Mechanical Function ◽  
Af Recurrence

Abstract Background Atrial fibrillation (AF) impairs mechanical function of the heart, especially atria and restoration of sinus rhythm (SR) leads to improvement of mechanics. The predicting role of changes in strain parameters for AF recurrence is not established yet. Purpose To analyse changes in left atrial (LA) and left ventricular (LV) mechanical function after conversion to SR and their prognostic values for AF recurrence during 24 months follow-up. Methods Prospective study involved 59 patients after successful electrical cardioversion (EC) because of nonvalvular AF (mean age 65±4 years, 47% female). Speckle tracking analysis (STE) was applied to calculate longitudinal strain of LV and LA before EC and within 24 hours after restoration of SR and additionally total left heart strain (TS) defined as a sum of absolute peak LV and LA strain. We calculated change in strain between AF and SR analyses expressed as delta (Δ). During follow-up we noticed AF recurrence in 42 (71%) patients, most of them (93%) during 1st year after EC. Median time of AF recurrence was 3 months. Results We noticed significant immediate post-EC improvement in peak LA longitudinal strain (PALS) and LV global longitudinal strain (LVGLS) (table). Unlike CHA2DS2-VASc score, strain parameters were predictors of AF recurrence. Every 1% increment in ΔLVGLS was related with 13% increase in AF recurrence risk (p=0.02) and every 1% increment in ΔPALS and ΔTS were related with 9% decrease in AF recurrence risk (p=0.007 and p=0.0014, respectively). Multivariate analysis revealed ΔTS as a strongest predictor with 9% decrease in AF risk per every 1% increment. The criterion of ΔTS ≤7.5% allows to predict AF recurrence with 81% sensitivity and 63% specificity. Conclusions Speckle tracking measurements are able to detect early mechanical changes in LA even within 24 hours of SR and these absolute changes in LVGLS as well as PALS can predict AF recurrence, with optimal stratification by novel parameter - TS. Funding Acknowledgement Type of funding source: None

Impact of rhythm in non-valvular atrial fibrillation on four cardiac chamber deformation imaging

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Philabout ◽  
L Soulat-Dufour ◽  
I Benhamou-Tarallo ◽  
S Lang ◽  
S Ederhy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Cardiac Rhythm ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Chamber ◽  
Deformation Imaging ◽  
And Function

Abstract Background Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome. Purpose To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6). Methods In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7) Results In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p&lt;0.001), lower global RA reservoir strain (+8.6 (−5.4 to 11.6) versus +24.3 (+12.3 to +44.9)%; p&lt;0.001), lower global LV longitudinal strain (respectively −12.8 (−15.2 to −10.4) versus −19.1 (−21.8 to −18.3)%; p&lt;0.001) and lower global RV longitudinal strain (respectively −14.2 (−17.3 to −10.7) versus −23.8 (−31.1 to −16.2)%; p=0.001). When compared with the AF-SR group at M0 the AF-AF group had no significant differences with regard to global LA and RA reservoir strain, global LV and RV longitudinal strain (Table). Between M0 and M6 there was a significant improvement in global longitudinal strain of the four chambers in the AF-SR group whereas no improvements were noted in the AF-AF and SR-SR group (Figure). Conclusion Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm. Evolution of strain between M0 and M6 Funding Acknowledgement Type of funding source: None

Abstract 16154: Baseline Left Ventricular Diameter Predicts Recovery in New Systolic Heart Failure Syndromes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Daniel Gold ◽  
Nathan Kong ◽  
Matthew Gold ◽  
Tess Allan ◽  
Anand Shah ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Medical Decision ◽  
Left Ventricular Ejection ◽  
Internal Diameter ◽  
Event Free Survival ◽  
Short Term Treatment ◽  
Ventricular Ejection Fraction ◽  
Free Survival ◽  
Advanced Therapies

Introduction: It is unknown how often patients with very advanced left ventricular (LV) dilation at initial presentation demonstrate meaningful recovery with medical therapy. Understanding short term treatment outcomes may impact medical decision making and counseling. Hypothesis: Patients with left ventricular end diastolic internal diameter (LVEDD) > 6.5cm will be less likely to recover left ventricular ejection fraction (LVEF) as compared to patients with LVEDD < 6.5cm. Methods: Patients were retrospectively identified by a database search of echocardiogram studies obtained at the University of Chicago between 2008-2018. Manual review was performed to ensure new diagnosis of systolic dysfunction with LVEF ≤ 35% and follow up echocardiogram study within 3 to 9 months of index study. LVEDD was determined from parasternal long axis views per routine. LVEF recovery was specified as LVEF > 35%. Chart review was done to assess for composite death, hospice, transplant, left ventricular assist device, and sustained ventricular tachycardia. Chi-square, multivariable logistic regression, and Kaplan-Meier survival were used for analysis. Results: Out of 100 patients included for analysis, mean age was 59.7 years, 41 were female and 82 were African American. 17.7% of patients’ with LVEDD > 6.5 cm had LVEF recovery compared to 53.0% of patients’ with LVEDD ≤ 6.5 cm (p = 0.008). LVEDD > 6.5 cm was associated with less LVEF recovery even when adjusted for age, gender, hypertension, and diabetes (adjusted odds ratio 0.18, 95% CI 0.04 to 0.65). LVEDD > 6.5cm was associated with worse event free survival (p = 0.004) with a median follow-up time of 2.4 years. Conclusions: An LVEDD of > 6.5cm is associated with diminished LVEF recovery and event free survival when compared to those patients with an LVEDD ≤ 6.5cm. Delaying consideration for advanced therapies and device based therapies in hopes of recovery may be inappropriate for many such patients.

Sign in / Sign up

Export Citation Format

Share Document