In-hospital interstage improves interstage survival after the Norwood stage 1 operation

Abstract OBJECTIVES The interstage mortality rate after a Norwood stage 1 operation remains 12–20% in current series. In-hospital interstage facilitates escalation of care, possibly improving outcome. METHODS A retrospective study was designed for hypoplastic left heart syndrome (HLHS) and HLHS variants, offering an in-hospital stay after the Norwood operation until the completion of stage 2. Daily and weekly examinations were conducted systematically, including two-dimensional and speckle-tracking echocardiography. Primary end points included aggregate survival until the completion of stage 2 and interstage freedom from escalation of care. Moreover, we calculated the sensitivity and specificity of speckle-tracking echocardiographic myocardial deformation in predicting death/transplant after the Norwood procedure. RESULTS Between 2015 and 2019, 33 neonates with HLHS (24) or HLHS variants (9) underwent Norwood stage 1 (31) or hybrid palliation followed by a comprehensive stage 2 operation (2). Stage 1 Norwood–Sano was preferred in 18 (54.5%) neonates; the classic Norwood with Blalock–Taussig shunt was performed in 13 (39.4%) neonates. The Norwood stage 1 30-day mortality rate was 6.2%. The in-hospital interstage strategy was implemented after Norwood stage 1 with a 3.4% interstage mortality rate. The aggregate Norwood stage 1 and interstage Kaplan–Meier survival rate was 90.6 ± 5.2%. Escalation of care was necessary for 5 (17.2%) patients at 2.5 ± 1.2 months during the interstage for compromising atrial arrhythmias (2), Sano-shunt stenosis (1) and pneumonia requiring a high-frequency oscillator (2); there were no deaths. A bidirectional Glenn (25) or a comprehensive-Norwood stage 2 (2) was completed in 27 patients at 4.7 ± 1.2 months with a 92.6% survival rate. The overall Kaplan–Meier survival rate is 80.9 ± 7.0% at 4.3 years (mean 25.3 ± 15.7 months). An 8.7% Δ longitudinal strain 30 days after Norwood stage 1 had 100% sensitivity and 81% specificity for death/transplant. CONCLUSIONS In-hospital interstage facilitates escalation of care, which seems efficacious in reducing interstage Norwood deaths. A significant reduction of longitudinal strain after Norwood stage 1 is a strong predictor of poor outcome.

Download Full-text

Hypermethylation of MT1G and MT1H CpGs Promoter Sites and High Serum Levels of Cu Affect Survival Rate of Patients Affected by Hepatocellular Carcinoma

Current Developments in Nutrition ◽

10.1093/cdn/nzaa067_018 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1791-1791

Author(s):

Domenica De Santis ◽

Silvia Udali ◽

Andrea Ruzzenente ◽

Greta Beschin ◽

Patrizia Pattini ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Dna Methylation ◽

Trace Elements ◽

Survival Rate ◽

Mortality Rate ◽

Liver Tissue ◽

Kaplan Meier ◽

Promoter Dna Methylation ◽

Promoter Dna

Abstract Objectives Recent evidences suggest a principal role of trace elements and metallothioneins (MTs), proteins involved in metal ions homeostasis and detoxification, in hepatocellular carcinogenesis. The study was designed to evaluate whether serum and liver tissue concentrations of the trace elements Cu, Zn and Se are implicated in survival rate of hepatocellular carcinoma (HCC) patients and if promoter DNA methylation is involved in trace elements-related proteins regulation. Methods Cu, Zn and Se levels were determined in serum and liver tissue samples, both HCC and homologous non neoplastic tissue (N) of 27 HCC patients by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Gene expression analysis of MT1G and MT1H, was performed by Real-time qPCR in HCC and N tissue. Promoter DNA methylation of a region overlapping MT1G and MT1H promoters was assessed by bisulfite amplicon sequencing (BSAS) in HCC and N tissues of 23 patients. Kaplan-Meier survival curves were drawn using the log-rank test (Mantel-Cox test) to examine the differences in survival according to serum trace elements and to gene-specific methylation levels. Results Kaplan-Meier analysis according to serum Cu levels showed that subjects within the highest quintile had an increased mortality rate (88.9%) compared with the other four quintiles (P = 0.025). Considering the 80th percentile of Cu levels (1118 μg/L), subjects with Cu concentrations above this value had a significantly decreased survival rate (P < 0.001). Se and Zn content were depleted in HCC tissues as compared to N tissues (P < 0.0001). MT1G and MT1H were strongly repressed in HCC tissues and precisely, MT1H in 24 out of 27 HCC tissues (P = 0.008) and MT1G in 23 out of 27 HCC tissues (P = 0.037). Nine out of 19 HCC tissues showing a down-regulation of MTs with three CpG sites, significantly hypermethylated in HCC tissue as compared to N tissue (P < 0.05). Considering the median methylation level, patients with higher methylation values showed increased mortality rate (P = 0.015). Conclusions The significant repression of MT1G and MT1H in HCC tissue is related to promoter hypermethylation and support the hypothesis of MT1G and MT1H as possible tumor suppressor genes in HCC. The evidence of promoter methylation levels and survival rate association provide new insights for the role of DNA methylation in liver carcinogenesis. Funding Sources N/A.

Download Full-text

Identified mortality risk factors associated with presentation, initial hospitalisation, and interstage period for the Norwood operation in a multi-centre registry: a report from the National Pediatric Cardiology-Quality Improvement Collaborative

Cardiology in the Young ◽

10.1017/s1047951113000127 ◽

2013 ◽

Vol 24 (2) ◽

pp. 253-262 ◽

Cited By ~ 28

Author(s):

Russell R. Cross ◽

Ashraf S. Harahsheh ◽

Robert McCarter ◽

Gerard R. Martin ◽

Keyword(s):

Risk Factors ◽

Relative Risk ◽

Pediatric Cardiology ◽

Left Heart ◽

Hypoplastic Left Heart ◽

Quality Improvement Collaborative ◽

Interstage Mortality ◽

Independent Risk Factors ◽

Stage 1 ◽

Left Heart Syndrome

AbstractIntroductionDespite improvements in care following Stage 1 palliation, interstage mortality remains substantial. The National Pediatric Cardiology-Quality Improvement Collaborative captures clinical process and outcome data on infants discharged into the interstage period after Stage 1. We sought to identify risk factors for interstage mortality using these data.Materials and methodsPatients who reached Stage 2 palliation or died in the interstage were included. The analysis was considered exploratory and hypothesis generating. Kaplan–Meier survival analysis was used to screen for univariate predictors, and Cox multiple regression modelling was used to identify potential independent risk factors.ResultsData on 247 patients who met the criteria between June, 2008 and June, 2011 were collected from 33 surgical centres. There were 23 interstage mortalities (9%). The identified independent risk factors of interstage mortality with associated relative risk were: hypoplastic left heart syndrome with aortic stenosis and mitral atresia (relative risk = 13), anti-seizure medications at discharge (relative risk = 12.5), earlier gestational age (relative risk = 11.1), nasogastric or nasojejunal feeding (relative risk = 5.5), unscheduled readmissions (relative risk = 5.3), hypoplastic left heart syndrome with aortic atresia and mitral stenosis (relative risk = 5.2), fewer clinic visits with primary cardiologist identified (relative risk = 3.1), and fewer post-operative vasoactive medications (relative risk = 2.2).ConclusionInterstage mortality remains substantial, and there are multiple potential risk factors. Future efforts should focus on further exploration of each risk factor, with potential integration of the factors into surveillance schemes and clinical practice strategies.

Download Full-text

Speckle tracking echocardiography as a promising tool for the prognostic assessment of patients with sarcoidosis

European Heart Journal ◽

10.1093/eurheartj/ehab724.2761 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M C Pastore ◽

P Cameli ◽

G E Mandoli ◽

M D'Alessandro ◽

G De Carli ◽

...

Keyword(s):

Transthoracic Echocardiography ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Speckle Tracking Echocardiography ◽

Pulmonary Function Tests ◽

Global Longitudinal Strain ◽

Cardiovascular Death ◽

Cardiac Events ◽

Prognostic Assessment ◽

Kaplan Meier

Abstract Background Sarcoidosis is a chronic granulomatous disease characterized by multiorgan inflammatory involvement and recurrent relapses with significant impact on morbidity and mortality. The prognostic assessment of these patients is still challenging. Although the international guidelines didn't recommend basic transthoracic echocardiography (TTE) for diagnostic and prognostic assessment of sarcoidosis, speckle tracking echocardiography (STE) has emerged as more sensitive for the early detection of cardiac sarcoidosis and outcome. Purpose This prospective study aimed to assess the potential value of STE parameters for the prediction of major adverse cardiac events (MACE) and sarcoidosis relapse. Methods Consecutive patients with confirmed diagnosis of sarcoidosis who underwent transthoracic echocardiography (TTE) and subsequent pulmonary function tests (PFTs) were enrolled. Patients with acute events or treatment escalation between TTE and PFTs and previous cardiac surgery were excluded. All patients were followed for sarcoidosis relapse requiring increase in step-up therapy and MACE (cardiovascular death, cardiovascular hospitalizations, arrhythmias). Results 172 patients were included (111 females, 57.4±12.6 years); 56 patients showed extrapulmonary localizations of sarcoidosis; at baseline, 99 patients were on steroid and/or immunosuppressive therapy. During a median follow up of 2217 days, 8 deaths (3 cardiovascular deaths), 23 MACE and 36 sarcoidosis relapses were reported. Patients with MACE were older (p=0.0022), but didn't show significant differences in PFTs and sarcoidosis phenotype. LV global longitudinal strain (GLS) was the only echocardiographic index to show significant differences (lower values) in patients with MACE (p=0.025). LV GLS ≤17.13% (absolute value) was identified as a fair predictor of MACE both with ROC curves (AUC=0.64) and Kaplan Meier analysis (Fig. 1). No significant differences of demographic, clinical, functional, and therapeutic data were observed between patients with/without sarcoidosis relapse. TTE revealed a significant reduction of LV ejection fraction (p=0.0432), tricuspid annular plane systolic excursion (TAPSE, p=0.0272) and global peak atrial longitudinal strain (PALS, p=0.0012) in patients with relapse. Among these 3 parameters, PALS ≤28.5% showed to be the best predictor of sarcoidosis relapse with ROC (AUC=0.7155) and Kaplan Meier curves (Fig. 2). Conclusions Our results highlight a potential role of LV GLS and PALS as prognostic markers in sarcoidosis, suggesting the use of STE in the clinical management of these patients, regardless the evidence or the suspect of cardiac localizations of the disease. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

Download Full-text

RV free wall longitudinal strain as an independent predictor of survival in wtATTR-CA patients

European Heart Journal ◽

10.1093/eurheartj/ehab724.005 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

T.S Tan ◽

M Grogan ◽

D Borgeson ◽

S.V Pislaru ◽

A Dispenzieri ◽

...

Keyword(s):

Prognostic Value ◽

Longitudinal Strain ◽

Independent Predictor ◽

Troponin T ◽

Free Wall ◽

Kaplan Meier ◽

2D Strain ◽

All Cause Mortality ◽

Incremental Prognostic Value ◽

Stage 1

Abstract Background Wild type transthyretin cardiac amyloidosis (wtATTR-CA) is increasingly recognized as a cause of heart failure with preserved ejection fraction (HFpEF) but prognosis is often limited due to late or misdiagnosis.Longitudinal left ventricular strain and biomarkers are established as markers of disease severity, but the role of RV free wall strain, reflecting RV contractility, is less well understood. Purpose We sought to determine whether RV free wall strain might add incremental prognostic value in wtATTR-CA. Methods Consecutive patients diagnosed with wtATTR-CA with tissue confirmation at Mayo clinic between 2013 and 2015 were included. Patients with TTR gene mutations were excluded. Baseline characteristics and transthoracic echocardiography measurements were obtained from the medical records. Speckle tracking RV free wall longitudinal 2D strain and peak LA longitudinal 2D strain were measured using Tom Tec Imaging System. Survival was determined using Kaplan Meier estimates and using the cox proportional hazard ratio, univariate and multivariable analysis were performed to identify predictors of mortality in patients with wtATTR. Results The study group comprised 139 patients (mean age 74.9±8.6, 92.8% male), of which 102 had adequate image quality for RV strain, and 99 for LA strain. Amongst these, 102 (73.3%) had AF and 118 patients (84.8%) had HF. During 3.23±2.0 years of follow up, 66 patients died. Both mean RV and LA strain were impaired at baseline: RV free wall strain was −14.7±4.9, and peak atrial longitudinal strain (PALS) was 13.2±8.8%. Using ROC analysis, RV strain of −16.8% was an independent predictor of all-cause mortality. In univariate modeling, higher levels of NT-proBNP (HR: 1.1 per 1000 pg.ml; 95%, CI 1.05–1.15, p<0.001) and Troponin T (HR: 2.0 per 0.1ng/ml; 95% CI 1.49–2.61, p<0.001) were associated with increased all-cause mortality. In addition, LV GLS (HR: 1.13 per 1%; 95% CI1.04–1.24, p=0.003), RV free wall LS (HR: 2.16 per 5%; 95%, CI 1.57–3.03, p<0.0001), and PALS (HR: 0.91 per1%; 95% CI 0.85–0.96, p<0.0001) were univariate predictors of all-cause mortality. In multivariate analysis using a stepwise regression model, RV free wall longitudinal strain (HR: 1.81; 95% CI 1.29–2.62, p<0.001) and Troponin T (HR: 1.7; 95% CI 1.25–2.26, p=0.001) remained independent predictors. Kaplan-Meier survival analysis demonstrated a higher mortality rate above −16.8 RV strain cut-off (Wilcoxon <0.0001). All stages were divided into two groups by −16.8% RV strain, and survival in individual stages analyzed. Stage 1 and 2 with <−16.8 RV free wall strain value had higher mortality than ≤-16.8% RV strain (Stage 1: Wilcoxon = 0.0041 and Stage 2: Wilcoxon = 0.023). However, there was not a survival difference between two RV strain groups in stage3 (Wilcoxon = 0.34) Conclusion RV free wall strain is an independent predictor of survival in wtATTR patients and may add incremental prognostic value to NT-proBNP and Troponin. FUNDunding Acknowledgement Type of funding sources: None. Kaplan-Meier curve of all patients Kaplan-Meier curve of stages

Download Full-text

Feeding, growth, nutrition, and optimal interstage surveillance for infants with hypoplastic left heart syndrome

Cardiology in the Young ◽

10.1017/s1047951111001600 ◽

2011 ◽

Vol 21 (S2) ◽

pp. 59-64 ◽

Cited By ~ 36

Author(s):

David A. Hehir ◽

David S. Cooper ◽

Elizabeth M. Walters ◽

Nancy S. Ghanayem

Keyword(s):

Hypoplastic Left Heart Syndrome ◽

Home Monitoring ◽

Failure To Thrive ◽

Normal Growth ◽

Left Heart ◽

Hypoplastic Left Heart ◽

Interstage Mortality ◽

Annual International Symposium ◽

Stage 1 ◽

Left Heart Syndrome

AbstractImprovement in operative survival of patients with hypoplastic left heart syndrome has led to increasing emphasis on prevention of interstage mortality. Many centres have improved interstage results through programmes of home monitoring following discharge after the Norwood (Stage 1) operation. Experience with heightened interstage surveillance has identified failure to thrive during infancy as a modifiable risk factor for this population, one that has been linked to concerning outcomes at subsequent palliative surgeries. Ensuring normal growth as an infant has thus become a priority of management of patients with functionally univentricular hearts. Herein, we review the existing evidence for best practices in interstage surveillance and optimal nutrition in infants with functionally univentricular hearts. In addition, we highlight data presented at HeartWeek 2011, from Cardiology 2011, the 15th Annual Update on Pediatric and Congenital Cardiovascular Disease, and the 11th Annual International Symposium on Congenital Heart Disease.

Download Full-text

MO528INFLUENCE OF CARDIOVASCULAR DISEASES ON SURVIVAL RATES IN DIALYSIS PATIENTS IN A COHORT OF THE UZBEK POPULATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab087.0048 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Olimkhon Sharapov ◽

Sherzod Abdullaev

Keyword(s):

Survival Rate ◽

Cardiovascular Diseases ◽

Mortality Rate ◽

Survival Rates ◽

Dialysis Patients ◽

Cardiovascular Comorbidity ◽

Kaplan Meier ◽

N 93 ◽

End Stage ◽

To Receive

Abstract Background and Aims The mortality rate of patients on hemodialysis is 6.3-8.2 times higher than in the general population. The presence of cardiovascular comorbidity worsens the prognosis and survival in this category of patients. According to various sources, the mortality rate in patients with CVD is 3 times higher than in patients without CVD. The aim of our study was to study the effect of comorbidity of the CVD on survival in patients with end-stage CKD receiving programmed hemodialysis among the population of Uzbekistan. Method We conducted a multicenter prospective cohort study of 165 patients among the Uzbek population. The study took place in 3 different dialysis centers in the country for 30 months (from January 2018 to July 2020). All patients received programmed hemodialysis due to ESRD. All patients were of Uzbek nationality, there were 90 men, 75 women. The average age was 48.1 ± 14.1 years. The duration of hemodialysis at the time of inclusion of patients in the study ranged from 6 to 165 months. The main primary diseases were glomerulonephritis (46%), diabetes mellitus (27%) and urolithiasis (8%). 56% (n = 92) of patients (52 men and 40 women) had CVD and 44% (n = 73) of patients (38 men and 35 women) had no CVD. The main CVDs were hypertension, coronary heart disease, heart failure and various arrhythmias. All patients were observed during the observation period, at the end of which the outcome was noted: patients either died or continued to receive hemodialysis. The survival rate was determined using the Kaplan-Meier method. The 95% confidence interval was determined using the Greenwood method. Results After 30 months of follow-up, 43.6% (n = 72) of all observed patients died, 56.4% (n = 93) patients survived (of which 11 underwent kidney transplantation). The average age of the deceased (53.6 ± 1.6) was significantly higher than that of patients continuing to receive HD (45.6 ± 1.5). The average duration of hemodialysis in survivors (33.0 ± 5.4) was higher than in the dead (28.6 ± 3.9). The study of the further fate of patients, depending on the presence or absence of cardiovascular diseases, showed that among the deceased patients, 68.1% (n = 49) of patients were patients who had CVD, while among those who survived, 53.7% ( n = 44) had no CVS pathologies. Among those continuing to receive programmed hemodialysis, there were 31.7% more patients without CVD than among patients with diagnosed CVD. In dialysis patients with CVD who died within the period of 30 months of prospective observation was 39.6% higher than in patients without CVD. The survival rate of patients with CVD was 0.44 [95% CI 0.34-0.55], while in patients without CVD it was 0.67 [95% CI 0.55-0.78]. Conclusion The concomitant pathology of the cardiovascular system affects the survival rate of patients with end-stage CKD on hemodialysis. Dialysis patients of the population of Uzbekistan who do not have concomitant cardiovascular pathology have a 33% higher survival rate than patients without CVD.

Download Full-text

Candidate Identification Technique for Lung Cancer

International Journal of Reliable and Quality E-Healthcare ◽

10.4018/ijrqeh.2021010101 ◽

2021 ◽

Vol 10 (1) ◽

pp. 1-13

Author(s):

Sadaf Batool Naqvi ◽

Abad Ali Shah

Keyword(s):

Lung Cancer ◽

Survival Rate ◽

Mortality Rate ◽

Early Identification ◽

Research Work ◽

Cancer Prognosis ◽

Lung Cancer Patients ◽

Identification Technique ◽

Stage 1 ◽

Candidate Identification

Intensive research work has been done related to lung cancer prognosis. However, the current research mainly emphasises on decreasing the mortality rate, and increasing the survival rate of lung cancer patients. In this paper, the authors argue that an early identification and candidate identification (CI) of this disease can change the early detection treatment of lung cancer and hence can markedly reduce the mortality rate. The proposed technique CI will recognize the disease well in advance and can potentially save the candidate's life. In other words, a candidate of lung cancer is identified and treated in Stage 0 (explained later) instead of in Stage 1 or in the later stages of the lung cancer. In this paper, the authors have introduced a technique, called candidate identification, to identify candidates of the lung cancer. In the proposed technique, a backward forecasting function (BFF) is also proposed to generate Stage 0 data of the patients who have already lung cancer.

Download Full-text

The Variant rs145204276 of GAS5 is Associated with the Development and Prognosis of Gastric Cancer

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.271.qjl ◽

2018 ◽

Vol 27 (1) ◽

pp. 19-24 ◽

Cited By ~ 7

Author(s):

Qianjun Li ◽

Gang Ma ◽

Huimin Guo ◽

Suhua Sun ◽

Ying Xu ◽

...

Keyword(s):

Gastric Cancer ◽

Survival Rate ◽

Cancer Progression ◽

Regulatory Mechanism ◽

Tumor Stage ◽

Kaplan Meier ◽

Non Coding Rna ◽

Early Tumor ◽

Long Non Coding Rna ◽

Clinicopathological Variables

Background & Aims: Down-regulation of the growth arrest specific transcript 5 (GAS5) (long non-coding RNA) is associated with cell proliferation of gastric cancer (GC) and a poor prognosis. We aimed to investigate whether the variant rs145204276 of GAS5 is associated with the prognosis of GC in the Chinese population, and to unveil the regulatory mechanism underlying the GAS5 expression in GC tissues.Method: 1,253 GC patients and 1,354 healthy controls were included. The frequency of the genotype del/del and the allele del of rs145204276 were compared between the patients and the controls and between different subgroups of patients classified by clinicopathological variables. The overall survival rate was analyzed according to the Kaplan-Meier method using the log-rank test.Results: The frequency of genotype del/del was significantly lower in patients than in the controls (7.0% vs. 9.1%, p = 0.001). Kaplan-Meier analysis showed that genotype del/del was significantly associated with a higher survival rate (p = 0.01). Patients with late tumor stage were found to have a significantly lower rate of genotype del/del than those with an early tumor stage (4.9% vs. 8.8%, p = 0.01). Patients with UICC III and IV were found to have a significantly lower rate of genotype del/del than those with UICC I and II (5.3% vs. 8.1%, p = 0.02).Conclusion: The variant rs145204276 of GAS5 is associated with the development and prognosis of GC. The allele del of rs145204276 is associated with a remarkably lower incidence of cancer progression and metastasis.

Download Full-text

Subtle right ventricular dysfunction in asymptomatic chronic heavy cigarette smokers: a speckle tracking case-control study

The Egyptian Heart Journal ◽

10.1186/s43044-021-00151-y ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Mohammad Iqbal Janhangeer ◽

Ghada Youssef ◽

Weal El Naggar ◽

Dalia El Remisy

Keyword(s):

Cigarette Smoking ◽

Right Ventricular ◽

Ventricular Function ◽

Right Ventricular Function ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Cigarette Consumption ◽

Cigarette Smokers ◽

The Right

Abstract Background Chronic heavy cigarette smoking can affect the right ventriclular function. The standard echocardiography may not show early right ventricular functional changes, and a more sensitive measure is needed. The aim of this work was to evaluate the subtle subclinical effects of chronic heavy cigarette smoking on the right ventricular function. The study included 55 healthy asymptomatic chronic heavy cigarette smokers (smoking history of at least 5 pack-years and a daily cigarette consumption of at least 1 pack) and 35 healthy non-smoking control subjects. Patients underwent a full clinical assessment and a conventional as well as a 2D-speckle tracking transthoracic echocardiography of the right ventricle and data was compared between the 2 groups. Results The mean age was 32.9 ± 7.2 years in smokers and 30.9 ± 7.9 years in non-smokers (p = 0.227). The 2 groups showed comparable conventional right ventricular systolic and diastolic functions. Smokers showed a significantly lower (less negative) right ventricular global longitudinal strain (− 19.0 ± 3.2% vs. − 24.5 ± 3.5%, p < 0.001). Patients with a higher daily cigarette consumption showed a poorer right ventricular global longitudinal strain (p = 0.014). Conclusion Chronic heavy cigarette smoking can adversely affect the right ventricular function, a finding that can be easily missed by conventional echocardiography and can be better detected by the right ventricular speckle tracking.

Download Full-text

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.0387 ◽

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

Download Full-text