scholarly journals 25 Atrial remodelling in patients affected by chronic heart failure in therapy with sacubitril/valsartan

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Michele Magnesa ◽  
Pietro Mazzeo ◽  
Martino Fortunato ◽  
Raffaele Mennella ◽  
Lucia Tricarico ◽  
...  
Keyword(s):  
Heart Failure ◽  
Real World ◽  
Left Atrial ◽  
Cardiovascular Death ◽  
Functional Class ◽  
Left Atrial Strain ◽  
Systolic Volume ◽  
Atrial Strain ◽  
And Function

Abstract Aims Left atrial (LA) enlargement has been demonstrated to be a predictor of adverse cardiovascular outcomes, such as atrial fibrillation (AF), heart failure (HF), and cardiovascular death. Previous studies showed left ventricle ejection fraction (LVEF) improvement and reverse remodelling can be achieved after therapy with sacubitril/valsartan in real-world settings. We sought to investigate the association between left atrial (LA) structural and functional remodelling in patients with chronic HF after therapy with sacubitril/valsartan. Methods and results Patients affected by chronic HF with LV dysfunction (LVEF < 35%), NYHA functional class II–III were followed up between September 2019 and March 2020. All patients underwent clinical and echocardiography Follow-up at baseline and after 6 months of therapy with sacubitril/valsartan. Measures of LA structure [LA end-systolic volume (LAESV)] and function [left atrial emptying fraction (LAEF), peak atrial longitudinal strain (PALS), LA conduit strain and peak atrial contraction strain (PACS)] were calculated. A total of 47 patients (median age 66 ± 7.97, male gender 85%, mean LVEF 28.33 ± 5.61%) were enrolled. The left atrial strain parameters (PALS and LA conduit) resulted higher at 6 months follow-up respect to baseline values, (14.68 ± 7.16 vs. 18.67 ± 8.03, P < 0.001, and −7.61 ± 4.07 vs. −9.71 ± 5.23, P = 0.007, respectively). Conclusions Treatment with sacubitril/valsartan in patients with HFrEF is associated with an improvement in LA functional remodelling in a real-world scenario.

scholarly journals Atrial fibrillation recurrence after transcatheter ablation worsens left atrial strain

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Annunziata ◽  
F Notaristefano ◽  
L Spighi ◽  
S Piraccini ◽  
G Giuffre' ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Strain ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
Atrial Strain ◽  
Af Recurrence

Abstract Introduction Left atrial strain (LAs) shows correlation with atrial fibrosis and is a predictor of atrial fibrillation (AF) recurrence after transcatheter ablation. Little is known about LAs evolution after ablation. Purpose We sought to evaluate the atrial function with echocardiographic strain before and 6 months after AF ablation. Methods 65 consecutive patients undergoing radiofrequency or cryoballoon ablation for atrial fibrillation at our centre were enrolled. They underwent a transthoracic echocardiography before the procedure and at 6 months follow-up. 5 patients were excluded because of low quality images. Global left atrial strain during the reservoir phase (LASr) was calculated as a mean of the values obtained in 4 and 2 chamber apical view; the ventricular end-diastole was set as reference to allow the calculation both in patients in AF and sinus rhythm during the echocardiography. Recurrence was defined as any atrial arrhythmia episode lasting more than 30 seconds recorded on an EKG strip after the 3 months blanking period; all patients underwent a 24 hours EKG Holter after the blanking period to detect asymptomatic recurrence. Quality of life was assessed before the procedure and at follow-up with the EQ-5D-3L model. Results At 6 months 14 patients (13%) had AF recurrence. Patients with recurrence (AF-R) had similar baseline characteristics compared to those without recurrence (AF-NR) but the former had a longer history of AF (39±53 vs 85±94 months, p=0,018). LASr, LA volume and left ventricle ejection fraction (EF) were similar at baseline between groups. At follow-up LASr was significantly impaired in the AF-R group compared to AF-NR (14±6% vs 26±10% respectively, p<0,0001) whereas LA volume, LV end systolic volume and EF remained similar. Compared to baseline LASr worsened in patients experiencing AF recurrence (22±11% vs 14±6%, p=0.016) and this finding was consistent also in patients in sinus rhythm during both examinations (29±8 vs 17±7, p=0,005). Compared to baseline LASr (22±10% vs 26±10%, p=0.024), LV end-systolic volume (29±15 ml vs 22±6 ml, p=0,006) and EF (51±9% vs 58±18%, p=0,038) improved in the AF-NR group but the effect was driven mainly by patients restoring sinus rhythm. Both groups showed a significant improvement of the quality of life (55±23 vs 85±13, p<0,0001 AF-NR; 63±17 vs 80±12, p=0,012 AF-R). Conclusions Atrial fibrillation recurrence after transcatheter ablation is associated with significant left atrial strain worsening which indicates disease progression and may predispose to further long-term recurrences whereas a successful ablation has a protective effect on atrial function. Funding Acknowledgement Type of funding source: None

scholarly journals Refining the Role of Left Atrial Strain in Heart Failure with Reduced Ejection Fraction

2021 ◽  
Author(s):  
Alessandro Malagoli ◽  
Luca Rossi ◽  
Alessia Zanni ◽  
Concetta Sticozzi ◽  
Massimo Francesco Piepoli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Left Atrial Strain ◽  
Reduced Ejection Fraction ◽  
Atrial Strain

scholarly journals Left Atrial Strain as a Predictor of New-Onset Atrial Fibrillation in Patients With Heart Failure

2020 ◽  
Vol 13 (10) ◽  
pp. 2071-2081 ◽  
Author(s):  
Jin Joo Park ◽  
Jae-Hyeong Park ◽  
In-Chang Hwang ◽  
Jun-Bean Park ◽  
Goo-Yeong Cho ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Strain ◽  
Patients With Heart Failure ◽  
Atrial Strain ◽  
Onset Atrial Fibrillation ◽  
New Onset

scholarly journals Association of Asymptomatic Diastolic Dysfunction Assessed by Left Atrial Strain With Incident Heart Failure

2020 ◽  
Vol 13 (11) ◽  
pp. 2316-2326 ◽  
Author(s):  
Elizabeth L. Potter ◽  
Satish Ramkumar ◽  
Hiroshi Kawakami ◽  
Hong Yang ◽  
Leah Wright ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Left Atrial Strain ◽  
Incident Heart Failure ◽  
Atrial Strain

scholarly journals Impaired left atrial strain predicts abnormal exercise haemodynamics in heart failure with preserved ejection fraction

2019 ◽  
Vol 21 (4) ◽  
pp. 495-505 ◽  
Author(s):  
Fernando Telles ◽  
Shane Nanayakkara ◽  
Shona Evans ◽  
Hitesh C. Patel ◽  
Justin A. Mariani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Preserved Ejection Fraction ◽  
Left Atrial Strain ◽  
Atrial Strain

scholarly journals Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction

2019 ◽  
Vol 21 (7) ◽  
pp. 891-900 ◽  
Author(s):  
Yogesh N.V. Reddy ◽  
Masaru Obokata ◽  
Alexander Egbe ◽  
Jeong Hoon Yang ◽  
Sorin Pislaru ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Diagnostic Evaluation ◽  
Preserved Ejection Fraction ◽  
Left Atrial Strain ◽  
Atrial Strain

Abstract 16571: An Appraisal on Prognostic Value of Left Atrial Strain in Exercise Echocardiography

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zi Ye ◽  
William Miranda ◽  
Garvan Kane ◽  
Robert B McCully ◽  
Jae K Oh
Keyword(s):  
Heart Failure ◽  
Diastolic Function ◽  
Left Atrial ◽  
Prognostic Value ◽  
Filling Pressure ◽  
Exercise Echocardiography ◽  
Heart Failure Hospitalization ◽  
Left Atrial Strain ◽  
Echocardiographic Parameters ◽  
Atrial Strain

Introduction: Diastolic dysfunction impairs exercise capacity and has prognostic value in exercise echocardiography. We aimed to assess whether left atrial strain (LAS), which is reduced with worsening in diastolic function, is associated with all-cause death or heart failure hospitalization in patients undergoing treadmill echocardiography. Methods: We performed 2D-speckle tracking analysis of LAS in 1636 consecutive patients (mean age 64±13 and 59% men) who underwent treadmill echocardiography between 1/2013 and 1/2014. We used the 2016 ASE recommendation to define diastolic function and elevated LV filling pressure. Results: Of 1636 study subjects, 95% had LV ejection fraction ≥ 50%. Diastolic function was normal in 44% of patients and abnormal in the remaining (23% grade I, 9% grade II, 1% grade III, and 23% indeterminate). During a mean follow-up of 5.5±1.8 years, 210 patients (12.8%) experienced the composite outcome (157 death and 88 heart failure hospitalization). Lower LASreseroivr, LASbooster and LA emptying fraction (LAEF) were all associated with increased risk for the adverse outcome independent of age, sex, clinical and echocardiographic parameters, and after further adjustment for diastolic function (abnormal vs. normal) (all p≤0.001). The association of LASbooster with the outcome attenuated in a model with LASreservoir or LAEF (both p>0.1). Adding LASreservoir to clinical and echocardiographic parameters provided incremental prognostic value (continuous net reclassification improvement=0.09, p=0.04), but not LAEF or LASbooster. Patients with LASreservoir <34.2% (lowest tertile) had more than doubled risk for death or heart failure hospitalization than those with LASreservoir ≥34.2% after multivariable adjustment in the entire cohort (adjusted hazard ratio 2.2, 95%CI: 1.53 - 3.23), as well as in those with normal stress test (n=1217, adjusted HR, 3.53, 95%CI: 2.29 - 5.53) or those without elevated resting LV filling pressure (n=1466, adjusted HR: 2.08, 95%CI: 1.46 - 2.96). Conclusions: LASreservoir provides independent prognostic information in patients undergoing exercise echocardiography.

scholarly journals Changes in diastology and atrial function in multimodality imaging after breast cancer radiotherapy - a six-year follow-up study

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Vaarpu ◽  
L Lehmonen ◽  
S Kivisto ◽  
T Skytta ◽  
P-L Kellokumpu-Lehtinen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Left Atrial ◽  
Multimodality Imaging ◽  
Atrial Function ◽  
Left Atrial Function ◽  
Left Atrial Strain ◽  
Cancer Radiotherapy ◽  
Breast Cancer Radiotherapy ◽  
Atrial Strain

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): State research funding (Finland) Heart Hospital funding (Tampere, Finland) Aims Breast cancer radiotherapy (RT) increases the incidence of heart failure with preserved ejection fraction with long latency. The prevalence and the early phases of this process are not well characterized. The aims of our study were to evaluate changes in diastology and left atrial function after breast cancer RT in a prospective manner. Methods 31 patients with early stage left-sided breast cancer were studied prior to RT, immediately after RT and three and six years after RT. Biomarkers were measured and echocardiography, including left atrial strain, was performed at each visit. Cardiac magnetic resonance imaging (CMR) was performed at the six-year follow-up (FU). Results At baseline, the median diastology gradus was 1 with 5 patients displaying diastology gradus greater than 2. At six-year follow-up the median diastology gradus had increased to 2 (p = 0.012) with 13 patients in diastology gradus 3-4. Additionally, proBNP increased progressively from  baseline level of 63 [37, 124] ng/l to post-RT level of 84 [40, 154] ng/l (p = 0.031), to 90 [46, 132] ng/l at the three-year follow-up (p = 0.021) and to 98 [50, 176] ng/l at the six-year follow-up (p = 0.010). Left atrial strain initially increased from 23.2 ± 4.9% at baseline to 25.5 ± 6.7% post-RT (p = 0.199) and thereafter decreased to 21.2 ± 6.0% (p = 0.002) at six-year follow-up. There was no correlation in left atrial strain between 2D-echocardiography and CMR. Age (mean 62.2 years) had no correlation with changes in diastology or left atrial strain. Furthermore, left atrial strain rate (SR) increased progressively from 2.14 [1.83, 2.50]1/s at baseline to  2.35 [1.95, 2.96]1/s at the three-year follow-up (p = 0.040) and thereafter declined to 1.92 [1.62, 2.59]1/s (p = 0.014). The change in left atrial SR (from RT to the six-year control) was independently correlated with body mass index (BMI) (p = 0.044, β=0.472). The changes in diastology had no independent predictors. Conclusions RT induced a gradual worsening in diastology gradus, which was initially compensated with an increase in left atrial function. However, at the six-year follow-up, 43.7% of the patients had restrictive or pseudonormal diastology and a significant decline in left atrial strain and SR were detected. A lower BMI had a negative influence on the left atrial function. Abstract Figure. Changes in diastoly during six-year FU

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