scholarly journals 322 Atrial morphological and functional parameters in hypertrophic cardiomyopathy: cardiovascular outcome implication

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Martina Setti ◽  
Francesca Rizzetto ◽  
Giovanni Benfari ◽  
Beatrice Cavazza ◽  
Marta Dal Porto ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Atrial ◽  
Cardiovascular Death ◽  
Atrial Function ◽  
Clinical Settings ◽  
Echocardiographic Evaluation ◽  
2D Speckle Tracking ◽  
Surgical Myectomy ◽  
The Impact

Abstract Aims The impact of atrial function measured by standard and advanced echocardiographic techniques is emerging in various clinical settings but remains poorly explored in patients with hypertrophic cardiomyopathy (HCM). Methods and results Consecutive patients with HCM referred to the heart failure outpatient clinic were prospectively enrolled. Complete clinical and echocardiographic evaluation was performed, including fully automated 2D speckle tracking analysis software (AutoStrain, TomTec). Atrial function was assessed by means of left atrial (LA) volume, LA diameter, a’-TDI, and global peak atrial longitudinal strain (PALS). The primary endpoint was a composite of cardiovascular (CV) events (cardiovascular death or hospitalization, new-onset atrial fibrillation, surgical myectomy, sustained ventricular tachycardia or ventricular fibrillation) during the follow-up. A total of 40 patients with confirmed HCM diagnoses and complete follow-up were included, mean age was 61 ± 14 years, 62% male, ejection fraction 64 ± 8%. LA was frequently enlarged (indexed LA volume 43 ± 14 ml/m2, LA diameter 39 ± 7 mm), and dysfunctional (a’-TDI 7.1 ± 2.2 cm/s, PALS 21 ± 7%). During a mean follow-up of 460 ± 300 days, seven patients had a CV event. Among LA parameters, septal a’-TDI seems to characterize patients with events the most (5.5 ± 2.1 vs. 7.5 ± 2.3, P = 0.03). This was confirmed in an age-adjusted survival model [HR: 0.62 (0.39–0.92), P = 0.03]. The spline curve in the Figure illustrates the relationship between a’-TDI and the age-adjusted probability of CV events; the association began at about 7 cm/s and increased steeply for lower values. Of note, the association between PALS and CV events was highly significant in younger patients (<70 years, P < 0.001). Conclusions According to our pilot study, a’-TDI can be considered a simple, feasible, and routinely available parameter of left atrial function, which can help to identify HCM patients at higher risk of CV events.

277 Temporal trends of advanced 2D-speckle tracking echocardiography in trastuzumab treated patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Paolo Springhetti ◽  
Corinna Bergamini ◽  
Lorenzo Niro ◽  
Luisa Ferri ◽  
Giovanni Benfari ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Left Ventricular ◽  
Atrial Function ◽  
Left Atrial Function ◽  
2D Speckle Tracking ◽  
Her 2 ◽  
Positive Breast Cancer

Abstract Aims Trastuzumab (TZ) is widely used for his key role in HER2 positive breast cancer. However, it may have different side effects on the cardiovascular system. One of the most concerning complication is cardiotoxicity. Many studies have highlighted the importance of the screening for subclinical myocardial dysfunction using left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). However, there are few studies investigating the left atrial function in relation to the development of early cardiac damage. Aim of this study is to analyse the modification of GLS and PALS in patients undergoing therapy with TZ in a follow-up period of 12 months. The eventual fluctuation of left atrial function under chemotherapy was evaluated and the correlation between subclinical atrial disfunction and early left ventricular impairment was searched. Methods One hundred and five women affected by non-metastatic HER-2 positive breast cancer treated with TZ were enrolled. Each patient underwent a complete echocardiography every 3 months, for a total of five exams pro patient. Thirty-seven patients (35%) were excluded from the left atrial function analysis while LV function evaluation was performed in 83 patients (21%). Exclusion criteria were poor quality imaging and lack of a complete Follow-up with consequent missing data. 2D-Speckle tracking analysis was performed at baseline and at each examination using Tomtec software in order to analyse both atrial and left ventricular function. Subclinical LV disfunction was defined as a GLS reduction of ≥ 15% compared to the baseline value. Left atrial impairment was arbitrary defined as a PALS reduction of ≥ 25% compared to the initial value. Finally, trends of GLS and PALS during 12 months-Follow-up periods were analysed. Results A total of 48.9% patients developed subclinical LV dysfunction. Similarly, 48.3% patients showed a left atrial impairment. Interestingly a significant (P = 0.0001) reduction in GLS was observed during the follow-up, particularly in the first 6 months of treatment. PALS showed a similar trend with a significant decrease during the whole 12 months-follow-up (P = 0.0001) and mostly in the first 6 months. Only 11% patients showed a significant reduction of LVEF defined as an absolute reduction of LVEF >10% from baseline. Conclusions In HER 2 positive breast cancer patients treated with Trastuzumab development of left atrial impairment in not uncommon and PALS modifications follow a similar pattern to GLS variations during the treatment course, suggesting a possible cardiotoxic effect of such therapy on both atrial and left ventricular myocardium and physiology. However, the potential role of an early atrial impairment detection in predicting subsequent cardiotoxicity in terms of significant LVEF reduction still needs to be tested with further studies.

scholarly journals Left Atrial Function After Radiofrequency Catheter Ablation of Atrial Fibrillation　– Can Pre-Ablation Function Predict Contractile Improvement During Follow-up? –

2015 ◽  
Vol 79 (12) ◽  
pp. 2576-2583 ◽  
Author(s):  
Marina Antolini ◽  
Alessandro Brustio ◽  
Mara Morello ◽  
Federica Bongiovanni ◽  
Cristina Fornengo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Radiofrequency Catheter Ablation ◽  
Atrial Function ◽  
Left Atrial Function

scholarly journals Left Atrial Dispersion Predicts Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy: A 5-year Follow-up study

2020 ◽  
Author(s):  
OZKAN CANDAN ◽  
Ender Cakmak ◽  
CETIN GECMEN ◽  
Muzaffer Kahyaoglu ◽  
Zeki im ek ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Left Atrial ◽  
Follow Up Study

Comparative data on left atrial appendage occlusion efficacy and clinical outcomes by age group in the Amplatzer™ Amulet™ Occluder Observational Study

EP Europace ◽  
2020 ◽  
Author(s):  
Xavier Freixa ◽  
Boris Schmidt ◽  
Patrizio Mazzone ◽  
Sergio Berti ◽  
Sven Fischer ◽  
...  
Keyword(s):  
Observational Study ◽  
Ischaemic Stroke ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Serious Adverse Events ◽  
Left Atrial Appendage Occlusion ◽  
Increased Risk ◽  
The Impact

Abstract Aims Left atrial appendage occlusion (LAAO) may be considered for patients with non-valvular atrial fibrillation (NVAF) and a relative/formal contraindication to anticoagulation. This study aimed to summarize the impact of aging on LAAO outcomes at short and long-term follow-up. Methods and results We compared subjects aged <70, ≥70 and <80, and ≥80 years old in the prospective, multicentre Amplatzer™ Amulet™ Occluder Observational Study (Abbott, Plymouth, MN, USA). Serious adverse events (SAEs) were reported from implant through a 2-year post-LAAO visit and adjudicated by an independent clinical events committee. Overall, 1088 subjects were prospectively enrolled. There were 265 subjects (24.4%) <70 years old, 491 subjects (45.1%) ≥70 and <80 years old, and 332 subjects (30.5%) ≥80 years old, with the majority (≥80%) being contraindicated to anticoagulation. As expected, CHA2DS2-VASc and HAS-BLED Scores increased with age. Implant success was high (≥98.5%) across all groups, and the proportion of subjects with a procedure- or device-related SAE was similar between groups. At follow-up, the observed ischaemic stroke rate was not significantly different between groups, and corresponding risk reductions were 62, 56, and 85% when compared with predicted rates for subjects <70, ≥70 and <80, and ≥80 years old, respectively. Major bleeding and mortality rates increased with age, while the incidence of device-related thrombus tended to increase with age. Conclusions Despite the increased risk for ischaemic stroke with increasing age in AF patients, LAAO reduced the risk for ischaemic stroke compared with the predicted rate across all age groups without differences in procedural SAEs.

scholarly journals Spontaneously occluded left atrial appendage in a patient with atrial fibrillation and stroke: a case report

2020 ◽  
Vol 4 (2) ◽  
pp. 1-4
Author(s):  
Andreas Bugge Tinggaard ◽  
Kasper Korsholm ◽  
Jesper Møller Jensen ◽  
Jens Erik Nielsen-Kudsk
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Transoesophageal Echocardiography ◽  
Similar Efficacy ◽  
Cardiovascular Death ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion ◽  
All Cause Mortality

Abstract Background  The left atrial appendage (LAA) is the main source of thromboembolism in atrial fibrillation (AF). Transcatheter closure is non-inferior to warfarin therapy in preventing stroke. Case summary  A patient with two consecutive strokes associated with AF was referred for transcatheter LAA occlusion (LAAO). Preprocedural cardiac CT and transoesophageal echocardiography demonstrated a spontaneously occluded LAA with a smooth left atrial surface, with stationary results at 6- and 12-month imaging follow-up. Warfarin was discontinued, and life-long aspirin instigated. Discussion  Left atrial appendage occlusion has shown non-inferiority to warfarin for prevention of stroke, cardiovascular death, and all-cause mortality. No benefits from anticoagulation have been demonstrated in patients with embolic stroke of undetermined source. In the present case, we observed that the LAA was occluded and, therefore, treated with aspirin monotherapy assuming similar efficacy as transcatheter LAAO.

P5553Right ventricular involvement in hypertrophic cardiomyopathy: insights from a tertiary centre

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A R Pereira ◽  
I Cruz ◽  
A R Almeida ◽  
A Marques ◽  
S Alegria ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Independent Predictor ◽  
Hemodynamic Instability ◽  
Tissue Doppler ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
S Wave ◽  
Significant Difference

Abstract Introduction Hypertrophic cardiomyopathy (HCM) is the main cause of sudden cardiac death in the young and a cause of heart failure (HF) and death at any age. Nevertheless, adverse long-term outcomes are not easy to predict. Objectives To assess the prevalence and prognostic value of right ventricular (RV) involvement in patients (pts) with HCM. Methods Retrospective single-centre study of consecutive pts with HCM evaluated in a specialized consultation. Selected those submitted to cardiac magnetic resonance imaging (CMR) as the gold-standard for RV assessment. The primary endpoint (PE) was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, ventricular arrhythmias with hemodynamic instability and unplanned HF admission. Results Of a total of 181 pts, 104 fulfilled the inclusion criteria (mean age at first consultation 62.1±9.7 years, 63.5% male). Septal asymmetric phenotype was the most frequent (73.1%) and 24 pts (23.1%) had rest LV outflow tract obstruction. Mean value of maximum wall thickness was 18.8±4.6 mm. Regarding CMR parameters (Fig A), 5.8% had RV dysfunction and 2.9% RV free wall hypertrophy; no patient presented RV dilation. Late gadolinium enhancement (LGE) of joint points was observed in 47.1%. During follow-up (FU, mean 56.6±29.5 months), survival free of RV dysfunction was 94.3%. Only 5 pts developed RV compromise assessed by echocardiographic parameters: TAPSE 12.0±3.4 mm and pulsed tissue Doppler systolic annular velocity (tricuspid S') wave 7.3±0.9 cm/s. These pts were significantly older (p<0.01) and had higher values of average tissue doppler E/E' ratio at diagnosis (p<0.01). Global RV involvement (at diagnosis or during FU) were associated with increased values of indexed left atrial area (p<0.01), LV dysfunction (p=0.01), LGE of joint points (p=0.01) and higher values of NT-proBNP (p=0.01). In multivariate logistic regression, left atrial enlargement was the only independent predictor of global RV dysfunction (OR 1.9, 95% CI 1.1–3.2, p=0.01) and average E/E' ratio an independent predictor of RV dysfunction during FU (OR 1.3, 95% CI 1.1–1.5, p<0.01). PE rate was 10.6%. It was significantly higher in pts with global RV involvement and there was a significant difference in survival analysis (Fig B). Average E/E' ratio (OR 1.5, 95% CI 1.1–1.9, p=0.01) and RV ejection fraction (OR 0.8, 95% CI 0.7–0.9, p=0.01) were independent predictors of the outcome. Conclusions Although not common, RV dysfunction was associated with a higher rate of cardiovascular events. Average E/E' ratio, as a measure of left ventricular filling pressure, was a risk factor for both RV dysfunction and PE. Higher values of RV ejection fraction were protective of adverse events occurrence. Together, these results support a potential role of RV function in the risk stratification of HCM pts.

P5431The relationship between pulse rate and the risk of cardiac events in patients with atrial fibrillation: the Fushimi AF registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Iguchi ◽  
N Masunaga ◽  
M Ishii ◽  
Y An ◽  
M Esato ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Confidence Intervals ◽  
Pulse Rate ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Cardiac Events ◽  
The Impact

Abstract Background Relationship between pulse rate (PR) and cardiac events in patients with sustained (persistent and permanent) atrial fibrillation (AF) in routine clinical practice remains unclear. Methods The Fushimi AF Registry is a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto. Follow-up data were available for 4,454 patients, and we obtained PR at baseline in 2,209 patients of 2,248 sustained AF patients. We divided these patients into four groups based on their PR; G1 (PR≥100 bpm, n=249), G2 (80 bpm≤PR<100 bpm, n=821), G3 (60 bpm≤PR<80 bpm, n=986), and G4 (PR<60 bpm, n=153), and examined the relationship between PR and cardiac events (composite of cardiovascular death and hospitalization for heart failure (HF)). Results Proportion of female and symptomatic AF were more in G1 group, and diastolic blood pressure was higher in G1 group, despite that systolic blood pressure was similar between the four groups. Prevalence of anemia was higher in G1 group, and that of chronic kidney disease was higher in G4 group. Prevalence of HF and left ventricular dysfunction tended to be higher in G1 group but not statistically significant. Beta-blockers and non-dihydropyridine calcium blockers were more often prescribed in G1 group. During the median follow-up of 1,449 days, cardiac events occurred in 399 patients (358 hospitalization for HF and 41 cardiovascular death). In Kaplan-Meier analysis, the incidence of cardiac events were comparable between the four groups (p=0.3). The incidence of all cause death (p=0.06) and stroke or systemic embolism (p=0.4) was also similar between the four groups. The incidence of cardiac events did not differ between the four groups when we divided the patients based on the presence of HF at baseline, and the incidence of cardiac events was also comparable between the four groups after adjusting potential confounders. However, when we examined the impact of PR according to 10 bpm increment, patients with very low PR (<50 bpm) (hazard ratio [95% confidence intervals], 2.22 [1.04–4.15]) and very high PR (≥110 bpm) (hazard ratio [95% confidence intervals], 1.67 [1.00–2.64]) had higher incidence of cardiac events than patients with PR of 70–79 bpm (Figure). Furthermore, we acquired the annual follow-up data of PR. Mean PR during the follow-up periods was not different between patients with cardiac events and those without (with vs without, 79.5±15.3 bpm vs 79.7±12.7 bpm; p=0.8), whereas maximum PR was less in patients with cardiac events (85.2±17.5 bpm vs 89.3±16.2 bpm; p<0.0001). Patients with maximum PR<60 bpm showed higher incidence of cardiac events, and the incidence of cardiac events was the lowest in patients with maximum PR of 80 to 99 bpm (maximum PR<60 bpm: 31.3%, 60–79 bpm: 24.5%, 80–99 bpm: 14.5%, 100 bpm: 16.1%; P<ehz746.03881). Conclusion PR did not appear to have strong impact on cardiac events in patients with sustained AF. However, low PR might be a risk for developing cardiac events. Acknowledgement/Funding Japan Agency for Medical Research and Development, AMED (15656344, 16768811), Boehringer Ingelheim, Bayer Healthcare, Pfizer, Bristol-Myers Squibb

The Impact of Atrial Fibrillation Ablation on Left Atrial Function: Association with Baseline Left Atrial Function

2011 ◽  
Vol 35 (3) ◽  
pp. 327-334 ◽  
Author(s):  
MASAHARU MASUDA ◽  
KOICHI INOUE ◽  
KATSUOMI IWAKURA ◽  
ATSUNORI OKAMURA ◽  
YASUSHI KOYAMA ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Atrial Function ◽  
Left Atrial Function ◽  
Atrial Fibrillation Ablation ◽  
The Impact
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