Abstract 14899: Personalized Computational Modeling Identifies Embolic Stroke of Undetermined Source Patients With Potential Arrhythmic Substrate

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Savannah Bifulco ◽  
Griffin D Scott ◽  
Sakher Sarairah ◽  
Zeinab Birjandian ◽  
Caroline Roney ◽  
...  
Keyword(s):  
Computational Modeling ◽  
Left Atrial ◽  
Computational Models ◽  
Embolic Stroke ◽  
Potential Explanation ◽  
Significant Difference ◽  
Mri Scans ◽  
Modeling Study

Introduction: Late-gadolinium enhanced (LGE)-MRI has revealed atrial fibrotic remodeling in embolic stroke of undetermined source (ESUS) patients. Curiously, fibrosis levels in ESUS patients are the same as those observed in AF. A potential explanation is that ESUS patients have pre-clinical arrhythmic substrate, but lack the triggers needed to initiate AF. Hypothesis: Simulations in computational models reconstructed from LGE-MRI scans can determine if the fibrotic substrate of a particular ESUS patient has the capacity to sustain reentry. Methods: ESUS (per standard criteria) was verified by a neurologist. 45 ablation-naïve AF patients and 45 ESUS patients within three months of stroke underwent LGE-MRI for fibrosis assessment. Left atrial (LA) models were built from LGE-MRI scans. Fiber orientations were mapped into each LA model using universal atrial coordinates. Burst pacing from 15 sites was used to test inducibility of arrhythmia sustained by reentry (Fig A). Results: In 23/45 (51%) ESUS and 29/45 (64%) AF models, we observed sustained reentry. Fibrosis burden was significantly higher for patients in whom simulations suggested the existence of pre-clinical arrhythmic substrate; however, within the inducible and non-inducible sub-groups, there was no significant difference in fibrosis burden for ESUS vs. AF patients (Fig B). This suggests that the presence of pre-clinical substrate in ESUS is correlated with fibrosis burden, although exceptions to this supposition were not uncommon (i.e., inducible low-fibrosis and non-inducible high-fibrosis models; Fig C). Conclusions: In this modeling study, pro-arrhythmic properties of fibrosis in ESUS and AF are indistinguishable. This suggests that some ESUS patients have pre-clinical fibrotic substrate, but do not have AF due to a lack of suitable triggers. Ongoing clinical follow-up will test whether abundance of pre-clinical substrate is predictive of incident AF.

scholarly journals Clinical Outcomes of Computational Virtual Mapping-Guided Catheter Ablation in Patients With Persistent Atrial Fibrillation: A Multicenter Prospective Randomized Clinical Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Yong-Soo Baek ◽  
Oh-Seok Kwon ◽  
Byounghyun Lim ◽  
Song-Yi Yang ◽  
Je-Wook Park ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trial ◽  
Catheter Ablation ◽  
Computational Modeling ◽  
Controlled Trial ◽  
Dominant Frequency ◽  
Complication Rates ◽  
Clinical Recurrence ◽  
Significant Difference

Background: Clinical recurrence after atrial fibrillation catheter ablation (AFCA) still remains high in patients with persistent AF (PeAF). We investigated whether an extra-pulmonary vein (PV) ablation targeting the dominant frequency (DF) extracted from electroanatomical map–integrated AF computational modeling improves the AFCA rhythm outcome in patients with PeAF.Methods: In this open-label, randomized, multi-center, controlled trial, 170 patients with PeAF were randomized at a 1:1 ratio to the computational modeling-guided virtual DF (V-DF) ablation and empirical PV isolation (E-PVI) groups. We generated a virtual dominant frequency (DF) map based on the atrial substrate map obtained during the clinical AF ablation procedure using computational modeling. This simulation was possible within the time of the PVI procedure. V-DF group underwent extra-PV V-DF ablation in addition to PVI, but DF information was not notified to the operators from the core lab in the E-PVI group.Results: After a mean follow-up period of 16.3 ± 5.3 months, the clinical recurrence rate was significantly lower in the V-DF than with E-PVI group (P = 0.018, log-rank). Recurrences appearing as atrial tachycardias (P = 0.145) and the cardioversion rates (P = 0.362) did not significantly differ between the groups. At the final follow-up, sinus rhythm was maintained without any AADs in 74.7% in the V-DF group and 48.2% in the E-PVI group (P < 0.001). No significant difference was found in the major complication rates (P = 0.489) or total procedure time (P = 0.513) between the groups. The V-DF ablation was independently associated with a reduced AF recurrence after AFCA [hazard ratio: 0.51 (95% confidence interval: 0.30–0.88); P = 0.016].Conclusions: The computational modeling-guided V-DF ablation improved the rhythm outcome of AFCA in patients with PeAF.Clinical Trial Registration: Clinical Research Information Service, CRIS identifier: KCT0003613.

scholarly journals Effect of persistence of left ventricular hypertrophy and left atrial dilatation after aortic valve replacement on early outcomes and survival: a prospective study

2019 ◽  
Vol 6 (10) ◽  
pp. 3786
Author(s):  
Hari Krishna Murthy P. ◽  
Abha Chandra
Keyword(s):  
Aortic Valve ◽  
Left Ventricular Hypertrophy ◽  
Aortic Stenosis ◽  
Left Atrial ◽  
Ventricular Hypertrophy ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Significant Difference ◽  
A Prospective Study

Background: The objective of the study was to evaluate the early outcomes and survival in patients with severe aortic stenosis associated with concentric left ventricular hypertrophy following aortic valve replacement.Methods: This is a prospective study done at SVIMS, Tirupati, from June 2014 to September 2015 evaluating out comes and survival in patients undergoing primary isolated aortic valve replacement (AVR) for severe aortic stenosis, severe aortic stenosis with mild aortic regurgitation and severe aortic stenosis with moderate aortic regurgitation.Results: A total of 40 cases 26 males and 14 females aged 18 to 60 years (mean age, 48.5±13.4 years) underwent elective AVR. Left ventricular end diastolic diameter (p=0.008) at 6 months, a statistically highly significant difference in left ventricular mass  preoperatively, at discharge, at 3rd and 6th month follow up. The difference in mean left ventricular mass index (LVMI) had declined from 244.425 to 141.100 at 6 months, showing a statistically highly significant difference in LVMI preop, at discharge, at 3rd month and at 6th month follow up.Conclusions: Patients with preoperative increase in LVMI, with large left atrial diameter carries a strong predictor of postoperative mortality for patients undergoing aortic valve surgery. We also conclude that there will be significant regression of LVMI following successful AVR. But, the decrease in LVMI is maximum during early three months and it is minimal though significant in the later course of follow up. 

P4139Prediction of atrial fibrillation in embolic stroke of unknown source

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F T Range ◽  
D P Peters ◽  
T Zeus ◽  
S Jander ◽  
P Mueller ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real Life ◽  
Patient Characteristics ◽  
Embolic Stroke ◽  
Baseline Heart Rate ◽  
Loop Recorder ◽  
Chads2 Score ◽  
Unknown Source ◽  
Significant Difference

Abstract Background Atrial fibrillation (AF) is one of the leading cardiogenic causes for embolic stroke of unknown source (ESUS). Its incidence is growing with patients' age. Detection and rule out of AF is complex and cumbersome. The best method is an implantable loop recorder (ILR). In patients elder than 60 years, incidence of AF is reported incongruently and reliable patient characteristics that can predict a low or high risk for AF are scarce. Purpose This study reports real life incidences of AF in a group of patients undergoing ILR after ESUS. It aims to depict age dependency of AF and to identify potential confounding factors. Methods In a single center study, we analysed 111 patients (age=62±13 years, nmale=65) who received an ILR in our centre following ESUS. Patient characteristics, brain imaging, hemodynamic monitoring, blood pressure, electrocardiography, holter ecg and echocardiography data from the initial hospital stay and ILR follow-up over a mean of 460 days were analysed. Primary endpoint was the recording of AF during follow-up. Results AF was detected in 23% of all patients. Patients with AF were significantly elder than those without AF (p=0.01). Incidence of AF was in Patients <60y: 14%, 60–69y: 13%, 70–79y: 45%, >80y: 67%. We observed a significant difference in AF incidence comparing patients younger and elder than 70 years (p=0.034). Both, CHADS-Vasc (p=0.036) and HATCH-scores (p=0.018) were higher in the AF group while the simple CHADS2 Score missed significance (p=0.068). PQ duration was longer in AF patients (p=0.022) and baseline heart rate at admission was lower (p=0.027). NIHSS scores were lower in the AF group at admission (2.97 vs. 4.10; p=0.049) but due to less neurological improvement in the AF group, this difference faded until dismission (1.09 vs 1.79 p=ns). Conclusions In our real life ILR group following ESUS, strongest predictor of AF was age. Pivot point rather was at 70 than at 60 years of age.

P2839The golden age of ablation: results for atypical flutter ablation in the very elderly

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Lozano-Granero ◽  
J Moreno ◽  
R Matia ◽  
A Hernandez-Madrid ◽  
I Sanchez-Perez ◽  
...  
Keyword(s):  
Success Rate ◽  
Median Survival ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Atrial Arrhythmias ◽  
Atrial Volume ◽  
Significant Difference

Abstract Introduction Atypical flutter ablation (AFL) is a challenging procedure with limited long-term benefits and not exempt from significant risks. Purpose To compare the efficacy and safety of this procedure in a population of octogenarian patients over a population of younger patients. Methods From 2015 to 2018, all patients in which AFL ablation was attempted were included. Activation and voltage mapping were used to define AFL circuit. Radiofrequency lesions were performed to operator's discretion until AFL termination. Programmed atrial stimulation was repeated to test inducibility, and any sustained induced arrhythmia was ablated. Follow-up included visits with ECG and/or 24h Holter-ECG at 3 and 12 months. Results 107 patients (55 females) were included, 26 (24%) aged 80 or older (table). Successful ablation of the original circuit was achieved in 96% in both groups (acute success rate, p=0.973), with induction of other AFL circuits in 43% (46% octogenarians, 42% younger, p=0.708), successfully ablated in 88% in both groups (total success rate, p=0.952). No significant difference was detected in the rate of adverse events (8% in octogenarians versus 7% in younger, p=0.962), with a case of cardiac tamponade in the former, successfully resolved. After a mean follow-up of 11±12 months, 52 patients (49%) were free from recurrence, 13 (50%) in the octogenarian group and 39 (48%) in the younger, with an estimated median survival free from atrial arrhythmias of 26 months (95% CI: 4–48) in the octogenarian group and 18 months (95% CI: 5–32) in the younger group (p=0.716). After multivariate analysis, history of prior AF and indexed left atrial volume, but not age, predicted recurrence. Demographical and clinical variables All patients (n=107) Octogenarians (n=26) No octogenarians (n=81) p-value Age (years) 69±13 83±3 65±11 <0.0001* Cardiomyopathy (%) 54 (50%) 13 (26%) 41 (51%) 0.956 Left ventricular ejection fraction (%) 60±13 57±17 61±11 0.24 Indexed left atrial volume (ml/m2) 45±19 48±14 43±19 0.55 Prior AF history 49 (46%) 7 (27%) 42 (52%) 0.026* Prior ablation procedures 53 (50%) 8 (31%) 45 (56%) 0.028* Prior cardiac surgery 30 (28%) 2 (8%) 28 (35%) 0.008* Left AFL origin (%) 87 (81%) 24 (92%) 63 (78%) 0.098 *Statistically significant difference. Survival function Conclusion AFL ablation was as effective and safe in octogenarian as in younger ones, with a median survival time free from atrial arrhythmias of more than 2 years.

Does left atrial appendage morphology have any impact on the results of percutaneous closure?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Constantin ◽  
A Cinaud ◽  
F Brigadeau ◽  
A Lepillier ◽  
B Pierre ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Left Atrial ◽  
Retrospective Cohort ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Atrial Appendage ◽  
Significant Difference ◽  
The Impact

Abstract Introduction Transcatheter left atrial appendage (LAA) occlusion is an alternative treatment in patients with atrial fibrillation (AF), high CHADSVASC Score and a contra-indication to anticoagulants. This retrospective cohort study aims to evaluate the impact of LLA morphology on procedure outcomes. Methods Patients from eight French centers who underwent left atrial appendage occlusion from February 2012 to January 2017 were included in this retrospective cohort study. LLA morphology was described by preoperative cardiac computed tomography (CT). Clinical data and Transoesophageal echocardiography (TEE) or CT results were collected during follow-up. Results Among 469 included patients, LAA morphologies were described in 215 cases 45.8%), 150 patients (70%) were implanted with Watchman devices, 57 (26%) with Amplatzer devices and 8 procedures (4%) failed. LAA Morphology was Chicken Wing (34%), Windsock (45%), cauliflower (18%) and 3% had another morphology including Cactus. There was no difference in patient characteristics between the different morphology groups. Mean follow-up was 9.6±11 months, during which 190 patients underwent LAA imaging (TEE in 171 and CT in 19 patients). There was no significant difference in the failure rate (p=0.72), duration of the procedure (p=0.065), peri-device leak (p=0.83) device-related thrombus (p=0.96) and the occurrence of stroke (p=1) during follow-up. Conclusion LLA morphology did not influence complication occurrence after occlusion in this cohort. Funding Acknowledgement Type of funding source: None

scholarly journals Post Procedural Peak Left Atrial Contraction Strain Predicts Recurrence of Arrhythmia after Catheter Ablation of Atrial Fibrillation

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Songnan Wen ◽  
Manasawee Indrabhinduwat ◽  
Peter A. Brady ◽  
Cristina Pislaru ◽  
Fletcher A. Miller ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Cumulative Probability ◽  
Risk Of Recurrence ◽  
Af Ablation ◽  
Kaplan Meier ◽  
Atrial Contraction ◽  
Significant Difference ◽  
Long Term Follow Up

Abstract Background Left atrial (LA) function can be impaired by the atrial fibrillation (AF) ablation and might be associated with the risk of recurrence. We sought to determine whether the post-procedural changes in LA function impact the risk of recurrence following AF ablation. Methods We retrospectively reviewed patients who underwent AF ablation between 2009 and 2011 and underwent transthoracic echocardiography before ablation, 1-day and 3-month after ablation. Peak left atrial contraction strain (PACS) and left atrial emptying fraction (LAEF) were evaluated during sinus rhythm and compared across the three time points. The primary endpoint was atrial tachyarrhythmia recurrence after ablation. Results A total of 144 patients were enrolled (mean age 61 ± 11 years, 77% male, 46% persistent AF). PACS and LAEF initially decreased 1-day following ablation but partially recovered within 3 months in PAF patients, with a similar trend in the PerAF patients. After median 24 months follow-up, 68 (47%) patients had recurrence. Patients with recurrence had higher PACS1-day than that in non-recurrence subjects (-10.9 ± 5.0% vs. -13.4 ± 4.7%, p = 0.003). PACS1-day -12% distinguished recurrence cases with a sensitivity of 67.7% and specificity of 60.5%. The Kaplan–Meier curves showed significant difference in 5-year cumulative probability of recurrence between those with PACS ≥ -12% and PACS < -12% (log rank p < 0.0001). Multivariate regression showed that PACS1-day was an independent risk factor of arrhythmia recurrence. Conclusions Left atrial function deteriorates immediately following AF ablation and partially recovers in 3 months but remains abnormal in the majority of patients. PACS1-day post procedure predicts arrhythmia recurrence at long-term follow-up.

scholarly journals Personalized Computational Modeling Identifies Embolic Stroke of Undetermined Source Patients with Potential Arrhythmic Substrate

2020 ◽  
Author(s):  
Savannah F. Bifulco ◽  
Griffin D. Scott ◽  
Sakher Sarairah ◽  
Zeinab Birjandian ◽  
Caroline H. Roney ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Computational Modeling ◽  
Left Atrial ◽  
Embolic Stroke ◽  
Modeling Framework

AbstractLate-gadolinium enhanced (LGE)-MRI has revealed atrial fibrotic remodeling in embolic stroke of undetermined source (ESUS) patients comparable to that observed in atrial fibrillation (AFib) patients. Here, we use computational modeling to understand why fibrosis in ESUS does not cause arrhythmia. Left atrial (LA) models were reconstructed via a standardized process and simulations were conducted to probe the fibrotic substrate’s capacity to sustain reentrant drivers (RD). RD-perpetuated arrhythmia was observed in 23/45 (51%) ESUS and 28/45 (62%) AFib models. LA models in which RDs were inducible had significantly more fibrosis than those which were non-inducible (16.8±5.04% vs. 10.19±3.14%; P<0.0001); however, between the specific subsets of inducible ESUS and AFib models, there was no difference in fibrosis burden (P=0.068). Thus, within our modeling framework, pro-arrhythmic properties of fibrosis in ESUS and AFib are indistinguishable, suggesting many ESUS patients have latent fibrotic substrate that may be a potential future source of arrhythmogenicity.

scholarly journals 710 Advanced echocardiographic analysis to identify cardiac toxicity after TKI exposure in patients with CML

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Antonio Parlavecchio ◽  
Rodolfo Caminiti ◽  
Giampaolo Vetta ◽  
Giuseppe Pelaggi ◽  
Francesca Lofrumento ◽  
...  
Keyword(s):  
Left Atrial ◽  
Longitudinal Strain ◽  
Cardiac Toxicity ◽  
Strain Analysis ◽  
Control Group ◽  
Additional Tool ◽  
Significant Difference ◽  
Global Work ◽  
Atrial Strain

Abstract Aims Worsening of cardiac function with increased arrhythmic risk is common in cancer patients undergoing chemotherapy. Impaired LV global longitudinal strain (GLS) in these patients despite preserved ejection fraction is a common issue. Recently, myocardial work by speckle-tracking echocardiography has been used to overcome GLS limitations in various conditions, but little is known about its usefulness in the detection of cardiac toxicity. Moreover, left atrial (LA) toxicity may occur early in the course of cancer therapy. The main aim of the study was to assess the cardiotoxic effects of tyrosine kinase inhibitors (TKIs) on patients with Philadelphia chromosome-positive chronic myeloid leukaemia (Ph+ CML) by using novel echocardiographic tools as myocardial work and atrial strain analysis. Methods and results We retrospectively enrolled Ph+ CML patients treated with TKIs followed at the cardio-oncology outpatient clinic of our hospital from December 2018 to March 2019 who underwent clinical evaluation with ECG and echocardiogram (TTE) before and after 1 year of treatment with TKIs. Healthy subjects were enrolled in the control group matched for gender, age and cardiovascular risk factors. Myocardial work was derived from the strain-pressure relation, integrating in its calculation the non-invasive arterial pressure. LA longitudinal strain (reservoir, conduit, and booster) was obtained from an optimized apical 4-chamber view of the LA. The study recruited 32 patients in Ph+ CML group and 32 healthy controls. 39% of patients were treated with Imatinib, 29.3% with Nilotinib, 4.9% with Dasatinib and 4.9% with Ponatinib. Main results are detailed in Table 1. At 1-year follow-up there was a significant reduction compared to baseline in global constructive work (2555.22 ± 564.33 vs. 2119.31 ± 700.19; P = 0.0001), global work efficiency (96.13 ± 1.90 vs. 94.00 ± 2.96; P = 0.002), and global work index (2340.75 ± 579.57 vs. 1938.46 ± 680.23; P = 0.001), and a non-significant reduction in global wasted work (P = 0.393). Regarding left atrial strain analysis at the 1-year follow-up there was a statistically significant reduction in LA contractile strain (booster= 14.63 ± 1.408 vs. 12.38 ± 1.581; P = 0.018). LA contractile strain reduction was also observed in the comparison with controls (12.38 ± 2.99 vs. 14.91 ± 3.09; P = 0.009). Any other significant difference was detected between baseline and FU TTE data in the Ph+ CML group. Conclusions New imaging methods for the study of cardiotoxicity provide an additional tool for early prediction of potential adverse effects of antineoplastic drugs. TKIs therapy leads to an impairment of atrial contractility, which can be detected by atrial strain e myocardial work analysis.

scholarly journals Anticoagulation Therapy Reduces Recurrent Stroke in Embolic Stroke of Undetermined Source Patients With Elevated Coagulation Markers or Severe Left Atrial Enlargement

2021 ◽  
Vol 12 ◽  
Author(s):  
Kishan Patel ◽  
Elio Mikhael ◽  
Michael Liu ◽  
Srikant Rangaraju ◽  
Deandra Ellis ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Left Atrial ◽  
Recurrent Stroke ◽  
Anticoagulation Therapy ◽  
Embolic Stroke ◽  
Volume Index ◽  
Major Hemorrhage ◽  
Left Atrial Enlargement ◽  
Atrial Enlargement

Background: The objective of this study was to evaluate if anticoagulation therapy reduces recurrent stroke in embolic stroke of undetermined source (ESUS) patients with left atrial enlargement (LAE) or abnormal markers of coagulation and hemostatic activity (MOCHA) compared to antiplatelet therapy.Methods: ESUS patients from January 1, 2017, to June 30, 2019, underwent outpatient cardiac monitoring and the MOCHA profile (serum d-dimer, prothrombin fragment 1.2, thrombin–antithrombin complex, and fibrin monomer). Anticoagulation was offered to patients with abnormal MOCHA (≥2 elevated markers) or left atrial volume index 40 mL/m2. Patients were evaluated for recurrent stroke or major hemorrhage at routine clinical follow-up. We compared this patient cohort (cohort 2) to a historical cohort (cohort 1) who underwent the same protocol but remained on antiplatelet therapy.Results: Baseline characteristics in cohort 2 (n = 196; mean age = 63 ± 16 years, 59% female, 49% non-White) were similar to cohort 1 (n = 42) except that cohort 2 had less diabetes (43 vs. 24%, p = 0.01) and more tobacco use (26 vs. 43%, p = 0.04). Overall, 45 patients (23%) in cohort 2 initiated anticoagulation based on abnormal MOCHA or LAE. During mean follow-up of 13 ± 10 months, cohort 2 had significantly lower recurrent stroke rates than cohort 1 (14 vs. 3%, p = 0.009) with no major hemorrhages.Conclusions: Anticoagulation therapy in a subgroup of ESUS patients with abnormal MOCHA or severe LAE may be associated with a reduced rate of recurrent stroke compared to antiplatelet therapy. A prospective, randomized study is warranted to validate these results.

Echocardiographic findings on aortic stenosis: an observational, prospective, and multi-center registry

Perfusion ◽  
2020 ◽  
pp. 026765912092492
Author(s):  
Shehab Anwer ◽  
Didem Oğuz ◽  
Laura Galian-Gay ◽  
Irena Peovska Mitevska ◽  
Lilit Baghdassarian ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Right Ventricular ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Low Flow ◽  
Aortic Valve Area ◽  
Significant Difference

Background: The aim of this aortic stenosis registry was to investigate the changes of routine echocardiographic indices and strain in patients with moderate-to-severe aortic stenosis over a 6-month follow-up period. Methods: Our aortic stenosis registry is observational, prospective, multicenter registry of nine countries, with 197 patients with aortic valve area less than 1.5 cm2. The enrolment took place from January to August 2017. We excluded patients with uncontrolled atrial arrhythmias, pulmonary hypertension or cardiomyopathies, as well as those with hemodynamically significant valvular disease other than aortic stenosis. We included patients who did not require intervention and who had a complete follow-up study. Results: In patients with preserved ejection fraction, left ventricular mass has significantly increased between baseline and follow-up studies (218 ± 34 grams vs 253 ± 29 grams, p = 0.02). However, when indexed to body surface area, there was no significant difference. Left ventricular global longitudinal strain significantly decreased (-19.7 ± -4.8 vs (-16.4 vs -3.8, p = 0.01). Left atrial volume was significantly higher at follow-up (p = 0.035). Right ventricular basal diameter and mid-cavity diameter were greater at the follow-up (p = 0.04 and p = 0.035, respectively). Patients with low-flow low-gradient aortic stenosis had significantly lower global longitudinal strain (-12.3% ± -3.9% vs -19.7% ± -4.8%, p = 0.01). Conclusion: Left atrial dilatation is one of the first changes to take place in low-flow low-gradient aortic stenosis patients even when left ventricular dimensions and function remains intact. Global longitudinal strain is an important determinant of left ventricular systolic and diastolic dysfunction and right ventricular function is an important parameter of aortic stenosis assessment. Accordingly, our registry has further shed the light on these indices role as multisite follow-up of aortic stenosis.

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