THE VALUE OF ATRIAL ELECTROMECHANICAL DELAY IN PREDICTING ATRIAL FIBRILLATION DEVELOPMENT AFTER CORONARY ARTERY BYPASS SURGERY

Objective: Predicting postoperative atrial fibrillation (PoAF) in the preoperative period will provide a serious advantage in preventing the morbidity and mortality associated with this arrhythmia and in planning the treatment. In this study, we investigated the value of atrial electromechanical delay (AEMD) in predicting the development of PoAF. Methods: A total of 93 patients who underwent isolated coronary artery bypass grafting (CABG) operation were included in this prospective study. Patients’ demographic characteristics, laboratory parameters, echocardiographic data, and AEMD durations that could be measured by the co-use of electrocardiography and echocardiography were recorded. The patients at sinus rhythm during the postoperative period were identified as “Group 1”, and those who developed PoAF were identified as “Group 2”. Results: PoAF incidence was 26.88% (n=25). Left ventricle (LV) lateral AEMD, LV medial AEMD, right ventricle lateral AEMD, and left atrium (LA) lateral AEMD durations of Group 2 were significantly higher than Group 1 (p<0.001, p=0.004, p=0.004, p<0.001; respectively). In Univariate Logistic Regression Analysis, the age, hypertension, LA maximum volume, LA lateral AEMD and pulmonary artery pressure were significantly associated with PoAF development (p=0.01, p=0.004, p=0.004, p=0.001, p=0.01; respectively). However, only LA lateral AEMD was found as an independent predictive factor for the development of PoAF in the Multivariate Logistic Regression Analysis (OR:1.03, 95% CI:1,001-1.06, p=0.04). AUC was 0.741 for LA lateral AEMD in ROC Curve Analysis (95% CI:0.633-0.849, p<0.001). Conclusions: The development of PoAF can be predicted by AEMD durations measured in the preoperative period in patients undergoing isolated CABG.

Atrial electromechanical delay of patients with COPD in acute and stable periods

Background: The increased level of the airway and systemic inflammation, worsened clinical symptoms, and impaired lung functions are regarded as the characteristics of chronic obstructive pulmonary disease (COPD). The COPD may cause right/left ventricle dysfunction, pulmonary hypertension, and cor pulmonale. Objectives: The current study aimed to assess atrial electromechanical delay (AEMD) and echocardiographic changes and their relationship with inflammatory markers in subjects suffering from COPD during acute and stable periods. Methods: This prospective study was carried out on a total of 45 patients (including 22 and 23 female and male participants, respectively) suffering from COPD exacerbation. The stable phase of the participants was considered the control group. The first and second echocardiography was conducted in the first 24 h and following 3 months, respectively. Conventional and Tissue Doppler Imaging was utilized for the evaluation of atrial conduction times and systolic-diastolic functions of the right-left heart. The inflammatory markers, including the c-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio, were also measured in this study. Results: In the stable period, there was a significant reduction in lateral/tricuspid, lateral/mitral, and septal AEMD. The evaluation of right ventricle basal, mid and vertical diameters, tricuspid annular plane systolic excursion, Amax tricuspid, tricuspid regurgitant velocity, systolic pulmonary arterial pressure, tricuspid annular systolic motion, left atrium diameter, left ventricle end-diastolic diameter, interventricular septum thickness, mitral early diastole/atrium systole ratio, systolic mitral motion, systolic septal motion, and heart rate showed significant differences after 3 months. In addition, there was a significant decrease in C-reactive protein, CAR, and NLR. Conclusion: In the stable period, a significant reduction was observed in AEMDs and there was an improvement in the systolic functions of the right-left heart. No correlation was observed between AEMDs and inflammatory markers.

RISK PREDICTION FOR ARRHYTHMIA IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The aim: To evaluate P-wave dispersion (PwD), as an independent predictor of atrial fibrillation, corrected QT interval dispersion (cQTD), the noninvasive marker of ventricular arrhythmia and sudden cardiac death, investigate the atrial electromechanical delay in patients with COPD and assess their relation with the severity of the disease. Materials and methods: We prospectively enrolled consecutive patients with newly diagnosed COPD (n = 53, age 41.2 ± 6.8 years), compared with an age-matched healthy control group (n = 51, age 40.9 ± 6.5 years). A standard 12-lead electrocardiogram of each patient was analyzed for PwD and сQTD. Atrial electromechanical delay was analyzed by echocardiographic tissue Doppler imaging. The difference between PAs-PAl, PAs-PAt, and PAl-PAt were defined as left intra-atrial, right intra-atrial, and interatrial electromechanical delays (EMD), respectively. Results: PwD was higher in COPD patients than in control subjects (39.47 ± 3.12 ms vs. 30.29 ± 3.17 ms, p < 0.05). In comparison between control group and COPD subgroups (mild, moderate and severe), there was a statistically significant difference among these free groups in terms of PwD. Subgroup analyses showed that this difference was mainly due to patients with severe COPD. Regarding cQTD, there was a statistically significant increase in COPD patients 57.92 ± 3.43 ms vs 41.03 ± 5.21 ms, p < 0.05 respectively. PAs, PAl and PAt durations, right intra-atrial and interatrial EMD were also significantly longer in COPD patients (p < 0.05). Furthermore, there were significant negative correlations between FEV1 and PwD (r = – 0.46, p < 0.05), right intra-atrial (r = – 0.39 ms, p < 0.05), interatrial EMD ( r = – 0.35 ms, p < 0.05) and cQTD (r = – 0.32, p < 0.05). Conclusions: Atrial conduction time, such as inter- and intra-atrial EMD intervals, PwD and cQTD were longer than in healthy controls and correlated with the severity of COPD. These parameters offer a non-invasive and cost-effective assessment method for detecting patients at high risk of arrhythmia. Nevertheless, further prospective investigations on this issue are required.

Atrial Electromechanical Delay Is Impaired in Patients with Primary Hyperparathyroidism

Aim: Primary hyperparathyroidism (PHPT) is an endocrine disease that poses a risk for cardiac arrhythmias. Atrial electromechanical delay (EMD) has been known as an early marker of atrial fibrillation (AF). This study aimed to evaluate the atrial EMD in PHPT. Methods: Fifty PHPT patients (45 females, 5 males) aged 30-75 years and 38 controls (35 females, 3 males) aged 31-73 years were included in the study. Atrial EMD parameters were measured by using tissue Doppler imaging (TDI). Inter-atrial EMD was calculated as the difference between PA lateral and PA tricuspid, intra-atrial EMD was calculated as the difference between PA septum and PA tricuspid, and left-atrial EMD was calculated as the difference between PA lateral and PA septum Results: Atrial EMD parameters (PA lateral, PA septum, PA tricuspid) significantly increased in PHPT group compared to control group (p<0.001, for all). Also, inter-atrial and intra-atrial EMD were higher in PHPT group compared to control group (p<0.001, for all). In correlation analysis, calcium was well associated with PA lateral (r=0.748, p<0.001), PA septum (r = 0.720, p <0.001), inter-atrial EMD (r = 0.670, p <0.001) and intra-atrial EMD (r = 0.616, p <0.001). There was the same correlation relationship between PTH levels with PA lateral (r=671, p<0.001), PA septum (r=0.660, p<0,001), inter-atrial EMD (r=0.674, p<0,001) and intra-atrial EMD (r=0.732, p<0.001) Conclusions: Atrial EMD parameters were prolonged in PHPT. The measurement of atrial EMD parameters might be used to determine the risk of development of AF in PHPT

Evaluation of left atrial mechanics and p-wave dispersion as markers of left atrial cardiopathy in patients of embolic stroke of undetermined source (ESUS)

Introduction Around 25% of all ischaemic strokes have no known cause despite standard investigations. Most of these cases are suspected to have an embolic source for ischaemia, leading to the moniker of Embolic Stroke of Undetermined Source (ESUS). Recent studies suggest that abnormalities of the left atrium, in the form of atrial cardiopathy, can lead to increased risk of stroke even in the absence of atrial fibrillation (AF), which may be either as precursors to AF or as independent risk factors for the development of left atrial thrombus and subsequent stroke. Purpose The aim of this study was to measure LA electromechanical dissociation, LA volumes and P-wave dispersion as markers of atrial cardiopathy in patients with ESUS to determine whether atrial cardiopathy may be in the causal pathway of ESUS. Methods 28 patients presenting with ischaemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study. All patients had 24-hour Holter monitoring done to rule out the presence of AF. The control group consisted of 28 age- and gender-matched apparently healthy individuals. On ECG, P-wave Dispersion (PWD) was calculated by subtracting minimum P-wave duration from maximum P-wave duration. On echocardiography, time intervals from the beginning of P-wave to beginning of A' wave from the lateral mitral annulus in tissue doppler imaging was measured as the atrial electromechanical delay. LA volumes were recorded using the Modified Biplane Simpson's method. Statistical analysis was performed using student's t-test, chi-square test, and Pearson's test. Results Baseline demographic and laboratory characteristics were similar between the two groups. Increased PWD (34.14±9.89 ms vs. 27.32±8.95 ms; p=0.01), atrial electromechanical delay (73.32±16.31 ms vs. 63.63±13.59 ms; p=0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p&lt;0.01). Discussion According to the results of our study, PWD, atrial electromechanical delay and LA volumes may be novel predictors for ESUS. Atrial cardiopathy is a unique mechanism of thrombo-embolism in ESUS patients and our data establishes its association with ESUS. Further studies will be needed to shed more light on its role in the causality of stroke in the ESUS population. Measurement of electromechanical delay Funding Acknowledgement Type of funding source: None