Left atrial strain can predict right ventricular impairment and developement of atrial fibrilation in patients with severe mitral stenosis better than transmitral gradients

Funding Acknowledgements Type of funding sources: None. Introduction. Rheumatic heart disease is a major health problem in developing countries and remains the leading cause of mitral valve stenosis (MS) and valve replacement in adults. Left atrial (LA) inflammation due to rheumatic carditis, pressure overload because of mitral stenosis, lead to fibrosis and remodeling to progressive lost of LA reservoir/compliant capacity that might be responsible of the pressure backward load to the pulmonary circulation. The aims of the study were to determine if 1) there is any correlation between LA strain parameters with pulmonary systolic arterial pressure (PASP) and other parameters related with pulmonary pressure and right ventricular (RV) function and 2) if LA strain can better identify those patients who developed atrial fibrilation (AF). Methods. Strain of the LA was measured in 101 patients retrospectively enrolled with severe MS using two dimensional speckle tracking (2DSTE). Sixty of them were in sinus rhythm (SR) and 40 in atrial fibrillation (AF). The LA 2DSTE was measured from the 4 chamber view of 2 consecutive cycles at expiration and offline evaluated. Based on the QRS onset, the positive peak strain curve was defined as LA end systolic strain. The end of the reservoir phase was defined as 1 frame before mitral valve opening (LA- RES). When the patient was in SR, immediately after the P wave, LA contractile function was identified (LA-booster). Strain of the free wall and global RV was measured in 4CH. A standard echocardiographic assessment was done in accordance with the recommendation of the American Society of Echocardiography. Results. Patients mean age was 47.4 ± 11.9 years, 30 males and 71 females. Mean gradient across the mitral valve (MV) was 8.3 ± 5.1 mmHg and the MV area derived by pressure half time was 1.3 ± 0.3 cm2, LVEF was 51.79 ± 11.3%. Right ventricular (RV) function parameters were TAPSE 19.6 ± 5.2 mm, S` 10.5 ± 2.5 cm/s, RV fraction area change 35.6 ± 9.1% and RV free wall peak strain – 17.96 ± 6.5%. LVMi 51.79 ± 11.3 gr/m2, SVi 34.6 ± 10.3 ml/m2. LA-RES 11.18 ± 3.7%, LA volume in systole 128.3 ± 48.3 ml, LAEF 20.1 ± 12.5%. The group was divided according to tertiles of LA-RES (group 1, 33 patients, strain was < =7%, group 2, 32 patients with strain between 8 and 13%, group 3, 32 patients, strain > =14%). There was a decrease in PASP (group 1, 42.3 ± 17.8 mmHg; group 2, 38.3 ± 17.9 mmHg; group 3, 31.6 ± 17.9 mmHg, p =0.028) and PVR (group 1, 2.5 ± 1; group 2, 2.0 ± 0.6; group 3, 1.6 ± 0.4, p< 0.0001) as LA-RES increased. RV function represented by TAPSE, Sm, RVFAC and RV free wall strain significantly increased as LA-RES increased. The area under the ROC curve was calculated for LA-RES, MV mean gradient, MV area derived by PHT and LA systolic volume as a predictors of AF. LA-RES was the one that better predicted the presence of AF. Conclusion. In severe MS, LA-RES was able to better identify those with higher PASP and worst RV function. Moreover LA-RES was also able to better predict those patients who developed AF.

Abstract 15366: Cancer Diagnosis Following Bleeding in Patients With Atrial Fibrilation Undergoing Anticoagulation Therapy

Introduction: Bleeding is frequent in patients with atrial fibrillation (AF) undergoing oral anticoagulation (OAC), and may be the first manifestation of underlying cancer. OAC could be usefull as a screening tool to unveil an occult cancer and enhance early diagnosis. Hypothesis: We aim to analyze whether bleeding represents an useful tool to unmasking an occult cancer in AF patients treated with OAC. Methods: We used a cohort including all patients ≥ 75 years-old from the health area of Vigo (Galicia, Spain) with AF between 2014 and 2017 (CardioCHUVI-AF_75 registry). Results: Of 8,753 AF patients evaluated (mean age, 82.7 years; women, 61.7%), 2,171 (24.8%) experienced any (major or non-major) bleeding and 479 (5.5%) were diagnosed with cancer (mean follow-up of 3 years). Among 2,171 who experienced bleeding, 198 (9.1%) were diagnosed with cancer. Patients with bleeding have a 3-fold higher risk of new cancer diagnosis compared with those without bleeding (4.7 per 100 patient/year vs1.4 per 100/patients year; hazard ratio [HR]: 3,72 [95% CI 3.05-4.55]). Gastrointestinal bleeding was associated with a 13-fold higher hazard of new gastrointestinal cancer diagnosis (HR 13.44 [95% CI 9.11-19.85]). Genitourinary bleeding was associated with an 18-fold higher hazard of new genitourinary cancer diagnosis (HR 18.11 [95% CI 12.52-26.20]). And bronchopulmonary bleeding was associated with a 15-fold higher hazard of new bronchopulmonary cancer diagnosis (HR 15.78 [95% CI 6.03-41.28]). For those other bleeding (non-gastrointestinal, non-genitourinary, non-bronchopulmonary), the HR for cancer was 2.31 (95% CI 1.47-3.64). Conclusions: Any gastrointestinal, genitourinary, or bronchopulmonary bleeding was associated with higher rates of new cancer diagnosis in AF patients undergoing OAC. These bleeding events behave as an useful screening tool and should encourage prompt investigation for underlying cancers at those sites.

Critical Limb Ischemia In a Diabetes Mellitus Patient with Atrial Fibrilation

Critical Limb Ischemia (CLI) is a clinical syndrome in the form of ischemic pain, especially at rest or a tissue loss condition, such as an ulcer or gangrene that does not heal, associated with Peripheral Arterial Disease (PAD). Diabetes mellitus (DM) accelerates atherosclerosis and becomes one of the risks of PAD. It is also known to accelerate the worsening of PAD with a 4x greater risk of developing CLI compared to patients without DM. At the other side, 60-95% of patients who are operated on as a result of limb ischemia are diagnosed with atrial fibrillation (AF). This paper is a case report regarding a patient with CLI as a complication of DM and AF.