Characteristics of left atrial strain in patients with atrial fibrillatio after cardioversion

The aim of the study – to evaluate the parameters of left atrial myocardial strain in patients with atrial fibrillation who underwent electrical and drug cardioversion.Materials and methods. The study included 118 patients of the University Clinical Hospital No 1 of the First Sechenov Moscow State Medical University. The analysis was carried out in three groups of patients: group 1 (n=54) – patients with atrial fibrillation who underwent electrical cardioversion; group 2 (n=31) – patients with atrial fibrillation who underwent drug cardioversion; group 3 (n=43) – patients without a history of atrial fibrillation. The clinical and anamnestic data of the medical history of each patient, as well as ultrasound indicators were evaluated: global strain of the left atrial, the values of negative peaks as a reflection of the left atrial systole and the values of positive peaks as a reflection of the filling of the left atrium, LASI – the left atrial stiffness index.Results. The analysis showed that left atrial strain in patients with atrial fibrillation were reduced in all analyzed parameters: negative strain peaks (-9.00 vs. -12.6 in the control group, p<0.001), positive strain peaks (12.6 vs. 14.6 in the control group, p<0.001), global left atrial strain (21.5 in the atrial fibrillation group vs. 27.3 in the control group, p<0.001). Left Atrial Stiffness Index (LASI) was significantly higher in patients with a stopped episode of atrial fibrillation (0.50 vs. 0.40, p=0.006).Conclusions. The indicators of left atrial strain were significantly reduced, and the left atrial stiffness index was significantly increased both in the group with electrical cardioversion and in the group with drug-induced cardioversion, compared with patients with similar cardiovascular pathologies, but without a history of atrial fibrillation episodes.

582 Changes on diastolic and atrial functions following a single bout of two different exercise modalities in patients with hypertension and ischaemic heart disease

Aims Concurrent aerobic plus resistance exercise (RAE) and high intensive interval exercise (HIIE) are both effective on inducing post-exercise hypotension (PEH) in patients with hypertension. However central haemodynamic changes associated to PEH in hypertensive subjects with underlying ischaemic heart disease (IHD) have been poorly investigated. To compare the acute effects produced by these two exercise modalities on left ventricular diastolic function and left atrial function. Methods and results Twenty untrained male patients with history of hypertension and IHD under stable pharmacological therapy were enrolled. Each patient underwent three exercise sessions: RAE, HIIE, and a control session without exercise each lasting 45 min. Echocardiography examination was performed before and between 30 and 40 min from the end of the exercise sessions. In the first hour post exercise, BP values decreased in a similar way in RAE and HIIE and were unchanged after control. Compared to pre-session, E/E1 ratio increased after HIIE and remained unchanged after both RAE and control sessions (between-sessions P 0.002). PALS increased slightly after RAE (+1.4 ± 1.1%), decreased after HIIE (−4.6 ± 2.4%). and was unchanged after control. (between-sessions P 0.03). PACS was mildly increased after RAE, was reduced after HIIE, and was unchanged after control. Atrial volume was unchanged after both sessions. Left ventricular and left atrial stiffness increased significantly after HIEE while remained unchanged after RAE and control. Stroke volume and cardiac output increased after RAE, decreased after HIIE, and were unchanged after control. Conclusions Single sessions of RAE and HIIE determined similar PEHs in hypertensive subjects with IHD, while they evoked different central haemodynamic adjustments. Given its neutral effects of on diastolic and atrial functions, RAE seems more suitable for reducing blood pressure in hypertensive patients with IHD.

Left atrial stiffness measured by echocardiography is a stronger predictor of atrial fibrillation recurrence after radiofrequency catheter ablation than left atrial volume

Introduction Left atrial volume (LAV) is an accepted predictor of atrial fibrillation (AF) recurrence after radiofrequency catheter ablation, stronger than AF duration. Objective The aim of this study was to assess the value of left atrial stiffness (LAS) index as a new parameter evaluated by echocardiography to the prediction of AF recurrence after radiofrequency catheter ablation. Methods We retrospectively studied consecutive patients with paroxysmal or persistent AF submitted to radiofrequency catheter ablation at our institution between 2017 and 2019. We used transthoracic echocardiography to measure the LAV indexed to body surface area and the LAS index, defined as the ratio between the mitral E/e' (obtained with pulsed Doppler at the tip of the mitral leaflets – E, and tissue Doppler imaging at the mitral annulus – e') and the left atrial strain during the reservoir phase (obtained by speckle tracking echocardiography) [LAS index = (E/e') / LA reservoir strain]. The left ventricular ejection fraction (LVEF) was also evaluated. Patients with poor quality echocardiographic images were excluded. We compared 2 groups of patients, according to the recurrence of AF after the blanking period. We analysed the clinical characteristics and echocardiographic findings. The effect of clinical and echocardiography parameters on AF recurrence was evaluated by univariate and multivariate Cox Regression analysis. Results We studied 33 patients, 27 with paroxysmal AF and 6 with persistent AF. Baseline patients' characteristics are presented in Table 1. During a mean follow-up time of 17.9±10.4 months, 7 patients (21%) had AF recurrence, and none died. Patients with AF recurrence had a higher LAS index. After adjusting for confounding variables, only LAS index and LAV were independently associated with AF recurrence (Table 2). Every one unit increase in LAS index was associated with an 11-fold increased risk of AF recurrence (HR 10.86, 95% CI 1.38–85.56; p=0.024), while every one unit increase in LAV index was only associated with a 6% increased risk of AF recurrence (HR 1.06, 95% CI 1.01–1.11, p=0.010). Conclusion LAS index evaluated by echocardiography was a much stronger predictor of AF recurrence after radiofrequency catheter ablation than left atrial volume. FUNDunding Acknowledgement Type of funding sources: None.

Left atrial stiffness index is associated with metabolic syndrome and independently related to urine albumin-creatinine ratio in young subjects with hypertension

Background and objective Left atrial (LA) functional decline seems to be the earliest sign of hypertension-related heart damage detectable with echocardiography for the moment. Left atrial stiffness index (LASI) is a novel index reflecting both LA function and LA–left ventricular (LV) coupling. Early detection of hypertension-mediated organ damage (HMOD) is critically important in clinical decision making in certain groups of patients, such as young persons with first time diagnosed HTN. We intended to analyze the relations of LASI with office and 24 hours blood pressure levels and HMOD characteristics in subjects with HTN aged of 18 to 45 years. Methods We included 78 young subjects (median of age 23 [21; 25] years, mean BMI 25,9±4,7 kg/m2, median 24 hours systolic blood pressure (SBP) and diastolic blood pressure (DBP) 134,0 [128,8; 143,3] and 79,5 [74,0; 88,0] mm Hg, respectively) with HTN diagnosed with 24-hours ambulatory blood pressure monitoring (ABPM) according to ESH guidelines criteria (2018). Most patients (73%) had masked HTN. We performed routine clinical evaluation, including registration of anthropometric characteristics and blood and urine tests, central pulse wave assessment with applanation tonometry and echocardiography including two-dimensional speckle tracking. LASI was calculated as E/e$'$ to left atrial longitudinal strain during reservoir phase (LASr) ratio. We performed correlation analysis and multiple linear regression analysis to investigate the relationship between LASI, LASr and variables indicating presence of HMOD. Results Correlation analysis did not reveal any significant associations of LASI and LASR with office and ambulatory BP values. Both LASI and LASr were correlated with age, body mass index (BMI), waist circumference (WC) (r=0,312, p&lt;0,05 and (−0,354), p&lt;0,01) and HOMA-IR (r=0,551, p&lt;0,001 and (−0,345), p&lt;0,01). LASI had stronger correlation with albumin-creatinine ratio (ACR) than LASr (r=0,550, p&lt;0,001 vs (−0,288), p&lt;0,05, respectively). Glomerular filtration rate (GFR) was associated with LASI: r=−0,329, p&lt;0,01 but not with LASr. Left ventricular mass index (LVMI) also had a significant correlation with LASI only: r=0,284, p&lt;0,05 as had carotid-femoral pulse wave velocity (cfPWV): r=0,275, p&lt;0,05. We performed multiple linear regression analysis in which LASI remained related to ACR independently of age, sex, BMI, WC, HOMA-IR, GFR and 24 hours SBP and DBP (β=0,306, p&lt;0,05) while LASr lost the association. The link between LASI and other HMOD markers (GFR, cfPWV, LVMI) got insignificant in multiple regression analysis. Conclusion Early left atrial functional impairment is associated with overweight, abdominal obesity and insulin resistance in young never treated patients with HTN, while impact of elevated BP in HTN of low grades seems to be not so important. LASI in contrast with LASr is independently related to albuminuria but not with other HMOD markers FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): RFBRRUDN University program 5-100

Left atrial strain and left atrial stiffness for early detection of cardiotoxicity in cancer patients

Background Anti-cancer drugs can cause cardiovascular complications. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are usually used to identify clinical and subclinical cardiotoxicity. Purpose The aim of our study was to assess the addictional role of left atrial reservoir strain (LAS-S) and left atrial stiffness (LASI – the ratio of E/e' to LAS-S) in identifying patients at higher risk of cardiotoxicity. Methods 102 breast cancer patients (median age 53±9.5 years), without cardiovascular diseases, were enrolled before starting chemotherapy. Electrocardiogram and transthoracic echocardiogram (conventional measurements based on EACVI recommendations; GLS, LAS-S and LASI measurement) were performed in all patients before starting chemotherapy (T0) and 3 (T1) and 6 months (T2) after chemotherapy. Results No patient developed clinical cardiotoxicity. Moreover we did not find at all times a significant reduction in LVEF compared to baseline. At T1 and T2, we found a significant reduction in GLS (−21.1% IQR −21.9, −20.2% at T0 vs −18.8% IQR −9.5, −18.1% at T1 vs −18.0% IQR −19.8, −17.8% at T2; p value &lt;0.01) and LAS-S (34.4% IQR 31.4–37.4% at T0 vs 28.5% IQR 26.2–30.8% at T1 vs 30.8% IQR 27.6–34% at T2; p&lt;0.001), a significant increase of LASI (0.21%-1 IQR 0.10–0.20%-1 at T0 vs 0.28%-1 IQR 0.20–0.31%-1 at T1 vs 0.35%-1 IQR 0.23–0.41%-1 at T2, p&lt;0.001). In addiction patients were divided into 2 groups based on the presence at T2 and not at T1 (A group) or absence (B group) of a subclinical cardiac dysfunction (identified by a reduction in GLS ≥15% compared to baseline). In A group (47% of population) LASI increased significantly already at T1 and remained significantly increased at T2 (0.21±0.07 at T0 vs 0.3±0.12 at T1, p value &lt;0.0001; 0.33±0.16 at T2, p value &lt;0.0001); LAS-S was significantly reduced at T1 and T2 (35±5 at T0 vs 30±8 at T1, p value 0.0005; 29±9 at T2, p value 0.0001). In patients without subclinical cardiac dysfunction during follow-up (B group, 53% of population), a significant reduction in LAS-S was already evident at T1 and not only at T2 (p value &lt;0.0001 at T1-T2); we found a significant increase in LASI at T1 and T2 (p value &lt;0.0001). Conclusion LAS-S and LASI are able to identify subclinical cardiac dysfunction during chemotherapy, they appear to be even more precious markers of cardio-toxicity than GLS. Further study are needed to verify the prognostic implications of atrial strain impairment during chemotherapeutic treatment. FUNDunding Acknowledgement Type of funding sources: None.