A index of non-invasive myocardial work (MWI) can account for pressure during the assessment of cardiac function, potentially separating the influence of loading conditions from the influence of the ...underlying tissue remodelling. The aim is to assess LV function accounted for loading and explore hypertensive MWI distribution by comparing healthy individuals to hypertensive patients without and with localized basal septal hypertrophy (BSH). An echocardiogram was performed in 170 hypertensive patients and 20 healthy individuals. BSH was defined by a basal-to-mid septal wall thickness ratio ≥ 1.4. LV speckle-tracking was performed, and the MWI calculated globally and regionally for the apical, mid and basal regions. An apex-to-base gradient, seen in regional strain values, was preserved in the distribution of myocardial work, with the apical region compensating for the impairment of the basal segments. This functional redistribution was further pronounced in patients with localized BSH. In these patients, segmental MWI analysis revealed underlying impairment of regional work unrelated to acute loading conditions. Non-invasive MWI analysis offers the possibility to compare LV function regardless of blood pressure at the time of observation. Changes in MWI distribution can be seen in hypertension unrelated to the load-dependency of strain. Accentuated functional changes affirm the role of BSH as an echocardiographic marker in hypertension.
Left atrial (LA) dysfunction has been related to symptom onset in patients with heart failure (HF). However, the potential prognostic role of LA function has been scarcely studied in outpatients with ...new-onset HF symptoms.
Consecutive outpatients with suspected HF onset evaluated at a one-stop clinic were screened. HF diagnosis was performed according to current guidelines. LA function was analyzed in patients in sinus rhythm by speckle-tracking echocardiography, determining LA peak strain rate after atrial contraction (LASRa) as a surrogate of atrial contractile function. Yearly prospective follow-up was conducted to report cardiovascular hospital admission or death. Patients without HF in sinus rhythm were followed as a control group. Survival curves were estimated using the Kaplan-Meier method.
One hundred fifty-four outpatients were included (mean age, 74 ± 10 years; 67% women) with a median follow-up duration of 44.4 months (interquartile range, 31-58 months). Final diagnosis was 29.9% non-HF and 70.1% HF. More than two in five patients with HF (44.4%) had AF (n = 48), and 55.6% (n = 60) were in sinus rhythm. The latter were divided according to LASRa tertile: highest, -1.93 ± 0.39 sec
; middle, -1.08 ± 0.21 sec
; and lowest, -0.47 ± 0.18 sec
. At the end of follow-up, patients with atrial fibrillation had a low event-free survival rate (56.3%), similar to those in the lower LASRa tertile (55.0%). The non-HF group had the best prognosis, and the higher and middle LASRa tertiles had intermediate prognoses (event-free survival, 85%, 75%, and 70%, respectively).
The study of contractile LA function in outpatients with new-onset HF provides prognostic stratification. The early identification of patients at higher risk on the basis of their atrial function would allow focusing on them independently of their final diagnoses.
Sustained re‐entrant tachyarrhythmias treatment has become pivotal in the grown‐up congenital heart patients clinical management. Cardiac LGE‐MRI tissue characterization integrated with high ...definition electroanatomic map could allow fast recognition and effective treatment of substrate of tachyarrhythmias. Cardiac LGE‐MRI areas were suggestive of post‐surgical changes both in atrium and ventricle. High‐density electro‐anatomical map localized areas of slow conduction identifying conducting isthmuses of re‐entrant arrhythmias.
The role of high-intensity exercise and other emerging risk factors in lone atrial fibrillation (Ln-AF) epidemiology is still under debate. The aim of this study was to analyse the contribution of ...each of the emerging risk factors and the impact of physical activity dose in patients with Ln-AF.
Patients with Ln-AF and age- and sex-matched healthy controls were included in a 2:1 prospective case-control study. We obtained clinical and anthropometric data transthoracic echocardiography, lifetime physical activity questionnaire, 24-h ambulatory blood pressure monitoring, Berlin questionnaire score, and, in patients at high risk for obstructive sleep apnoea (OSA) syndrome, a polysomnography. A total of 115 cases and 57 controls were enrolled. Conditional logistic regression analysis associated height odds ratio (OR) 1.06 1.01-1.11, waist circumference (OR 1.06 1.02-1.11), OSA (OR 5.04 1.44-17.45), and 2000 or more hours of cumulative high-intensity endurance training to a higher AF risk. Our data indicated a U-shaped association between the extent of high-intensity training and AF risk. The risk of AF increased with an accumulated lifetime endurance sport activity ≥ 2,000 h compared with sedentary individuals (OR 3.88 1.55-9.73). Nevertheless, a history of <2000 h of high-intensity training protected against AF when compared with sedentary individuals (OR 0.38 0.12-0.98).
A history of ≥ 2,000 h of vigorous endurance training, tall stature, abdominal obesity, and OSA are frequently encountered as risk factors in patients with Ln-AF. Fewer than 2000 total hours of high-intensity endurance training associates with reduced Ln-AF risk.
Right ventricular (RV) diastolic dysfunction in patients with a surgically-repaired RV outflow tract (RVOT) obstruction merits further studies. Right atrial (RA) dilation and function may be related ...to (RV) diastolic dysfunction in this setting. The end-diastolic forward flow (EDFF) in the pulmonary artery (PA) has been suggested as a non-invasive marker of poor RV compliance, however, there is controversy regarding its true significance; EDFF quantification may help elucidate this controversy.
to study predictors of RA enlargement and dysfunction in patients with a surgically-repaired RVOT obstruction and its relationship with quantitative EDFF.
In 81 consecutive patients (mean age: 37.5 (±7) years), transthoracic echocardiography (Echo) and cardiac magnetic resonance (CMR) were performed. Echo parameters: RA size (indexed RA area (iRAA)), RA function (RA global strain (RAGS)) and maximum EDFF velocity-time integral (VTI-EDFF) obtained during a whole respiratory cycle. CMR-indexed RA area (imRAA) was also obtained. Patients were divided into three groups according to iRAA, imRAA and RAGS; bivariate analysis was performed. A multivariate model was then applied using variables that were found to be statistically significant in the bivariate analysis.
Upon multivariate analysis, higher VTI-EDFF values and the presence of significant tricuspid regurgitation proved to be independent factors associated with increased iRAA and imRAA and lower RAGS, whereas RV volumes, function and pulmonary regurgitant fraction were not.
VTI-EDFF linearly correlated with the degree of RA dilation and deformation; EDFF quantification as against qualitative assessment may be considered a non-invasive tool for diastolic RV dysfunction.
Key question: what are the determinants of right atrial dilatation in adult patients with congenital heart disease and previous surgical repair of right ventricular outflow obstruction? Key findings: EDFF quantification should be included in the echocardiographic assessment of patients with CHD. Take Home Message: End-diastolic forward flow quantification is determinant of right atrial dilatation and function. Right ventricular diastolic dysfunction is a main determinant of right atrial dilatation and function. Display omitted
Predictors of second radiofrequency catheter ablation (RFCA) success are not well known. Surgical ablation is accepted for failed first RFCA, but second RFCA has fewer complications.
The purpose of ...this study was to evaluate left atrial (LA) size and function as potential predictors of second RFCA for atrial fibrillation (AF).
Thirty-three healthy volunteers (group I) and 83 patients with symptomatic drug-refractory AF treated with a first RFCA (group II, n = 48) or a second RFCA (group III, n = 35 patients) were included. Echocardiography was performed in all patients in sinus rhythm before RFCA and in all volunteers. LA size and function were measured using longitudinal strain and strain rate during ventricular systole (LASs, LASRs) and during early diastole (LASRe) or late diastole (LASRa) with speckle tracking echocardiography. The effectiveness of RFCA on arrhythmia recurrence was evaluated at 6-month follow-up.
LASs, LASRs, and LASRa were significantly lower in group III patients compared to other groups (P < .001 for all). LA diameter or volumes did not predict success after RFCA. LASs was an independent predictor of arrhythmia suppression after a first RFCA and after a second RFCA, with the best cutoff at LASs >20% (sensitivity 86%, specificity 70%) and LASs >12% (sensitivity 84%, specificity 90%), respectively.
LA myocardial deformation imaging is a reliable tool for predicting success after a first and a second RFCA. These parameters could improve candidate selection, especially for a second RFCA.
A 35-year-old female athlete presented with recent episodes of pre-syncope on exertion while exercising. An isolated double-chambered right ventricle…
A 35-year-old female athlete presented with ...recent episodes of pre-syncope on exertion while exercising. An isolated double-chambered right ventricle was diagnosed by transthoracic echocardiography and cardiac magnetic resonance. This defect typically presents during infancy and/or early childhood, is rarely reported in adults, and is usually associated with other congenital defects. (Level of Difficulty: Advanced.)
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Left atrial (LA) size has been related to the success of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). However, potential predictors after a repeated procedure are unknown. We ...evaluate predictive factors related to successful AF ablation after a first and a repeated RFCA.
A total of 154 patients with AF were treated with RFCA. LA size and function were assessed with three-dimensional echocardiography (3D Echo) before RFCA. The effectiveness of RFCA was evaluated after 6 months. Recurrence of the arrhythmia was defined as any documented (clinically or by 24-h Holter recording) atrial tachyarrhythmia lasting >30 s after 12 weeks following RFCA. Of 154 patients, 103 (67%) underwent a first ablation (Group 1) and 51 (33%) a repeated RFCA (Group 2). At follow-up, arrhythmias were eliminated in 56 of 103 (54%) patients after a first RFCA and in 20 of 51 (40%) after a repeated ablation. In Group I, hypertension and LA expansion index derived from 3D Echo were independent predictors of arrhythmia elimination. In Group 2, only age predicted persistence of sinus rhythm; and only in younger patients (≤54 year old), though 3D LA maximal volumes were significantly smaller in those without when compared with those with AF recurrences.
A combination of the analysis of LA function with 3D Echo and clinical data predicts elimination of AF after a first ablation procedure for AF, beyond LA size. Among patients undergoing a repeated procedure, age and 3D echocardiographic LA maximum volume in younger patients predict the success of RFCA.
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