The measurement of central Pb+Au collisions at the maximum SPS energy of 158 GeV per nucleon in the fall of 2000 was the first run of the fully upgraded CERES and at the same time the last run of ...this experiment. Today, after several years of tedious calibration, the physics analysis is in its peak. A snapshot of the current results is presented here.
Abstract
Background
Atrial fibrillation (AF) impairs cardiac mechanics and leads to adverse remodelling. Increased left atrial (LA) stiffness reflecting LA reservoir function and left ventricular ...(LV) filling pressure is one of the symptoms of LA remodelling.
Purpose
To analyse LA stiffness within 24 hours after successful electrical cardioversion and its prognostic value during 2-years follow-up.
Methods
Prospective study involved 71 patients with nonvalvular AF (mean age 64±13 years, 61% male). All patients underwent echo during 24 hours after conversion to sinus rhythm. We analysed standard echocardiographic and Doppler parameters. Using speckle-tracking method we assessed peak LA longitudinal strain in 4- and 2-chamber view. LA stiffness was calculated as the quotient of peak LA longitudinal strain (LA reservoir function) and mean E/E' ratio. The clinical endpoints were predefined as AF recurrence and cardiovascular hospitalization.
Results
Median time of current AF episode was 2 (IQR 0.4–5) months. Standard echo measurements revealed median of LV ejection fraction 55% (IQR 45–58) and median of LA volume indexed to body surface area 42 ml/m2 (IQR 34–51). During follow-up we noticed AF recurrence in 48 (68%) patients and cardiovascular hospitalization in 43 (61%) patients. Median time-to-event was 2.4 (IQR 1 to 6.9) and 7 (IQR 2.1–11) months, respectively. Receiver operating characteristic curve analysis revealed that LA stiffness >0.53 (AUC=0.821; p<0.0001) and >0.95 (AUC=0.788; p<0.0001) were the optimal cut-off values for predicting AF recurrence and cardiovascular hospitalization. Figure presents Kaplan-Meier survival analysis for AF recurrence (A) and for hospitalization (B). Moreover LA stiffness remain statistically significant in multivariate Cox regression analysis even after adjustment for betablockers, antiarrhythmic drugs, coronary artery disease, heart failure and mitral regurgitation. Relative risk was 1.51 (95% CI 1.09–2.09), p=0.01 for AF recurrence and 1.49 (95% CI 1.05–2.13) for cardiovascular hospitalization.
Conclusions
Speckle tracking-derived LA stiffness assessed early after the restoration of sinus rhythm independently predicts AF recurrence and cardiovascular hospitalization.
Funding Acknowledgement
Type of funding sources: None.
Abstract Background Transseptal puncture is one of the most challenging steps in catheter ablation of atrial fibrillation (AF) because of the potential risk of complication. While single TSP reduces ...the puncture-related risk, double TSP simplifies the procedure (immediate signal visualization in pulmonary veins, avoidance of multiple changes of catheters through the single sheath). The purpose of this study was to analyze the impact of single versus double TSP during pulmonary vein isolation (PVI) with radiofrequency (RF) catheter ablation for AF on the fluoroscopy usage and procedure time. Methods Data reported from the international, multicenter prospective „Go For Zero Fluoroscopy Registry" performed in years 2018–2019 were analyzed. Overall 25 European electrophysiology centers from 14 countries and up to 5 operators from each center were enrolled. Only isolated PVI procedures were analyzed. Results A total data of 393 PVI RF procedures were collected from 25 centers. The median dose-area-product (DAP), fluoroscopy time and overall procedure time were: 810 (325 – 1839) cGy*cm2, 8 (4 – 14) minutes and 124 (92 – 168) minutes, respectively. Single TSP was associated with significantly higher DAP: 984 (459 – 1939) vs 667 (227 – 1469) cGy*cm2 (p=0.002), longer fluoroscopy time: 11 (6 – 19) vs 6 (3 – 11) minutes (p<0.001) and longer overall procedure time: 133 (103 – 168) vs 110 (90 – 168) minutes (p=0.003) as compared with double TSP. Single and double TSP group did not differ significantly in regards of general anesthesia usage, circular and multipolar mapping catheter use (p>0.05). However, single TSP was performed by operators with longer EP lab experience: 10 (4 – 15) vs 3 (0 – 10) years (p<0,001). Conclusions Double TSP is related with lower fluoroscopy usage and shorter overall procedure time of pulmonary vein isolation with radiofrequency catheter ablation for atrial fibrillation.
Abstract
Methods
Out-hospital clinic patients (pts) recovered from COVID-19 were prospectively recruited and underwent cardiac magnetic resonance (CMR) examination with a protocol including: edema, ...hyperemia, and necrosis or scar-derived from signal intensity assessment in T2-weighted, early gadolinium enhancement (EGE) and late gadolinium enhancement (LGE) CMR images.
Results
A total of 702 patients (mean age 50±12 years, 62% female) were included. The median (IQR) time interval between COVID-19 diagnosis and CMR was 13 (8–22) weeks. In none pts signs of edema, hyperemia and necrosis derived from signal intensity assessment in T2-weighted and early gadolinium enhancement was found. LGE was found in 152 (22%). LGE+ patients had significantly lower left ventricular (LV) ejection fraction (58.5±7.7 vs 61.1±7.9%, p<0.001) and greater LV end-diastolic (117.0±52.2 vs 103,0±36.3 ml, p=0.023) and end-systolic (50.3±28.0 vs 41.0±17.5 ml, p=0.010) volumes when compared with LGE− patients. In the resting electrocardiogram (ECG) fragmented QRS was observed significantly more frequently (46% vs 25%, p<0.001) in LGE+ group, whereas in 24h Holter ECG neither single premature, nor complex ventricular extrasystole burden did not differ between groups (p>0.05). There were observed no differences between symptoms of COVD-19 and comorbidities between LGE+ and LGE− pts. In the multivariable logistic regression analysis: fragmented QRS OR and 95% CI: 2.85 (1.93–4.21) and any ST-T segment deviation in resting ECG OR: 1.93 (1.15–3.25) were identified as independent predictors of LGE, even after adjustment for comorbidities and COVID-19 symptoms.
Conclusions
1. In patients with fibrosis after COVID-19 reduced left ventricular ejection fraction and greater volume of the heart was found.
2. Fragmented QRS and ST-T abnormalities were independent predictors for LGE in patients after COVID-19.
Funding Acknowledgement
Type of funding sources: None.
Abstract
Background
Strain rate reflects the rate of change of the distance between two points of the myocardium occurring in the cardiac cycle. It is a time-dependent parameter requiring higher ...temporal resolution than standard strain assessment. Because of this limitation, speckle tracking-derived left atrial (LA) strain rate analysis is of less interest in the literature.
Purpose
To analyze the prognostic value of LA strain rate during 2-years follow-up in patients with atrial fibrillation (AF).
Methods
The prospective study involved 80 patients with nonvalvular AF scheduled for elective electrical cardioversion (mean age 63.5±13 years, 60% male). All patients underwent echo before cardioversion and 24 hours after conversion to sinus rhythm. We analyzed standard echocardiographic parameters. Using the speckle-tracking method, we assessed LA strain rate during ventricular systole LA-SSR, in the early stage of ventricular diastole LA-ESR, and during atrial active pump phase LA-ASR. The last one is possible to measure only in the sinus rhythm. The analysis included 4-chamber and 2-chamber views. The clinical endpoint was predefined as AF recurrence.
Results
Median time of the current AF episode was 2.1 (IQR 0.5–5) months. Standard echo measurements revealed a median left ventricular ejection fraction of 55% (IQR 46–58) and the median of LA volume indexed to body surface area 42 ml/m2 (IQR 33–51). The successful cardioversion rate was 90%. During follow-up, we noticed AF recurrence in 49 (68%) patients. The median time-to-event was 2 (IQR 1 to 6.9) months. Receiver operating characteristic curve analysis revealed that LA-SSR <−0.73 s–1 (AUC=0.745; p=0.0004) and LA-ESR >−1 s–1 (AUC=0.703; p=0.0015) assessed during AF as well as LA-ESR >−0.88 s–1 (AUC=0.644; p=0.04) and LA-ASR >−1 s–1 (AUC=0.837; p<0.0001) measured in sinus rhythm were the optimal cut-off values for predicting AF recurrence. The figure presents Kaplan-Meier survival analysis for AF recurrence.
Conclusions
Speckle tracking-derived LA strain rate predicts the recurrence of AF after successful electrical cardioversion.
Funding Acknowledgement
Type of funding sources: None.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Despite the fact that most people with COVID-19 (C-19) do not require hospitalization, little is known about the changes in ECG in ...this group of patients (pts). The electrocardiogram (ECG) is one of the leading tools to assess the extent of cardiac involvement in C-19 pts.
Our main aim was to asses ECG abnormalities related to cardiac involvement in patients without hospitalization with mild and moderate course of C-19 .
Methods
Only pts without co morbidities, not taking any medications were included to the study. In all pts standard 12-lead electrocardiograms (EKG) mean 8,2week +/- 4,6) after C-19 was performed in supine position after 15 minutes in rest. The following parameters were analyzed: mean heart rate (mHR), bradycardia and tachycardia episodes defined as HR <40bpm and HR> 100 bpm, PQ duration, QRS durations, the Bazett-corrected QT interval, changes in the ST-T segment and the T wave. Additionally heart rhythm disturbances were assessed and atrial fibrillation/flutter episodes, the presence of atrial premature contractions (APCs), ventricular premature contractions VES) Number of atrioventricular blocks, bundle branch blocs (BBB) – (RBBB, LBBB, a nonspecific intraventricular conduction block) were also analyzed.
Results
264 pts were included to final assessment, with mean age 43,5 ± 13,5 years. The results were as follow: HR <40bpm - in 0pts, HR> 100 bpm in 9(3%)pts, PQ duration > 200ms in 7(3%)pts, QRS durations > 100ms in 19(6%)pts, QTc interval in 16 (6%)pts, ST-T segment abnormalities in 21(8%)pts and the T wave abnormalities in16(6%)pts Following heart rhythm disturbances were noted: AF/AFl in 0pts, (APCs) in 0pts, VES – in 3(1%)pts. No episodes of atrioventricular blocks were recorded, but BB in bundle branch blocs (BBB) – (RBBB, LBBB, a nonspecific intraventricular conduction block) in 14 (3%) pts were noted.
Conclusions. The most frequent ECG abnormalities in pts without co-morbidities after COVID-19 without hospitalization were ST-T segment and T abnormalities. A large number of changes in ECG confirms that we can expect cardiac involvement also in the group of patients with mild and moderate course of COVID-19.
Abstract
Introduction
Antazoline (ANT) is an old antihistaminic medication with antiarrhythmic properties. After intravenous administration ANT exerts rapid antiarrhythmic effect often resulting in ...conversion of atrial fibrillation (AF) to sinus rhythm (SR) and is widely used in Poland for this purpose in the last years. However, published data on its effectiveness, safety and clinical utility for rapid AF termination are limited and ANT is not recognized as a cardioversion drug.
Aim
To assess the real-world efficacy of ANT for pharmacological cardioversion of paroxysmal and persistent non-valvular AF.
Methods
Our single center, retrospective, observational study included patients (pts) with history paroxysmal or persistent AF episode lasting less than 6 months, in stable cardiopulmonary condition who were qualified for elective pharmacological cardioversion with intravenous ANT. The primary end-point was the conversion of AF to SR confirmed in electrocardiography (ECG) during the 6-hours observation.
Results
A total of 176 pts (mean age 68.4±12.0 years, 49% male) were enrolled into the study. In 93 patients (52%) AF duration was shorter than 48 hours and median AF duration time was 24 (7–432) hours. The overall success rate of pharmacological cardioversion of AF with intravenous ANT was 45.5% (80/176 pts). The mean used dose of ANT was 250.9±65.4mg. The subgroup analysis, regarding the AF duration, suggested the effectiveness of ANT mainly in in short-lasting AF (effectiveness of antazoline based cardioversion for AF lasting <48h vs others: 75.3% vs 12.0%, p<0.001). In multivariable logistic regression model AF duration (for every 24h in AF – OR=0.97; 95% CI 0.96–0.98), the left atrium antero-posterior diameter (OR=0.92; 95% CI 0.86–0.99) and the serum creatinine level (OR=0.15; 95% CI 0.03–0.73) were identified as independent predictors of antazoline based pharmacological cardioversion effectiveness, even after adjustment for comorbidities. The ROC curves revealed that the optimal cut-off value for AF duration time predicting ANT's effectiveness was 48h (AUC=0.876; 95% CI 0.815–0.922) – Figure 1. There were only one episode of bradycardia <45 bpm related to ANT administration.
Conclusions
Antazoline is effective and safe in rapid pharmacological cardioversion of paroxysmal AF, especially in the short-lasting AF (<48 hours) and in patients without the left atrium enlargement and significant renal disease.
Funding Acknowledgement
Type of funding sources: None. Figure 1. ROC curve analysis
Abstract
Introduction
In COVID-19 patients, both preexisting cardiovascular disease as well as cardiac injury resulting from SARS-CoV-2 infection are associated with increased mortality. We ...hypothesized that novel parameters of myocardial function may be useful in the assessment of in-hospital and long-term prognosis.
Aim
The aim of study was to determine the prevalence of myocardial dysfunction revealed by speckle tracking echocardiography and its association with in-hospital and one-year mortality.
Methods
The study group comprised 192 patients hospitalized in the cardiology department due to COVID-19. All patients underwent transthoracic echocardiographic examination with off-line analysis. Using speckle tracking technique, we measured the following parameters: left ventricular global longitudinal strain (GLS), right ventricular global longitudinal strain (RV-GLS), right ventricular free wall strain (RV-FWS) and myocardial work parameters – global work index (GWI), global wasted work (GWW), global constructive work (GCW) and global work efficiency (GWE). The primary outcome was in-hospital and one-year mortality.
Results
112 patients (mean age 68±14 years, 76 (68%) male) had adequate image quality to evaluate strain-derived parameters. 27 patients died during hospitalization and 44 patients died within one-year after discharge. In-hospital non-survivors were older, had lower baseline oxygen saturation (SpO2) and had higher NTproBNP (Table 1). In non-survivors speckle-tracking echocardiography revealed significant impairment of left and right ventricular function compared to the group of survivors (Table 1). The independent predictors of in-hospital death were GWE (OR 0.85; 95% CI 0.78–0.93) and SpO2 on admission (OR 0.91; 95% CI 0.86–0.96). Based on the ROC curve analysis, the optimal cut-off points for predicting in-hospital death were identified: GWE ≤87% (sensitivity 63%, specificity 89%) and baseline SpO2 value ≤88% (sensitivity 81%, specificity 71%).
The independent predictors of one-year mortality were: age (OR 1.28 1.13–1.46), NTproBNP (OR 1.002 1.001–1.003), baseline SpO2 (OR 0.71 0.59–0.86) and RV-GLS (OR 1.32 1.12–1.55). Based on the ROC curve analysis, the cut-off points optimal for predicting death within 12 months after COVID-19 were also identified: baseline SpO2 value ≤88% (sensitivity 69.8%, specificity 77.3%), age >60 years (sensitivity 90%, specificity 43%), NTproBNP >500 pg/ml (sensitivity 95%, specificity 41.8%), RV-GLS >−18.5 (sensitivity 93%, specificity 64.2%).
Conclusions
Two-dimensional speckle tracking echocardiography is a useful technique to evaluate myocardial function in COVID-19 patients and provides good prognostic value for identifying patients at risk of death during hospitalization and in long term follow-up.
Funding Acknowledgement
Type of funding sources: None.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The successful electrical cardioversion (EC) in patients with atrial fibrillation (AF) improves cardiac mechanical ...function and enables early assessment of atrial activity by echocardiography.
Purpose
To analyze conventional and novel parameters characterizing left atrium (LA) within 24 hours after the restoration of sinus rhythm (SR) and their prognostic value during 2-years follow-up.
Methods
Prospective study involved 71 patients with nonvalvular AF (mean age 64 ± 13 years, 61% male). All patients underwent echo 24 hours after conversion to SR. In addition, standard echocardiographic and Doppler parameters were assessed. Using speckle-tracking method we analysed LA longitudinal strain in reservoir and contractile phase. The clinical endpoint was predefined as AF recurrence.
Results
During a 24-months follow-up we noticed AF recurrence in 48 (68%) patients. The median time-to-event was 2.4 months (IQR 1 to 6.9). Standard echo measurements revealed a median of LV ejection fraction 55% (IQR 45-58) and median of LA volume indexed to body surface area 42 ml/m2 (IQR 34-51). Median mitral A wave was 0.46 m/s (IQR 0.39-0.5) vs 0.35 m/s (IQR 0.28-0.5) in patients without and with AF recurrence, respectively (p = 0.04). Patients without AF recurrence had also higher mitral annular A’ velocity obtained by tissue Doppler imaging (7.4 ± 2.8 cm/s vs 3.5 cm/s, IQR 2.8-4.8; p < 0.0001), LA reservoir strain (19.4 ± 7.3% vs 11%, IQR 9.6-15.3; p = 0.0003) and LA contractile strain (9.4 ± 4.1% vs 2.8%, IQR 1.2-4.4; p < 0.0001). The table presents results derived from univariate Cox regression analysis.
Conclusion
LA activity assessed early after the restoration of sinus rhythm is the predictor of AF recurrence. The strongest association was proven for LA contractile strain. Abstract Figure. Univariate Cox regression analysis
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