Radionuclide analysis of right and left ventricular response to exercise in patients with atrial and ventricular septal defects

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Peter, C.A.; Bowyer, K.; Jones, R.H.

1983-01-01

In patients with ventricular or atrial septal defect, the ventricle which is chronically volume overloaded might not appropriately respond to increased demand for an augmentation in output and thereby might limit total cardiac function. In this study we simultaneously measured right and left ventricular response to exercise in 10 normal individuals, 10 patients with ventricular septal defect (VSD), and 10 patients with atrial septal defect (ASD). The normal subjects increased both right and left ventricular ejection fraction, end-diastolic volume, and stroke volume to achieve a higher cardiac output during exercise. Patients with VSD failed to increase right ventricular ejection fraction, but increased right ventricular end-diastolic volume and stroke volume. Left ventricular end-diastolic volume did not increase in these patients but ejection fraction, stroke volume, and forward left ventricular output achieved during exercise were comparable to the response observed in healthy subjects. In the patients with ASD, no rest-to-exercise change occurred in either right ventricular ejection fraction, end-diastolic volume, or stroke volume. In addition, left ventricular end-diastolic volume failed to increase, and despite an increase in ejection fraction, left ventricular stroke volume remained unchanged from rest to exercise. Therefore, cardiac output was augmented only by the heart rate increase in these patients. Right ventricular function appeared to be the major determinant of total cardiac output during exercise in patients with cardiac septal defects and left-to-right shunt

Changes in left atrial deformation in hypertrophic cardiomyopathy: Evaluation by vector velocity imaging

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Badran, Hala Mahfouz; Soltan, Ghada; Hassan, Hesham; Nazmy, Ahmed; Faheem, Naglaa; Saadan, Haythem; Yacoub, Magdi H.

2012-01-01

Abstract: Objectives: Hypertrophic cardiomyopathy (HCM) represents a generalized myopathic process affecting both ventricular and atrial myocardium. We assessed the global and regional left atrial (LA) function and its relation to left ventricular (LV) mechanics and clinical status in patients with HCM using Vector Velocity Imaging (VVI). Methods: VVI of the LA and LV was acquired from apical four- and two-chamber views of 108 HCM patients (age 40 ± 19years, 56.5% men) and 33 healthy subjects, all had normal LV systolic function. The LA subendocardium was traced to obtain atrial volumes, ejection fraction, velocities, and strain (ϵ)/strain rate (SR) measurements. Results: Left atrial reservoir (ϵsys,SRsys) and conduit (early diastolic SRe) function were significantly reduced in HCM compared to controls (P  − 1.8s− 1 was 81% sensitive and 30% specific, SRa> − 1.5s− 1 was 73% sensitive and 40% specific. By multivariate analysis global LVϵsys and LV septal thickness are independent predictors for LAϵsys, while end systolic diameter is the only independent predictor for SRsys, P < .001. Conclusion: Left atrial reservoir and conduit function as measured by VVI were significantly impaired while contractile function was preserved among HCM patients. Left atrial deformation was greatly influenced by LV mechanics and correlated to severity of phenotype. PMID:24688992

Evaluation of atrial electromechanical delay and diastolic functions in patients with hyperthyroidism.

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Sokmen, Abdullah; Acar, Gurkan; Sokmen, Gulizar; Akcay, Ahmet; Akkoyun, Murat; Koroglu, Sedat; Nacar, Alper Bugra; Ozkaya, Mesut

2013-11-01

Hyperthyroidism is a well-known cause of atrial fibrillation (AF) which is associated with increased morbidity and mortality. Atrial electromechanical delay (EMD) is a significant predictor of AF. The aim of this study was to assess the atrial EMD and diastolic functions in subclinical and overt hyperthyroidism by using tissue Doppler imaging (TDI). The study population consisted of 3 groups: group I (30 healthy subjects), group II (38 patients with subclinical hyperthyroidism), and group III (25 patients with overt hyperthyroidism). Atrial electromechanical coupling was measured with TDI. Standard echocardiographic measurements and parameters of diastolic function were obtained by conventional echocardiography and TDI. Intra- and inter-atrial EMD were significantly prolonged in subclinical and overt hyperthyroidism compared with control group (P = 0.03 and P hyperthyroidism. TSH level and mitral Em /Am ratio were found as independent predictors of atrial EMD. © 2013, Wiley Periodicals, Inc.

Evaluation of the influence of change in heart rate on left ventricular diastolic function indices

International Nuclear Information System (INIS)

Kimura, Motomasa; Yamagishi, Hiroaki; Seino, Yasuyuki; Odano, Ikuo; Sakai, Kunio; Yamamoto, Tomohiko; Tsuda, Takashi

1988-01-01

In order to assess the influence of change in heart rate on left ventricular diastolic function indices, ECG gated cardiac pool study was performed in 6 patients with implanted programmable AAI pacemakers. Heart rate was changed by atrial pacing from 50 to 120 beats/min, every 10 beats/min. The filling fraction during first third of diastole (1/3FF), the peak filling rate (PFR), mean first third filling rate (1/3FR-mean) and early filling volume ratio (%EFV), being used as the indices of left ventricular diastolic performance, were assessed. In accordance with increase in heart rate, 1/3FF decreased significantly. PFR were fairly stable from 50 to 80 beats/min, but increased significantly from 90 to 120 beats/min. 1/3FR-mean and %EFV did not change significantly, but 1/3FR-mean showed decreasing tendency and %EFV showed increasing tendency as the heart rate was increased. %EFV was more changeable index than other indices among clinical cases. These results indicate that PFR and 1/3FR-mean were appropriate diastolic phase indices at rest. (author)

The importance of integrated left atrial evaluation: From hypertension to heart failure with preserved ejection fraction.

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Beltrami, Matteo; Palazzuoli, Alberto; Padeletti, Luigi; Cerbai, Elisabetta; Coiro, Stefano; Emdin, Michele; Marcucci, Rossella; Morrone, Doralisa; Cameli, Matteo; Savino, Ketty; Pedrinelli, Roberto; Ambrosio, Giuseppe

2018-02-01

Functional analysis and measurement of left atrium are an integral part of cardiac evaluation, and they represent a key element during non-invasive analysis of diastolic function in patients with hypertension (HT) and/or heart failure with preserved ejection fraction (HFpEF). However, diastolic dysfunction remains quite elusive regarding classification, and atrial size and function are two key factors for left ventricular (LV) filling evaluation. Chronic left atrial (LA) remodelling is the final step of chronic intra-cavitary pressure overload, and it accompanies increased neurohormonal, proarrhythmic and prothrombotic activities. In this systematic review, we aim to purpose a multi-modality approach for LA geometry and function analysis, which integrates diastolic flow with LA characteristics and remodelling through application of both traditional and new diagnostic tools. The most important studies published in the literature on LA size, function and diastolic dysfunction in patients with HFpEF, HT and/or atrial fibrillation (AF) are considered and discussed. In HFpEF and HT, pulsed and tissue Doppler assessments are useful tools to estimate LV filling pressure, atrio-ventricular coupling and LV relaxation but they need to be enriched with LA evaluation in terms of morphology and function. An integrated evaluation should be also applied to patients with a high arrhythmic risk, in whom eccentric LA remodelling and higher LA stiffness are associated with a greater AF risk. Evaluation of LA size, volume, function and structure are mandatory in the management of patients with HT, HFpEF and AF. A multi-modality approach could provide additional information, identifying subjects with more severe LA remodelling. Left atrium assessment deserves an accurate study inside the cardiac imaging approach and optimised measurement with established cut-offs need to be better recognised through multicenter studies. © 2017 John Wiley & Sons Ltd.

Right and Left Ventricular Volumes in Atrial Septal Defect Studied by Radiocardiography

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Ivancevic, D. [Radioisotope Department, Internal Clinic, Rebro, Zagreb, Yugoslavia (Croatia); Vernejoul, P. de; Kellershohn, C. [CEA, Service Hospitalier Frederic Joliot, Departement de Biologie, Orsay (France)

1971-02-15

Radiocardiography with radioiodinated ({sup 131}I) human serum albumin and barium ({sup 137m}Ba) solution injected into the right subclavian vein has been performed in a group of 43 patients with atrial septal defect and left-to-right shunt. Data on the output and ejection index of each ventricle are essential for the estimation of the diastolic and residual volumes of the right and left ventricle. The systemic flow was therefore calculated according to Veall's formula and the pulmonary flow and the shunt How were determined using the method of de Vernejoul and co-workers. The formulas for the calculation of ventricular volumes were modified. The results show that many cases of atrial septal defect have an enlarged right ventricle whereas the left ventricle remains normal or is diminished. These changes correlate well with the amount of the shunt flow. In both ventricles the ventricular volumes show a good correlation with the stroke volumes. For the regulation of the pulmonary blood volume the right ventricle seems to be more important than the left ventricle. The operative closure of atrial septal defect (in 14 patients) has normalized the size of ventricular volumes. (author)

Changes in Mitral Annular Ascent with Worsening Echocardiographic Parameters of Left Ventricular Diastolic Function

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Paula M. Hernández Burgos

2016-01-01

Full Text Available Background. While the mitral annular plane systolic excursion (MAPSE has been suggested as a surrogate measurement of left ventricular ejection fraction, less is known about the relative value of mitral annular ascent (MAa. Methods. Our database was queried for complete transthoracic echocardiograms performed for any clinical indication. Baseline echocardiographic measurements were compared to determine any correlation between MAa and traditional Echo-Doppler echocardiographic measures to characterize left ventricular diastolic dysfunction (LVDD. Results. Patients with normal LV diastolic function were younger (41±13 years than patients with LVDD (stage 1: 61±13 years; stage 2: 57±14 years; and stage 3: 66±17 years; p=0.156. LV ejection fraction decreased in patients with stage 2 LVDD (63±17% and was further reduced in patients with stage 3 LVDD (28±21; p=0.003. Discussion. While a vigorous MAa excursion was seen in patients with stage 1 LVDD, MAa significantly decreased in stage 2 and stage 3 LVDD patients. Our results highlight the importance of atrioventricular coupling, as MAa motion seems to reflect changes in left atrial pressure. Additional studies are now required to better examine atrioventricular interactions and electromechanical coupling that might improve our assessment of LV diastolic function.

Effects of sedation on echocardiographic variables of left atrial and left ventricular function in healthy cats.

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Ward, Jessica L; Schober, Karsten E; Fuentes, Virginia Luis; Bonagura, John D

2012-10-01

Although sedation is frequently used to facilitate patient compliance in feline echocardiography, the effects of sedative drugs on echocardiographic variables have been poorly documented. This study investigated the effects of two sedation protocols on echocardiographic indices in healthy cats, with special emphasis on the assessment of left atrial size and function, as well as left ventricular diastolic performance. Seven cats underwent echocardiography (transthoracic two-dimensional, spectral Doppler, color flow Doppler and tissue Doppler imaging) before and after sedation with both acepromazine (0.1 mg/kg IM) and butorphanol (0.25 mg/kg IM), or acepromazine (0.1 mg/kg IM), butorphanol (0.25 mg/kg IM) and ketamine (1.5 mg/kg IV). Heart rate increased significantly following acepromazine/butorphanol/ketamine (mean±SD of increase, 40±26 beats/min) and non-invasive systolic blood pressure decreased significantly following acepromazine/butorphanol (mean±SD of decrease, 12±19 mmHg). The majority of echocardiographic variables were not significantly different after sedation compared with baseline values. Both sedation protocols resulted in mildly decreased left ventricular end-diastolic dimension and mildly increased left ventricular end-diastolic wall thickness. This study therefore failed to demonstrate clinically meaningful effects of these sedation protocols on echocardiographic measurements, suggesting that sedation with acepromazine, butorphanol and/or ketamine can be used to facilitate echocardiography in healthy cats.

LEFT ATRIAL FUNCTION: MODERN ASSESSMENT METHODS AND CLINICAL SIGNIFICANCE

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E. N. Pavlyukova

2017-01-01

Full Text Available Assessment of the left atrial (LA function is important aspect of comprehensive cardiovascular system estimation. Many cardiac diseases make an impact to LA work either by direct affect on myocardium or hemodynamic condition changing. It is considered, LA and left ventricle diastolic pressure is interrelated, thus without mitral valve disease LA expanding is a sign of LV filling pressure augmentation. Examination of LA size and function by analysis of atrial reservoir, conduit, and booster pump can predict cardiovascular outcomes in patients with cardiomyopathy, ischemic heart disease and valvular heart disease. The last two decades gave new technologies to accurate and comprehensive LA mechanics estimation, in the first place related to tissue Doppler imaging. Atrial strain and strain rate obtained using two-dimensional speckle-tracking echocardiography have proved to be feasible and reproducible techniques to evaluate LA mechanics.In physiological settings, LA is a highly expandable chamber with relatively low pressures. However in the presence of acute and chronic injury, LA wall stretches. LA stretching is a hallmark of structure changing with myocardial fibrosis and has influence on LA strain and strain rate. LA strain estimation could be useful in the prediction of sinus rhythm restoration and maintenance after cardioversion and catheter ablation. Low values of global longitudinal LA strain indicate irreversible LA remodeling and are related to the atrial fibrillation progression from paroxysmal to permanent forms. The most interesting in these circumstances is the potential contribution of echocardiography to thromboembolic risk stratification in atrial fibrillation and invasive procedures such as atrial ablation. Therefore, at present, the main task is to understand the ways of clinical application of data  obtained during the LA study.

Left ventricular systolic and diastolic function in hyperthyroidism

International Nuclear Information System (INIS)

Friedman, M.J.; Okada, R.D.; Ewy, G.A.; Hellman, D.J.

1982-01-01

In order to assess the effect of hyperthyroidism on systolic and diastolic function of the left ventricle, M-mode echocardiograms and systolic time intervals were obtained in 13 patients while they were clinically hyperthyroid and again when they were euthyroid following radioactive iodine therapy. Echocardiographic tracings of the septum and left ventricular posterior wall were digitized and analyzed to provide the maximum velocity of shortening and maximum velocity of lengthening. These velocities were normalized for left ventricular diastolic dimension. The left ventricular minor axis fractional shortening and the normalized maximum velocity of shortening were both increased during the hyperthyroid state. The normalized maximum velocity of lengthening, a measure of diastolic left ventricular function, was also increased during the hyperthyroid state when compared to the euthyroid state. The preejection period index and the preejection period/left ventricular ejection time ratio were lower when the patients were hyperthyroid than when they were euthyroid. These data confirm the increased inotropic state and demonstrated increased diastolic relaxation velocities of the hyperthyroid left ventricle

Normalised radionuclide measures of left ventricular diastolic function

International Nuclear Information System (INIS)

Lee, K.J.; Southee, A.E.; Bautovich, G.J.; Freedman, B.; McLaughlin, A.F.; Rossleigh, M.A.; Hutton, B.F.; Morris, J.G.; Royal Prince Alfred Hospital, Sydney

1989-01-01

Abnormal left ventricular diastolic function is being increasingly recognised in patients with clinical heart failure and normal systolic function. A simple routine radionuclide measure of diastolic function would therefore be useful. To establish, the relationship of peak diastolic filling rate (normalized for either end diastolic volume, stroke volume, or peak systolic emptying rate), and heart rate, age, and left ventricular ejection fraction was studied in 64 subjects with normal cardiovascular systems using routine gated heart pool studies. The peak filling rate when normalized to end diastolic volume correlated significantly with heart rate, age and left ventricular ejection fraction, whereas normalization to stroke volume correlated significantly to heart rate and age but not to left ventricular ejection fraction. Peak filling rate normalized for peak systolic emptying rate correlated with age only. Multiple regression equations were determined for each of the normalized peak filling rates in order to establish normal ranges for each parameter. When using peak filling rate normalized for end diastolic volume or stroke volume, appropriate allowance must be made for heart rate, age and ejection fraction. Peak filling rate normalized to peak ejection rate is a heart rate independent parameter which allows the performance of the patient's ventricle in diastole to be compared with its systolic function. It may be used in patients with normal systolic function to serially follow diastolic function, or if age corrected to screen for diastolic dysfunction. (orig.)

Left ventricular filling under elevated left atrial pressure

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Gaddam, Manikantam; Samaee, Milad; Santhanakrishnan, Arvind

2017-11-01

Left atrial pressure (LAP) is elevated in diastolic dysfunction, where left ventricular (LV) filling is impaired due to increase in ventricular stiffness. The impact of increasing LAP and LV stiffness on intraventricular filling hemodynamics remains unclear. We conducted particle image velocimetry and hemodynamics measurements in a left heart simulator (LHS) under increasing LAP and LV stiffness at a heart rate of 70 bpm. The LHS consisted of a flexible-walled LV physical model fitted within a fluid-filled chamber. LV wall motion was generated by a piston pump that imparted pressure fluctuations in the chamber. Resistance and compliance elements in the flow loop were adjusted to obtain bulk physiological hemodynamics in the least stiff LV model. Two LV models of increasing stiffness were subsequently tested under unchanged loop settings. LAP was varied between 5-20 mm Hg for each LV model, by adjusting fluid level in a reservoir upstream of the LV. For constant LV stiffness, increasing LAP lowered cardiac output (CO), while ejection fraction (EF) and E/A ratio were increased. For constant LAP, increasing LV stiffness lowered CO and EF, and increased E/A ratio. The implications of these altered hemodynamics on intraventricular filling vortex characteristics will be presented.

[Left versus bi-atrial radiofrequency ablation in the treatment of atrial fibrillation].

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Wang, Jian-Gang; Meng, Xu; Li, Hui

2008-11-25

To evaluate the effectiveness of radiofrequency modified maze operation for the treatment of atrial fibrillation (AF) and compare the results of the left versus bi-atrial procedures. 305 patients of organic heart disease combined with AF, 117 males and 188 females, aged (53 +/- 10), that underwent cardiac valve operation (n = 293) and/or coronary artery bypass graft surgery (n = 14), received concomitant atrial fibrillation, bi-atrial (n = 160) or left atrial (n = 145) with a mean duration of (36 +/- 43) months. Follow-up was conducted for (28 +/- 5) (3 - 42) months. Thirteen patients (4.3%) died postoperatively: 7 died of multisystem and organ failure, 3 of low cardiac output, 1 of rupture of left ventricle, 1 of arrhythmia, and 1 of sudden death. During the follow-up, 1 patient died of heart failure, 1 of encephalorrhagia and 1 of unknown reason in the bi-atrial group. At the end of the procedure 223 patients (73.1%) had sinus rhythm, with a sinus rhythm rate of 66.9% (107/160) in the bi-atrial group, significant lower than that in the left atrial group (80.0%, 116/145, P bi-atrial group was 80.0%, not significantly different from that of the left atrial group (81.9%, P > 0.05). The Kaplan-Meier survival analysis showed there was no significant difference in the AF rhythm rate between these 2 groups (P = 0.33). Logistic regression analysis showed that the left atrial diameter of >/= 80 mm was an independent predictor of AF recurrence. Both the left and bi-atrial procedures are successful in terms of restoring sinus rhythm. Left atrial ablation in severe cases and where the incision of right atrium is not needed is a reasonable choice.

Left atrial appendage occlusion

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Ahmad Mirdamadi

2013-01-01

Full Text Available Left atrial appendage (LAA occlusion is a treatment strategy to prevent blood clot formation in atrial appendage. Although, LAA occlusion usually was done by catheter-based techniques, especially percutaneous trans-luminal mitral commissurotomy (PTMC, it can be done during closed and open mitral valve commissurotomy (CMVC, OMVC and mitral valve replacement (MVR too. Nowadays, PTMC is performed as an optimal management of severe mitral stenosis (MS and many patients currently are treated by PTMC instead of previous surgical methods. One of the most important contraindications of PTMC is presence of clot in LAA. So, each patient who suffers of severe MS is evaluated by Trans-Esophageal Echocardiogram to rule out thrombus in LAA before PTMC. At open heart surgery, replacement of the mitral valve was performed for 49-year-old woman. Also, left atrial appendage occlusion was done during surgery. Immediately after surgery, echocardiography demonstrates an echo imitated the presence of a thrombus in left atrial appendage area, although there was not any evidence of thrombus in pre-pump TEE. We can conclude from this case report that when we suspect of thrombus of left atrial, we should obtain exact history of previous surgery of mitral valve to avoid misdiagnosis clotted LAA, instead of obliterated LAA. Consequently, it can prevent additional evaluations and treatments such as oral anticoagulation and exclusion or postponing surgeries including PTMC.

[Doppler echocardiographic investigation of left ventricular diastolic function in preterm infants with and without a patent ductus arteriosus].

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Schmitz, L; Stiller, B; Koehne, P; Koch, H; Lange, P E

2004-01-01

We studied the influence of preload augmentation on Doppler-derived left ventricular diastolic function parameters in infants with a birth weight ductus arteriosus a complete echocardiographic study including Doppler investigations of the mitral inflow signals and analysis of diastolic time intervals was performed. Neonates with an open duct had a lower median gestational age (27.1 vs. 29, Pductus peak early filling velocity (41.2 vs. 30.4 cm, Pventricular diastolic failure in extremely low birth weight infants in the presence of a preload challenge. The coincidence of higher peak velocities with a shortened isovolumic relaxation time is very likely a result of left atrial pressure elevation. Preload mismatch has to be considered in preterm infants with a persistent ductus arteriosus. The results of this study can be helpful to find the indication for PDA-closure and to adjust volume replacement therapy, and catecholamine medication to a level appropriate for the individual cardiac performance.

Beat-to-beat assessment of left ventricular ejection in atrial fibrillation

International Nuclear Information System (INIS)

Benjelloun, H.; Brochier, M.; Itti, R.; Philippe, L.; Lorgeron, J.M.

1983-01-01

Beat-to-beat left ventricular ejection was evaluated in a group of 20 patients with chronic atrial fibrillation using a computerized single probe detector. The reference group consisted of 10 patients with sinus rhythm. For each patient 30 successive cardiac cycles were analyzed and the relative variations of four parameters were assessed: R-R interval, diastolic and systolic time intervals, and ejection amplitude, corresponding to the left ventricular stroke volume. The mean variations were respectively 3.4%, 10.4%, 8.4%, and 11.8% in patients with sinus rhythm, and 21.9%, 37.9%, 10.6% and 30.5% in patients with artrial fibrillation. This demonstrates that changes in ejection are mainly related to the duration of the filling phase, with nearly constant systolic times. Correlations between R-R intervals and systolic ejection amplitudes were highly significant (P<0.001) in patients with atrial fibrillation in 85% of cases. This information complements the average ejection fraction obtained from multiple cycle superimposition. (orig.)

Beat-to-beat assessment of left ventricular ejection in atrial fibrillation

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Benjelloun, H; Brochier, M; Itti, R; Philippe, L; Lorgeron, J M

1983-05-01

Beat-to-beat left ventricular ejection was evaluated in a group of 20 patients with chronic atrial fibrillation using a computerized single probe detector. The reference group consisted of 10 patients with sinus rhythm. For each patient 30 successive cardiac cycles were analyzed and the relative variations of four parameters were assessed: R-R interval, diastolic and systolic time intervals, and ejection amplitude, corresponding to the left ventricular stroke volume. The mean variations were respectively 3.4%, 10.4%, 8.4%, and 11.8% in patients with sinus rhythm, and 21.9%, 37.9%, 10.6% and 30.5% in patients with artrial fibrillation. This demonstrates that changes in ejection are mainly related to the duration of the filling phase, with nearly constant systolic times. Correlations between R-R intervals and systolic ejection amplitudes were highly significant (P<0.001) in patients with atrial fibrillation in 85% of cases. This information complements the average ejection fraction obtained from multiple cycle superimposition.

Relationship of carotid arterial functional and structural changes to left atrial volume in untreated hypertension.

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Jaroch, Joanna; Rzyczkowska, Barbara; Bociąga, Zbigniew; Vriz, Olga; Driussi, Caterina; Loboz-Rudnicka, Maria; Dudek, Krzysztof; Łoboz-Grudzień, Krystyna

2016-04-01

The contribution of arterial functional and structural changes to left ventricular (LV) diastolic dysfunction has been the area of recent research. There are some studies on the relationship between arterial stiffness (a.s.) and left atrial (LA) remodelling as a marker of diastolic burden. Little is known about the association of arterial structural changes and LA remodelling in hypertension (H). The aim of this study was to examine the relationship between carotid a.s. and intima-media thickness (IMT) and LA volume in subjects with H. The study included 245 previously untreated hypertensives (166 women and 79 men, mean age 53.7 ± 11.8 years). Each patient was subjected to echocardiography with measurement of LA volume, evaluation of left ventricular hypertrophy (LVH) and LV systolic/diastolic function indices, integrated assessment of carotid IMT and echo-tracking of a.s. and wave reflection parameters. Univariate regression analysis revealed significant correlations between indexed LA volume and selected clinical characteristics, echocardiographic indices of LVH and LV diastolic/systolic function and a.s./wave reflection parameters. The following parameters were identified as independent determinants of indexed LA volume on multivariate regression analysis: diastolic blood pressure (beta = -0.229, P arterial stiffness but not intima-media thickness and LA volume in patients with untreated hypertension.

Diastolic compliance and exercise-induced left ventricular diastolic volume changes in patients with coronary artery disease

International Nuclear Information System (INIS)

Choi, W.; Varma, V.; Wasserman, A.; Katz, R.; Reba, R.; Ross, A.

1983-01-01

This study consists of 46 consecutive patients who had supine resting and exercise multigated (MUGA) blood pool studies. All patients had angio-graphically important coronary stenosis in at least one major vessel. Thirty-five out of 46 patients with coronary artery disease increased left ventricular end diastolic volume with a supine exercise. The remaining eleven patients dit not dilate the left ventricle. Those patients, who were able to increase their end diastolic volume during exercise, had better compliance of the left ventricle manifested by lower end diastolic pressures, whereas, patients with poor left ventricular compliance were unable to volume expand during supine exercise

Left Atrial Decompression by Percutaneous Left Atrial Venting Cannula Insertion during Venoarterial Extracorporeal Membrane Oxygenation Support

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Ha Eun Kim

2016-06-01

Full Text Available Patients with venoarterial extracorporeal membrane oxygenation (ECMO frequently suffer from pulmonary edema due to left ventricular dysfunction that accompanies left heart dilatation, which is caused by left atrial hypertension. The problem can be resolved by left atrium (LA decompression. We performed a successful percutaneous LA decompression with an atrial septostomy and placement of an LA venting cannula in a 38-month-old child treated with venoarterial ECMO for acute myocarditis.

Left atrial systolic force in hypertensive patients with left ventricular hypertrophy: the LIFE study

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Chinali, M.; Simone, G. de; Wachtell, K.

2008-01-01

In hypertensive patients without prevalent cardiovascular disease, enhanced left atrial systolic force is associated with left ventricular hypertrophy and increased preload. It also predicts cardiovascular events in a population with high prevalence of obesity. Relations between left atrial...... systolic force and left ventricular geometry and function have not been investigated in high-risk hypertrophic hypertensive patients. Participants in the Losartan Intervention For Endpoint reduction in hypertension echocardiography substudy without prevalent cardiovascular disease or atrial fibrillation (n...... = 567) underwent standard Doppler echocardiography. Left atrial systolic force was obtained from the mitral orifice area and Doppler mitral peak A velocity. Patients were divided into groups with normal or increased left atrial systolic force (>14.33 kdyn). Left atrial systolic force was high in 297...

Atorvastatin can ameliorate left atrial stunning induced by radiofrequency ablation for atrial fibrillation.

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Xie, Ruiqin; Yang, Yingtao; Cui, Wei; Yin, Hongning; Zheng, Hongmei; Zhang, Jidong; You, Ling

2017-09-01

The objective of this study was to study the functional changes of the left atrium after radiofrequency ablation treatment for atrial fibrillation and the therapeutic effect of atorvastatin. Fifty-eight patients undergoing radiofrequency ablation for atrial fibrillation were randomly divided into non-atorvastatin group and atorvastatin group. Patients in the atorvastatin group were treated with atorvastatin 20 mg p.o. per night in addition to the conventional treatment of atrial fibrillation; patients in the non-atorvastatin group received conventional treatment of atrial fibrillation only. Echocardiography was performed before radiofrequency ablation operation and 1 week, 2 weeks, 3 weeks, and 4 weeks after operation. Two-dimensional ultrasound speckle tracking imaging system was used to measure the structural indexes of the left atrium. Results indicated that there was no significant change for indexes representing the structural status of the left atrium within a month after radiofrequency ablation (P > 0.05); however, there were significant changes for indexes representing the functional status of the left atrium. There were also significant changes in indexes reflecting left atrial strain status: the S and SRs of atorvastatin group were higher than those of non-atorvastatin group (P atorvastatin could improve left atrial function and shorten the duration of atrial stunning after radiofrequency ablation of atrial fibrillation.

Urinary type IV collagen is related to left ventricular diastolic function and brain natriuretic peptide in hypertensive patients with prediabetes.

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Iida, Masato; Yamamoto, Mitsuru; Ishiguro, Yuko S; Yamazaki, Masatoshi; Ueda, Norihiro; Honjo, Haruo; Kamiya, Kaichirou

2014-01-01

Urinary type IV collagen is an early biomarker of diabetic nephropathy. Concomitant prediabetes (the early stage of diabetes) was associated with left ventricular (LV) diastolic dysfunction and increased brain natriuretic peptide (BNP) in hypertensive patients. We hypothesized that urinary type IV collagen may be related to these cardiac dysfunctions. We studied hypertensive patients with early prediabetes (HbA1c 110, n=18), those with prediabetes (HbA1c 5.7-6.4, n=98), and those with diabetes (HbA1c>6.5 or on diabetes medications, n=92). The participants underwent echocardiography to assess left atrial volume/body surface area (BSA) and the ratio of early mitral flow velocity to mitral annular velocity (E/e'). Left ventricular diastolic dysfunction (LVDD) was defined if patients had E/e'≥15, or E/e'=9-14 accompanied by left atrial volume/BSA≥32ml/mm(2). Urinary samples were collected for type IV collagen and albumin, and blood samples were taken for BNP and HbA1c. Urinary type IV collagen and albumin increased in parallel with the deterioration of glycemic status. In hypertensive patients with prediabetes, subjects with LVDD had higher levels of BNP and urinary type IV collagen than those without LVDD. In contrast, in hypertensive patients with diabetes, subjects with LVDD had higher urinary albumin and BNP than those without LVDD. Urinary type IV collagen correlated positively with BNP in hypertensive patients with prediabetes, whereas it correlated with HbA1c in those with diabetes. In hypertensive patients with prediabetes, urinary type IV collagen was associated with LV diastolic dysfunction and BNP. Copyright © 2014 Elsevier Inc. All rights reserved.

Left Atrial 4D Blood Flow Dynamics and Hemostasis following Electrical Cardioversion of Atrial Fibrillation

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Merih Cibis

2017-12-01

Full Text Available Background: Electrical cardioversion in patients with atrial fibrillation is followed by a transiently impaired atrial mechanical function, termed atrial stunning. During atrial stunning, a retained risk of left atrial thrombus formation exists, which may be attributed to abnormal left atrial blood flow patterns. 4D Flow cardiovascular magnetic resonance (CMR enables blood flow assessment from the entire three-dimensional atrial volume throughout the cardiac cycle. We sought to investigate left atrial 4D blood flow patterns and hemostasis during left atrial stunning and after left atrial mechanical function was restored.Methods: 4D Flow and morphological CMR data as well as blood samples were collected in fourteen patients at two time-points: 2–3 h (Time-1 and 4 weeks (Time-2 following cardioversion. The volume of blood stasis and duration of blood stasis were calculated. In addition, hemostasis markers were analyzed.Results: From Time-1 to Time-2: Heart rate decreased (61 ± 7 vs. 56 ± 8 bpm, p = 0.01; Maximum change in left atrial volume increased (8 ± 4 vs. 22 ± 15%, p = 0.009; The duration of stasis (68 ± 11 vs. 57 ± 8%, p = 0.002 and the volume of stasis (14 ± 9 vs. 9 ± 7%, p = 0.04 decreased; Thrombin-antithrombin complex (TAT decreased (5.2 ± 3.3 vs. 3.3 ± 2.2 μg/L, p = 0.008. A significant correlation was found between TAT and the volume of stasis (r2 = 0.69, p < 0.001 at Time-1 and between TAT and the duration of stasis (r2 = 0.34, p = 0.04 at Time-2.Conclusion: In this longitudinal study, left atrial multidimensional blood flow was altered and blood stasis was elevated during left atrial stunning compared to the restored left atrial mechanical function. The coagulability of blood was also elevated during atrial stunning. The association between blood stasis and hypercoagulability proposes that assessment of left atrial 4D flow can add to the pathophysiological understanding of thrombus formation during atrial fibrillation

Left Atrial 4D Blood Flow Dynamics and Hemostasis following Electrical Cardioversion of Atrial Fibrillation

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Cibis, Merih; Lindahl, Tomas L.; Ebbers, Tino; Karlsson, Lars O.; Carlhäll, Carl-Johan

2017-01-01

Background: Electrical cardioversion in patients with atrial fibrillation is followed by a transiently impaired atrial mechanical function, termed atrial stunning. During atrial stunning, a retained risk of left atrial thrombus formation exists, which may be attributed to abnormal left atrial blood flow patterns. 4D Flow cardiovascular magnetic resonance (CMR) enables blood flow assessment from the entire three-dimensional atrial volume throughout the cardiac cycle. We sought to investigate left atrial 4D blood flow patterns and hemostasis during left atrial stunning and after left atrial mechanical function was restored. Methods: 4D Flow and morphological CMR data as well as blood samples were collected in fourteen patients at two time-points: 2–3 h (Time-1) and 4 weeks (Time-2) following cardioversion. The volume of blood stasis and duration of blood stasis were calculated. In addition, hemostasis markers were analyzed. Results: From Time-1 to Time-2: Heart rate decreased (61 ± 7 vs. 56 ± 8 bpm, p = 0.01); Maximum change in left atrial volume increased (8 ± 4 vs. 22 ± 15%, p = 0.009); The duration of stasis (68 ± 11 vs. 57 ± 8%, p = 0.002) and the volume of stasis (14 ± 9 vs. 9 ± 7%, p = 0.04) decreased; Thrombin-antithrombin complex (TAT) decreased (5.2 ± 3.3 vs. 3.3 ± 2.2 μg/L, p = 0.008). A significant correlation was found between TAT and the volume of stasis (r2 = 0.69, p < 0.001) at Time-1 and between TAT and the duration of stasis (r2 = 0.34, p = 0.04) at Time-2. Conclusion: In this longitudinal study, left atrial multidimensional blood flow was altered and blood stasis was elevated during left atrial stunning compared to the restored left atrial mechanical function. The coagulability of blood was also elevated during atrial stunning. The association between blood stasis and hypercoagulability proposes that assessment of left atrial 4D flow can add to the pathophysiological understanding of thrombus formation during atrial fibrillation related

[Left atrial function and left atrial appendage flow velocity in hypertrophic cardiomyopathy: comparison of patients with and without paroxysmal atrial fibrillation].

Science.gov (United States)

Akasaka, K; Kawashima, E; Shiokoshi, T; Ishii, Y; Hasebe, N; Kikuchi, K

1998-07-01

The involvement of left atrial (LA) appendage flow velocity in reduced left atrial function was investigated in 24 patients with hypertrophic cardiomyopathy, who retained sinus rhythm at the examination. Patients were divided into 11 with a history of paroxysmal atrial fibrillation [PAf(+)] and 13 without such history [PAf(-)]. Transthoracic echocardiography was performed to evaluate LA fractional shortening (LA%FS) and mean velocity of circumferential LA fiber shortening (LAmVcf), as contractile functions of the left atrium at the phase of active atrial contraction. Transesophageal echocardiographic Doppler examination was performed in all patients to measure the LA appendage velocity. In all patients, significant positive correlations were observed between the LA appendage velocity and LA%FS (r = 0.50, p fibrillation were significantly lower than in those without (0.84 +/- 0.15 vs 1.28 +/- 0.37 circ/sec, 44 +/- 12 vs 65 +/- 20 cm/sec, both p fibrillation. These results indicate that there is a close relationship between LA appendage velocity and LA contractile function in patients with hypertrophic cardiomyopathy with paroxysmal atrial fibrilation, and these patients have potential risk of cerebral infarction.

Relationship between left ventricular diastolic function and myocardial sympathetic denervation measured by {sup 123}I-meta-iodobenzylguanidine imaging in Anderson-Fabry disease

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Spinelli, Letizia; Giudice, Caterina Anna; Imbriaco, Massimo; Trimarco, Bruno; Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Pellegrino, Teresa [Institute of Biostructure and Bioimaging, National Council of Research, Naples (Italy); Pisani, Antonio; Riccio, Eleonora [University Federico II, Department of Public Health, Naples (Italy); Salvatore, Marco [IRCCS SDN, Naples (Italy)

2016-04-15

Whether cardiac sympathetic nervous function abnormalities may be present in patients with Anderson-Fabry disease (AFD) remains unexplored. We investigated the relationship between left ventricular (LV) function and cardiac sympathetic nervous function in patients with AFD. Twenty-five patients (12 men, mean age 43 ± 13 years) with genetically proved AFD and preserved LV ejection fraction and ten age and gender-matched control subjects underwent speckle tracking echocardiography and {sup 123}I-meta-iodobenzylguanidine (MIBG) imaging from which early and late heart to mediastinum (H/M) ratios and myocardial washout rate values were calculated. In AFD patients, a significant correlation between late H/M ratio and LV mass index (r = -61, p = 0.001), left atrial volume (r = -0.72, p < 0.001), systolic pulmonary artery pressure (r = -0.75, p < 0.001), and early diastolic untwisting rate (r = -0.66, p < 0.001) was found. Ten AFD patients exhibited a late H/M ratio below two fold standard deviation of control subjects (≤1.75). Patients showing late H/M ratio ≤ 1.75 had significantly higher LV mass index, relative wall thickness, left atrial volume and systolic pulmonary artery pressure, lower systolic longitudinal strain and an early diastolic untwisting rate compared to patients with late H/M ratio > 1.75. At multivariable linear regression analysis, early diastolic untwisting rate was the only independent predictor of late H/M ratio ≤ 1.75 (odds ratio 1.15, 95 % confidence interval 1.07-1.31, p < 0.05). The present findings provide the first demonstration of a cardiac sympathetic derangement in AFD patients with preserved LV ejection fraction, which is mostly related to LV diastolic dysfunction. (orig.)

Increased dependence on slow filling for left ventricular diastolic filling in patients with coronary artery disease and a depressed systolic function

International Nuclear Information System (INIS)

Yamagishi, Takashi; Ozaki, Masaharu; Furutani, Yuhji; Yamamoto, Kouzo; Saeki, Atsushi; Satoh, Shinichi; Kusukawa, Reizo

1990-01-01

Contributions of rapid filling, slow filling and atrial systole to the left ventricular(LV) filling volume were analyzed with the use of radionuclide ventriculography at rest, both globally and regionally, in 34 patients with isolated disease of the left anterior descending coronary artery. The patients included 17 with a normal ejection fraction (EF≥50%; group 1) and 17 with a depressed EF (<50%; group 2), and the data were compared with those obtained from 13 normal subjects. A computer program subdivided the LV image into 4 regions, and time-activity curves were constructed globally and regionally by reverse-gating from the R wave. In both groups the contribution of rapid filling to the LV filling volume was decreased significantly in the affected septal and apical regions, and in the global left ventricle compared with that in normal subjects. In group 1, the contribution of atrial systole showed an increase in these affected regions and in the global left ventricle. In contrast, in group 2, the atrial contribution was not increased globally or regionally as much as was expected. However, the contribution of slow filling was either increased significantly or tended to increase in the affected regions and in the global left ventricle. There were negative correlations between the contribution of rapid filling and that of slow filling in the global left ventricle (r=-0.73, p<0.001) and in each of the septal, apical and lateral regions (r≥-0.60, p<0.001), which suggested that the contribution of slow filling as well as of atrial systole undergoes an increase as rapid filling is impaired. Thus, in patients with coronary artery disease, the left ventricle relies on slow filling as well as atrial systole to affect diastolic LV filling in the affected regions and in the global left ventricle in the presence of LV systolic dysfunction. (author)

Beat-to-beat left ventricular performance in atrial fibrillation: radionuclide assessment with the computerized nuclear probe

International Nuclear Information System (INIS)

Schneider, J.; Berger, H.J.; Sands, M.J.; Lachman, A.B.; Zaret, B.L.

1983-01-01

There is wide beat-to-beat variability in cycle length and left ventricular performance in patients with atrial fibrillation. In this study, left ventricular ejection fraction and relative left ventricular volumes were evaluated on a beat-to-beat basis with the computerized nuclear probe, an instrument with sufficiently high sensitivity to allow continuous evaluation of the radionuclide time-activity curve. Of 18 patients with atrial fibrillation, 5 had mitral stenosis, 6 had mitral regurgitation, and 7 had coronary artery disease. Fifty consecutive beats were analyzed in each patient. The mean left ventricular ejection fraction ranged from 17 to 51%. There was substantial beat-to-beat variation in cycle length and left ventricular ejection fraction in all patients, including those with marked left ventricular dysfunction. In 14 patients who also underwent multiple gated cardiac blood pool imaging, there was an excellent correlation between mean ejection fraction derived from the nuclear probe and gated ejection fraction obtained by gamma camera imaging (r . 0.90). Based on beat-to-beat analysis, left ventricular function was dependent on relative end-diastolic volume and multiple preceding cycle lengths, but not preceding end-systolic volumes. This study demonstrates that a single value for left ventricular ejection fraction does not adequately characterize left ventricular function in patients with atrial fibrillation. Furthermore, both the mean beat-to-beat and the gated ejection fraction may underestimate left ventricular performance at rest in such patients

Coronary artery disease, left ventricular hypertrophy and diastolic dysfunction are associated with stroke in patients affected by persistent non-valvular atrial fibrillation: a case-control study

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Andrea Passantino

2009-04-01

Full Text Available Persistent non-valvular atrial fibrillation (NVAF is associated with an increased risk of cardiovascular events such as stroke, and its rate is expected to rise because of the ageing population. The absolute rate of stroke depends on age and comorbidity. Risk stratification for stroke in patients with NVAF derives from populations enrolled in randomized clinical trials. However, participants in clinical trials are often not representative of the general population. Many stroke risk stratification scores have been used, but they do not include transthoracic echocardiogram (TTE, pulsate wave Doppler (PWD and tissue Doppler imaging (TDI, simple and non-invasive diagnostic tools. The role of TTE, PWD and TDI findings has not been previously determined. Our study goal was to determine the association between TTE and PWD findings and stroke prevalence in a population of NVAF prone outpatients. Patients were divided into two groups: P for stroke prone and F for stroke free. There were no statistically significant differences between the two groups concerning cardiovascular risk factors, age (p=0.2, sex (p=0.2, smoking (p=0.3, diabetes (p=0.1 and hypercholesterolemia (p=0.2; hypertension was statistically significant (p less than 0.001. There were statistically significant differences concerning coronary artery disease, previous acute myocardial infarction (AMI (p less than 0.05 and non- AMI coronaropathy (p less than 0.04, a higher rate being in the P group. Concerning echo-Doppler findings, a higher statistically significant rate of left ventricular hypertrophy (LVH (p less than  0.05 and left ventricular diastolic dysfunction (p less than 0.001 was found in the P group and dilated left atrium (p Velocity encoded cardiovascular magnetic resonance to assess left atrial appendage emptying

Directory of Open Access Journals (Sweden)

Muellerleile Kai

2012-06-01

Full Text Available Abstract Background The presence of impaired left atrial appendage (LAA function identifies patients who are prone to thrombus formation in the LAA and therefore being at high risk for subsequent cardioembolic stroke. LAA function is typically assessed by measurements of LAA emptying velocities using transesophageal echocardiography (TEE in clinical routine. This study aimed at evaluating the feasibility of assessing LAA emptying by velocity encoded (VENC cardiovascular magnetic resonance (CMR. Methods This study included 30 patients with sinus rhythm (n = 18 or atrial fibrillation (n = 12. VENC-CMR velocity measurements were performed perpendicular to the orifice of the LAA. Peak velocities were measured of passive diastolic LAA emptying (e-wave in all patients. Peak velocities of active, late-diastolic LAA emptying (a-wave were assessed in patients with sinus rhythm. Correlation and agreement was analyzed between VENC-CMR and TEE measurements of e- and a-wave peak velocities. Results A significant correlation and good agreement was found between VENC-CMR and TEE measurements of maximal e-wave velocities (r = 0.61, P  Conclusions The assessment of active and passive LAA emptying by VENC-CMR is feasible. Further evaluation is required of potential future clinical applications such as risk stratification for cardioembolic stroke.

Mapping of the left-sided phrenic nerve course in patients undergoing left atrial catheter ablations.

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Huemer, Martin; Wutzler, Alexander; Parwani, Abdul S; Attanasio, Philipp; Haverkamp, Wilhelm; Boldt, Leif-Hendrik

2014-09-01

Catheter ablation of atrial fibrillation has been associated with left-sided phrenic nerve palsy. Knowledge of the individual left phrenic nerve course therefore is essential to prevent nerve injury. The aim of this study was to test the feasibility of an intraprocedural pace mapping and reconstruction of the left phrenic nerve course and to characterize which anatomical areas are affected. In patients undergoing left atrial catheter ablation, a three-dimensional map of the left atrial anatomical structures was created. The left-sided phrenic nerve course was determined by high-output pace mapping and reconstructed in the map. In this study, 40 patients with atrial fibrillation or atrial tachycardias were included. Left phrenic nerve capture was observed in 23 (57.5%) patients. Phrenic nerve was captured in 22 (55%) patients inside the left atrial appendage, in 22 (55%) in distal parts, in 21 (53%) in medial parts, and in two (5%) in ostial parts of the appendage. In three (7.5%) patients, capture was found in the distal coronary sinus and in one (2.5%) patient in the left atrium near the left atrial appendage ostium. Ablation target was changed due to direct spatial relationship to the phrenic nerve in three (7.5%) patients. No phrenic nerve palsy was observed. Left-sided phrenic nerve capture was found inside and around the left atrial appendage in the majority of patients and additionally in the distal coronary sinus. Phrenic nerve mapping and reconstruction can easily be performed and should be considered prior catheter ablations in potential affected areas. ©2014 Wiley Periodicals, Inc.

Right heart function in impaired left ventricular diastolic function: 2D speckle tracking echocardiography-based and Doppler tissue imaging-based analysis of right atrial and ventricular function.

Science.gov (United States)

Brand, Anna; Bathe, Marny; Oertelt-Prigione, Sabine; Seeland, Ute; Rücke, Mirjam; Regitz-Zagrosek, Vera; Stangl, Karl; Knebel, Fabian; Stangl, Verena; Dreger, Henryk

2018-01-01

The aim of our study was to describe right atrial (RA) and right ventricular (RV) function, assessed by Doppler tissue imaging and 2D speckle tracking echocardiography (2DSTE), in women with signs of early impaired left ventricular diastolic function (DD). In a cross-sectional trial, standard parameters of diastolic and right heart function were investigated in 438 women of the Berlin Female Risk Evaluation (BEFRI) study. In a subset of women, average peak systolic RA strain (RAS), as well as the average peak systolic RV strain of the free wall (RVS free wall) and of all RV segments (average RV strain; RVS Avg), was analyzed using 2DSTE. Compared to women with normal diastolic function (DD0), RAS, RVS free wall and RVS Avg were significantly reduced in DD (43.1% ± 11.9%, -26.7% ± 5.6%, and -23.3% ± 3.5% in DD0; vs 35.1% ± 10.4%, -23.9% ± 5.5%, and -20.6% ± 3.8% in DD; P right heart function is significantly altered in DD. DTI as well as 2DSTE constitute sensitive echocardiographic tools that enable the diagnosis of impaired right heart mechanics in early-staged DD. © 2017 Wiley Periodicals, Inc.

Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

International Nuclear Information System (INIS)

Santos, Simone Nascimento dos; Henz, Benhur Davi; Zanatta, André Rodrigues; Barreto, José Roberto; Loureiro, Kelly Bianca; Novakoski, Clarissa; Santos, Marcus Vinícius Nascimento dos; Giuseppin, Fabio F.; Oliveira, Edna Maria; Leite, Luiz Roberto

2014-01-01

Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. To evaluate the impact of AF ablation on estimated LV filling pressure. A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m 2 ± 10.6 mL/m 2 to 22.6 mL/m 2 ± 1.1 mL/m 2 , p < 0.001) compared to the non-successful group (37.7 mL/m 2 ± 14.3 mL/m 2 to 37.5 mL/m 2 ± 14.5 mL/m 2 , p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001). Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure

Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

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Santos, Simone Nascimento dos, E-mail: simonens@cardiol.br [Instituto Brasília de Arritmia- Universidade de Brasília, DF (Brazil); Faculdade de Medicina (UnB), Brasília, DF (Brazil); Henz, Benhur Davi; Zanatta, André Rodrigues; Barreto, José Roberto; Loureiro, Kelly Bianca; Novakoski, Clarissa; Santos, Marcus Vinícius Nascimento dos; Giuseppin, Fabio F.; Oliveira, Edna Maria; Leite, Luiz Roberto [Instituto Brasília de Arritmia- Universidade de Brasília, DF (Brazil)

2014-12-15

Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. To evaluate the impact of AF ablation on estimated LV filling pressure. A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m{sup 2} ± 10.6 mL/m{sup 2} to 22.6 mL/m{sup 2} ± 1.1 mL/m{sup 2}, p < 0.001) compared to the non-successful group (37.7 mL/m{sup 2} ± 14.3 mL/m{sup 2} to 37.5 mL/m{sup 2} ± 14.5 mL/m{sup 2}, p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001). Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.

Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

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Simone Nascimento dos Santos

2014-12-01

Full Text Available Background: Left ventricular (LV diastolic dysfunction is associated with new-onset atrial fibrillation (AF, and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. Objective: To evaluate the impact of AF ablation on estimated LV filling pressure. Methods: A total of 141 patients underwent radiofrequency (RF ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind, and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e' were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. Results: One hundred seventeen patients (82.9% were free of AF during the follow-up (average, 18 ± 5 months. LAVind reduced in the successful group (30.2 mL/m2 ± 10.6 mL/m2 to 22.6 mL/m2 ± 1.1 mL/m2, p < 0.001 compared to the non-successful group (37.7 mL/m2 ± 14.3 mL/m2 to 37.5 mL/m2 ± 14.5 mL/m2, p = ns. Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001 but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns. The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001. Conclusion: Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.

Left atrial accessory appendages, diverticula, and left-sided septal pouch in multi-slice computed tomography. Association with atrial fibrillation and cerebrovascular accidents.

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Hołda, Mateusz K; Koziej, Mateusz; Wszołek, Karolina; Pawlik, Wiesław; Krawczyk-Ożóg, Agata; Sorysz, Danuta; Łoboda, Piotr; Kuźma, Katarzyna; Kuniewicz, Marcin; Lelakowski, Jacek; Dudek, Dariusz; Klimek-Piotrowska, Wiesława

2017-10-01

The aim of this study is to provide a morphometric description of the left-sided septal pouch (LSSP), left atrial accessory appendages, and diverticula using cardiac multi-slice computed tomography (MSCT) and to compare results between patient subgroups. Two hundred and ninety four patients (42.9% females) with a mean of 69.4±13.1years of age were investigated using MSCT. The presence of the LSSP, left atrial accessory appendages, and diverticula was evaluated. Multiple logistic regression analysis was performed to check whether the presence of additional left atrial structures is associated with increased risk of atrial fibrillation and cerebrovascular accidents. At least one additional left atrial structure was present in 51.7% of patients. A single LSSP, left atrial diverticulum, and accessory appendage were present in 35.7%, 16.0%, and 4.1% of patients, respectively. After adjusting for other risk factors via multiple logistic regression, patients with LSSP are more likely to have atrial fibrillation (OR=2.00, 95% CI=1.14-3.48, p=0.01). The presence of a LSSP was found to be associated with an increased risk of transient ischemic attack using multiple logistic regression analysis after adjustment for other risk factors (OR=3.88, 95% CI=1.10-13.69, p=0.03). In conclusion LSSPs, accessory appendages, and diverticula are highly prevalent anatomic structures within the left atrium, which could be easily identified by MSCT. The presence of LSSP is associated with increased risk for atrial fibrillation and transient ischemic attack. Copyright © 2017 Elsevier B.V. All rights reserved.

Total average diastolic longitudinal displacement by colour tissue doppler imaging as an assessment of diastolic function

DEFF Research Database (Denmark)

de Knegt, Martina Chantal; Biering-Sørensen, Tor; Søgaard, Peter

2016-01-01

of LD during early diastole and atrial contraction, can potentially be used as a simple and reliable alternative. METHODS: In 206 patients, using GE Healthcare Vivid E7 and 9 and Echopac BT11 software, we determined both diastolic LD, measured in the septal and lateral walls in the apical 4-chamber view...... by TDI, and the degree of diastolic dysfunction, based on current guidelines. Of these 206 patients, 157 had cardiac anomalies that could potentially affect diastolic LD such as severe systolic heart failure (n = 45), LV hypertrophy (n = 49), left ventricular (LV) dilation (n = 30), and mitral...... for the general discrimination of patients with or without diastolic dysfunction. Using linear regression, total average diastolic LD was estimated to fall by 2.4 mm for every increase in graded severity of diastolic dysfunction (β = -0.61, p-value

ABO blood groups: A risk factor for left atrial and left atrial appendage thrombogenic milieu in patients with non-valvular atrial fibrillation.

Science.gov (United States)

Fu, Yuan; Li, Kuibao; Yang, Xinchun

2017-08-01

Previous studies have identified ABO blood groups as predictors of thromboembolic diseases. In patients with atrial fibrillation (AF), however, potential association between ABO blood groups and the risk of left atrial (LA) and/or left atrial appendage (LAA) thrombogenic milieu (TM) has not been established. This is a retrospective case-control study that included 125 consecutive patients with non-valvular atrial fibrillation (NVAF) plus TM, as evidenced by transesophageal echocardiography (TEE) during a period from1 January 2010 to 31 December 2016. The controls were selected randomly from 1072 NVAF without TM at a 1:2 ratio. Potential association between ABO blood groups and TM was analyzed using multivariate logistic regression analysis. The risk of TM was higher in patients with blood group A (33.6% vs. 20.2% in non-A blood groups, P=0.005). After adjusting for age, sex, oral anticoagulant use, AF type and duration, and relevant functional measures (e.g., NT-pro BNP level, left atrium diameter, and left ventricular ejection fraction), blood group A remained associated with an increased risk of TM (OR=2.99, 95% CI 1.4-6.388, P=0.005). Blood group A is an independent risk factor for TM in NVAF patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

ASSESSMENT OF DIASTOLIC DYSFUNCTION, ARTERIAL STIFFNESS, AND CAROTID INTIMA-MEDIA THICKNESS IN PATIENTS WITH ACROMEGALY.

Science.gov (United States)

Cansu, Güven Barış; Yılmaz, Nusret; Yanıkoğlu, Atakan; Özdem, Sebahat; Yıldırım, Aytül Belgi; Süleymanlar, Gültekin; Altunbaş, Hasan Ali

2017-05-01

Early diagnosis and treatment of cardiovascular diseases, the most frequent cause of morbidity and mortality in acromegaly, may be an efficient approach to extending the lifespan of affected patients. Therefore, it is crucial to determine any cardiovascular diseases in the subclinical period. The study objectives were to determine markers of subclinical atherosclerosis and asses heart structure and function. This was a cross-sectional, single-center study of 53 patients with acromegaly and 22 age- and sex-matched healthy individuals. Carotid intima-media thickness (CIMT), pulse-wave velocity (PWV), and echocardiographic data were compared between these groups. CIMT and PWV were higher in the acromegaly group than in the healthy group (P = .008 and P = .002, respectively). Echocardiography showed that left ventricular diastolic dysfunction was present in 11.3% of patients. Left ventricular mass index and left atrial volume index were higher in the patients (P = .016 and Pacromegaly and the control group. Our results showed that subclinical atherosclerosis (i.e., CIMT and PWV markers) and heart structure and function were worse in patients with acromegaly than in healthy individuals. Because there were no differences in these parameters between patients with controlled and uncontrolled acromegaly, our results suggest that the structural and functional changes do not reverse with biochemical control. AA = active acromegaly BSA = body surface area CA = biochemically controlled acromegaly CH = concentric hypertrophy CIMT = carotid intima-media thickness DBP = diastolic blood pressure DM = diabetes mellitus ECHO = echocardiography EDV = enddiastolic volume EF = ejection fraction ESV = endsystolic volume GH = growth hormone HC = healthy control HL = hyperlipidemia HT = hypertension IGF-1 = insulin-like growth factor 1 LA = left atrial LAV = left atrial volume LAVI = left atrial volume index LV = left ventricular LVDD = left ventricular diastolic dysfunction LVEF = left

Anatomic relationship between left coronary artery and left atrium in patients undergoing atrial fibrillation ablation.

Science.gov (United States)

Anselmino, Matteo; Torri, Federica; Ferraris, Federico; Calò, Leonardo; Castagno, Davide; Gili, Sebastiano; Rovera, Chiara; Giustetto, Carla; Gaita, Fiorenzo

2017-07-01

Atrial fibrillation transcatheter ablation (TCA) is, within available atrial fibrillation rhythm control strategies, one of the most effective. To potentially improve ablation outcome in case of recurrent atrial fibrillation after a first procedure or in presence of structural myocardial disease, isolation of the pulmonary veins may be associated with extensive lesions within the left atrium. To avoid rare, but potentially life-threatening, complications, thorough knowledge and assessment of left atrium anatomy and its relation to structures in close proximity are, therefore, mandatory. Aim of the present study is to describe, by cardiac computed tomography, the anatomic relationship between aortic root, left coronary artery and left atrium in patients undergoing atrial fibrillation TCA. The cardiac computed tomography scan of 21 patients affected by atrial fibrillation was elaborated to segment left atrium, aortic root and left coronary artery from the surrounding structures and the following distances measured: left atrium and aortic root; left atrium roof and aortic root; left main coronary artery and left atrium; circumflex artery and left atrium appendage; and circumflex artery and mitral valve annulus. Above all, the median distance between left atrium and aortic root (1.9, 1.5-2.1 mm), and between circumflex artery and left atrium appendage ostium (3.0, 2.1-3.4 mm) were minimal (≤3 mm). None of measured distances significantly varied between patients presenting paroxysmal versus persistent atrial fibrillation. The anatomic relationship between left atrium and coronary arteries is extremely relevant when performing atrial fibrillation TCA by extensive lesions. Therefore, at least in the latter case, preablation imaging should be recommended to avoid rare, but potentially life-threatening, complications with the aim of an as well tolerated as possible procedure.

Plain chest PA evaluation of left atrial thrombosis in mitral valvular disease

International Nuclear Information System (INIS)

Choo, Yeon Myung; Park, Jae Hyung; Han, Man Chung

1984-01-01

Conventional posteroanterior chest radiographs of 73 patients with mitral valve disease who had had surgery were analyzed, and particular attention was directed to the absence of the convexity of the left lower mid cardiac border (left atrial segment) and to the relation with duration of illness, atrial fibrillation, pulmonary capillary wedge pressure (PCWP) as well as surgical findings. The results obtained are as follows: 1. The flatness or concavity of this segment, despite other evidence of left atrial enlargement, was observed in eleven (64.7%) of 17 patients who had left atrial thrombosis and in six (10.7%) of 56 patients who did not have thrombosis (false positive diagnosis). Six (35.5%) of the 17 patients who had left atrial thrombosis did not this findings on radiographs (false positive diagnosis). Six (35.3%) of the 17 patients who had left atrial thrombosis did not show this finding on radiographs (false positive diagnosis). Therefore, the accuracy in the diagnosis of thrombosis of left atrium wa 64.7% (eleven of seventeen) for patients who had thrombosis of left atrium. 2. The atrial fibrillation was observed in sixteen (94.1%)of 17 patients who had left atrial thrombosis. So, correlation between the presence of left atrial thrombosis and atrial fibrillation wa evident. But there was no correlation between the duration of illness of the PCWP of patients and the presence of left atrial thrombosis.

Plain chest PA evaluation of left atrial thrombosis in mitral valvular disease

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Choo, Yeon Myung; Park, Jae Hyung; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1984-09-15

Conventional posteroanterior chest radiographs of 73 patients with mitral valve disease who had had surgery were analyzed, and particular attention was directed to the absence of the convexity of the left lower mid cardiac border (left atrial segment) and to the relation with duration of illness, atrial fibrillation, pulmonary capillary wedge pressure (PCWP) as well as surgical findings. The results obtained are as follows: 1. The flatness or concavity of this segment, despite other evidence of left atrial enlargement, was observed in eleven (64.7%) of 17 patients who had left atrial thrombosis and in six (10.7%) of 56 patients who did not have thrombosis (false positive diagnosis). Six (35.5%) of the 17 patients who had left atrial thrombosis did not this findings on radiographs (false positive diagnosis). Six (35.3%) of the 17 patients who had left atrial thrombosis did not show this finding on radiographs (false positive diagnosis). Therefore, the accuracy in the diagnosis of thrombosis of left atrium wa 64.7% (eleven of seventeen) for patients who had thrombosis of left atrium. 2. The atrial fibrillation was observed in sixteen (94.1%)of 17 patients who had left atrial thrombosis. So, correlation between the presence of left atrial thrombosis and atrial fibrillation wa evident. But there was no correlation between the duration of illness of the PCWP of patients and the presence of left atrial thrombosis.

Incisional left atrial isolation for ablation of atrial fibrillation in mitral valve surgery.

Science.gov (United States)

Graffigna, Angelo; Branzoli, Stefano; Sinelli, Stefano; Vigano, Mario

2009-01-01

The renewed interest in surgical techniques for atrial fibrillation (AF) limited to the left atrium has risen the importance of the original technique of left atrial isolation by means of surgical incision. Transmurality of lesions and cost containment are strong elements to be appreciated in this technique.

Changes in Left Ventricular Diastolic Function During Hemodialysis Sessions

NARCIS (Netherlands)

Assa, Solmaz; Hummel, Yoran M.; Voors, Adriaan A.; Kuipers, Johanna; Groen, Henk; de Jong, Paul E.; Westerhuis, Ralf; Franssen, Casper F. M.

Background: Left ventricular diastolic dysfunction is common in hemodialysis patients and is associated with worse outcome. Previous studies have shown that diastolic function worsens from pre- to post-dialysis session, but this has not been studied during hemodialysis. We studied the evolution of

Left atrial function in heart failure with impaired and preserved ejection fraction.

Science.gov (United States)

Fang, Fang; Lee, Alex Pui-Wai; Yu, Cheuk-Man

2014-09-01

Left atrial structural and functional changes in heart failure are relatively ignored parts of cardiac assessment. This review illustrates the pathophysiological and functional changes in left atrium in heart failure as well as their prognostic value. Heart failure can be divided into those with systolic dysfunction and heart failure with preserved ejection fraction (HFPEF). Left atrial enlargement and dysfunction commonly occur in systolic heart failure, in particular, in idiopathic dilated cardiomyopathy. Atrial enlargement and dysfunction also carry important prognostic value in systolic heart failure, independently of known parameters such as left ventricular ejection fraction. In HFPEF, there is evidence of left atrial enlargement, impaired atrial compliance, and reduction of atrial pump function. This occurs not only at rest but also during exercise, indicating significant impairment of atrial contractile reserve. Furthermore, atrial dyssynchrony is common in HFPEF. These factors further contribute to the development of new onset or progression of atrial arrhythmias, in particular, atrial fibrillation. Left atrial function is an integral part of cardiac function and its structural and functional changes in heart failure are common. As changes of left atrial structure and function have different clinical implications in systolic heart failure and HFPEF, routine assessment is warranted.

Age-specific changes in left ventricular diastolic function: A velocity-encoded magnetic resonance imaging study

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Ashrafpoor, Golmehr [Sorbonne Universites, UPMC Univ Paris 06, UMR 7371, UMR S 1146, Laboratoire d' Imagerie Biomedicale, Paris (France); INSERM, UMR S 1146, Laboratoire d' Imagerie Biomedicale, Paris (France); CNRS, UMR 7371, Laboratoire d' Imagerie Biomedicale, Paris (France); Universite Paris Descartes, Cardiovascular Imaging Department, European Hospital Georges Pompidou, Paris (France); Bollache, Emilie; Cesare, Alain de; Giron, Alain; Defrance, Carine; Kachenoura, Nadjia [Sorbonne Universites, UPMC Univ Paris 06, UMR 7371, UMR S 1146, Laboratoire d' Imagerie Biomedicale, Paris (France); INSERM, UMR S 1146, Laboratoire d' Imagerie Biomedicale, Paris (France); CNRS, UMR 7371, Laboratoire d' Imagerie Biomedicale, Paris (France); Redheuil, Alban [Sorbonne Universites, UPMC Univ Paris 06, UMR 7371, UMR S 1146, Laboratoire d' Imagerie Biomedicale, Paris (France); INSERM, UMR S 1146, Laboratoire d' Imagerie Biomedicale, Paris (France); CNRS, UMR 7371, Laboratoire d' Imagerie Biomedicale, Paris (France); Hopital Pitie-Salpetriere, Department of Cardiovascular Radiology, Institut de Cardiologie, Paris (France); ICAN, Imaging Core Lab, Paris (France); Azarine, Arshid [INSERM, UMR S 1146, Laboratoire d' Imagerie Biomedicale, Paris (France); Universite Paris Descartes, Cardiovascular Imaging Department, European Hospital Georges Pompidou, Paris (France); Perdrix, Ludivine; Ladouceur, Magalie [European Hospital Georges Pompidou, Cardiology Department, Paris (France); Diebold, Benoit [Sorbonne Universites, UPMC Univ Paris 06, UMR 7371, UMR S 1146, Laboratoire d' Imagerie Biomedicale, Paris (France); INSERM, UMR S 1146, Laboratoire d' Imagerie Biomedicale, Paris (France); CNRS, UMR 7371, Laboratoire d' Imagerie Biomedicale, Paris (France); European Hospital Georges Pompidou, Cardiology Department, Paris (France); Mousseaux, Elie [Sorbonne Universites, UPMC Univ Paris 06, UMR 7371, UMR S 1146, Laboratoire d' Imagerie Biomedicale, Paris (France); INSERM, UMR S 1146, Laboratoire d' Imagerie Biomedicale, Paris (France); CNRS, UMR 7371, Laboratoire d' Imagerie Biomedicale, Paris (France); Universite Paris Descartes, Cardiovascular Imaging Department, European Hospital Georges Pompidou, Paris (France); European Hospital Georges Pompidou, Cardiology Department, Paris (France)

2015-04-01

Our objectives were to assess the ability of phasecontrast MRI (PC-MRI) to detect sub-clinical age-related variations of left ventricular (LV) diastolic parameters and thus to provide age-related reference ranges currently available for echocardiography but not for MRI-PC, and to identify independent associates of such variations. We studied 100 healthy volunteers (age = 42 ± 15years, 50 females) who had MRI with simultaneous blood pressure measurements. LV mass and volumes were assessed. Semiautomated analysis of PC-MRI data provided: 1) early transmitral (Ef) and atrial (Af) peak filling flow-rates (ml/s) and filling volume (FV), 2) deceleration time (DT), isovolumic relaxation time (IVRT), and 3) early myocardial longitudinal (E') peak velocity. MRI-PC diastolic parameters were reproducible as reflected by low coefficients of variations (ranged between 0.31 to 6.26 %). Peak myocardial velocity E' (r = -0.63, p < 0.0001) and flow-rate parameters were strongly and independently associated to age (Ef/Af:r = -0.63, DT:r = 0.46, IVRT:r = 0.44, Ef/FV:r = -0.55, Af/FV:r = 0.56, p < 0.0001). Furthermore, LV relaxation parameters (E', DT, IVRT), were independently associated to LV remodelling (LV mass/end-diastolic volume) and myocardial wall thickness (p < 0.01). PC-MRI age-related reference ranges of diastolic parameters are provided. Such parameters might be useful for a fast, reproducible and reliable characterization of diastolic function in patients referred for clinical MRI exam. (orig.)

Left atrial isolation associated with mitral valve operations.

Science.gov (United States)

Graffigna, A; Pagani, F; Minzioni, G; Salerno, J; Viganò, M

1992-12-01

Surgical isolation of the left atrium was performed for the treatment of chronic atrial fibrillation secondary to valvular disease in 100 patients who underwent mitral valve operations. From May 1989 to September 1991, 62 patients underwent mitral valve operations (group I); 19, mitral valve operations and DeVega tricuspid annuloplasty (group II); 15, mitral and aortic operations (group III); and 4, mitral and aortic operations and DeVega tricuspid annuloplasty (group IV). Left atrial isolation was performed, prolonging the usual left paraseptal atriotomy toward the left fibrous trigone anteriorly and the posteromedial commissure posteriorly. The incision was conducted a few millimeters apart from the mitral valve annulus, and cryolesions were placed at the edges to ensure complete electrophysiological isolation of the left atrium. Operative mortality accounted for 3 patients (3%). In 79 patients (81.4%) sinus rhythm recovered and persisted until discharge from the hospital. No differences were found between the groups (group I, 80.7%; group II, 68.5%; group III, 86.7%; group IV, 75%; p = not significant). Three late deaths (3.1%) were registered. Long-term results show persistence of sinus rhythm in 71% of group I, 61.2% of group II, 85.8% of group III, and 100% of group IV. The unique risk factor for late recurrence of atrial fibrillation was found to be preoperative atrial fibrillation longer than 6 months. Due to the satisfactory success rate in recovering sinus rhythm, we suggest performing left atrial isolation in patients with chronic atrial fibrillation undergoing valvular operations.

Contemporary Assessment of Left Ventricular Diastolic Function in Older Adults

DEFF Research Database (Denmark)

Shah, Amil M.; Claggett, Brian; Kitzman, Dalane

2017-01-01

Background: Although age-Associated changes in left ventricular diastolic function are well recognized, limited data exist characterizing measures of diastolic function in older adults, including both reference ranges reflecting the older adult population and prognostically relevant values...

Accessory left atrial diverticulae: contractile properties depicted with 64-slice cine-cardiac CT.

LENUS (Irish Health Repository)

Killeen, Ronan P

2012-02-01

To assess the contractility of accessory left atrial appendages (LAAs) using multiphasic cardiac CT. We retrospectively analyzed the presence, location, size and contractile properties of accessory LAAs using multiphasic cardiac 64-slice CT in 102 consecutive patients (63 males, 39 females, mean age 57). Multiplanar reformats were used to create image planes in axial oblique, sagittal oblique and coronal oblique planes. For all appendages with an orifice diameter >or= 10 mm, axial and sagittal diameters and appendage volumes were recorded in atrial diastole and systole. Regression analysis was performed to assess which imaging appearances best predicted accessory appendage contractility. Twenty-three (23%) patients demonstrated an accessory LAA, all identified along the anterior LA wall. Dimensions for axial oblique (AOD) and sagittal oblique (SOD) diameters and sagittal oblique length (SOL) were 6.3-19, 3.4-20 and 5-21 mm, respectively. All appendages (>or=10 mm) demonstrated significant contraction during atrial systole (greatest diameter reduction was AOD [3.8 mm, 27%]). Significant correlations were noted between AOD-contraction and AOD (R = 0.57, P < 0.05) and SOD-contraction and AOD, SOD and SOL (R = 0.6, P < 0.05). Mean diverticulum volume in atrial diastole was 468.4 +\\/- 493 mm(3) and in systole was 171.2 +\\/- 122 mm(3), indicating a mean change in volume of 297.2 +\\/- 390 mm(3), P < 0.0001. Stepwise multiple regression analysis revealed SOL to be the strongest independent predictor of appendage contractility (R(2) = 0.86, P < 0.0001) followed by SOD (R(2) = 0.91, P < 0.0001). Accessory LAAs show significant contractile properties on cardiac CT. Those accessory LAAs with a large sagittal height or depth should be evaluated for contractile properties, and if present should be examined for ectopic activity during electrophysiological studies.

Occlusion of left atrial appendage in patients with atrial fibrillation

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О. Н. Ганеева

2015-10-01

Full Text Available The article reviews a new method of prophylaxis of thromboembolitic complications, specifically occlusion of left atrial appendage, in patients with atrial fibrillation. Indications and contraindications for the procedure, as well as a step-by-step process of the intervention itself are described. Special emphasis is placed on the up-to-date evidence and the review of clinical trials.

Relation of the Number of Parity to Left Ventricular Diastolic Function in Pregnancy.

Science.gov (United States)

Keskin, Muhammed; Avşar, Şahin; Hayıroğlu, Mert İlker; Keskin, Taha; Börklü, Edibe Betül; Kaya, Adnan; Uzun, Ahmet Okan; Akyol, Burcu; Güvenç, Tolga Sinan; Kozan, Ömer

2017-07-01

Left ventricular diastolic dysfunction (LVDD) has been relatively less studied than other cardiac changes during pregnancy. Previous studies revealed a mild diastolic deterioration during pregnancy. However, these studies did not evaluate the long-term effect of parity on left ventricular diastolic function. A comprehensive study evaluating the long-term effect of parity on diastolic function is required. A total of 710 women with various number of parity were evaluated through echocardiography to reveal the status of diastolic function. Echocardiographic parameters were compared among the women by parity number and categorized accordingly: none, 0 to 4 and 4 4 parity and that had 21 and 5.8 times higher than nulliparous group, respectively. In conclusion, according to the present study, grand multiparity but not multiparity, severely deteriorates left ventricular diastolic function. Further studies are warranted to evaluate the risk of gradual diastolic dysfunction after each pregnancy. Copyright © 2017 Elsevier Inc. All rights reserved.

Relation of N-Terminal Pro-B-Type Natriuretic Peptide and Left Ventricular Diastolic Function to Exercise Tolerance in Patients With Significant Valvular Heart Disease and Normal Left Ventricular Systolic Function.

Science.gov (United States)

Hwang, Ji-Won; Park, Sung-Ji; Cho, Eun Jeong; Kim, Eun Kyoung; Lee, Ga Yeon; Chang, Sung-A; Choi, Jin-Oh; Lee, Sang-Chol; Park, Seung Woo

2017-06-01

An association between N-terminal prohormone brain natriuretic peptide (NT-proBNP) and exercise tolerance in patients with valvular heart disease (VHD) has been suggested; however, there are few data available regarding this relation. The aim of this study is to evaluate the correlation between exercise tolerance and NT-proBNP in patients with asymptomatic or mildly symptomatic significant VHD and normal left ventricular ejection fraction (LV EF). A total of 96 patients with asymptomatic or mildly symptomatic VHD and normal LV EF (≥50%) underwent cardiopulmonary exercise echocardiography. NT-proBNP levels were determined at baseline and after exercise in 3 hours. Patients were divided in 2 groups based on lower (left atrial volume index before exercise, right ventricular systolic pressure before exercise, E velocity after exercise, and E/e' ratio after exercise varied significantly. In addition, peak VO 2 was inversely related to NT-proBNP before (r = -0.352, p left atrial volume index, E/e' ratio, and right ventricular systolic pressure before and after exercise. NT-proBNP after exercise was also directly related to the same parameters. NT-proBNP levels both before and after exercise were higher in the group with lower exercise tolerance. In conclusion, through the correlation among exercise tolerance, NT-proBNP, and parameters of diastolic dysfunction, we demonstrated that diastolic dysfunction and NT-proBNP could predict exercise tolerance in patients with significant VHD and normal LV EF. Copyright © 2017 Elsevier Inc. All rights reserved.

Altered diastolic function and aortic stiffness in Alzheimer’s disease

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Çalık AN

2014-07-01

Full Text Available Ali Nazmi Çalik,3 Kazim Serhan Özcan,4 Gülbün Yüksel,2 Baris Güngör,1 Emre Arugarslan,1 Figen Varlibas,2 Ahmet Ekmekci,1 Damirbek Osmonov,1 Mustafa Adem Tatlisu,1 Mehmet Karaca,1 Osman Bolca,1 Izzet Erdinler1 1Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey; 2Department of Neurology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey; 3Department of Cardiology, Yozgat State Hospital, Yozgat, Turkey; 4Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey Background: Alzheimer’s disease (AD is closely linked to cardiovascular risk factors.Methods: Echocardiographic studies were performed, including left ventricular diastolic functions, left and right atrial conduction times, and arterial stiffness parameters, namely stiffness index, pressure-strain elastic modulus, and distensibility, on 29 patients with AD and 24 age-matched individuals with normal cognitive function.Results: The peak mitral flow velocity of the early rapid filling wave (E was lower, and the peak velocity of the late filling wave caused by atrial contraction (A, deceleration time of peak E velocity, and isovolumetric relaxation time were higher in the AD group. The early myocardial peak (Ea velocity was significantly lower in AD patients, whereas the late diastolic (Aa velocity and E/Ea ratio were similar between the two groups. In Alzheimer patients, stiffness index and pressure-strain elastic modulus were higher, and distensibility was significantly lower in the AD group compared to the control. Interatrial electromechanical delay was significantly longer in the AD group.Conclusion: Our findings suggest that patients with AD are more likely to have diastolic dysfunction, higher atrial conduction times, and increased arterial stiffness compared to the controls of same sex and similar age. Keywords: diastolic dysfunction, atrial conduction timeA Letter to the Editor has been

Left atrial size and function as predictors of new-onset of atrial fibrillation in patients with asymptomatic aortic stenosis

DEFF Research Database (Denmark)

Bang, Casper Niels Furbo; Dalsgaard, Morten; Greve, Anders

2013-01-01

Left atrial (LA) size and function change with chronically increased left ventricular (LV) filling pressures. It remains unclear whether these variations in LA parameters can predict new-onset atrial fibrillation (AF) in asymptomatic patients with aortic stenosis (AS).......Left atrial (LA) size and function change with chronically increased left ventricular (LV) filling pressures. It remains unclear whether these variations in LA parameters can predict new-onset atrial fibrillation (AF) in asymptomatic patients with aortic stenosis (AS)....

Pulmonary edema following transcatheter closure of atrial septal defect

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Keerthi Chigurupati

2015-01-01

Full Text Available We describe an incident of development of acute pulmonary edema after the device closure of a secundum atrial septal defect in a 52-year-old lady, which was treated with inotropes, diuretics and artificial ventilation. Possibility of acute left ventricular dysfunction should be considered after the defect closure in the middle-aged patients as the left ventricular compliance may be reduced due to increased elastic stiffness and diastolic dysfunction. Baseline left atrial pressure may be > 10 mmHg in these patients. Associated risk factors for the left ventricular dysfunction are a large Qp:Qs ratio, systemic hypertension, severe pulmonary hypertension and paroxysmal atrial fibrillation.

Left atrial appendage function in prediction of paroxysmal atrial fibrilation in patients with untreated hypertension.

Science.gov (United States)

Tenekecioglu, Erhan; Agca, Fahriye Vatansever; Karaagac, Kemal; Ozluk, Ozlem Arican; Peker, Tezcan; Kuzeytemiz, Mustafa; Senturk, Muhammed; Yılmaz, Mustafa

2014-01-01

Abstract The onset of AF results in a significant increase in mortality rates and morbidity in hypertensive patients and this rhythm disorder exposes patients to a significantly increased risk of cerebral or peripheral embolisms. Tissue Doppler imaging was found to be useful in early detection of myocardial dysfunction in several diseases. It was shown that tissue Doppler analysis of the walls of the left atrial appendage (LAA) can give accurate information about the function of the LAA in hypertensive patients. In this study, we aimed to investigate and identify the specific predictive parameters for the onset of AF in patients with hypertension with tissue Doppler imaging of LAA. We studied age and sex matched 57 untreated hypertensive patients with paroxysmal atrial fibrillation (PAF) and 27 untreated hypertensive subjects without PAF. With transthoracic echocardiography, diastolic mitral A-velocity and LA maximal volume index which reflects reservoir function of left atrium was measured, with transesophageal echocardiography, LAA emptying velocity (LAA-PW D2) and tissue Doppler contracting velocity of LAA (LAA-TDI-D2) were measured. LA maximal volume index of the groups (22.28 ± 3.59 mL/m(2) in Group 1 versus 20.37 ± 3.97 mL/m(2) in Group 2, p = 0.07) and diastolic mitral A-velocity [0.93 (0.59-1.84) m/s in patients with PAF versus 0.90 (0.62-1.76) m/s in patients without PAF, p = 0.26] was not significantly different between study groups, during TEE, LAA-PW D2 (0.31 ± 0.04 m/s in Group 1 versus 0.33 ± 0.03 m/s in Group 2, p = 0.034) and LAA-TDI-D2 (0.18 ± 0.04 m/s in Group 1 versus 0.21 ± 0.05 m/s in Group 2, p = 0.014) were significantly decreased in Group 1. In this study, we found that in hypertensive PAF patients despite normal global LA functions, LAA contracting function was deteriorated. Tissue Doppler analysis of LAA is clinically usefull approach to detect the risk of developing PAF in

Geographic origin as a determinant of left ventricular mass and diastolic function - the Cardiovascular Risk in Young Finns Study.

Science.gov (United States)

Vähämurto, L; Juonala, M; Ruohonen, S; Hutri-Kähönen, N; Kähönen, M; Laitinen, T; Tossavainen, P; Jokinen, E; Viikari, J; Raitakari, O T; Pahkala, K

2018-03-01

Eastern Finns have higher risk of coronary heart disease (CHD) and carotid intima-media thickness than western Finns although current differences in CHD risk factors are minimal. Left ventricular (LV) mass and diastolic function predict future cardiovascular events but their east-west differences are unknown. We examined the association of eastern/western baseline origin with LV mass and diastolic function. The study population included 2045 subjects of the Cardiovascular Risk in Young Finns Study with data from the baseline survey (1980) and the latest follow-up (2011) when echocardiography was performed at the age of 34-49 years. Subjects with eastern baseline origin had in 2011 higher LV mass (139±1.0 vs. 135±1.0 g, p=0.006) and E/e'-ratio indicating weaker LV diastolic function (4.86±0.03 vs. 4.74±0.03, p=0.02) than western subjects. Results were independent of age, sex, area of examination and CHD risk factors such as blood pressure and BMI (LV mass indexed with height: porigin (135±0.9 vs. 131±0.9 ml, p=0.0011) but left atrial end-systolic volume, also indicating LV diastolic function, was not different between eastern and western subjects (43.4±0.5 vs. 44.0±0.5 ml, p=0.45). Most of the subjects were well within the normal limits of these echocardiographic measurements. In our healthy middle-aged population, geographic origin in eastern Finland associated with higher LV mass compared to western Finland. Higher E/e'-ratio suggests that subjects with eastern baseline origin might have higher prevalence of diastolic dysfunction in the future than western subjects.

Altered Aortic Upper Wall TDI Velocity Is Inversely Related with Left Ventricular Diastolic Function in Operated Tetralogy of Fallot.

Science.gov (United States)

Bassareo, Pier Paolo; Saba, Luca; Marras, Andrea R; Mercuro, Giuseppe

2016-12-01

Postoperative tetralogy of Fallot (TOF) patients often develop progressive aortic root dilatation due to an impairment in aortic elastic properties. (1) to assess aortic elasticity at the level of the aortic upper wall by tissue Doppler imaging (TDI); (2) to evaluate the influence of aortic elasticity on left ventricular (LV) diastolic function in TOF patients. Twenty-eight postoperative TOF patients (14 males, 14 females. Mean age: 25.7 ± 1.6 years) and 28 age- and sex-matched normal subjects were examined. Aortic distensibility and stiffness index were calculated. Aortic wall systolic and diastolic velocities, LV systolic and diastolic parameters were assessed by TDI. Aortic distensibility was significantly lower (P = .024), and aortic stiffness index significantly higher (P = .036) in TOF patients compared to controls. E/E' was significantly higher in TOF than in control group (P < .001). Aortic upper wall early diastolic velocity (AWEDV) was significantly correlated with aortic stiffness index (r: -0.42; P < .03), aortic distensibility (r = 0.54; P < .004), left atrial volume (r = -0.62; P = .0004), and E/E' ratio (r = -0.87; P < .0001). The latter relationship remained significant even when excluding the influence of age at surgery (r = -0.60; P < .0007) and of previous palliative surgery (r = -0.53; P < .02). Aortic elastic properties can be directly assessed using TDI to measure AWEDV. Aortic elasticity is significantly lower in postoperative TOF patients, exerting a negative effect also on LV diastolic function, with a potential long-term influence on clinical status. © 2016 Wiley Periodicals, Inc.

Effect of Left Ventricular Outflow Tract Obstruction on Left Atrial Mechanics in Hypertrophic Cardiomyopathy

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Lynne K. Williams

2015-01-01

Full Text Available Left atrial (LA volumes are known to be increased in hypertrophic cardiomyopathy (HCM and are a predictor of adverse outcome. In addition, LA function is impaired and is presumed to be due to left ventricular (LV diastolic dysfunction as a result of hypertrophy and myocardial fibrosis. In the current study, we assess the incremental effect of outflow tract obstruction (and concomitant mitral regurgitation on LA function as assessed by LA strain. Patients with HCM (50 obstructive, 50 nonobstructive were compared to 50 normal controls. A subset of obstructive patients who had undergone septal myectomy was also studied. Utilising feature-tracking software applied to cardiovascular magnetic resonance images, LA volumes and functional parameters were calculated. LA volumes were significantly elevated and LA ejection fraction and strain were significantly reduced in patients with HCM compared with controls and were significantly more affected in patients with obstruction. LA volumes and function were significantly improved after septal myectomy. LVOT obstruction and mitral regurgitation appear to further impair LA mechanics. Septal myectomy results in a significant reduction in LA volumes, paralleled by an improvement in function.

Types of Diastolic Dysfunction of the Left Ventricle in Adolescents with Myocardial Pathology

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L.F. Bogmat

2014-05-01

Full Text Available In adolescents with myocardial pathology during isometric tests we detected three types of diastolic dysfunction of the left ventricle (LV of the heart, depending on E/A ratio. The most pronounced signs of diastolic filling disorders were detected in the third group of patients, as evidenced: by a tendency to increase isovolumic relaxation time, a significant increase of slowing down time of the first phase of left ventricular filling, reduced LV filling rate both in the first phase of the passive filling and the second phase of active LV filling, increasing E/A ratio of more than 2, significant dilation of the left atrium, as well as positive increase in diastolic reserve that confirms deeper diastolic dysfunction in these adolescents compared with other subgroups.

Usefulness of left ventricular speckle tracking echocardiography and novel measures of left atrial structure and function in diagnosing paroxysmal atrial fibrillation in ischemic stroke and transient ischemic attack patients.

Science.gov (United States)

Skaarup, Kristoffer Grundtvig; Christensen, Hanne; Høst, Nis; Mahmoud, Masti Mahdy; Ovesen, Christian; Olsen, Flemming Javier; Jensen, Jan Skov; Biering-Sørensen, Tor

2017-12-01

Asymptomatic paroxysmal atrial fibrillation (PAF) is often assumed to be the cause of cryptogenic ischemic strokes (IS) and transient ischemic attacks (TIA). We examined the usefulness of measures obtained by 2D speckle tracking echocardiography and novel left atrial measurements, in the diagnosis of PAF in patients with IS and TIA. We retrospectively included 205 patients who after acute IS or TIA underwent an echocardiogram in sinus rhythm. Patients were designated as PAF-patients if they had one or more reported incidents of AF before or after their echocardiographic examination. None of the conventional echocardiographic parameters were significantly associated with PAF. Of the speckle tracking measurements, only early diastolic strain rate (0.7±0.2 s -1 vs. 0.8±0.3 s -1 , p = 0.048) and global longitudinal displacement (GLD) (3.15 ± 1.40 mm vs. 3.87 ± 1.56 mm, p = 0.007) proved significantly different. Of the left atrial parameters both minimal and maximal left atrium volume divided by left ventricular length (min LAV/LVL and max LAV/LVL, respectively) were significantly impaired (min LAV/LVL: 3.7 ± 2.1 cm 2 vs. 2.8 ± 1.11 cm 2 , p = 0.012; max LAV/LVL: 6.6 ± 3.1 cm 2 vs. 5.6 ± 1.7 cm 2 , p = 0.012). GLD, min max LAV/LVL proved significant after adjustment for age, gender, CHA 2 DS 2 -VASc and NIHSS. By combining information regarding age, GLD, min and max LAV/LVL the diagnostic accuracy of PAF improved, resulting in a significantly increased area under the curve (p = 0.037). In patients with IS and TIA GLD, min and max LAV/LVL were independently associated with the presence of PAF.

Estimation of left ventricular end diastolic pressure by tissue doppler imaging in patients with acute myocardial infarction

International Nuclear Information System (INIS)

Ali, M.; Abid, A.R.; Rehman, T.A.; Masood, A.; Sohail, S.

2010-01-01

Objective: To evaluate sensitivity and specificity of E / Ea > 10 for prediction of LVEDP > 15 mmHg in patients with coronary artery disease undergoing left heart catheterization. Materials and Methods: Sixty patients of acute transmural myocardial infarction at Jinnah Hospital Lahore were enrolled in study from December 2008 to December 2009. Patients with sinus rhythm were included in the study. Patients with valvular heart disease, complete right/left bundle branch block, Pacemaker dependence, Atrial fibrillation and Post mitral valve replacement were excluded. All patients were examined by performing trans thoracic Doppler echocardiography. The trans-mitral LV filling signal was traced manually and the following variables were obtained: peak early (E) and late (A) trans-mitral velocities, and E/A ratio. Tissue - Doppler derived indices were recorded at the lateral mitral annulus. These indices included systolic velocities (S'), early diastolic (Ea) velocities and late diastolic (Aa) velocities. Finally, the dimensionless index of E/Ea was calculated. All were averaged from at least three beats. Cardiac catheterization was performed via trans-femoral / trasradial route using six French (6F) sheaths. Left ventricular diastolic pressure was directly measured by fluid filled pigtail catheter attached to a pressure transducer. Results: Mean age of the study population was 56.8 +- 12.7 years. There were 47 (78.3%) males and 13 (21.7%) females. Diabetes mellitus was present in 12(20%), hypertension in 32 (53.3%), smoking in 35 (58.3%), dyslipidemia in 24 (40%). Anterior wall myocardial infarction occurred in 44 (73.3%) and inferior wall MI in 16 (26.7%). Grade I diastolic dysfunction was present in 22 (36.7%), Grade II in 31 (51.7%) and Grade III in 7 (11.7%) patients. E/E 15 in 9 (15%). Overall 21 patients were true positive, 6 were false positive, 25 were true negative and 8 were false negative. By applying 2 X 2 table sensitivity was 77.7%, specificity was 80

Estimation of left ventricular end diastolic pressure by tissue doppler imaging in patients with acute myocardial infarction

Energy Technology Data Exchange (ETDEWEB)

Ali, M; Abid, A R; Rehman, T A; Masood, A; Sohail, S [Allama Iqbal Medical College/Jinnah Hospital, Lahore(Pakistan)

2010-10-15

Objective: To evaluate sensitivity and specificity of E / Ea > 10 for prediction of LVEDP > 15 mmHg in patients with coronary artery disease undergoing left heart catheterization. Materials and Methods: Sixty patients of acute transmural myocardial infarction at Jinnah Hospital Lahore were enrolled in study from December 2008 to December 2009. Patients with sinus rhythm were included in the study. Patients with valvular heart disease, complete right/left bundle branch block, Pacemaker dependence, Atrial fibrillation and Post mitral valve replacement were excluded. All patients were examined by performing trans thoracic Doppler echocardiography. The trans-mitral LV filling signal was traced manually and the following variables were obtained: peak early (E) and late (A) trans-mitral velocities, and E/A ratio. Tissue - Doppler derived indices were recorded at the lateral mitral annulus. These indices included systolic velocities (S'), early diastolic (Ea) velocities and late diastolic (Aa) velocities. Finally, the dimensionless index of E/Ea was calculated. All were averaged from at least three beats. Cardiac catheterization was performed via trans-femoral / trasradial route using six French (6F) sheaths. Left ventricular diastolic pressure was directly measured by fluid filled pigtail catheter attached to a pressure transducer. Results: Mean age of the study population was 56.8 +- 12.7 years. There were 47 (78.3%) males and 13 (21.7%) females. Diabetes mellitus was present in 12(20%), hypertension in 32 (53.3%), smoking in 35 (58.3%), dyslipidemia in 24 (40%). Anterior wall myocardial infarction occurred in 44 (73.3%) and inferior wall MI in 16 (26.7%). Grade I diastolic dysfunction was present in 22 (36.7%), Grade II in 31 (51.7%) and Grade III in 7 (11.7%) patients. E/E < 10 was observed in 31 (51.7%), 11 - 15 in 20 (33.3%) and > 15 in 9 (15%). Overall 21 patients were true positive, 6 were false positive, 25 were true negative and 8 were false negative. By

Gender differences in left vantricular diastolic dysfunction in normotensive type 2 diabetic patients

International Nuclear Information System (INIS)

Hameedullah, A.; Khan, S.S.; Khan, S.S.; Shah, I.; Hifizullah, M.

2012-01-01

Objective: To determine the pattern and severity of left ventricular diastolic dysfunction in normotensive type 2 diabetic males and females patients. Methodology: This descriptive study was performed in Department of Cardiology, Lady Reading Hospital, Peshawar, from March 2007 to February 2008. Total of 60 patients were enrolled. Glycemic status was defined on the basis of HbA1c level. Detailed history and physical examination was performed on every patient. Exercise tolerance test was performed on every patient to exclude major ischemia. Echocardiography was performed in left lateral position. Main outcome measure was left ventricular diastolic dysfunction. Results: We enrolled 60 normotesive type 2 diabetic patients in the study that fulfills the inclusion criteria. Left ventricular diastolic dysfunction was found in 50% (30/60). There were 12 males (40%) and 18 females (60%) among subjects presenting with diastolic dysfunction. In male gender impaired relaxation was found in 75% (9 males) and in female gender it was found in 66.6% (12 females) (p=0.58). Pseudonormal pattern was found in 25% in male gender (3 males) and in 33.3% in female gender (6 females) (p=0.003). Males subjects with diastolic dysfunction the mean age were 54 +- 8.8 and mean age of females' subject were 60+-13.2 (p=0.17). Conclusion: Left ventricular diastolic dysfunction is more common in female gender and is more severely impaired in female gender than in male gender. (author)

[Left atrial electric isolation in the treatment of atrial fibrillation secondary to rheumatic valvular disease].

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Graffigna, A; Pagani, F; Minzioni, G; Salerno, J; Viganò, M

1992-08-01

Surgical isolation of the left atrium was performed for the treatment of chronic atrial fibrillation secondary to valvular disease in 100 patients who underwent valve surgery. From May 1989 to September 1991, 62 patients underwent mitral valve surgery (Group I), 19 underwent mitral valve surgery and DeVega tricuspid annuloplasty (Group II), 15 underwent mitral and aortic surgery (Group III), and 4 patients underwent mitral and aortic surgery and DeVega tricuspid annuloplasty (Group IV). Left atrial isolation was performed prolonging the usual left paraseptal atriotomy towards the left fibrous trigone anteriorly, and the postero-medial commissure posteriorly. The incision was conducted a few millimeters apart from the mitral valve annulus, and cryolesion were placed at the edges to ensure complete electrophysiological isolation of the left atrium. Operative mortality accounted for 3 cases (3%). In 79 patients (81.4%) sinus rhythm recovered and persisted until discharge from the hospital. No differences were found between the groups (Group I: 80.7%; Group II: 68.5%; Group III 86.7%, Group IV 75% - p = N.S.). Three cases of late mortality (3.1%) were registered. long-term results showed persistence of SR in 71% of Group I, 61.2% of Group II, 85.8% of Group III, and 100% of Group IV. The unique risk factor for late recurrency of atrial fibrillation was found to be a duration of preoperative AF longer than 6 months. Due to the high success rate in recovering the sinus rhythm, we suggest left atrial isolation in patients with chronic atrial fibrillation undergoing valvular surgery.

Left atrial size in patients with cryptogenic stroke as a predictor of occurrence of atrial fibrillation

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Antonio Cruz Culebras

2017-04-01

Full Text Available Objective: To determine whether the left atrial size can predict the development of atrial fibrillation (AF in patients with embolic stroke of undetermined source (ESUS. Methods: Patients with ischemic stroke were included prospectively (January 2015-July 2015 when ESUS was suspected. Clinical and cardiac imaging data were recorded. Patients with cardiac failure were excluded. Results: a total of 55 patients were included. Medium age was 71 years. The proportion of patients who developed AF during the follow-up (1 year was 23, 63%. 10 % of patients did not have any vascular risk factor. Basal ECG was normal in 98% of cases. The left atrial size volume was 36, 08 ml in patients who developed AF and 27, 14 ml in patients who did not. Conclusions: In patients with ESUS, left atrial size dimensions do not predict the occurrence of AF.

Percutaneous left atrial appendage closure for stroke prevention

DEFF Research Database (Denmark)

De Backer, Ole; Loupis, Anastasia M; Ihlemann, Nikolaj

2014-01-01

INTRODUCTION: In atrial fibrillation (AF) patients with an increased stroke risk, oral anticoagulation (OAC) is the standard treatment for stroke prevention. However, this therapy carries a high risk of major bleeding. Percutaneous closure of the left atrial appendage (LAA) is suggested as an alt...

Left atrial low-voltage areas predict atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation.

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Masuda, Masaharu; Fujita, Masashi; Iida, Osamu; Okamoto, Shin; Ishihara, Takayuki; Nanto, Kiyonori; Kanda, Takashi; Tsujimura, Takuya; Matsuda, Yasuhiro; Okuno, Shota; Ohashi, Takuya; Tsuji, Aki; Mano, Toshiaki

2018-04-15

Association between the presence of left atrial low-voltage areas and atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) has been shown mainly in persistent AF patients. We sought to compare the AF recurrence rate in paroxysmal AF patients with and without left atrial low-voltage areas. This prospective observational study included 147 consecutive patients undergoing initial ablation for paroxysmal AF. Voltage mapping was performed after PVI during sinus rhythm, and low-voltage areas were defined as regions where bipolar peak-to-peak voltage was low-voltage areas after PVI were observed in 22 (15%) patients. Patients with low-voltage areas were significantly older (72±6 vs. 66±10, plow-voltage areas than without (36% vs. 6%, pLow-voltage areas were independently associated with AF recurrence even after adjustment for the other related factors (Hazard ratio, 5.89; 95% confidence interval, 2.16 to 16.0, p=0.001). The presence of left atrial low-voltage areas after PVI predicts AF recurrence in patients with paroxysmal AF as well as in patients with persistent AF. Copyright © 2017 Elsevier B.V. All rights reserved.

Left ventricular diastolic filling in patients with systemic hypertension

International Nuclear Information System (INIS)

Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa; Honda, Minoru; Kanao, Keisuke

1985-01-01

To study the prevalence and significance of left ventricular (LV) diastolic dysfunction in mild to moderate systemic hypertension (HT), cardiac blood pool imagings with Tc-99 m were obtained in 10 normal subjects and 27 patients with HT. The patients with HT did not show any evidence of coronary heart disease, renal insufficiency, cerebrovascular accident or diabetes mellitus. They were divided into 3 groups; (1) HT-1 (n=10): without evidence of echocardiographic (UCG) and electrocardiographic (ECG) left ventricular hypertrophy (LVH), (2) HT-2 (n=8): with evidence of ECG-LVH without UCG-LVH, (3) HT-3 (n=9): with evidence of UCG-LVH. UCG-LVH was defined when posterior or interventricular septal tall thickness exceeded 13 mm at end-diastole. From UCG findings LV mass was calculated and from UCG findings and auscultating brachial systolic pressure LV peak-systolic wall stress (WS) was obtained. Cardiac blood pool imagings were performed at modified LAO at rest and during exercise stress. Indices of LV systolic function (rest ejection fraction, mean ejection rate during the first third of ejection and exercise ejection fraction response) were essentially similar in normal subjects and all HT groups. In contrast, LV diastolic filling rate during the first third of diastole (1/3 FR mean) decreased significantly in any group of HT, and it was prominent in HT-3. In patients with HT, 1/3 FR mean did not correlate with blood pressure, LV peak-systolic WS, LV systolic functions and LV end-diastolic volume. But it correlated inversely with LV mass (r=-0.84). These results suggest that impairment of early diastolic LV filling can be detected before systolic cardiac impairment and LVH develop, and it is, at least in part, relate to the LV mass. (author)

Association Between Left Atrial Compression And Atrial Fibrillation: A Case Presentation And A Short Review Of Literature.

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Ahmed, Niloy; Carlos, Morales-Mangual; Moshe, Gunsburg; Yitzhak, Rosen

2016-01-01

This case report describes a patient who developed palpitations and chest pain and was found to be in atrial fibrillation, which was likely due to the presence of an extra-cardiac mass. This was compressing the left atrium. The mass was related to small cell carcinoma, which decreased significantly in size after chemotherapy. Resolution of the atrial fibrillation correlated temporally with reduction in the size of the mass and alleviation of the left atrial compression.

Left atrial thrombus following bilobectomy: a case report

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Kaya Ugur

2010-02-01

Full Text Available Abstract Introduction Left atrial free floating ball thrombus is a relatively rare event, especially without mitral valve disease. Case presentation A 61-year-old Turkish man was admitted to our hospital with a thrombus mass in his left atrium. Five months earlier, he had undergone right bilobectomy and superior bronchoplasty due to squamous cell carcinoma in the lung. The patient had no evidence of cardiac disease except atrial fibrillation and there were no defined embolizations. The thrombus mass was surgically removed. The patient was discharged from hospital on the sixth postoperative day. Conclusion Surgery with cardiopulmonary bypass is a safe method for treatment. The patient should be medicated with warfarin, especially in the presence of atrial fibrillation.

Utility of pulmonary venous flow diastolic deceleration time in an adult patient undergoing surgical closure of atrial septal defect and coronary artery bypass grafting

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Dharmesh R Agrawal

2013-01-01

Full Text Available Acute left ventricular (LV failure has been reported after surgical closure of atrial septal defect (ASD in adult patients. We report acute LV failure in a 56 year old gentleman following coronary artery bypass grafting (CABG and surgical closure of ASD. Transesophageal echocardiography examination of the patient following closure of ASD and CABG showed a residual ASD and a shunt (Qp :Qs = 1.5. The residual ASD was closed after re-institution of cardiopulmonary bypass (CPB under cardioplegic cardiac arrest. However, the patient did not tolerate closure of the residual ASD. The CPB was re-established and under cardioplegic cardiac arrest residual ASD was reopened to create a fenestration. This time patient was weaned easily from CPB. Postoperatively, 16 hours after extubation, patient became hemodynamically unstable, the patient was electively put on ventilator and intra-aortic balloon pump. Later the patient was weaned off successfully from ventilator. Retrospective analysis of pulmonary venous flow diastolic deceleration time (PVDT D recorded during prebypass period measured 102 msec suggestive of high left atrial pressure which indicate possibility of LV failure after ASD closure.

Alternative parameters for echocardiographic assessment of fetal diastolic function

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Zielinsky P.

2004-01-01

Full Text Available Alternative methods to assess ventricular diastolic function in the fetus are proposed. Fetal myocardial hypertrophy in maternal diabetes was used as a model of decreased left ventricular compliance (LVC, and fetal respiratory movements as a model of increased LVC. Comparison of three groups of fetuses showed that, in 10 fetuses of diabetic mothers (FDM with septal hypertrophy (SH, the mean excursion index of the septum primum (EISP (ratio between the linear excursion of the flap valve and the left atrial diameter was 0.36 ± 0.09, in 8 FDM without SH it was 0.51 ± 0.09 (P = 0.001, and in the 8 normal control fetuses (NCF it was 0.49 ± 0.12 (P = 0.003. In another study, 28 fetuses in apnea had a mean EISP of 0.39 ± 0.05 which increased to 0.57 ± 0.07 during respiration (P < 0.001. These two studies showed that the mobility of the septum primum was reduced when LVC was decreased and was increased when LVC was enhanced. Mean pulmonary vein pulsatility was higher in 14 FDM (1.83 ± 1.21 than in 26 NCF (1.02 ± 0.31; P = 0.02. In the same fetuses, mean left atrial shortening was decreased (0.40 ± 0.11 in relation to NCF (0.51 ± 0.09; P = 0.011. These results suggest that FDM may have a higher preload than normal controls, probably as a result of increased myocardial mass and LV hypertrophy. Prenatal assessment of LV diastolic function by fetal echocardiography should include analysis of septum primum mobility, pulmonary vein pulsatility, and left atrial shortening.

Etiologic significance of enlargement of the left atrial appendage in adults

International Nuclear Information System (INIS)

Green, C.E.; Kelley, M.J.; Higgins, C.B.

1982-01-01

Fifty-one patients were divided into two groups: 20 patients with proven rheumatic mitral valve disease (RMVD) and 31 patients with left atrial enlargement (LAE) of a nonrheumatic etiology. The latter group included patients with ischemic papillary muscle dysfunction, mitral valve prolapse, and congestive cardiomyopathy. Radiographic studies showed that enlargement of the left atrial appendage (LAAE) was present in 18 of 20 rheumatics but in only one of 31 nonrheumatics. There was no direct relationship between enlargement of the LAA and radiographic or echocardiographic left atrial size, degree of pulmonary venous hypertension (PVH), or presence of atrial fibrillation. It is postulated that rheumatic influammation of the LAA allows it to dilate out of proportion to the body of the left atrium. In the adult patient with radiographic findings of PVH, LAAE is a valuable and specific radiographic sign of rheumatic mitral valve disease

Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation

International Nuclear Information System (INIS)

Murdoch, Dale; McAulay, Laura; Walters, Darren L.

2014-01-01

Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy

Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation

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Murdoch, Dale, E-mail: dale_murdoch@health.qld.gov.au [The Prince Charles Hospital, Brisbane (Australia); The University of Queensland, Brisbane (Australia); McAulay, Laura [The Prince Charles Hospital, Brisbane (Australia); Walters, Darren L. [The Prince Charles Hospital, Brisbane (Australia); The University of Queensland, Brisbane (Australia)

2014-11-15

Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy.

Percutaneous closure of the left atrial appendage in patients with diabetes mellitus.

Science.gov (United States)

Azizy, Obayda; Rammos, Christos; Lehmann, Nils; Rassaf, Tienush; Kälsch, Hagen

2017-09-01

Left atrial appendage closure is a preventive treatment of atrial fibrillation-related thrombo-embolism. Patients with diabetes mellitus have increased risk for a negative outcome in percutaneous cardiac interventions. We assessed whether percutaneous left atrial appendage closure is safe and effective in patients with diabetes mellitus. We included 78 patients (mean age of 74.4 ± 8.3 years) with indication for left atrial appendage closure in an open-label observational single-centre study. Patients with diabetes mellitus ( n = 31) were at higher thrombo-embolic and bleeding risk (CHA 2 DS 2 -VASc: 4.5 ± 0.9, HAS-BLED: 4.7 ± 0.7) compared to patients without diabetes mellitus ( n = 47, CHA 2 DS 2 -VASc: 3.5 ± 1.0, HAS-BLED: 4.1 ± 0.8; p diabetes mellitus (Euro II-Score: 6.6 ± 3.7 vs 3.9 ± 1.9, p diabetes mellitus had no events ( p = 0.672). Follow-up of 6 months revealed no bleeding complication in both groups. No stroke occurred in follow-up, and left atrial appendage flow velocity reduction (55.6 ± 38.6 vs 51.4 ± 19.1 cm/s, p = 0.474) and rate of postinterventional leakage in the left atrial appendage were comparable (0% vs 2.1%, p = 0.672). Despite patients with diabetes mellitus are high-risk patients, the outcome of percutaneous left atrial appendage closure is similar to patients without diabetes mellitus.

Echocardiography-based hemodynamic management of left ventricular diastolic dysfunction: a feasibility and safety study.

Science.gov (United States)

Shillcutt, Sasha K; Montzingo, Candice R; Agrawal, Ankit; Khaleel, Maseeha S; Therrien, Stacey L; Thomas, Walker R; Porter, Thomas R; Brakke, Tara R

2014-11-01

Patients with left ventricular diastolic dysfunction (LVDD) are at increased risk of postoperative adverse events. The primary aim of this study was to evaluate the safety and feasibility of using echocardiography-guided hemodynamic management (EGHEM) during surgery in subjects with LVDD compared to conventional management. The feasibility of using echocardiography to direct a treatment algorithm and clinical outcomes were compared for safety between groups. Subjects were screened for LVDD by preoperative transthoracic echocardiography (TTE) and randomized to the conventional or EGHEM group. Subjects in EGHEM received hemodynamic management based on left ventricular filling patterns on transesophageal echocardiography (TEE). Primary outcomes measured were the feasibility to obtain TEE images and follow a TEE-based treatment algorithm. Safety outcomes also compared the following clinical differences between groups: length of hospitalization, incidence of atrial fibrillation, congestive heart failure (CHF), myocardial infarction, cerebrovascular accident, transient ischemic attack and renal failure measured 30 days postoperatively. Population consisted of 28 surgical subjects (14 in conventional group and 14 in EGHEM group). Mean subject age was 73.4 ± 6.7 years (36% male) in conventional group and 65.9 ± 14.4 years (36% male) in EGHEM group. Procedures included orthopedic (conventional = 29%, EGHEM 36%), general (conventional = 50%, EGHEM = 36%), vascular (conventional = 7%, EGHEM = 21%), and thoracic (conventional = 14%, EGHEM = 7%). There was no statistically significant difference in adverse clinical events between the 2 groups. The EGHEM group had less CHF, atrial fibrillation, and shorter length of stay. Echocardiography-guided hemodynamic management of patients with LVDD during surgery is feasible and may be a safe alternative to conventional management. © 2014, Wiley Periodicals, Inc.

Relationship of left atrial enlargement to persistence or development of ECG left ventricular hypertrophy in hypertensive patients: implications for the development of new atrial fibrillation

DEFF Research Database (Denmark)

Okin, Peter M; Gerdts, Eva; Wachtell, Kristian

2010-01-01

Persistence and development of ECG left ventricular hypertrophy (LVH) by Cornell product criteria are associated with an increased risk of atrial fibrillation compared with regression or continued absence of LVH. We postulated that this association might be in part mediated via greater left atrial...... enlargement (LAE) in patients with new and persistent ECG LVH....

The Relationship between Left Atrial Mechanical Function and Functional Capacity in Mitral Stenosis

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Mücahit Yetim

2013-11-01

Full Text Available Aim: In this study, left atrial functions of patients with rheumatic mitral stenosis and sinus rhythm, which was determined by transthorasic echocardiography, was compared with those of healhty subjects and the association of left atrial functions with functional capacity was investigated in subgroup analyses.   Material and methods: 32 patients with isolated rheumatic mitral stenosis (median age was 39.1±11  (group 1 and 20 patients in the control group ( median age was 37±8,2 (group 2 were enrolled to study. The average mitral valve area of patients was 1.1±0,3 cm2. When patients were divided according to New York Heart Association (NYHA classification ; 16 patients were NYHA 2 (Grup A and 16 patients were NYHA 3 (Grup B. There were not any asymptomatic patients and no patients were NYHA 4. Left atrium diameters, left atrium volume, left atrium fractional area change and left atrium ejection fractions  of patients in these groups were calculated.   Results: The demographic characteristics of patients is shown in table 1. Left atrium ejection fraction (LAEF and left atrium fractional area change (LAFAC that were determined echocardiographycally were significantly lower in patients with mitral stenosis (32 ± 5, 44 ± 3; p<0.001- 25 ± 11, 32 ± 6; p< 0.02.  When patients were divided according to New York Heart Association (NYHA classification ; 16 patients were NYHA 2 (Grup A and 16 patients were NYHA 3 (Grup B. There were not any asymptomatic patients and no patients were NYHA 4. The clinical and echocardiographic data of patients are shown in table 2. Despite of similar mitral valve area and average mitral gradient ,systolic pulmonary artery pressure was found to be higher in symptomatic group. But there was no difference between left atrial functions of the two groups.   Discussion: In this study we have shown that left atrial functions determined echocardiographically  can decline in patients with mitral stenosis but the

Effect of atrial systole on canine and porcine coronary blood flow.

Science.gov (United States)

Bellamy, R F

1981-09-01

A feature of phasic coronary flow patterns recorded in conscious chronically instrumented dogs is the atrial cove--a transient depression of arterial flow that occurs during atrial systole. The association between the hemodynamic effects of atrial systole and the atrial cove was studied in anesthetized dogs and pigs with complete heart block. Many atrial coves are available for study in these preparations because atrial activity continues unabated during the diastolic ventricular arrest that follows cessation of electrical pacing. The effect of atrial systole is to translate the pressure-flow relation found during diastole to a higher intercept pressure without change in slope. The increase in the intercept pressure equals the increase in intramyocardial pressure measured with microtransducers embedded in the left ventricular wall. The decrement in flow during the atrial cove is a direct function of the change in intramyocardial pressure and an inverse function of coronary vascular resistance. Each atrial systole is associated with a forward flow transient in the coronary veins, the peak of which occurs at the same instant as does the nadir of atrial flow. These data suggest that the coronary vessels are acting as collapsible tubes and that the waterfall model of the coronary circulation is applicable. The following sequence is proposed to account for the atrial cove. Atrial systole ejects a bolus of blood into the left ventricle increasing both ventricular cavity and intramyocardial pressures. The increase in intramyocardial pressure raises the back pressure opposing coronary flow, reducing the arterial perfusion pressure gradient and causing flow to fall.

Clinical application of percutaneous balloon mitral valvuloplasty in patients with rheumatic mitral stenosis and left atrial thrombi

International Nuclear Information System (INIS)

Chen Junzhu; Zhang Furong; Tao Qianmin; Cheng Guanchang; Zheng Liangrong; Zhu Jianhua

2002-01-01

Objective: To evaluate safety and effect of percutaneous balloon mitral valvuloplasty (PBMV) for patients with rheumatic mitral stenosis and left atrial thrombi. Methods: PBMV was performed in 27 patients with rheumatic mitral stenosis and left atrial thrombi. 19 cases of left atrial fresh thrombi revealed by trans-esophageal echocardiography (TEE) received warfarin orally for 3-6 months before PBMV. Results: PBMV was successful in all cases of mitral stenosis and left atrial thrombi. Left atrial fresh thrombi was completely resolved in 9 cases and became smaller chronic organized thrombi in 10 cases after warfarin anticoagulation treatment among 19 cases of left atrial fresh thrombi revealed by TEE. In 5 cases of left atrial chronic organized thrombi shown only transthoracic echocardiography and without anticoagulation treatment, one case had cerebral embolism. No complication occurred in other cases. Conclusions: The study showed that patients with rheumatic mitral stenosis and atrial fibrillation should have routine TEE. PBMV for rheumatic mitral stenosis with left atrial thrombi after anticoagulation treatment is safe and effective

Systolic and Diastolic Function by Tissue Doppler Imaging Predicts Mortality in Patients with Atrial Fibrillation

DEFF Research Database (Denmark)

Dons, Maria; BieringSørensen, Tor; Jensen, Jan Skov

2015-01-01

AIM: Tissue Doppler Imaging (TDI) detects early signs of left ventricular dysfunction. The prognostic potential of TDI in patients with atrial fibrillation (AF) has, however, not yet been clarified. This study evaluates the prognostic value of TDI in patients with atrial fibrillation. METHODS...

Association of pulse pressure with new-onset atrial fibrillation in patients with hypertension and left ventricular hypertrophy

DEFF Research Database (Denmark)

Larstorp, Anne Cecilie K; Ariansen, Inger; Gjesdal, Knut

2012-01-01

, and mean arterial pressure. When evaluated in the same model, the predictive effect of systolic and diastolic blood pressures together was similar to that of PP. In this population of patients with hypertension and left ventricular hypertrophy, PP was the strongest single blood pressure predictor of new......Previous studies have found pulse pressure (PP), a marker of arterial stiffness, to be an independent predictor of atrial fibrillation (AF) in general and hypertensive populations. We examined whether PP predicted new-onset AF in comparison with other blood pressure components in the Losartan...... Intervention For Endpoint reduction in hypertension study, a double-blind, randomized (losartan versus atenolol), parallel-group study, including 9193 patients with hypertension and electrocardiographic left ventricular hypertrophy. In 8810 patients with neither a history of AF nor AF at baseline, Minnesota...

Left-to-Right Atrial Inward Rectifier Potassium Current Gradients in Patients With Paroxysmal Versus Chronic Atrial Fibrillation

Science.gov (United States)

Voigt, Niels; Trausch, Anne; Knaut, Michael; Matschke, Klaus; Varró, András; Van Wagoner, David R.; Nattel, Stanley; Ravens, Ursula; Dobrev, Dobromir

2018-01-01

Background Recent evidence suggests that atrial fibrillation (AF) is maintained by high-frequency reentrant sources with a left-to-right–dominant frequency gradient, particularly in patients with paroxysmal AF (pAF). Unequal left-to-right distribution of inward rectifier K+ currents has been suggested to underlie this dominant frequency gradient, but this hypothesis has never been tested in humans. Methods and Results Currents were measured with whole-cell voltage-clamp in cardiomyocytes from right atrial (RA) and left (LA) atrial appendages of patients in sinus rhythm (SR) and patients with AF undergoing cardiac surgery. Western blot was used to quantify protein expression of IK1 (Kir2.1 and Kir2.3) and IK,ACh (Kir3.1 and Kir3.4) subunits. Basal current was ≈2-fold larger in chronic AF (cAF) versus SR patients, without RA-LA differences. In pAF, basal current was ≈2-fold larger in LA versus RA, indicating a left-to-right atrial gradient. In both atria, Kir2.1 expression was ≈2-fold greater in cAF but comparable in pAF versus SR. Kir2.3 levels were unchanged in cAF and RA-pAF but showed a 51% decrease in LA-pAF. In SR, carbachol-activated (2 μmol/L) IK,ACh was 70% larger in RA versus LA. This right-to-left atrial gradient was decreased in pAF and cAF caused by reduced IK,ACh in RA only. Similarly, in SR, Kir3.1 and Kir3.4 proteins were greater in RA versus LA and decreased in RA of pAF and cAF. Kir3.1 and Kir3.4 expression was unchanged in LA of pAF and cAF. Conclusions Our results support the hypothesis that a left-to-right gradient in inward rectifier background current contributes to high-frequency sources in LA that maintain pAF. These findings have potentially important implications for development of atrial-selective therapeutic approaches. PMID:20657029

Left ventricular diastolic dysfunction in chronic renal failure patients on chronic hemodialysis in Dr. Cipto-Mangunkusumo Hospital : the association with left ventricular mass

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Idrus Alwi

2006-06-01

Full Text Available Fourty three patients with chronic renal failure undergoing chronic hemodialysis in Division of Nephrology and Hypertension, Faculty of Medicine, University of Indonesia/Cipto-Mangunkusumo Hospital, Jakarta, since October 2003 until February 2004, were examined for echocardiography (2-D, M-mode, Doppler imaging.Diastolic dysfunction was found in 58.1 % of chronic renal failure patients on hemodialysis. There was no significant difference between left ventricular mass in the group with or without left ventricular diastolic dysfunction. (Med J Indones 2006; 15:105-8Keywords: Left ventricular mass, diastolic function, chronic renal failure, hemodyalisis

Left atrial appendage occlusion for stroke prevention in atrial fibrillation in Europe

DEFF Research Database (Denmark)

Lip, Gregory Y.H.; Dagres, Nikolaos; Proclemer, Alessandro

2013-01-01

The purpose of this EP wire survey was to assess clinical practice in relation to the use of left atrial appendage occlusion (LAAO) devices for stroke prevention in atrial fibrillation (AF) among members of the European Heart Rhythm Association research network. The average number of performed LA...... are most often performed by interventional cardiologists. Experience varied widely, and this was reflected in the wide range of thromboembolic and procedural (tamponade, bleeding) complications reported by the respondents to this EP wire survey....

Speckle tracking analysis: a new tool for left atrial function analysis in systemic hypertension: an overview.

Science.gov (United States)

Cameli, Matteo; Ciccone, Marco M; Maiello, Maria; Modesti, Pietro A; Muiesan, Maria L; Scicchitano, Pietro; Novo, Salvatore; Palmiero, Pasquale; Saba, Pier S; Pedrinelli, Roberto

2016-05-01

Speckle tracking echocardiography (STE) is an imaging technique applied to the analysis of left atrial function. STE provides a non-Doppler, angle-independent and objective quantification of left atrial myocardial deformation. Data regarding feasibility, accuracy and clinical applications of left atrial strain are rapidly gathering. This review describes the fundamental concepts of left atrial STE, illustrates its pathophysiological background and discusses its emerging role in systemic arterial hypertension.

Left Atrial Linear Ablation of Paroxysmal Atrial Fibrillation Guided by Three-dimensional Electroanatomical System

DEFF Research Database (Denmark)

Zhang, Dai-Fu; Li, Ying; Qi, Wei-Gang

2005-01-01

Objective To investigate the safety and efficacy of Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system. Methods 29 patients with paroxysmal atrial fibrillation in this study. A nonfluoroscopic mapping system was used to generate a 3D...... electroanatomic LA mapping, and all pulmonary vein ostia were marked under the help of pulmonary veins angiography on the 3D map. Radiofrequency (RF) energy was delivered to create continuous linear lesions encircling the pulmonary veins, it was delivered with a target temperature of 43¿, a maximal power limit...

Nuclear medical determination of left ventricular diastolic function in coronary heart disease

International Nuclear Information System (INIS)

Brugger, P.; Laesser, W.K.; Kullich, W.; Stoiberer, I.; Klein, G.

1985-01-01

In 64 patients with coronary heart disease, the left ventricular diastolic function was determined by means of a new nuclear medical method (nuclear stethoscope). The investigations revealed an abnormal diastolic filling in 85.9% of the cases on the basis of the parameters peak filling rate and time to peak filling rate as manifestation of a disturbed ventricular function

Angiotensin converting enzyme 2 activity and human atrial fibrillation: increased plasma angiotensin converting enzyme 2 activity is associated with atrial fibrillation and more advanced left atrial structural remodelling.

Science.gov (United States)

Walters, Tomos E; Kalman, Jonathan M; Patel, Sheila K; Mearns, Megan; Velkoska, Elena; Burrell, Louise M

2017-08-01

Angiotensin converting enzyme 2 (ACE2) is an integral membrane protein whose main action is to degrade angiotensin II. Plasma ACE2 activity is increased in various cardiovascular diseases. We aimed to determine the relationship between plasma ACE2 activity and human atrial fibrillation (AF), and in particular its relationship to left atrial (LA) structural remodelling. One hundred and three participants from a tertiary arrhythmia centre, including 58 with paroxysmal AF (PAF), 20 with persistent AF (PersAF), and 25 controls, underwent clinical evaluation, echocardiographic analysis, and measurement of plasma ACE2 activity. A subgroup of 20 participants underwent invasive LA electroanatomic mapping. Plasma ACE2 activity levels were increased in AF [control 13.3 (9.5-22.3) pmol/min/mL; PAF 16.9 (9.7-27.3) pmol/min/mL; PersAF 22.8 (13.7-33.4) pmol/min/mL, P = 0.006]. Elevated plasma ACE2 was associated with older age, male gender, hypertension and vascular disease, elevated left ventricular (LV) mass, impaired LV diastolic function and advanced atrial disease (P < 0.05 for all). Independent predictors of elevated plasma ACE2 activity were AF (P = 0.04) and vascular disease (P < 0.01). There was a significant relationship between elevated ACE2 activity and low mean LA bipolar voltage (adjusted R2 = 0.22, P = 0.03), a high proportion of complex fractionated electrograms (R2 = 0.32, P = 0.009) and a long LA activation time (R2 = 0.20, P = 0.04). Plasma ACE2 activity is elevated in human AF. Both AF and vascular disease predict elevated plasma ACE2 activity, and elevated plasma ACE2 is significantly associated with more advanced LA structural remodelling. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Management of left atrial myxomas at civil hospital, Karachi

International Nuclear Information System (INIS)

Iqbal, M.I.; Khan, A.B.; Aftab, S.; Mahmood, S.A.

2008-01-01

To study the outcome of the management of left atrial myxoma. The diagnosis was made according to clinical presentation and echocardiographic examinations. Tumour excised under cardiopulmonary bypass using aortic and bicaval cannulation and moderate hypothermia. Variables noted were surgical approach, pathological findings and complications after surgery. Of the 12 cases, six were male and six female, with a mean age of 33.67+-6.05 years. Fatigue and fever were the most common general symptoms, and dyspnoea the most common cardiologic symptom. The pedunculated atrial tumours were excised by trans-septal approach; tumour size ranged between 1.5x1x0.7 cms to 9x8x6 cms and weight 3-140 gms. Histopathology confirmed the tumours as atrial myxomas. One patient died of cerebrovascular accident on the 3rd postoperative day. So far, there has been no recurrence of the tumours. Surgical treatment with wide excision of left atrial myxomas by trans-septal approach is a suitable approach with negligible chances of recurrence. (author)

Left atrial myxoma, ruptured chordae tendinae causing mitral regurgitation and coronary artery disease

Directory of Open Access Journals (Sweden)

Bhupesh Kumar

2014-01-01

Full Text Available Mitral regurgitation is uncommon with left atrial myxoma. The echocardiographic assessment of presence of mitral regurgitation and its severity are impaired by the presence of left atrial myxoma. We describe an uncommon association of left atrial myxoma with coronary artery disease and mitral regurgitation. MR was reported as mild on pre-operative transthoracic echocardiography but found to be severe due to ruptured chordae tendinae during intra-operative transesophageal echocardiography, which lead to change in the surgical plan to mitral valve replacement in addition to excision of myxoma.

Hyperthyroidism and atrial myxoma--an intriguing cardio-endocrine association.

Science.gov (United States)

Kumar, Gautam; Chow, John T; Klarich, Kyle W; Dean, Diana S

2007-12-01

A 65-year-old woman presented with dyspnea and bilateral leg edema for 1 week, worsening fatigue for 1 month, and a 7-lb weight loss over the last summer. She was clinically and biochemically hyperthyroid. Echocardiography revealed a left atrial myxoma measuring 6.2 x 3.3 cm protruding into the mitral orifice and left ventricle during diastole. She was treated for Graves' disease with Iodine-131. Six weeks later, her left atrial myxoma measuring 10.1 x 6.2 x 2.4 cm was resected. She became euthyroid before surgery and then biochemically hypothyroid 6 weeks after radioiodine treatment, for which she subsequently required thyroxine replacement. Atrial myxomas are the most common primary cardiac neoplasms. At least 5% to 10% can be attributed to Carney's complex. More than two-thirds of patients with Carney's complex develop one or more cardiac myxomas. Although atrial myxomas in Carney's complex are histologically indistinguishable from the sporadic form, their clinical presentation and course is distinct. This is the first case of newly diagnosed Graves' disease that has been reported in association with an atrial myxoma. The features discussed in this article help differentiate between syndromic and sporadic atrial myxomas.

Early and simple detection of diastolic dysfunction during weaning from mechanical ventilation.

Science.gov (United States)

Voga, Gorazd

2012-07-06

Weaning from mechanical ventilation imposes additional work on the cardiovascular system and can provoke or unmask left ventricular diastolic dysfunction with consecutive pulmonary edema or systolic dysfunction with inadequate increase of cardiac output and unsuccessful weaning. Echocardiography, which is increasingly used for hemodynamic assessment of critically ill patients, allows differentiation between systolic and diastolic failure. For various reasons, transthoracic echocardiographic assessment was limited to patients with good echo visibility and to those with sinus rhythm without excessive tachycardia. In these patients, often selected after unsuccessful weaning, echocardiographic findings were predictive for weaning failure of cardiac origin. In some studies, patients with various degrees of systolic dysfunction were included, making evaluation of the diastolic dysfunction to the weaning failure even more difficult. The recent study by Moschietto and coworkers included unselected patients and used very simple diastolic variables for assessment of diastolic function. They also included patients with atrial fibrillation and repeated echocardiographic examination only 10 minutes after starting a spontaneous breathing trial. The main finding was that weaning failure was not associated with systolic dysfunction but with diastolic dysfunction. By measuring simple and robust parameters for detection of diastolic dysfunction, the study was able to predict weaning failure in patients with sinus rhythm and atrial fibrillation as early as 10 minutes after beginning a spontaneous breathing trial. Further studies are necessary to determine whether appropriate treatment tailored according to the echocardiographic findings will result in successful weaning.

The Prognostic Value of Left Atrial Peak Reservoir Strain in Acute Myocardial Infarction Is Dependent on Left Ventricular Longitudinal Function and Left Atrial Size

DEFF Research Database (Denmark)

Ersbøll, Mads; Andersen, Mads J; Valeur, Nana

2013-01-01

of PALS and left ventricular longitudinal strain (global longitudinal strain) in large-scale populations in regard to prognosis. METHODS AND RESULTS: We prospectively included 843 patients (mean age 62.1+/-11.8; 74% male) with acute myocardial infarction and measured global longitudinal strain, left......BACKGROUND: Peak atrial longitudinal strain (PALS) during the reservoir phase has been proposed as a measure of left atrium function in a range of cardiac conditions, with the potential for added pathophysiological insight and prognostic value. However, no studies have assessed the interrelation...

Magnetic resonance tissue phase mapping demonstrates altered left ventricular diastolic function in children with chronic kidney disease

International Nuclear Information System (INIS)

Gimpel, Charlotte; Pohl, Martin; Jung, Bernd A.; Jung, Sabine; Brado, Johannes; Odening, Katja E.; Schwendinger, Daniel; Burkhardt, Barbara; Geiger, Julia; Arnold, Raoul

2017-01-01

Echocardiographic examinations have revealed functional cardiac abnormalities in children with chronic kidney disease. To assess the feasibility of MRI tissue phase mapping in children and to assess regional left ventricular wall movements in children with chronic kidney disease. Twenty pediatric patients with chronic kidney disease (before or after renal transplantation) and 12 healthy controls underwent tissue phase mapping (TPM) to quantify regional left ventricular function through myocardial long (Vz) and short-axis (Vr) velocities at all 3 levels of the left ventricle. Patients and controls (age: 8 years - 20 years) were matched for age, height, weight, gender and heart rate. Patients had higher systolic blood pressure. No patient had left ventricular hypertrophy on MRI or diastolic dysfunction on echocardiography. Fifteen patients underwent tissue Doppler echocardiography, with normal z-scores for mitral early diastolic (V E ), late diastolic (V A ) and peak systolic (V S ) velocities. Throughout all left ventricular levels, peak diastolic Vz and Vr (cm/s) were reduced in patients: Vz base -10.6 ± 1.9 vs. -13.4 ± 2.0 (P < 0.0003), Vz mid -7.8 ± 1.6 vs. -11 ± 1.5 (P < 0.0001), Vz apex -3.8 ± 1.6 vs. -5.3 ± 1.6 (P = 0.01), Vr base -4.2 ± 0.8 vs. -4.9 ± 0.7 (P = 0.01), Vr mid -4.7 ± 0.7 vs. -5.4 ± 0.7 (P = 0.01), Vr apex -4.7 ± 1.4 vs. -5.6 ± 1.1 (P = 0.05). Tissue phase mapping is feasible in children and adolescents. Children with chronic kidney disease show significantly reduced peak diastolic long- and short-axis left ventricular wall velocities, reflecting impaired early diastolic filling. Thus, tissue phase mapping detects chronic kidney disease-related functional myocardial changes before overt left ventricular hypertrophy or echocardiographic diastolic dysfunction occurs. (orig.)

The left atrium, atrial fibrillation, and the risk of stroke in hypertensive patients with left ventricular hypertrophy

DEFF Research Database (Denmark)

Wachtell, K.; Devereux, R.B.; Lyle, P.A.

2008-01-01

was superior to atenolol-based treatment for reducing new-onset AF and complications, especially stroke, associated with new-onset or pre-existing AF. Potential mechanisms of AF prevention by angiotensin receptor blockade supported by LIFE results include greater reduction in left atrial size and LV......The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study provided extensive data on predisposing factors, consequences, and prevention of atrial fibrillation (AF) in patients with hypertension and left ventricular (LV) hypertrophy. Randomized losartan-based treatment...... hypertrophy. Differential effects of antihypertensive treatment on the left atrium and left ventricle may help prevent AF and reduce risk of stroke associated with hypertensive heart disease Udgivelsesdato: 2008/12...

Diastolic chamber properties of the left ventricle assessed by global fitting of pressure-volume data: improving the gold standard of diastolic function.

Science.gov (United States)

Bermejo, Javier; Yotti, Raquel; Pérez del Villar, Candelas; del Álamo, Juan C; Rodríguez-Pérez, Daniel; Martínez-Legazpi, Pablo; Benito, Yolanda; Antoranz, J Carlos; Desco, M Mar; González-Mansilla, Ana; Barrio, Alicia; Elízaga, Jaime; Fernández-Avilés, Francisco

2013-08-15

In cardiovascular research, relaxation and stiffness are calculated from pressure-volume (PV) curves by separately fitting the data during the isovolumic and end-diastolic phases (end-diastolic PV relationship), respectively. This method is limited because it assumes uncoupled active and passive properties during these phases, it penalizes statistical power, and it cannot account for elastic restoring forces. We aimed to improve this analysis by implementing a method based on global optimization of all PV diastolic data. In 1,000 Monte Carlo experiments, the optimization algorithm recovered entered parameters of diastolic properties below and above the equilibrium volume (intraclass correlation coefficients = 0.99). Inotropic modulation experiments in 26 pigs modified passive pressure generated by restoring forces due to changes in the operative and/or equilibrium volumes. Volume overload and coronary microembolization caused incomplete relaxation at end diastole (active pressure > 0.5 mmHg), rendering the end-diastolic PV relationship method ill-posed. In 28 patients undergoing PV cardiac catheterization, the new algorithm reduced the confidence intervals of stiffness parameters by one-fifth. The Jacobian matrix allowed visualizing the contribution of each property to instantaneous diastolic pressure on a per-patient basis. The algorithm allowed estimating stiffness from single-beat PV data (derivative of left ventricular pressure with respect to volume at end-diastolic volume intraclass correlation coefficient = 0.65, error = 0.07 ± 0.24 mmHg/ml). Thus, in clinical and preclinical research, global optimization algorithms provide the most complete, accurate, and reproducible assessment of global left ventricular diastolic chamber properties from PV data. Using global optimization, we were able to fully uncouple relaxation and passive PV curves for the first time in the intact heart.

Does Left Atrial Volume and Pulmonary Venous Anatomy Predict the Outcome of Catheter Ablation of Atrial Fibrillation ?

NARCIS (Netherlands)

Hof, Irene; Chilukuri, Karuna; Arbab-Zadeh, Armin; Scherr, Daniel; Dalal, Darshan; Nazarian, Saman; Henrikson, Charles; Spragg, David; Berger, Ronald; Marine, Joseph; Calkins, Hugh

Introduction: Preprocedural factors may be helpful in selecting patients with atrial fibrillation (AF) for treatment with catheter ablation and in making an assumption regarding their prognosis. The aims of this study were to investigate whether left atrial (LA) volume and pulmonary venous (PV)

Left atrial volume index is an independent predictor of hypertensive response to exercise in patients with hypertension.

Science.gov (United States)

Lee, Sang-Eun; Youn, Jong-Chan; Lee, Hye Sun; Park, Sungha; Lee, Sang-Hak; Cho, In-Jeong; Shim, Chi Young; Hong, Geu-Ru; Choi, Donghoon; Kang, Seok-Min

2015-02-01

A hypertensive response to exercise (HRE) is known to be associated with higher risk of heart failure and future cardiovascular events in patients with hypertension. Left atrial volume index (LAVI) is associated with the diastolic dysfunction, indicating exercise intolerance. Therefore, we investigated whether LAVI is relevant to HRE during cardiopulmonary exercise test (CPET). We studied 118 consecutive hypertensive patients (61 men, 57±11 years) and 45 normotensive control subjects (16 men, 54±8 years). Clinical characteristics, CPET, echocardiographic and laboratory findings were assessed at the time of enrollment. HRE was defined as maximum systolic blood pressure (SBP)⩾210 mm Hg in men and ⩾190 mm Hg in women. HRE was more prevalent in hypertensive patients compared with normotensive control subjects (50.8% vs. 20.0%, PHRE in normotensive control subjects, as were baseline SBP and LAVI in hypertensive group. In multivariate analysis, LAVI was found to be an independent predictor of HRE in hypertensive patients (P=0.020) but not in normotensive control subjects (P=0.936) when controlled for age, sex, body mass index and peak oxygen consumption. Higher LAVI, reflecting the duration and severity of increased left atrial pressure is independently associated with HRE in hypertensive patients, but not in normotensive control subjects.

Left-sided cardiac chamber evaluation using single-phase mid-diastolic coronary computed tomography angiography: derivation of normal values and comparison with conventional end-diastolic and end-systolic phases

Energy Technology Data Exchange (ETDEWEB)

Walker, Jonathan R. [Technion-Israel Institute of Technology, Haifa (Israel); Abadi, Sobhi [Rambam Health Care Campus, Medical Imaging Department, Haifa (Israel); Solomonica, Amir [Rambam Health Care Campus, Cardiology Department, Haifa (Israel); Mutlak, Diab; Aronson, Doron; Agmon, Yoram; Lessick, Jonathan [Rambam Health Care Campus, Cardiology Department, Haifa (Israel); Technion-Israel Institute of Technology, Haifa (Israel)

2016-10-15

With increasing use of prospective scanning techniques for cardiac computed tomography (CT), meaningful evaluation of chamber volumes is no longer possible due to lack of normal values. We aimed to define normal values for mid-diastolic (MD) chamber volumes and to determine their significance in comparison to maximum volumes. Normal ranges at MD for left ventricular (LV) volume and mass and left atrial (LA) volume were determined from 101 normal controls. Thereafter, 109 consecutive CT scans, as well as 21 post-myocardial infarction patients, were analysed to determine the relationship between MD and maximum volumes. MD volumes correlated closely with maximal volumes (r = 0.99) for both LV and LA, and could estimate maximum volumes accurately. LV mass, measured at ED or MD, were very similar (r = 0.99). Abnormal MD volumes had excellent sensitivity and specificity to detect chamber enlargement based on maximal volumes (LV 86 %, 100 %, respectively; LA 100 %, 92 %, respectively). A single MD phase can identify patients with cardiomegaly or LV hypertrophy with a high degree of accuracy and MD volumes can give an accurate estimate of maximum LV and LA volumes. circle Traditionally, helical cardiac CT provided clinically important information from chamber volume analysis. (orig.)

Pulmonary venous flows reflect changes in left atrial hemodynamics during mitral balloon valvotomy.

Science.gov (United States)

Yalçin, Fatih; El-Amrousy, Mahmoud; Müderrisoğlu, Haldun; Korkmaz, Mehmet; Flachskampf, Frank; Tuzcu, Murat; Garcia, Mario G; Thomas, James D

2002-01-01

Patients with mitral stenosis have usually blunted pulmonary venous (PV) flow, because of decreased mitral valve area and diastolic dysfunction. The authors compared changes in Doppler PV velocities by using transesophageal echocardiography (TEE) against hemodynamics parameters before and after mitral balloon valvotomy to observe relevance of PV velocities and endsystolic left atrial (LA) pressure-volume relationship. In 25 patients (aged 35 +/- 17 years) with mitral stenosis in sinus rhythm, changes in LA pressure and volumes were compared with PV velocities before and after valvotomy. Mitral valve area, mitral gradients, and deceleration time were obtained. Mitral valve area and mitral gradients changed from 1 +/- 0.2 cm2 and 14.6 +/- 5.4 mmHg to 1.9 +/- 0.3 cm2 and 6.3 +/- 1.7 mmHg, respectively (pLA pressure were correlated with changes in S/D (r=0.57, pLA pressure-volume relationship were also correlated with changes in S/D (r=0.52, pLA pressure-volume relationship decreased after mitral balloon valvotomy, as a result of a large decrease in pressure. PV systolic/diastolic (S/D) waves ratio reflects endsystolic LA pressure-volume relationship and may be used as another indicator of successful valvotomy.

Relation of Left Atrial Size, Cardiac Morphology, and Clinical Outcome in Asymptomatic Aortic Stenosis

DEFF Research Database (Denmark)

Christensen, Nicolaj Lyhne; Dahl, Jordi; Carter-Storch, Rasmus

2017-01-01

characterized by higher LV mass index (73 ± 17 g/m² vs. 66 ± 16 g/m² , p=0.03), increased right ventricle (70 ± 14 ml/m² vs. 63 ± 12 ml/m², p=0.01) and LV end-diastolic volume index (84 ± 18 ml/m² vs. 77 ± 16 ml/m², p=0.05), and higher brain natriuretic peptide (BNP). No difference in late enhancement was seen......Left atrial (LA) dilatation in asymptomatic severe aortic stenosis (AS) may be an indicator of advanced disease. The aim was to investigate the association between LA volume index (LAVi) and left ventricular (LV) morphology assessed with cardiac magnetic resonance imaging (cMRI), and to assess...... underwent echocardiography, cMRI, exercise test, and patients were followed for the composite endpoint of death, readmission or aortic valve replacement. AVA index was similar (0.45 ± 0.08 cm² /m² vs. 0.45 ± 0.09 cm², p=0.85) in patients with a dilated and normal LA. On cMRI patients with dilated LA were...

Surgery for atrial fibrillation.

Science.gov (United States)

Viganò, M; Graffigna, A; Ressia, L; Minzioni, G; Pagani, F; Aiello, M; Gazzoli, F

1996-01-01

The mechanisms of atrial fibrillation arc multiple reentry circuits spinning around the atrial surface, and these baffle any attempt to direct surgical interruption. The purpose of this article is to report the surgical experience in the treatment of isolated and concomitant atrial fibrillation at the Cardiac Surgical Institute of the University of Pavia. In cases of atrial fibrillation secondary to mitral/valve disease, surgical isolation of the left atrium at the time of mitral valve surgery can prevent atrial fibrillation from involving the right atrium, which can exert its diastolic pump function on the right ventricle. Left atrial isolation was performed on 205 patients at the time of mitral valve surgery. Atrial partitioning ("maze operation") creates straight and blind atrial alleys so that non-recentry circuits can take place. Five patients underwent this procedure. In eight-cases of atrial fibrillation secondary to atrial septal defect, the adult patients with atrial septal defect and chronic or paroxysmal atrial fibrillation underwent surgical isolation of the right atrium associated which surgical correction of the defect, in order to let sinus rhythm govern the left atrium and the ventricles. "Lone" atrial fibrillation occurs in hearts with no detectable organic disease. Bi-atrial isolation with creation of an atrial septal internodal "corridor" was performed on 14 patients. In cases of atrial fibrillation secondary to mitral valve disease, left atrial isolation was performed on 205 patients at the time of mitral valve surgery with an overall sinus rhythm recovery of 44%. In the same period, sinus rhythm was recovered and persisted in only 19% of 252 patients who underwent mitral valve replacement along (P < 0.001). Sinus rhythm was less likely to recover in patients with right atriomegaly requiring tricuspid valve annuloplasty: 59% vs 84% (P < 0.001). Restoration of the right atrial function raised the cardiac index from 2.25 +/- 0.55 1/min per m2

Association of renal biochemical parameters with left ventricular diastolic dysfunction in a community-based elderly population in China: a cross-sectional study.

Directory of Open Access Journals (Sweden)

Jingmin Zhou

Full Text Available BACKGROUND: Relationship of left ventricular diastolic dysfunction (LVDD with parameters that could provide more information than hemodynamic renal indexes has not been clarified. We aimed to explore the association of comprehensive renal parameters with LVDD in a community-based elderly population. METHODS: 1,166 community residents (aged ≥ 65 years, 694 females participating in the Shanghai Heart Health Study with complete data of renal parameters were investigated. Echocardiography was used to evaluate diastolic function with conventional and tissue Doppler imaging techniques. Serum urea, creatinine, urea-to-creatinine ratio, estimated glomerular filtration rate (eGFR and urinary albumin-to-creatinine ratio (UACR were analyzed on their associations with LVDD. RESULTS: The prevalence of LVDD increased in proportion to increasing serum urea, urea-to-creatinine ratio and UACR. These three renal parameters were found negatively correlated to peak early (E to late (A diastolic velocities ratio (E/A, and positively to left atrial volume index; UACR also positively correlated with E to peak early (E' diastolic mitral annular velocity ratio (E/E'. Serum urea, urea-to-creatinine ratio and UACR correlated with LVDD in logistic univariate regression analysis, and urea-to-creatinine ratio remained independently correlated to LVDD [Odds ratio (OR 2.82, 95% confidence interval (CI 1.34-5.95] after adjustment. Serum urea (OR 1.18, 95%CI 1.03-1.34, creatinine (OR 6.53, 95%CI 1.70- -25.02, eGFR (OR 0.22, 95%CI 0.07-0.65 and UACR (OR 2.15, 95%CI 1.42-3.24 were revealed independent correlates of advanced (moderate and severe LVDD. CONCLUSIONS: Biochemical parameters of renal function were closely linked with LVDD. This finding described new cardio-renal relationship in the elderly population.

Magnetic resonance tissue phase mapping demonstrates altered left ventricular diastolic function in children with chronic kidney disease

Energy Technology Data Exchange (ETDEWEB)

Gimpel, Charlotte; Pohl, Martin [Medical Center - University of Freiburg, Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Freiburg (Germany); Jung, Bernd A. [Inselspital Bern, Institute of Diagnostic, Interventional and Pediatric Radiology, Bern (Switzerland); Jung, Sabine [Medical Center - University of Freiburg, Department of Nuclear Medicine, Freiburg (Germany); Brado, Johannes; Odening, Katja E. [University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg (Germany); Schwendinger, Daniel [University Children' s Hospital Zurich, Zurich (Switzerland); Burkhardt, Barbara [University Children' s Hospital Zurich, Pediatric Heart Center, Zurich (Switzerland); Geiger, Julia [University Children' s Hospital Zurich, Department of Radiology, Zurich (Switzerland); Northwestern University, Department of Radiology, Chicago, IL (United States); Arnold, Raoul [University Hospital Heidelberg, Department of Pediatric and Congenital Cardiology, Heidelberg (Germany)

2017-02-15

Echocardiographic examinations have revealed functional cardiac abnormalities in children with chronic kidney disease. To assess the feasibility of MRI tissue phase mapping in children and to assess regional left ventricular wall movements in children with chronic kidney disease. Twenty pediatric patients with chronic kidney disease (before or after renal transplantation) and 12 healthy controls underwent tissue phase mapping (TPM) to quantify regional left ventricular function through myocardial long (Vz) and short-axis (Vr) velocities at all 3 levels of the left ventricle. Patients and controls (age: 8 years - 20 years) were matched for age, height, weight, gender and heart rate. Patients had higher systolic blood pressure. No patient had left ventricular hypertrophy on MRI or diastolic dysfunction on echocardiography. Fifteen patients underwent tissue Doppler echocardiography, with normal z-scores for mitral early diastolic (V{sub E}), late diastolic (V{sub A}) and peak systolic (V{sub S}) velocities. Throughout all left ventricular levels, peak diastolic Vz and Vr (cm/s) were reduced in patients: Vz{sub base} -10.6 ± 1.9 vs. -13.4 ± 2.0 (P < 0.0003), Vz{sub mid} -7.8 ± 1.6 vs. -11 ± 1.5 (P < 0.0001), Vz{sub apex} -3.8 ± 1.6 vs. -5.3 ± 1.6 (P = 0.01), Vr{sub base} -4.2 ± 0.8 vs. -4.9 ± 0.7 (P = 0.01), Vr{sub mid} -4.7 ± 0.7 vs. -5.4 ± 0.7 (P = 0.01), Vr{sub apex} -4.7 ± 1.4 vs. -5.6 ± 1.1 (P = 0.05). Tissue phase mapping is feasible in children and adolescents. Children with chronic kidney disease show significantly reduced peak diastolic long- and short-axis left ventricular wall velocities, reflecting impaired early diastolic filling. Thus, tissue phase mapping detects chronic kidney disease-related functional myocardial changes before overt left ventricular hypertrophy or echocardiographic diastolic dysfunction occurs. (orig.)

Beneficial effects of elevating cardiac preload on left-ventricular diastolic function and volume during heat stress

DEFF Research Database (Denmark)

Brothers, R M; Pecini, Redi; Dalsgaard, Morten

2014-01-01

via volume loading while heat stressed would 1) increase indices of left ventricular diastolic function, and 2) preserve left ventricular end-diastolic volume (LVEDV) during a subsequent simulated hemorrhagic challenge induced by lower-body negative pressure (LBNP). Indices of left ventricular......Volume loading normalizes tolerance to a simulated hemorrhagic challenge in heat-stressed individuals, relative to when these individuals are thermoneutral. The mechanism(s) by which this occurs is unknown. This project tested two unique hypotheses; that is, the elevation of central blood volume...... diastolic function were evaluated in nine subjects during the following conditions: thermoneutral, heat stress, and heat stress after acute volume loading sufficient to return ventricular filling pressures toward thermoneutral levels. LVEDV was also measured in these subjects during the aforementioned...

Left ventricular diastolic function in patients with coronary artery disease

Energy Technology Data Exchange (ETDEWEB)

Brugger, P.T.

1986-08-01

In 302 patients with confirmed coronary disease we determined the left ventricular diastolic function with the Nuclear Stethoscope by the aid of the Peak Filling Rate (PFR) and the Time to Peak Filling Rate (TPFR). Moreover we investigated the ejection fraction (EF). 201 patients had already suffered a myocardial infarction, of these 99 an anterior wall and 102 an inferior wall infarction. The remaining 101 patients had a CAD without a history of myocardial infarction. The PFR was 2.19 +- 0.65 EDV/sec in the 99 patients after anterior wall infarction and 2.62 +- 0.85 EDV/sec in the 102 patients after inferior wall infarction and 2.79 +- 0.85 EDV/sec in 101 patients with coronary artery disease without a history of myocardial infarction. For the PFR there could be found a statistically significant difference between normal patients and patients after anterior wall infarction (p < 0.0001), normal patients and patients after inferior wall infarction (p < 0.0001) and normal patients and patients with coronary artery disease (p < 0.0001). The TPFR was 180 +- 37.5 msec after anterior - and 158 +- 50.7 msec after inferior wall infarction and 156 +- 45.2 msec in the patients with CAD without previous infarction. The left ventricular diastolic function (PFR and/or TPFR) was abnormal in 88% after anterior- and in 82% after inferior wall infarction and in 69% in coronary patients without previous myocardial infarction. In comparison with this the ejection fraction was reduced in 66% in anterior- and in 61% inferior wall infarction at rest. These results indicate that the diastolic function at rest appears to be more informative for evaluation of a left ventricular dysfunction than the systolic function at rest.

Left Ventricular Diastolic Function and Characteristics in Fetal Aortic Stenosis

Science.gov (United States)

Friedman, Kevin G.; Schidlow, David; Freud, Lindsay; Escobar-Diaz, Maria; Tworetzky, Wayne

2014-01-01

Fetal aortic valvuloplasty (FAV) has shown promise in averting progression of mid-gestation aortic stenosis (AS) to hypoplastic left heart syndrome in a subset of patients. Patients who achieve biventricular circulation after FAV frequently have left ventricular (LV) diastolic dysfunction (DD). This study evaluates DD in fetuses with AS by comparing echocardiographic indices of LV diastolic function in fetuses undergoing FAV (n=20) to controls (n=40) and evaluates for LV factors associated with DD in FAV patients. We also compared pre- and post-FAV DD variables (n=16). Median gestational age (24 weeks, range 18–29 weeks) and fetal heart rate were similar between FAV and controls. Compared to controls, FAV patients had universally abnormal LV diastolic parameters including fused mitral inflow E and A waves (p=0.008), higher E velocity(p<0.001), shorter mitral inflow time (p=0.001), lower LV lateral annulus E′ (p<0.001), septal E′ (p=0.003) and higher E/E′ (p<0.001) than controls. FAV patients had abnormal right ventricular mechanics with higher tricuspid inflow E velocity (p<0.001), and shorter tricuspid inflow time (p=0.03). Worse LV diastolic function (lower LV E′) was associated with higher endocardial fibroelastosis (EFE) grade (r=0.74, p<0.001), large LV volume (r=0.55, p=0.013) and sphericity (r=0.58, P=0.009) and with lower LV pressure by mitral regurgitation jet (r=−0.68, p<0.001). Post-FAV, fewer patients had fused mitral inflow E and A than pre-FAV (p=0.05) and septal E′ was higher (=0.04). In conclusion, fetuses with mid-gestation AS have evidence of marked DD. Worse DD is associated with larger, more spherical LV, with more extensive EFE and lower LV pressure. PMID:24819899

In-treatment reduced left atrial diameter during antihypertensive treatment is associated with reduced new-onset atrial fibrillation in hypertensive patients with left ventricular hypertrophy: The LIFE Study

DEFF Research Database (Denmark)

Wachtell, Kristian; Gerdts, Eva; Aurigemma, Gerard P

2010-01-01

It is unclear whether improvement of left atrial (LA) and ventricular (LV) structure results in reduction in new-onset atrial fibrillation (AF). The aim of the present study was to examine whether changes in-treatment LA diameter were related to changes in risk of new-onset AF....

Diastolic coronary artery pressure-flow velocity relationships in conscious man.

Science.gov (United States)

Dole, W P; Richards, K L; Hartley, C J; Alexander, G M; Campbell, A B; Bishop, V S

1984-09-01

We characterised the diastolic pressure-flow velocity relationship in the normal left coronary artery of conscious man before and after vasodilatation with angiographic contrast medium. Phasic coronary artery pressure and flow velocity were measured in ten patients during individual diastoles (0.5 to 1.0 s) using a 20 MHz catheter-tipped, pulsed Doppler transducer. All pressure-flow velocity curves were linear over the diastolic pressure range of 110 +/- 15 (SD) mmHg to 71 +/- 7 mmHg (r = 0.97 +/- 0.01). In the basal state, values for slope and extrapolated zero flow pressure intercept averaged 0.35 +/- 0.12 cm X s-1 X mmHg-1 and 51.7 +/- 8.6 mmHg, respectively. Vasodilatation resulted in a 2.5 +/- 0.5 fold increase in mean flow velocity. The diastolic pressure-flow velocity relationship obtained during peak vasodilatation compared to that during basal conditions was characterised by a steeper slope (0.80 +/- 0.48 cm X s-1 X mmHg-1, p less than 0.001) and lower extrapolated zero flow pressure intercept (37.9 +/- 9.8 mmHg, p less than 0.05). Mean right atrial pressure for the group averaged 4.4 +/- 1.7 mmHg, while left ventricular end-diastolic pressure averaged 8.7 +/- 2.8 mmHg. These observations in man are similar to data reported in the canine coronary circulation which are consistent with a vascular waterfall model of diastolic flow regulation. In this model, coronary blood flow may be regulated by changes in diastolic zero flow pressure as well as in coronary resistance.

Effect of Mitral Annular Calcium on Left Ventricular Diastolic Parameters.

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Codolosa, Jose N; Koshkelashvili, Nikoloz; Alnabelsi, Talal; Goykhman, Igor; Romero-Corral, Abel; Pressman, Gregg S

2016-03-01

Assessment of left ventricular (LV) diastolic function by Doppler flow imaging and tissue Doppler is an integral part of the echocardiographic examination. Mitral annular calcium (MAC) is frequently encountered on echocardiography. The aim of this study was to assess the impact of MAC, quantitatively measured by computed tomography scan, on echocardiographic LV diastolic parameters. We included 155 patients aged ≥65 years. Computed tomography reconstructions of the mitral annulus were created, and calcium identified and quantified by Agatston technique. Calcium locations were assigned using an overlaid template depicting the annular segments in relation to surrounding anatomic structures. Echocardiographic assessment of diastolic function was performed in standard fashion. Mean age was 77 years; 49% were men; and 43% were black. Patients with MAC had lower septal e' (p = 0.003), lateral e' (p = 0.04), and average e' (p = 0.01) compared with those without MAC. They also had a higher E-wave velocity (p = 0.01) and E/e' ratio (p <0.001). When evaluated by severity of MAC, and after adjustment for multiple clinical factors, there was a graded (inverse) relation between MAC severity and septal e' (p = 0.01), lateral e' (p = 0.01), and average e' (p = 0.01). In conclusion, LV diastolic parameters, as measured by Doppler echocardiography, are altered in the presence of MAC. This could be due to direct effects of MAC on annular function or might reflect truly reduced diastolic function. Interpretation of diastolic parameters in patients with MAC should be performed with caution. Copyright © 2016 Elsevier Inc. All rights reserved.

4D flow MRI assessment of right atrial flow patterns in the normal heart - influence of caval vein arrangement and implications for the patent foramen ovale.

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Jehill D Parikh

Full Text Available To investigate atrial flow patterns in the normal adult heart, to explore whether caval vein arrangement and patency of the foramen ovale (PFO may be associated with flow pattern.Time-resolved, three-dimensional velocity encoded magnetic resonance imaging (4D flow was employed to assess atrial flow patterns in thirteen healthy subjects (6 male, 40 years, range 25-50 and thirteen subjects (6 male, 40 years, range 21-50 with cryptogenic stroke and patent foramen ovale (CS-PFO. Right atrial flow was defined as vortical, helico-vortical, helical and multiple vortices. Time-averaged and peak systolic and diastolic flows in the caval and pulmonary veins and their anatomical arrangement were compared.A spectrum of right atrial flow was observed across the four defined categories. The right atrial flow patterns were strongly associated with the relative position of the caval veins. Right atrial flow patterns other than vortical were more common (p = 0.015 and the separation between the superior and inferior vena cava greater (10±5mm versus 3±3mm, p = 0.002 in the CS-PFO group. In the left atrium all subjects except one had counter-clockwise vortical flow. Vortex size varied and was associated with left lower pulmonary vein flow (systolic r = 0.61, p = 0.001, diastolic r = 0.63 p = 0.002. A diastolic vortex was less common and time-averaged left atrial velocity was greater in the CS-PFO group (17±2cm/sec versus 15±1, p = 0.048. One CS-PFO subject demonstrated vortical retrograde flow in the descending aortic arch; all other subjects had laminar descending aortic flow.Right atrial flow patterns in the normal heart are heterogeneous and are associated with the relative position of the caval veins. Patterns, other than 'typical' vortical flow, are more prevalent in the right atrium of those with cryptogenic stroke in the context of PFO. Left atrial flow patterns are more homogenous in normal hearts and show a relationship with flow arising from the left

Transient left atrial dysfunction is a feature of Takotsubo syndrome

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Stiermaier, Thomas; Graf, Tobias; Möller, Christian

2017-01-01

BACKGROUND: Takotsubo syndrome (TTS) is characterized by a transient left and/or right ventricular dysfunction as a consequence of a distinctive pattern of regional wall motion abnormalities. However, a systematic evaluation of the left atrial (LA) function in patients with TTS is lacking. The ai...

Plasmacytoid lymphoma within a left atrial myxoma: a rare coincidental dual pathology.

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White, Ralph W; Hirst, Natalie A; Edward, Sara; Nair, Unnikrishnan R

2010-01-01

Primary malignant cardiac neoplasms are extremely rare. The occurrence of a malignant lymphoid tumour within a left atrial myxoma is highly atypical, with only one such case previously reported. Here, we describe a patient who presented with symptoms and signs of a left atrial myxoma. Subsequent specimen histology demonstrated the presence of lymphoma within the myxoma. We discuss the importance of histological diagnosis in order to best direct treatment and prognosis of such cases.

Overweight causes left ventricular diastolic asynchrony and diastolic dysfunction: a study based on speckle tracking echocardiography in healthy subjects.

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Nakabachi, Masahiro; Mikami, Taisei; Okada, Kazunori; Onozuka, Hisao; Kaga, Sanae; Inoue, Mamiko; Yokoyama, Shinobu; Nishida, Mutsumi; Shimizu, Chikara; Matsuno, Kazuhiko; Iwano, Hiroyuki; Yamada, Satoshi; Tsutsui, Hiroyuki

2012-09-01

Left ventricular (LV) diastolic dysfunction is often observed in healthy subjects and can be a cause of heart failure with preserved ejection fraction (EF). We aimed to investigate the role of LV diastolic asynchrony as a cause of diastolic dysfunction in healthy subjects. In 40 healthy subjects, two-dimensional speckle tracking imaging (2DSTI) was performed to measure the peak early diastolic longitudinal strain rates (Esr) of the apical, mid-ventricular, and basal segments of the septum and posterior wall. A mean value of the Esr of the 6 segments (mEsr) was calculated. The time from aortic valve closure to the Esr was measured for each segment, and the standard deviation (SDTEsr) was calculated. The peak global early diastolic strain rate (gEsr) was measured with a region of interest (ROI) on the whole LV myocardium. LV flow propagation velocity (FPV) was measured using conventional Doppler techniques. SDTEsr was not correlated with age, but was significantly correlated with body mass index (BMI) (r = 0.41, p < 0.01). Although no significant correlation was observed between mEsr and FPV, gEsr and SDTEsr significantly correlated with FPV (r = 0.41, p < 0.01; r = -0.54, p < 0.001). As a result of the multiple regression analysis, SDTEsr was the single determinant of FPV. Diastolic asynchrony, associated with overweight but not with aging, may contribute to diastolic dysfunction in healthy subjects.

Left atrial enlargement increases the risk of major adverse cardiac events independent of coronary vasodilator capacity

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Koh, Angela S. [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); National Heart Centre Singapore, Singapore (Singapore); Murthy, Venkatesh L.; Sitek, Arkadiusz; Gayed, Peter; Bruyere, John; Di Carli, Marcelo F. [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Wu, Justina [Brigham and Women' s Hospital, Division of Cardiology, Department of Medicine, and the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Boston, MA (United States); Dorbala, Sharmila [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Department of Radiology and the Division of Cardiology, Noninvasive Cardiovascular Imaging Section, Boston, MA (United States)

2015-09-15

Longstanding uncontrolled atherogenic risk factors may contribute to left atrial (LA) hypertension, LA enlargement (LAE) and coronary vascular dysfunction. Together they may better identify risk of major adverse cardiac events (MACE). The aim of this study was to test the hypothesis that chronic LA hypertension as assessed by LAE modifies the relationship between coronary vascular function and MACE. In 508 unselected subjects with a normal clinical {sup 82}Rb PET/CT, ejection fraction ≥40 %, no prior coronary artery disease, valve disease or atrial fibrillation, LAE was determined based on LA volumes estimated from the hybrid perfusion and CT transmission scan images and indexed to body surface area. Absolute myocardial blood flow and global coronary flow reserve (CFR) were calculated. Subjects were systematically followed-up for the primary end-point - MACE - a composite of all-cause death, myocardial infarction, hospitalization for heart failure, stroke, coronary artery disease progression or revascularization. During a median follow-up of 862 days, 65 of the subjects experienced a composite event. Compared with subjects with normal LA size, subjects with LAE showed significantly lower CFR (2.25 ± 0.83 vs. 1.95 ± 0.80, p = 0.01). LAE independently and incrementally predicted MACE even after accounting for clinical risk factors, medication use, stress left ventricular ejection fraction, stress left ventricular end-diastolic volume index and CFR (chi-squared statistic increased from 30.9 to 48.3; p = 0.001). Among subjects with normal CFR, those with LAE had significantly worse event-free survival (risk adjusted HR 5.4, 95 % CI 2.3 - 12.8, p < 0.0001). LAE and reduced CFR are related but distinct cardiovascular adaptations to atherogenic risk factors. LAE is a risk marker for MACE independent of clinical factors and left ventricular volumes; individuals with LAE may be at risk of MACE despite normal coronary vascular function. (orig.)

Creation of a restrictive atrial communication in heart failure with preserved and mid-range ejection fraction: effective palliation of left atrial hypertension and pulmonary congestion.

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Bauer, Anna; Khalil, Markus; Lüdemann, Monika; Bauer, Jürgen; Esmaeili, Anoosh; De-Rosa, Roberta; Voelkel, Norbert F; Akintuerk, Hakan; Schranz, Dietmar

2018-04-16

Left atrial decompression is considered in patients with symptomatic heart failure with preserved ejection fraction (HFpEF). We aimed to evaluate the feasibility and efficacy of transcatheter generation of a restrictive atrial septum communication to manage HFpEF from infancy to adulthood with cardiomyopathy and congenital heart defect. From June 2009 to December 2016, 24 patients (50% with an age less than 16 years) with HFpEF were palliated; NYHA-/Ross class IV (n = 10); median systemic ventricular ejection fraction 64 (range 35-78) %. Cardiomyopathy was classified as a restrictive (n = 4) or hypertrophic (n = 2). (75% related to congenital heart defects) Three patients had a systemic right ventricle; in the majority of patients, HFpEF was associated to complex congenital heart defects (n = 18). Mean pulmonary arterial pressures (PAP systolic/diastolic) were 56/28 (± 24/13), left atrial pressures (LAP, v-, a-wave, mean) 26/25/20 (± 7/10/6). Trans-septal puncture was used in 22 patients; foramen ovale dilatation in 2 patients. Median balloon size was 12 (range 6-18) mm; procedure time including diagnostic measures 125 (83-221) min. No procedural death or complications were observed. Mean LA-pressures decreased significantly to 19/19/15 ± 6/8/5 mmHg (p = 0.05); median brain natriuretic peptide (BNP) decreased from 392 (range 93-4401) pg/ml median BNP to 314 (range 61-1544) pg/ml (p = 0.05). Three patients died; one patient received orthotopic heart and one patient a heart-lung transplantation. No patient required so far an assist device. Clinical improvement occurred in all patients, in some after additional surgical or interventional approach. Transcatheter LA decompression is an age-independent, effective palliation treating patients with HFpEF.

The influence of type 2 diabetes and gender on ventricular repolarization dispersion in patients with sub-clinic left ventricular diastolic dysfunction.

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Jani, Ylber; Kamberi, Ahmet; Xhunga, Sotir; Pocesta, Bekim; Ferati, Fatmir; Lala, Dali; Zeqiri, Agim; Rexhepi, Atila

2015-01-01

To assess the influence of type 2 DM and gender, on the QT dispersion, Tpeak-Tend dispersion of ventricular repolarization, in patients with sub-clinic left ventricular diastolic dysfunction of the heart. QT dispersion, that reflects spatial inhomogeneity in ventricular repolarization, Tpeak-Tend dispersion, this on the other hand reflects transmural inhomogeneity in ventricular repolarization, that is increased in an early stage of cardiomyopathy, and in patients with left ventricular diastolic dysfunction, as well. The left ventricular diastolic dysfunction, a basic characteristic of diabetic heart disease (diabetic cardiomyopathy), that developes earlier than systolic dysfunction, suggests that diastolic markers might be sensitive for early cardiac injury. It is also demonstrated that gender has complex influence on indices of myocardial repolarization abnormalities such as QT interval and QT dispersion. We performed an observational study including 300 diabetic patients with similar epidemiological-demographic characteristics recruited in our institution from May 2009 to July 2014, divided into two groups. Demographic and laboratory echocardiographic data were obtained, twelve lead resting electrocardiography, QT, QTc, Tpeak-Tend-intervals and dispersion, were determined manually, and were compared between various groups. For statistical analysis a t-test, X(2) test, and logistic regression are used according to the type of variables. A p value <0.05 was considered statistically significant for a confidence interval of 95%. QTc max. interval, QTc dispersion and Tpeak-Tend dispersion, were significantly higher in diabetic group with subclinical LV (left ventricular) diastolic dysfunction, than in diabetic group with normal left ventricular diastolic function (445.24±14.7 ms vs. 433.55±14.4 ms, P<0.000; 44.98±18.78 ms vs. 32.05±17.9 ms, P<0.000; 32.60±1.6 ms vs. 17.46±2.0 ms, P<0.02. Prolonged QTc max. interval was found in 33% of patients, indiabetic group

LEFT ATRIAL FIBROSIS IN PATIENTS WITH ATRIAL FIBRILLATION ACCORDING TO MAGNETIC RESONANCE IMAGING WITH LATE GADOLINIUM ENHANCEMENT

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O. V. Stukalova

2015-01-01

Full Text Available Rationale: Atrial fibrillation (AF is the most common type of arrhythmia. Left atrial abnormalities in AF require further investigation.Aim: To evaluate characteristics of myocardial structure of the left atrium by magnetic resonance imaging (MRI with delayed contrast enhancement in patients with AF associated with essential hypertension (EH, in those without any cardiovascular disorders, and in patients with AF after cryoablation of the pulmonary artery orifice.Materials and methods: The study enrolled 53 patients with AF (mean age 56 years. Twenty eight of them had AF without any associated cardiovascular disorders (lone AF, or LAF group, 25 patients had AF related to EH (AF + EH group. Three patients had undergone anti-arrhythmic intervention. Cardiac MRI was performed in all patients with high resolution late gadolinium enhancement (LGE at 15–20 min after i.v. gadoversetamide (0.15 mmol/kg. For LGE MRI, we used a novel high resolution inversion recovery (inversion times 290–340 ms magnetic resonance pulse sequence with isotropic voxel (size 1.25 . 1.25 .2.5 mm and fat saturation. Left atrium walls were segmented semi-automatically on the LGE images. Left atrium fibrosis quantification was performed with the original software LGE Heart Analyzer, developed in Russian Cardiology Research and Production Complex (Moscow.Results: Left atrium fibrosis (mean, 9 [1.7; 18] % was found both in patients with AF + EH and with lone AF. There was a trend towards more significant left atrial fibrosis in the group of AF + EH, compared to that in the lone AF group (10.972 [6.98; 19.366] % vs 4.37 [0.893; 18.575] %, respectively, p = 0.1. The extent of left atrium fibrosis correlated with left atrium dilatation (r = 0.37, p < 0.001 and with the decreased ejection fraction (r = -0.4, р < 0.001. The patients who had undergone an antiarrhythmic intervention, demonstrated formation of intensive LGE zones in the ablation areas.Conclusion: Quantification of

Left Ventricular Diastolic Function in Essential Hypertensive Patients: Influence of Age and Left Ventricular Geometry

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Rosa Eduardo Cantoni

2002-01-01

Full Text Available PURPOSE - To evaluate diastolic dysfunction (DD in essential hypertension and the influence of age and cardiac geometry on this parameter. METHODS - Four hundred sixty essential hypertensive patients (HT underwent Doppler echocardiography to obtain E/A wave ratio (E/A, atrial deceleration time (ADT, and isovolumetric relaxation time (IRT. All patients were grouped according to cardiac geometric patterns (NG - normal geometry; CR - concentric remodeling; CH- concentric hypertrophy; EH - eccentric hypertrophy and to age (60 years. One hundred six normotensives (NT persons were also evaluated. RESULTS - A worsening of diastolic function in the HT compared with the NT, including HT with NG (E/A: NT - 1.38±0.03 vs HT - 1.27±0.02, p<0.01, was observed. A higher prevalence of DD occurred parallel to age and cardiac geometry also in the prehypertrophic groups (CR. Multiple regression analysis identified age as the most important predictor of DD (r²=0.30, p<0.01. CONCLUSION - DD was prevalent in this hypertensive population, being highly affected by age and less by heart structural parameters. DD is observed in incipient stages of hypertensive heart disease, and thus its early detection may help in the risk stratification of hypertensive patients.

Ia diastolic dysfunction: an echocardiographic grade.

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Pandit, Anil; Mookadam, Farouk; Hakim, Fayaz A; Mulroy, Eoin; Saadiq, Rayya; Doherty, Mairead; Cha, Stephen; Seward, James; Wilansky, Susan

2015-01-01

To demonstrate that a distinct group of patients with Grade Ia diastolic dysfunction who do not conform to present ASE/ESE diastolic grading exists. Echocardiographic and demographic data of the Grade Ia diastolic dysfunction were extracted and compared with that of Grades I and II in 515 patients. The mean of age of the cohort was 75 ± 9 years and body mass index did not differ significantly between the 3 groups (P = 0.45). Measurements of left atrial volume index (28.58 ± 7 mL/m(2) in I, 33 ± 10 mL/m(2) in Ia, and 39 ± 12 mL/m(2) in II P Ia, and 79 ± 15 msec in II P Ia, and 217 ± 57 msec in II P Ia, and 22 ± 8 in II), and lateral E/e' (8 ± 3 in I, 15 ± 6 in Ia, and 18 ± 9 in II P Ia compared with I and II. These findings remained significant even after adjusting for age, gender, diabetes, and smoking. Patients with echocardiographic characteristics of relaxation abnormality (E/A ratio of Ia group. © 2014, Wiley Periodicals, Inc.

Assessment of blood stasis in left-atrial appendage with electron-beam CT: filling delay in atrial fibrillation

International Nuclear Information System (INIS)

Nakanishi, Tadashi; Hamada, Seiki; Takamiya, Makoto; Kuribayashi, Sachio; Naito, Hiroaki

1994-01-01

The left-atrial appendage (LAA) is the most frequent site of thrombus formation. The most probable reason is its anatomical structure and blood stasis. We hypothesized that peak time delay should occur in the LAA with stagnant blood flow. We measured peak time delay in LAA against left atrium with the flow-mode study of electron-beam CT for 49 patients (including 23 patients with atrial fibrillation [AF]). Volume-mode scannings were also performed to detect intracardiac thrombi. Patients with atrial fibrillation showed a larger value than those with sinus rhythm. Some AF patients with no filling of contrast media into the LAA and/or thrombus showed a larger value than the others. The value obtained by the flow-mode study might have the potential by the flow-mode study might have the potential to assess blood stasis and to predict the jeopardized state in the LAA. (orig.)

Assessment of blood stasis in left-atrial appendage with electron-beam CT: filling delay in atrial fibrillation

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Nakanishi, Tadashi [Dept. of Radiology, National Cardiovascular Center, Suita, Osaka (Japan); Hamada, Seiki [Dept. of Radiology, National Cardiovascular Center, Suita, Osaka (Japan); Takamiya, Makoto [Dept. of Radiology, National Cardiovascular Center, Suita, Osaka (Japan); Kuribayashi, Sachio [Dept. of Radiology, National Cardiovascular Center, Suita, Osaka (Japan); Naito, Hiroaki [Biomedical Research Center, Osaka Univ. School of Medicine, Suita (Japan)

1994-10-01

The left-atrial appendage (LAA) is the most frequent site of thrombus formation. The most probable reason is its anatomical structure and blood stasis. We hypothesized that peak time delay should occur in the LAA with stagnant blood flow. We measured peak time delay in LAA against left atrium with the flow-mode study of electron-beam CT for 49 patients (including 23 patients with atrial fibrillation [AF]). Volume-mode scannings were also performed to detect intracardiac thrombi. Patients with atrial fibrillation showed a larger value than those with sinus rhythm. Some AF patients with no filling of contrast media into the LAA and/or thrombus showed a larger value than the others. The value obtained by the flow-mode study might have the potential by the flow-mode study might have the potential to assess blood stasis and to predict the jeopardized state in the LAA. (orig.)

Inadvertent puncture of the aortic noncoronary cusp during postoperative left atrial tachycardia ablation

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Dursun Aras, MD

2015-08-01

Full Text Available Transseptal catheterization has become part of the interventional electrophysiologist׳s technical armamentarium since the development of left atrial catheter ablation and percutaneous technologies for treating mitral and aortic valve disease. Although frequently performed, the procedure׳s most feared complication is aortic root penetration. Focal atrial tachycardia has been described as the most common late sequela of surgical valve replacements. We present a complicated case involving the inadvertent delivery of an 8 French sheath across the noncoronary cusp during radiofrequency catheter ablation for left atrial tachycardia originating from the mitral annulus in a patient with prior mitral valve replacement.

Left atrial appendage obliteration in atrial fibrillation patients undergoing bioprosthetic mitral valve replacement.

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Min, X P; Zhu, T Y; Han, J; Li, Y; Meng, X

2016-02-01

Left atrial appendage (LAA) obliteration is a proven stroke-preventive measure for patients with nonvalvular atrial fibrillation (AF). However, the efficacy of LAA obliteration for patients with AF after bioprosthetic mitral valve replacement (MVR) remains unclear. This study aimed to estimate the efficacy of LAA obliteration in preventing embolism and to investigate the predictors of thromboembolism after bioprosthetic MVR. We retrospectively studied 173 AF subjects with bioprosthetic MVR; among them, 81 subjects underwent LAA obliteration using an endocardial running suture method. The main outcome measure was the occurrence of thrombosis events (TEs). The mean follow-up time was 40 ± 17 months. AF rhythm was observed in 136 patients postoperatively. The incidence rate of TEs was 13.97 % for postoperative AF subjects; a dilated left atrium (LA; > 49.5 mm) was identified as an independent risk factor of TEs (OR = 10.619, 95 % CI = 2.754-40.94, p = 0.001). For postoperative AF patients with or without LAA, the incidence rate of TEs was 15.8 % (9/57) and 12.7 % (10/79; p = 0.603), respectively. The incidence rate of TEs was 2.7 % (1/36) and 4.2 % (2/48) for the subgroup patients with a left atrial diameter of  49.5 mm (p = 0.346). Surgical LAA obliteration in patients with valvular AF undergoing bioprosthetic MVR did not reduce TEs, even when the CHA2DS2-VASc score (a score for estimating the risk of stroke in AF) was ≥ 2 points.

Alcoholic liver cirrhosis increases the risk of left ventricular diastolic dysfunction

Czech Academy of Sciences Publication Activity Database

Brotánek, J.; Ort, Michael; Kubánek, M.; Stiborová, M.

2013-01-01

Roč. 34, Suppl.2 (2013), s. 64-70 ISSN 0172-780X R&D Projects: GA MŠk(CZ) 1M0517 Institutional research plan: CEZ:AV0Z50110509 Keywords : left ventricular diastolic dysfunction * cirrhosis * liver * alcohol Subject RIV: FH - Neurology Impact factor: 0.935, year: 2013

Noninvasive prediction of left ventricular end-diastolic pressure in patients with coronary artery disease and preserved ejection fraction.

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Abd-El-Aziz, Tarek A

2012-01-01

The aim of this study was to compare 3 different available methods for estimating left ventricular end-diastolic pressure (LVEDP) noninvasively in patients with coronary artery disease and preserved left ventricular ejection fraction (EF). We used 3 equations for noninvasive estimation of LVEDP: The equation of Mulvagh et al., LVEDP(1) = 46 - 0.22 (IVRT) - 0.10 (AFF) - 0.03 (DT) - (2 ÷ E/A) + 0.05 MAR; the equation of Stork et al., LVEDP(2) = 1.06 + 15.15 × Ai/Ei; and the equation of Abd-El-Aziz, LVEDP(3) = [0.54 (MABP) × (1 - EF)] - 2.23. ( A, A-wave velocity; AFF, atrial filling fraction; Ai, time velocity integral of A wave; DT, deceleration time; E, E-wave velocity; Ei, time velocity integral of E wave; IVRT, isovolumic relaxation time; MABP, mean arterial blood pressure; MAR, time from termination of mitral flow to the electrocardiographic R wave; Ti, time velocity integral of total wave.) LVEDP measured by catheterization was correlated with LVEDP(1) (r = 0.52, P Aziz, LVEDP = [0.54 MABP × (1 - EF)] - 2.23, appears to be the most accurate, reliable, and easily applied method for estimating LVEDP noninvasively in patients with preserved left ventricular ejection fraction and an LVEDP < 20 mm Hg. Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Effect of glycaemic status on left ventricular diastolic function in normotensive type 2 diabetic patients

International Nuclear Information System (INIS)

Hameedullah; Faheem, M.; Bahadar, S.; Hafizullah, M.; Najeeb, S.

2009-01-01

Diabetes is associated with Left ventricular diastolic and systolic dysfunction known as diabetic cardiomyopathy. Echocardiography is helpful for the detection of diastolic dysfunction and Echocardiographic screening for asymptomatic diabetic cardiomyopathy should be performed in all asymptomatic diabetic subjects. Identification of diabetic cardiomyopathy should result in the initiation of therapies to prevent the progression of diabetic cardiomyopathy. The objectives of this Descriptive case series was to determine the effect of glycaemic status on left ventricular diastolic function in normotesive type 2 diabetic patients. Methods: This study was performed at Cardiology department, PGMI Lady Reading Hospital, Peshawar from March 2007 to September 2007. Sixty normotesive type 2 diabetic patients were enrolled, 20 well control, 20 moderately control and 20 poorly control (Group- 3). Main outcome measures was Left ventricular diastolic function determined by Echocardiography. Results: Out of 60 patients there were 32 (53.3%) males and 28 (46.7%) females. Mean E/A ratio in Group 1 was 1.38.0.29, in Group 2 was 1.16.0.39 and in Group 3 was 0.60.0.15 (p<0.05). IVRT in Group-1 was 91.7.87 mSec, in Group-2 was 100.7.83 mSec and in Group-3 was 109.6.45 mSec (p<0.05). DT in Group 1 was 207.2 +- 12.6 mSec, in Group 2 was 218.11.3 mSec and in Group 3 was 229.7+- 9.52 mSec (p<0.05). Mean Em at mitral annulus in Group-1 was 0.14 +- 0.04 m/Sec, in Group-2 was 0.11+- 0.04 m/Sec and in Group-3 was 0.10 +- 0.03 m/Sec (p=0.002). Left ventricular diastolic dysfunction was documented in 4 (25%) patients in Group-1, 9 (45%) patients in Group-2 and 16 (80%) patients in Group-3 (p<0.05). There was Strong correlation between HbA1c level and diastolic indexes (p<0.05). Conclusion: Diastolic dysfunction is more frequent in poorly controlled diabetic patients and its severity is correlated with glycaemic control. (author)

Impact of congestive heart failure and left ventricular systolic function on the prognostic significance of atrial fibrillation and atrial flutter following acute myocardial infarction

DEFF Research Database (Denmark)

Pedersen, Ole Dyg; Bagger, Henning; Køber, Lars

2005-01-01

fibrillation in acute myocardial infarction patients that might explain previous discrepancies. METHODS: The study population was 6676 patients consecutively admitted to hospital with acute myocardial infarction. Information on the presence of atrial fibrillation/flutter, left ventricular systolic function......BACKGROUND: Reports on the prognostic importance of atrial fibrillation following myocardial infarction have provided considerable variation in results. Thus, this study examined the impact of left ventricular systolic function and congestive heart failure on the prognostic importance of atrial...... and congestive heart failure were prospectively collected. Mortality was followed for 5 years. RESULTS: In patients with left ventricular ejection fraction

Pulmonary artery-to-left atrial fistula discovered after the closure of atrial septal defect: A rare clinical scenario

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Akshay Chauhan

2018-01-01

Full Text Available A case of the right pulmonary artery-to- left atrial fistula with atrial septal defect (ASD is presented. The fistula was detected after the patient developed desaturation following surgical closure of the ASD. It was managed with a transcatheter (trans-RPA route closure of the fistula using a 12-mm Amplatzer ventricular septal defect closure device.

Case of right atrial myxoma with right to left shunt

Energy Technology Data Exchange (ETDEWEB)

Nakai, Kenji; Suzuki, Tomoyuki; Ohzeki, Tetsuro (Iwate Medical Coll., Morioka (Japan). School of Medicine)

1982-12-01

A case of 49-year-old woman with right atrial myxoma resulting to right to left shunt, diagnosed by cardiac pool isotope image, was reported. She was admitted to our clinic because of progressive shortness of breath. At admission lip cyanosis was noted. Laboratory data included polycythemia, low O/sub 2/ saturation (89%) and high erythrocyte sedimentation rate (65 mm/1 h). Chest x-p showed slight right atrial enlargement, but no pulmonary congestion. The electrocardiogram showed sinus regular rhythm with biphasic p wave in leads II, III, aVf. Although 1st heart sound at the apex was splited, no heart murmur was heard. In usual echocardiographic approach, no abnormal echogram was obtained in the right ventricular region. Lung perfusion scintiscan with Tc-99 m-MAA showed visualization of thyroid gland and kidney, which suggested intracardiac right-to-left shunt. Cardiac pool image with Tc-99m-HSA revealed large photo-deficient area in the right atrium and early visualization of aortic arch. Computor tomography showed large round low density region 8 x 7 cm in size. Based on their findings, this patient was diagnosed as right atrial tumor. At operation a large tumor (diameter 8 x 7 x 7 cm, weight 160g) filled the lower part of the right atrium and was adherent to the anterolateral wall in the right atrium. As a cause of R-L shunt, streched foramen ovale (5 x 10 mm) was found. Tumor histology was typical of atrial myxoma. Post-operative gated cardiac isotope image showed no evidence of residual atrial tumor. Cardiac blood pool isotope imaging was a method for the noninvasive detection and assessment of right atrial myxoma.

Assessment of the effect of left atrial cryoablation enhanced by ganglionated plexi ablation in the treatment of atrial fibrillation in patients undergoing open heart surgery.

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Bárta, Jiří; Brát, Radim

2017-08-17

The aim of our study was to investigate, whether enhancement of left atrial cryoablation by ablation of the autonomic nervous system of left atrium leads to influencing the outcomes of surgical treatment of atrial fibrillation in patients with structural heart disease undergoing open-heart surgery. The observed patient file consisted of 100 patients, who have undergone a combined open-heart surgery at our department between July 2012 and December 2014. The patients were indicated for the surgical procedure due to structural heart disease, and suffered from paroxysmal, persistent, or long-standing persistent atrial fibrillation. In all cases, left atrial cryoablation was performed in the extent of isolation of pulmonary veins, box lesion, connecting lesion with mitral annulus, amputation of the left atrial appendage and connecting lesion of the appendage base with left pulmonary veins. Furthermore, 35 of the patients underwent mapping and radiofrequency ablation of ganglionated plexi, together with discision and ablation of the ligament of Marshall (Group GP). A control group was consisted of 65 patients without ganglionated plexi intervention (Group LA). The main primary outcome was establishment and duration of sinus rhythm in the course of one-year follow-up. Evaluation of the number of patients with a normal sinus rhythm in per cent has shown comparable values in both groups (Group GP - 93.75%, Group LA - 86.67%, p = 0.485); comparable results were also observed in patients with normal sinus rhythm without anti-arrhythmic treatment in the 12th month (Group GP - 50%, Group LA - 47%, p = 0.306). We have not observed any relation between the recurrence of atrial fibrillation and the presence of a mitral valve surgery, or between the presence of a mitral and tricuspid valves surgery and between the left atrial diameter > 50 mm. Enhancement of left atrial cryoablation by gangionated plexi ablation did not influence the outcomes of surgical ablation due to

The influence of type 2 diabetes and gender on ventricular repolarization dispersion in patients with sub-clinic left ventricular diastolic dysfunction

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Jani, Ylber; Kamberi, Ahmet; Xhunga, Sotir; Pocesta, Bekim; Ferati, Fatmir; Lala, Dali; Zeqiri, Agim; Rexhepi, Atila

2015-01-01

Objective: To assess the influence of type 2 DM and gender, on the QT dispersion, Tpeak-Tend dispersion of ventricular repolarization, in patients with sub-clinic left ventricular diastolic dysfunction of the heart. Background: QT dispersion, that reflects spatial inhomogeneity in ventricular repolarization, Tpeak-Tend dispersion, this on the other hand reflects transmural inhomogeneity in ventricular repolarization, that is increased in an early stage of cardiomyopathy, and in patients with left ventricular diastolic dysfunction, as well. The left ventricular diastolic dysfunction, a basic characteristic of diabetic heart disease (diabetic cardiomyopathy), that developes earlier than systolic dysfunction, suggests that diastolic markers might be sensitive for early cardiac injury. It is also demonstrated that gender has complex influence on indices of myocardial repolarization abnormalities such as QT interval and QT dispersion. Material and methods: We performed an observational study including 300 diabetic patients with similar epidemiological-demographic characteristics recruited in our institution from May 2009 to July 2014, divided into two groups. Demographic and laboratory echocardiographic data were obtained, twelve lead resting electrocardiography, QT, QTc, Tpeak-Tend-intervals and dispersion, were determined manually, and were compared between various groups. For statistical analysis a t-test, X2 test, and logistic regression are used according to the type of variables. A p value <0.05 was considered statistically significant for a confidence interval of 95%. Results: QTc max. interval, QTc dispersion and Tpeak-Tend dispersion, were significantly higher in diabetic group with subclinical LV (left ventricular) diastolic dysfunction, than in diabetic group with normal left ventricular diastolic function (445.24±14.7 ms vs. 433.55±14.4 ms, P<0.000; 44.98±18.78 ms vs. 32.05±17.9 ms, P<0.000; 32.60±1.6 ms vs. 17.46±2.0 ms, P<0.02. Prolonged QTc max

Spatial Relation Between Left Atrial Anatomical Contact Areas and Circular Activation in Persistent Atrial Fibrillation.

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Nakahara, Shiro; Yamaguchi, Takanori; Hori, Yuichi; Anjo, Naofumi; Hayashi, Akiko; Kobayashi, Sayuki; Komatsu, Takaaki; Sakai, Yoshihiko; Fukui, Akira; Tsuchiya, Takeshi; Taguchi, Isao

2016-05-01

Atrial low-voltage zones (LVZs) may be related to maintenance of atrial fibrillation (AF). The influence of left atrial (LA) contact areas (CoAs) on reentrant or rotor-like sources maintaining AF has not been investigated. Forty patients with persistent AF (PsAF) were analyzed. Three representative CoA regions in the LA (ascending aorta: anterior wall; descending aorta: left inferior pulmonary vein; and vertebrae: posterior wall) were visualized by enhanced CT. Using circular catheters, the LVZs (80% of the mean AF cycle length. A pivot was defined as the core of the localized circular activation. Anterior (39/40 patients, 98%), left pulmonary vein antrum (27/40, 68%), and posterior (19/40, 48%) CoAs were identified, and 80% (68/85) of those sites were overlapped by or close (<3 mm) to LVZs. Thirty-six (90%) patients demonstrated circular activation (3.1±1.7 sites/patients) along with significantly higher organized dominant frequencies (6.3 ± 0.5 Hz, regularity-index: 0.26 [0.23-0.41]) within the LA, and the average electrogram amplitude of those pivots was 0.30 mV (0.18-0.52). Of those sites, 55% (66/120) were located at or close to CoA regions. Catheter ablation including of LVZs neighboring CoAs terminated AF in 9 (23%) patients. External anatomical structures contacting the LA may be related to unique conduction properties in diseased myocardium necessary for PsAF maintenance. © 2016 Wiley Periodicals, Inc.

The left atrial catheter: its uses and complications.

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Leitman, B S; Naidich, D P; McGuinness, G; McCauley, D I

1992-11-01

The authors describe the radiographic appearance of the left atrial catheter, a widely used postsurgical intracardiac device. Recognition of the characteristic appearance of this catheter should be of value in detection of potential complications, including line fracture with resultant retention and/or embolization, infection, prosthetic valve dysfunction, and even cardiac tamponade.

Metabolic Syndrome Is Associated with Atrial Electrical and Mechanical Dysfunction

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Yilmaz, Hale; Özcan, Kazım Serhan; Sayar, Nurten; Kemaloglu, Tugba; Gungor, Baris; Erer, Betul; Yilmaz, Mehmet; Gurkan, Ufuk; Cakmak, Nazmiye; Oz, Dilaver; Calik, Ali Nazmi; Bolca, Osman

2015-01-01

Objective In this study, we aimed to investigate the left atrial (LA) electrical and mechanical functions in patients with metabolic syndrome (MetS). Subjects and Methods The study population consisted of 87 patients with MetS and 67 controls. Intra-atrial and interatrial electromechanical delays (EDs) were measured with tissue Doppler imaging. P-wave dispersion (Pd) was calculated from the 12-lead electrocardiograms. LA volumes were measured echocardiographically by the biplane area-length method. Results Intra-atrial and interatrial EDs and Pd were significantly higher in patients with MetS (10.3 ± 6.3, 21.0 ± 11.5 and 41.7 ± 10.8) than in controls (7.4 ± 5.5, 12.3 ± 10.4 and 29.2 ± 7.4; p = 0.003, p < 0.001 and p < 0.001, respectively). The LA preatrial contraction volume and active emptying volumes were higher in this population, but the LA passive emptying fraction was lower. In the multivariate linear regression analysis, the presence of MetS, LA active emptying volume and left ventricular early diastolic (E) wave velocity/late diastolic (A) wave velocity (E/A) ratios were independent correlates of interatrial ED (p = 0.002, p = 0.001 and p = 0.025, respectively). Conclusions This study showed that intra-atrial and interatrial EDs and Pd were prolonged and LA mechanical functions were impaired in patients with MetS. PMID:25592764

Equilibrium radionuclide assessment of left ventricular ejection and filling. Comparison of list mode-and multigated frame-mode measurements

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Sugrue, D.D.; McKenna, W.J.; Dickie, S.; Oakley, C.M.; Myers, M.J.; Lavender, J.P. (Royal Postgraduate Medical School, London (UK))

1983-10-01

The relationship as studied between radionuclide indices of left ventricular systolic and diastolic function acquired in conventional multigated frame-mode compared to list-mode in patients with sinus rhythm. The study showed that frame-mode and list-mode measurements of ejection and filling indices are not significantly different in these patients but that backward reformatting of data acquired in list-mode is necessary to measure the atrial contribution to LV stroke counts. It was concluded that valid measurements of left ventricular systolic ejection and diastolic filling can be made in patients in sinus rhythm using frame-mode acquisition with the exception of measurements of the contribution from atrial systole to stroke volume.

Study of left ventricular diastolic dysfunction in recently diagnosed hypertensives in Central Nepal

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Shankar Laudari

2016-03-01

Full Text Available CORRECTION: The conclusion on the PDF of this article was replaced on 17th April 2016. The corrected PDF is now available by clicking on the link below.Background & Objectives: Ectopic Left ventricular diastolic dysfunction is now well established as a cause of left sided heart failure and as a powerful predictor of cardiovascular events. It is attributed mostly to systemic hypertension. The objective of the study was to determine the prevalence of left ventricular diastolic dysfunction in recently diagnosed hypertensives in Nepalese population using echocardiography. Materials & Methods: Two-dimensional echocardiography was performed on 120 newly diagnosed patients of systemic hypertension. Transmitral Doppler indexes of diastolic function, Valsalva maneuver applied to the same mitral inflow pattern, pulsed tissue Doppler of the mitral annulus, deceleration time, isovolumic relaxation time and pulmonary venous flow pattern.Results: The age of the patients in our study ranged from 20 to 84 years with mean age of 50years±14.13 years (standard deviation and male:female ratio being 1.35:1. Hypertensive patients were highest in age group 45-64 years followed by 25-44 years in both the genders. Majority of the patients had stage 1 hypertension (44.16% followed by stage 2 HTN in 34.17% and pre-hypertension in 21.67%. The majority of the patients in our study had Grade 1 LVDD (66.67%, 10.83% patients had Grade II LVDD, only 2.50% had non-restrictive Grade III LVDD and none had LVDD-IV. Stage II hypertensives had more LVDD(I+II+III: 39/41-95.12% than stage I hypertensives(39/53-73.58% and pre-hypertensives (8/26-30.77%. The association between stages of systemic HTN and LVDD was found to be highly statistically significant (p=0.002. Conclusion: Our study showed that left ventricular diastolic dysfunction is a common entity in Nepalese population with systemic hypertension.JCMS Nepal. 2016;12(1:14-18.

Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study.

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Sugimoto, Tadafumi; Robinet, Sébastien; Dulgheru, Raluca; Bernard, Anne; Ilardi, Federica; Contu, Laura; Addetia, Karima; Caballero, Luis; Kacharava, George; Athanassopoulos, George D; Barone, Daniele; Baroni, Monica; Cardim, Nuno; Hagendorff, Andreas; Hristova, Krasimira; Lopez, Teresa; de la Morena, Gonzalo; Popescu, Bogdan A; Penicka, Martin; Ozyigit, Tolga; Rodrigo Carbonero, Jose David; van de Veire, Nico; Von Bardeleben, Ralph Stephan; Vinereanu, Dragos; Zamorano, Jose Luis; Go, Yun Yun; Marchetta, Stella; Nchimi, Alain; Rosca, Monica; Calin, Andreea; Moonen, Marie; Cimino, Sara; Magne, Julien; Cosyns, Bernard; Galli, Elena; Donal, Erwan; Habib, Gilbert; Esposito, Roberta; Galderisi, Maurizio; Badano, Luigi P; Lang, Roberto M; Lancellotti, Patrizio

2018-02-23

To obtain the normal ranges for echocardiographic measurements of left atrial (LA) function from a large group of healthy volunteers accounting for age and gender. A total of 371 (median age 45 years) healthy subjects were enrolled at 22 collaborating institutions collaborating in the Normal Reference Ranges for Echocardiography (NORRE) study of the European Association of Cardiovascular Imaging (EACVI). Left atrial data sets were analysed with a vendor-independent software (VIS) package allowing homogeneous measurements irrespective of the echocardiographic equipment used to acquire data sets. The lowest expected values of LA function were 26.1%, 48.7%, and 41.4% for left atrial strain (LAS), 2D left atrial emptying fraction (LAEF), and 3D LAEF (reservoir function); 7.7%, 24.2%, and -0.53/s for LAS-active, LAEF-active, and LA strain rate during LA contraction (SRa) (pump function) and 12.0% and 21.6% for LAS-passive and LAEF-passive (conduit function). Left atrial reservoir and conduit function were decreased with age while pump function was increased. All indices of reservoir function and all LA strains had no difference in both gender and vendor. However, inter-vendor differences were observed in LA SRa despite the use of VIS. The NORRE study provides contemporary, applicable echocardiographic reference ranges for LA function. Our data highlight the importance of age-specific reference values for LA functions.

Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion

DEFF Research Database (Denmark)

Osmanagic, Armin; Möller, Sören; Osmanagic, Azra

2016-01-01

BACKGROUND: Attempts to achieve rhythm control using direct-current cardioversion (DCC) are common in those with persistent atrial fibrillation (AF). Although often successful, AF recurs within 1 month in as many as 57% of patients. The aim of this study was to assess whether a baseline left atri...

The left atrio-vertebral ratio. A new simple means for assessing left atrial enlargement on computed tomography

International Nuclear Information System (INIS)

Montillet, Marie; Tasu, Jean-Pierre; Baque-Juston, Marie; Bertrand, Sandra; Berthier, Frederic; Zarqane, Naima; Brunner, Philippe

2018-01-01

The purpose of this study is to describe a new method to quickly estimate left atrial enlargement (LAE) on Computed Tomography. Left atrial (LA) volume was assessed with a 3D-threshold Hounsfield unit detection technique, including left atrial appendage and excluding pulmonary venous confluence, in 201 patients with ECG-gated 128-slice dual-source CT and indexed to body surface area. LA and vertebral axial diameter and area were measured at the bottom level of the right inferior pulmonary vein ostium. Ratio of LA diameter and surface on vertebra (LAVD and LAVA) were compared to LA volume. In accordance with the literature, a cutoff value of 78 ml/m 2 was chosen for maximal normal LA volume. 18% of LA was enlarged. The best cutoff values for LAE assessment were 2.5 for LAVD (AUC: 0.65; 95% CI: 0.58-0.73; sensitivity: 57%; specificity: 71%), and 3 for LAVA (AUC: 0.78; 95% CI: 0.72-0.84; sensitivity: 67%; specificity: 79%), with higher accuracy for LAVA (P=0.015). Inter-observer and intra-observer variability were either good or excellent for LAVD and LAVA (respective intraclass coefficients: 0.792 and 0.910; 0.912 and 0.937). A left atrium area superior to three times the vertebral area indicates LAE with high specificity. (orig.)

The left atrio-vertebral ratio. A new simple means for assessing left atrial enlargement on computed tomography

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Montillet, Marie; Tasu, Jean-Pierre [Centre Hospitalier Universitaire de Poitiers, Poitiers (France); Baque-Juston, Marie; Bertrand, Sandra; Berthier, Frederic; Zarqane, Naima; Brunner, Philippe [Hopital Princesse Grace, Monaco (Monaco)

2018-03-15

The purpose of this study is to describe a new method to quickly estimate left atrial enlargement (LAE) on Computed Tomography. Left atrial (LA) volume was assessed with a 3D-threshold Hounsfield unit detection technique, including left atrial appendage and excluding pulmonary venous confluence, in 201 patients with ECG-gated 128-slice dual-source CT and indexed to body surface area. LA and vertebral axial diameter and area were measured at the bottom level of the right inferior pulmonary vein ostium. Ratio of LA diameter and surface on vertebra (LAVD and LAVA) were compared to LA volume. In accordance with the literature, a cutoff value of 78 ml/m{sup 2} was chosen for maximal normal LA volume. 18% of LA was enlarged. The best cutoff values for LAE assessment were 2.5 for LAVD (AUC: 0.65; 95% CI: 0.58-0.73; sensitivity: 57%; specificity: 71%), and 3 for LAVA (AUC: 0.78; 95% CI: 0.72-0.84; sensitivity: 67%; specificity: 79%), with higher accuracy for LAVA (P=0.015). Inter-observer and intra-observer variability were either good or excellent for LAVD and LAVA (respective intraclass coefficients: 0.792 and 0.910; 0.912 and 0.937). A left atrium area superior to three times the vertebral area indicates LAE with high specificity. (orig.)

Three Vessel Coronary Cameral Fistulae Associated with New Onset Atrial Fibrillation and Angina Pectoris

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Murat Yuksel

2014-01-01

Full Text Available Coronary cameral fistulas are abnormal communications between a coronary artery and a heart chamber or a great vessel which are reported in less than 0.1% of patients undergoing diagnostic coronary angiography. All three major coronary arteries are even less frequently involved in fistula formation as it is the case in our patient. A 68-year-old woman was admitted to cardiology clinic with complaints of exertional dyspnea and angina for two years and a new onset palpitation. Standard 12-lead electrocardiogram revealed atrial fibrillation (AF with a ventricular rate of 114 beat/minute and accompanying T wave abnormalities and minimal ST-depression on lateral derivations. Transthoracic echocardiographic examination was normal except for diastolic dysfunction, minimally mitral regurgitation, and mild to moderate enlargement of the left atrium. Sinus rhythm was achieved by medical cardioversion with amiodarone infusion. Coronary angiography revealed diffuse and multiple coronary-left ventricle fistulas originating from the distal segments of both left and right coronary arterial systems without any stenosis in epicardial coronary arteries. The patient’s symptoms resolved almost completely with medical therapy. High volume shunts via coronary artery to left ventricular microfistulas may lead to increased volume overload and subsequent increase in end-diastolic pressure of the left ventricle and may cause left atrial enlargement.

Psoriasis is associated with subsequent atrial fibrillation in hypertensive patients with left ventricular hypertrophy

DEFF Research Database (Denmark)

Bang, Casper N; Okin, Peter M; Køber, Lars

2014-01-01

BACKGROUND: Inflammation contributes to the pathogenesis of psoriasis as well as atrial fibrillation. The impact of psoriasis and its association with new-onset atrial fibrillation was assessed in hypertensive patients with left ventricular hypertrophy (LVH). METHODS: The predictive value...... or developed psoriasis and new-onset atrial fibrillation occurred in 506 patients (7.1%) during a mean follow-up of 4.7 ± 1.1 years. At baseline, the psoriasis patients were younger (65 ± 7 vs. 67 ± 7 years) and had less left ventricle hypertrophy by ECG Sokolow-Lyon voltage (27.6 ± 9.7 vs. 30.1 ± 10.4 mm...... of baseline or incident psoriasis for new-onset atrial fibrillation was evaluated in 7099 hypertensive patients with electrocardiographic LVH with no history of atrial fibrillation or other cardiovascular disease, in sinus rhythm on their baseline electrocardiogram. RESULTS: A total of 154 patients (2.2%) had...

Effects of verapamil on left ventricular systolic and diastolic function in patients with hypertrophic cardiomyopathy: pressure-volume analysis with a nonimaging scintillation probe.

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Bonow, R O; Ostrow, H G; Rosing, D R; Cannon, R O; Lipson, L C; Maron, B J; Kent, K M; Bacharach, S L; Green, M V

1983-11-01

To investigate the effects of verapamil on left ventricular systolic and diastolic function in patients with hypertrophic cardiomyopathy, we studied 14 patients at catheterization with a nonimaging scintillation probe before and after serial intravenous infusions of low-, medium-, and high-dose verapamil (total dose 0.17 to 0.72 mg/kg). Percent change in radionuclide stroke counts after verapamil correlated well with percent change in thermodilution stroke volume (r = .87), and changes in diastolic and systolic counts were used to assess relative changes in left ventricular volumes after verapamil. Verapamil produced dose-related increases in end-diastolic counts (19 +/- 9% increase; p less than .001), end-systolic counts (91 +/- 54% increase; p less than .001), and stroke counts (7 +/- 10% increase; p less than .02). This was associated with a decrease in ejection fraction (83 +/- 8% control, 73 +/- 10% verapamil; p less than .001) and, in the 10 patients with left ventricular outflow tract gradients, a reduction in gradient (62 +/- 27 mm Hg control, 32 +/- 35 mm Hg verapamil; p less than .01). The end-systolic pressure-volume relation was shifted downward and rightward in all patients, suggesting a negative inotropic effect. In 10 patients, left ventricular pressure-volume loops were constructed with simultaneous micromanometer pressure recordings and the radionuclide time-activity curve. In five patients, verapamil shifted the diastolic pressure-volume curve downward and rightward, demonstrating improved pressure-volume relations despite the negative inotropic effect, and also increased the peak rate of rapid diastolic filling. In the other five patients, the diastolic pressure-volume relation was unaltered by verapamil, and increased end-diastolic volumes occurred at higher end-diastolic pressures; in these patients, the peak rate of left ventricular diastolic filling was not changed by verapamil. The negative inotropic effects of intravenous verapamil are

Effect of well-controlled gestational diabetes on left ventricular diastolic dysfunction in neonates.

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Ghandi, Yazdan; Habibi, Danial; Nasri, Khadijeh; Alinejad, Saeed; Taherahmad, Hassan; Arjmand Shabestari, Ali; Nematinejad, Ali

2018-06-17

There are some evidences supporting the relation between gestational diabetes mellitus (GDM) and diastolic dysfunction. The aim of our study was to investigate the effect of well-controlled GDM on morphological and functional myocardium. We designed a prospective cross-sectional study to evaluate left ventricular (LV) diastolic function of 60 neonates born from mothers with well-controlled GDM (case group) on days of 3-5 after birth. The infants of diabetic mothers (IDM) group were divided into two groups: diabetic mothers treated only with diet (class A) and group of mothers on medical therapy by insulin or metformin (class B). Traditional echocardiography and pulsed-wave Doppler (PWD), tissue Doppler imaging (TDI) were performed for all the neonates. The study group consisted of 60 neonates as males (M) = 32, (0.53%) and females (F) = 28, (0.46%). Using M-mode echocardiography, interventricular septum thickness (IVS), and LV mass were significantly higher in IDM than control group (p = .0001). The PWD showed both a significantly more peak mitral flow at early diastolic wave (E) and an early filling deceleration time (E-DT) (p = .0001). Tissue Doppler echocardiography parameters A' (cm/s) (p = .0001), E' (cm/s) (p = .002), and E'/A' ratio (p = .0001), left ventricular myocardial performance index (LVMPI), and isovolumetric relaxation time (IVRT) were outstandingly different between the two groups (p = .0001, respectively). Evaluating the GDM group mothers of class A and class B, no significant difference was noted in PWD or TDI parameters compared with the healthy ones. It seems that neonates of mothers with well-controlled GDM are still at increased risk of cardiac hypertrophy, subclinical diastolic dysfunction, and impaired left ventricular relaxation. This can be interpreted that focusing only on glycemic control is not enough to prevent cardiac dysfunction.

Evaluation of left ventricular diastolic function by appreciating the shape of time activity curve

International Nuclear Information System (INIS)

Nishimura, Tohru; Taya, Makoto; Shimoyama, Katsuya; Sasaki, Akira; Mizuno, Haruyoshi; Tahara, Yorio; Ono, Akifumi; Ishikawa, Kyozo

1993-01-01

To determine left ventricular diastolic function (LVDF), the shape of time activity curve and primary differential curve, as acquired by Tc-99m radionuclide angiography, were visually assessed. The study popoulation consisted of 1647 patients with heart disease, such as hypertension, ischemic heart disease, cardiomyopathy and valvular disease. Fifty-six other patients were served as controls. The LVDF was divided into 4 degrees: 0=normal, I=slight disturbance, II=moderate disturbance, and III=severe disturbance. LVDF variables, including time to peak filling (TPF), TPF/time to end-systole, peak filling rate (PFR), PFR/t, 1/3 filling fraction (1/3 FR), and 1/3 FR/t, were calculated from time activity curve. There was no definitive correlation between each variable and age or heart rate. Regarding these LVDF variables, except for 1/3 FR, there was no significant difference between the group 0 of heart disease patients and the control group. Among the groups 0-III of heart disease patients, there were significant difference in LVDF variables. Visual assessement concurred with left ventricular ejection fraction, PFR/end-diastolic curve, and filling rate/end-diastolic curve. Visual assessment using time activity curve was considered useful in the semiquantitative determination of early diastolic function. (N.K.)

Echocardiographic assessment of fetal left ventricular function in hypertensive disorder of pregnancy

International Nuclear Information System (INIS)

Liu Xiaozhen; Liu Shaozhong

2011-01-01

Objective: To investigate fetal left ventricular function in hypertensive disorder of pregnancy (HDP). Methods: Fetuses of hypertensive (84) and normotensive (147) mothers were enrolled in this study. The fetal left ventricular ejection fractions, E/A ratios of mitral valves, left atrial shortening fractions and Tei indexes of the two groups were measured on fetal echocardiography. Results: The left ventricular ejection fractions (P=0.040), E/A ratios of the mitral valves (P=0.042) and the left atrial shortening fractions (P=0.036) in fetuses of HDP were significantly smaller than those of the normal group whereas the Tei indexes (P=0.030) were significantly larger than those of the normal group. Conclusion: The hypertensive disorder of pregnancy may cause decreased systolic, diastolic and global function of the fetal left ventricle. (authors)

LEFT ATRIAL APPENDAGE CLOSURE AS AN ALTERNATIVE TO WARFARIN FOR STROKE PREVENTION IN ATRIAL FIBRILLATION: A PATIENT¬LEVEL META¬ANALYSIS

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2015-01-01

Full Text Available Holmes D.R. Jr, Doshi S.K., Kar S., et al. Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation: A Patient­Level Meta­Analysis // J. Am. Coll. Cardiol. – 2015. – Vol. 65. – P. 2614–2623.

Usefulness of cardiac 123I-MIBG imaging for the evaluation of diastolic heart failure

International Nuclear Information System (INIS)

Tanaka, Haruki; Kozai, Toshiyuki; Urabe, Yoshitoshi

2007-01-01

Significance of 123 I-MIBG (metaiodobenzylguanidine) scintigraphy in diagnosis of cardiac sympathetic nerve function is not yet elucidated in chronic heart failure derived from left ventricular diastolic defect despite its established importance in evaluation of severity and prognosis of chronic systolic heart failure. This study was performed to elucidate the usefulness of the imaging for chronic diastolic heart failure. Comparison was made of 47 hospitalized patients with chronic diastolic heart failure (D-group; left ejection fraction, 50% or more), 45 with chronic systolic failure (S-group; the fraction 123 I-MIBG with 2-detector gamma camera (Toshiba E.CAM), of which images were analyzed by Toshiba GMS-7000. Cardiac sympathetic nerve function in D-group was found stimulated to be impaired, in a similar extent to that in S-group; severity in NYHA classification was significantly correlated with late H/M ratio and WR; WR in cases with atrial fibrillation complication showed a significant correlation with plasma BNP level; and 123 I-MIBG scintigraphic evaluation of the nerve function in D-group was concluded to be useful for severity assessment. (T.I.)

Left Atrial Appendage Closure in Atrial Fibrillation: A World without Anticoagulation?

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Tahmeed Contractor

2011-01-01

Full Text Available Atrial Fibrillation (AF is a common arrhythmia with an incidence that is as high as 10% in the elderly population. Given the large proportion of strokes caused by AF as well as the associated morbidity and mortality, reducing stroke burden is the most important part of AF management. While warfarin significantly reduces the risk of AF-related stroke, perceived bleeding risks and compliance limit its widespread use in the high-risk AF population. The left atrial appendage is believed to be the “culprit” for thrombogenesis in nonvalvular AF and is a new therapeutic target for stroke prevention. The purpose of this review is to explore the evolving field of percutaneous LAA occlusion. After briefly highlighting the risk of stroke with AF, problems with warfarin, and the role of the LAA in clot formation, this article discusses the feasibility and efficacy of various devices which have been developed for percutaneous LAA occlusion.

Association of ACE gene D polymorphism with left ventricular hypertrophy in patients with diastolic heart failure: a case-control study.

Science.gov (United States)

Bahramali, Ehsan; Rajabi, Mona; Jamshidi, Javad; Mousavi, Seyyed Mohammad; Zarghami, Mehrdad; Manafi, Alireza; Firouzabadi, Negar

2016-02-09

To explore the association between ACE gene insertion/deletion (I/D) polymorphism with left ventricular hypertrophy (LVH) in patients with hypertension who have developed heart failure with preserved ejection fraction (HFpEF). Being a major contributor to the development of diastolic heart dysfunction, the renin angiotensin aldosterone system and its genetic variations are thought to induce LVH in hypertensive hearts apart from haemodynamic factors. Case control study. An Iranian referral university hospital. 176 patients with hypertension and a diagnosis of HFpEF on presence of symptoms of heart failure plus Doppler echocardiographic documentation of left ventricular (LV) diastolic dysfunction and/or elevated NT-proBNP levels. Those with significant coronary, valvular, pericardial and structural heart diseases were excluded as well as patients with atrial fibrillation, renal failure and pulmonary causes of dyspnoea. They were divided into two cohorts of 88 cases with and 88 controls without LVH, after determination of LV mass index, using two-dimensional and M-mode echocardiography. The I/D polymorphism of the ACE gene was determined using the PCR method. The D allele was significantly more prevalent among cases with compared with controls without LVH (p=0.0007). Genotype distributions also differed significantly under additive (p=0.005, OR=0.53, 95% CI 0.34 to 0.84) and recessive (p=0.001, OR=0.29, 95% CI 0.13 to 0.66) models. In patients with hypertension who develop HFpEF, the D allele of the ACE gene is probably associated with the development of LVH. With the detrimental effects of LVH on the heart's diastolic properties, this can signify the role of genetic contributors to the development of HFpEF in patients with hypertension and may serve as a future risk predictor for the disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The influence of right ventricular apical pacing on left atrial volume in patients with normal left ventricular function

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AR Moaref1

2008-03-01

Full Text Available Background: Right ventricular apical (RVA pacing has been reported to induce several deleterious effects particularly in the presence of structural heart disease but can also involve patients with normal left ventricular (LV function. Left atrial (LA enlargement is one of these effects, but the majority of studies have measured LA dimension rather than volume.Objective: The present prospective study was designed to assess the effect of RVA pacing on LA volume in patients with normal LV function.Patients and Methods: The study comprised 41 consecutive patients with LV ejection fraction ≥ 45% and LV end diastolic dimension ≤ 56 mm who underwent single-or dual- chamber pacemaker implantation in RVA and followed for LA volume measurement and pacemaker analysis at least during the ensuing 4.2 months. Results: In all, 21 patients were excluded from the study due to five spontaneous wide QRS complex (≥120msec, one recent acute coronary syndrome,one significant valvular heart disease, three pacing frequency <90%, eight death or losing follow up in three cases. In remaining 20 patients, LA volume ragned from 21 to 54 mm3 with mean of 37.3±9.7 mm3 prior to pacemaker implantation that increased to 31 to 103 mm3 (54.3±17.0 during follow-up (P<0.001.Conclusion: RVA pacing might lead to an increase in LA volume even in patients with normal LV function.

Cardiac arrhythmias and left ventricular hypertrophy in systemic hypertension

International Nuclear Information System (INIS)

Sultana, R.; Sultana, N.; Rashid, A.; Rasheed, S.Z.; Ahmed, M.; Ishaq, M.; Samad, A.

2010-01-01

Background: Hypertensive left ventricular hypertrophy (LVH) is associated with increased risk of arrhythmias and mortality. Objective was to investigate the prevalence of cardiac arrhythmias and LVH in systemic hypertension. Methods: In all subjects blood pressure was measured, electrocardiography and echocardiography was done. Holter monitoring and exercise test perform in certain cases. There were 500 hypertensive patients, 156 (31.2%) men and 344 (69%) women >30 years of age in the study. Among them 177 (35.4%) were diabetic, 224 (45%) were dyslipidemia, 188 (37.6%) were smokers, and 14 (3%) had homocysteinemia. Mean systolic BP (SBP) was 180 +- 20 mm Hg and diastolic BP (DBP) was 95 +- 12 in male and female patients. Left ventricular mass index (LVMI) was 119.2 +- 30 2 2gm/m in male while 103 +- 22 gm/m in female patients. Palpitation was seen in 126 (25%) male and 299 (59.8%) female patients. Atrial fibrillation was noted in 108 (21.6%) male and 125 (25%) female patients, 30 (6%) male and 82 (16.4%) female patients had atrial flutter. Ventricular tachycardia was noted in 37 (7.4%) male and 59 (11.8%) female patients. Holter monitoring showed significant premature ventricular contractions (PVC'S) in 109 (21.8%) male and 128 (25.69%) female patients while Holter showed atrial arrhythmias (APC'S) in 89 (17.8%) males and 119 (23.8%) females. Angiography findings diagnosed coronary artery disease in 119 (23.8%) with CAD male and 225 (45%) without CAD while 47 (9.4%) females presented with CAD and 109 (21.8%) without CAD. Conclusion: A significant association has been demonstrated between hypertension and arrhythmias. Diastolic dysfunction of the left ventricle, left atrial size and function, as well as LVH have been suggested as the underlying risk factors for supraventricular, ventricular arrhythmias and sudden death in hypertensives with LVH. (author)

Cardiac arrhythmias and left ventricular hypertrophy in systemic hypertension

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Sultana, R; Sultana, N; Rashid, A; Rasheed, S Z; Ahmed, M; Ishaq, M; Samad, A [Karachi Institute of Heart Diseases, Karachi (Pakistan)

2010-10-15

Background: Hypertensive left ventricular hypertrophy (LVH) is associated with increased risk of arrhythmias and mortality. Objective was to investigate the prevalence of cardiac arrhythmias and LVH in systemic hypertension. Methods: In all subjects blood pressure was measured, electrocardiography and echocardiography was done. Holter monitoring and exercise test perform in certain cases. There were 500 hypertensive patients, 156 (31.2%) men and 344 (69%) women >30 years of age in the study. Among them 177 (35.4%) were diabetic, 224 (45%) were dyslipidemia, 188 (37.6%) were smokers, and 14 (3%) had homocysteinemia. Mean systolic BP (SBP) was 180 +- 20 mm Hg and diastolic BP (DBP) was 95 +- 12 in male and female patients. Left ventricular mass index (LVMI) was 119.2 +- 30 2 2gm/m in male while 103 +- 22 gm/m in female patients. Palpitation was seen in 126 (25%) male and 299 (59.8%) female patients. Atrial fibrillation was noted in 108 (21.6%) male and 125 (25%) female patients, 30 (6%) male and 82 (16.4%) female patients had atrial flutter. Ventricular tachycardia was noted in 37 (7.4%) male and 59 (11.8%) female patients. Holter monitoring showed significant premature ventricular contractions (PVC'S) in 109 (21.8%) male and 128 (25.69%) female patients while Holter showed atrial arrhythmias (APC'S) in 89 (17.8%) males and 119 (23.8%) females. Angiography findings diagnosed coronary artery disease in 119 (23.8%) with CAD male and 225 (45%) without CAD while 47 (9.4%) females presented with CAD and 109 (21.8%) without CAD. Conclusion: A significant association has been demonstrated between hypertension and arrhythmias. Diastolic dysfunction of the left ventricle, left atrial size and function, as well as LVH have been suggested as the underlying risk factors for supraventricular, ventricular arrhythmias and sudden death in hypertensives with LVH. (author)

Left atrial enlargement increases the risk of major adverse cardiac events independent of coronary vasodilator capacity.

Science.gov (United States)

Koh, Angela S; Murthy, Venkatesh L; Sitek, Arkadiusz; Gayed, Peter; Bruyere, John; Wu, Justina; Di Carli, Marcelo F; Dorbala, Sharmila

2015-09-01

Longstanding uncontrolled atherogenic risk factors may contribute to left atrial (LA) hypertension, LA enlargement (LAE) and coronary vascular dysfunction. Together they may better identify risk of major adverse cardiac events (MACE). The aim of this study was to test the hypothesis that chronic LA hypertension as assessed by LAE modifies the relationship between coronary vascular function and MACE. In 508 unselected subjects with a normal clinical (82)Rb PET/CT, ejection fraction ≥40 %, no prior coronary artery disease, valve disease or atrial fibrillation, LAE was determined based on LA volumes estimated from the hybrid perfusion and CT transmission scan images and indexed to body surface area. Absolute myocardial blood flow and global coronary flow reserve (CFR) were calculated. Subjects were systematically followed-up for the primary end-point - MACE - a composite of all-cause death, myocardial infarction, hospitalization for heart failure, stroke, coronary artery disease progression or revascularization. During a median follow-up of 862 days, 65 of the subjects experienced a composite event. Compared with subjects with normal LA size, subjects with LAE showed significantly lower CFR (2.25 ± 0.83 vs. 1.95 ± 0.80, p = 0.01). LAE independently and incrementally predicted MACE even after accounting for clinical risk factors, medication use, stress left ventricular ejection fraction, stress left ventricular end-diastolic volume index and CFR (chi-squared statistic increased from 30.9 to 48.3; p = 0.001). Among subjects with normal CFR, those with LAE had significantly worse event-free survival (risk adjusted HR 5.4, 95 % CI 2.3 - 12.8, p < 0.0001). LAE and reduced CFR are related but distinct cardiovascular adaptations to atherogenic risk factors. LAE is a risk marker for MACE independent of clinical factors and left ventricular volumes; individuals with LAE may be at risk of MACE despite normal coronary vascular function.

Abnormal glucose metabolism in acute myocardial infarction: influence on left ventricular function and prognosis

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Høfsten, Dan E; Løgstrup, Brian B; Møller, Jacob E

2009-01-01

tolerance test before discharge. LV function was assessed using echocardiographic measurements (LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, restrictive diastolic filling pattern, early transmitral flow velocity to early diastolic mitral annular velocity ratio [E/e'], and left...... atrial volume index) and by measuring plasma N-terminal pro-B-type natriuretic peptide levels. RESULTS: After adjustment for age and gender, a linear relationship between the degree of abnormal glucose metabolism was observed for each marker of LV dysfunction (p(trend)

Systolic and Diastolic Left Ventricular Mechanics during and after Resistance Exercise.

Science.gov (United States)

Stöhr, Eric J; Stembridge, Mike; Shave, Rob; Samuel, T Jake; Stone, Keeron; Esformes, Joseph I

2017-10-01

To improve the current understanding of the impact of resistance exercise on the heart, by examining the acute responses of left ventricular (LV) strain, twist, and untwisting rate ("LV mechanics"). LV echocardiographic images were recorded in systole and diastole before, during and immediately after (7-12 s) double-leg press exercise at two intensities (30% and 60% of maximum strength, one-repetition maximum). Speckle tracking analysis generated LV strain, twist, and untwisting rate data. Additionally, beat-by-beat blood pressure was recorded and systemic vascular resistance (SVR) and LV wall stress were calculated. Responses in both exercise trials were statistically similar (P > 0.05). During effort, stroke volume decreased, whereas SVR and LV wall stress increased (P mechanics (P 0.05). Immediately after exercise, systolic LV mechanics returned to baseline levels (P mechanics, but increases diastolic mechanics after exercise, suggesting that resistance exercise has a differential impact on systolic and diastolic heart muscle function. The findings may explain why acute resistance exercise has been associated with reduced stroke volume but chronic exercise training may result in increased LV volumes.

The effect of percutaneous transcatheter occlusion of left atrial appendage on left atrium and adjacent anatomic structure in canine

International Nuclear Information System (INIS)

Yang Zhihong; Wu Hong; Qin Yongwen; Hu Jianqiang; Ding Zhongru; Liu Zongjun; Liu Biao; Zheng Xing

2009-01-01

Objective: To observe the effect of percutaneous transcatheter occlusion of left atrial appendage (LAA) with a new self-manufactured LAA occluder on left atrium and adjacent anatomic structure in canine. Methods: A new self-manufactured LAA occluder was implanted into the LAA through a transseptal catheter in 20 dogs. Before and after the procedure, the experimental dogs were anaesthetized and examined by transthoracic echocardiography (TTE) to measure the diameter and the volume of the left atrium, the left superior pulmonary vein flow velocity and the left atrioventricular valve flow velocity separately. The contrast radiography of the LAA and the left coronary arteriography were performed. Results: The new LAA occluder was implanted successfully in 14 dogs. No obvious changes in the diameter and the volume of the left atrium, in left superior pulmonary vein flow velocity and in left atrioventricular valve flow velocity were found. On arteriography, left circumflex artery was normally displayed after the procedure. No migration of the occluder was seen on TTE and angiography after procedure. Conclusion: Percutaneous transcatheter occlusion of left atrial appendage with a new self-manufactured LAA occluder has no obvious effect on left atrium and adjacent anatomic structure in experimental canine, which indicates that the new-type device is a safe and feasible occluder for LAA. (authors)

Effect of atrial preference pacing on reducing long-term burden of atrial fibrillation:a clinical study

International Nuclear Information System (INIS)

Xu Jianfeng; Chen Yueguang; Su Yangang; Zhang Dadong

2010-01-01

Objective: To evaluate the clinical effect of atrial preference pacing (APP) on the prevention of paroxysmal atrial fibrillation. Methods: Based on the type of implanted pacemaker, 46 patients with sick sinus syndrome and paroxysmal atrial fibrillation were divided into two groups. Dual-chamber pacemaker equipped with APP function was implanted in patients of group APP (n=21), while conventional dual-chamber pacemaker was implanted in patients of control group (n=25). The patients were followed up for six months, the maximum P wave duration (Pmax), the P wave dispersion (Pd), the structure of heart chambers, the data of automatic mode switch (AMS) and the total burden of atrial fibrillation were estimated,and the results were statistically analyzed and compared between two groups. Results: The basic clinical characteristics of two groups were comparable. After six months pacing, the difference in Pmax between two groups was of no significance (115.0 ± 10.1 ms vs 122.0 ± 11.0 ms, P > 0.05), while the increase of Pd in control group was more obvious than that in group APP (32.7 ± 4.2 ms vs 20.1 ± 5.3 ms, P 0.05), and also no remarkable difference in the left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) could be found (P > 0.05). Moreover, no significant difference existed between two groups (P > 0.05). After six months pacing,in group APP the frequencies of AMS decreased more sharply (145 ± 37 times vs 327 ± 13 times, P < 0.05), the duration of AMS shortened more apparently (73 ± 15 hours vs 139 ± 28 hours, P < 0.05) and the total burden of atrial fibrillation was alleviated more obviously (13 ± 5% vs 28 ± 6%, P < 0.05) when compared to those in control group. Conclusion: Atrial preference pacing can coordinate the anisotropy of double atrial depolarization, reduce the frequencies of long-term paroxysmal atrial fibrillation, shorten the duration of atrial fibrillation

Evaluation with equilibrium radionuclide angiography of left ventricular systolic and diastolic function in pulmonary hypertension secondary to chronic pulmonary diseases

International Nuclear Information System (INIS)

Inoue, Kazuya; Sera, Kazuaki; Fukuzaki, Hisashi.

1989-01-01

To evaluate left ventricular systolic and diastolic function in patients with pulmonary hypertension secondary to chronic pulmonary diseases, 86 patients were studied using equilibrium radionuclide angiography with forward and reverse gating from the R wave. At rest left ventricular function, both in systolic and diastolic properties, in patients with pulmonary hypertension was significantly lower than in normal subjects (LVEF; P<0.05, PER; P<0.05, PFR; P<0.025, FF; P<0.025). During exercise left ventricular systolic function did not increase as much as in normals (LVEF; N.S., PER; N.S.). Left ventricular diastolic function during exercise was significantly lower than at rest (PFR; P<0.05, FF; P<0.001). The indices of left ventricular function obtained from radionuclide angiography had no close correlation with pulmonary hemodynamics or with blood gases. These results demonstrated that left ventricular dysfunction in patients with pulmonary hypertension was observed both at rest and during exercise, and might play an important role in reduced exercise tolerance. (author)

Evaluation with equilibrium radionuclide angiography of left ventricular systolic and diastolic function in pulmonary hypertension secondary to chronic pulmonary diseases

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Inoue, Kazuya; Sera, Kazuaki [National Akashi Hospital, Hyogo (Japan); Fukuzaki, Hisashi

1989-08-01

To evaluate left ventricular systolic and diastolic function in patients with pulmonary hypertension secondary to chronic pulmonary diseases, 86 patients were studied using equilibrium radionuclide angiography with forward and reverse gating from the R wave. At rest left ventricular function, both in systolic and diastolic properties, in patients with pulmonary hypertension was significantly lower than in normal subjects (LVEF; P<0.05, PER; P<0.05, PFR; P<0.025, FF; P<0.025). During exercise left ventricular systolic function did not increase as much as in normals (LVEF; N.S., PER; N.S.). Left ventricular diastolic function during exercise was significantly lower than at rest (PFR; P<0.05, FF; P<0.001). The indices of left ventricular function obtained from radionuclide angiography had no close correlation with pulmonary hemodynamics or with blood gases. These results demonstrated that left ventricular dysfunction in patients with pulmonary hypertension was observed both at rest and during exercise, and might play an important role in reduced exercise tolerance. (author).

Pressure-volume Relationship in the Stress-echocardiography Laboratory: Does (Left Ventricular End-diastolic) Size Matter?

Science.gov (United States)

Bombardini, Tonino; Mulieri, Louis A; Salvadori, Stefano; Costantino, Marco Fabio; Scali, Maria Chiara; Marzilli, Mario; Picano, Eugenio

2017-02-01

The variation between rest and peak stress end-systolic pressure-volume relation is an afterload-independent index of left ventricular contractility. Whether and to what extent it depends on end-diastolic volume remains unclear. The aim of this study was to assess the dependence of the delta rest-stress end-systolic pressure-volume relation on end-diastolic volume in patients with negative stress echo and all ranges of resting left ventricular function. We analyzed interpretable data obtained in 891 patients (593 men, age 63 ± 12 years) with ejection fraction 47% ± 12%: 338 were normal or near-normal or hypertensive; 229 patients had coronary artery disease; and 324 patients had ischemic or nonischemic dilated cardiomyopathy. They were studied with exercise (n = 172), dipyridamole (n = 482) or dobutamine (n = 237) stress echocardiography. The end-systolic pressure-volume relation was evaluated at rest and peak stress from raw measurement of systolic arterial pressure by cuff sphygmomanometer and end-systolic volume by biplane Simpson rule 2-dimensional echocardiography. Absolute values of delta rest-stress end-systolic pressure-volume relation were higher for exercise and dobutamine than for dipyridamole. In the overall population, an inverse relationship between end-systolic pressure-volume relation and end-diastolic volume was present at rest (r 2 = 0.69, P stress (r 2 = 0.56, P stress end-systolic pressure-volume relation was considered (r 2 = 0.13). Left ventricular end-diastolic volume does not affect the rest-stress changes in end-systolic pressure-volume relation in either normal or abnormal left ventricles during physical or pharmacological stress. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Magnetic resonance imaging and angiography of the brain in embolic left atrial myxoma

International Nuclear Information System (INIS)

Marazuela, M.; Yebra, M.; Diego, J.; Durantez, A.; Garcia-Merino, A.; Brasa, J.M.

1989-01-01

A case of left atrial myxoma presenting exclusively with neurological symptoms, studies with magnetic resonance imaging (MRI) combined with cerebral angiography and computed tomography (CT) is reported. Typical angiographic findings suggested the diagnosis of myxoma. MRI showed multiple ischemic lesions disseminated throughout the entire brain, some of which had been clinically asymptomatic. Because of its sensitivity in identifying small cerebral infarcts, MRI should prove in the future to be a first-choice technique in the evaluation of the presence of an extent of cerebral involvement in embolic left atrial myxoma. (orig.)

An Echocardiographic Study of Left Ventricular Size and Cardiac Function in Adolescent Females with Anorexia Nervosa.

Science.gov (United States)

Escudero, Carolina A; Potts, James E; Lam, Pei-Yoong; De Souza, Astrid M; Mugford, Gerald J; Sandor, George G S

2016-01-01

This retrospective case-control study investigated cardiac dimensions and ventricular function in female adolescents with anorexia nervosa (AN) compared with controls. Echocardiographic measurements of left ventricular (LV) dimensions, LV mass index, left atrial size and cardiac index were made. Detailed measures of systolic and diastolic ventricular function were made including tissue Doppler imaging. Patients were stratified by body mass index ≤10th percentile (AN ≤ 10th) and >10th percentile (AN > 10th). Ninety-five AN patients and 58 controls were included. AN and AN ≤ 10th groups had reduced LV dimensions, LV mass index, left atrial size and cardiac index compared with controls. There were no differences between groups in measures of systolic function. Measures of diastolic tissue Doppler imaging were decreased in AN and AN ≤ 10th. No differences in echocardiographic measurements existed between controls and AN > 10th. Female adolescents with AN have preserved systolic function and abnormalities of diastolic ventricular function. AN ≤ 10th may be a higher risk group. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

Left ventricular diastolic dyssynchrony assessed with phase analysis of gated myocardial perfusion SPECT: a comparison with tissue Doppler imaging

International Nuclear Information System (INIS)

Boogers, Mark J.; Veltman, Caroline E.; Chen, Ji; Garcia, Ernest V.; Bommel, Rutger J. van; Mooyaart, Eline A.Q.; Wall, Ernst E. van der; Schalij, Martin J.; Bax, Jeroen J.; Delgado, Victoria; Younis, Imad Al; Hiel, Bernies van der; Dibbets-Schneider, Petra

2011-01-01

The aim of the current study was to evaluate the feasibility of phase analysis on gated myocardial perfusion SPECT (GMPS) for the assessment of left ventricular (LV) diastolic dyssynchrony in a head-to-head comparison with tissue Doppler imaging (TDI). The population consisted of patients with end-stage heart failure of New York Heart Association functional class III or IV with a reduced LV ejection fraction of ≤35%. LV diastolic dyssynchrony was calculated using TDI as the maximal time delay between early peak diastolic velocities of two opposing left ventricle walls (diastolic mechanical delay). Significant LV diastolic dyssynchrony was defined as a diastolic mechanical delay of >55 ms on TDI. Furthermore, phase analysis on GMPS was performed to evaluate LV diastolic dyssynchrony; diastolic phase standard deviation (SD) and histogram bandwidth (HBW) were used as markers of LV diastolic dyssynchrony. A total of 150 patients (114 men, mean age 66.0 ± 10.4 years) with end-stage heart failure were enrolled. Both diastolic phase SD (r = 0.81, p 55 ms) showed significantly larger diastolic phase SD (68.1 ± 13.4 vs. 40.7 ± 14.0 , p < 0.01) and diastolic HBW (230.6 ± 54.3 vs. 129.0 ± 55.6 , p < 0.01) as compared to patients without LV diastolic dyssynchrony on TDI (≤55 ms). Finally, phase analysis on GMPS showed a good intra- and interobserver reproducibility for the determination of diastolic phase SD (ICC 0.97 and 0.88) and diastolic HBW (ICC 0.98 and 0.93). Phase analysis on GMPS showed good correlations with TDI for the assessment of LV diastolic dyssynchrony. (orig.)

Rare Chronic Gastric Volvulus Associated with Left Atrial and Mediastinal Compression

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Shriki, Jabi E.; Nguyen, Khanh; Rozo, Juan Carlos; Reul, George J.; Mortazavi, Ali

2002-01-01

We report a case of chronic gastric volvulus associated with left atrial compression in a 75-year-old woman who presented with chest pain, shortness of breath, and hypotension after elective hemiarthroplasty of the left hip. The patient's medical history included a paraesophageal hernia and gastric volvulus diagnosed in 1997 but left untreated. The present diagnosis of gastric volvulus was made on the basis of a chest radiograph and subsequent computed tomography. Echocardiography showed the ...

Assessment of right atrial function analysis

International Nuclear Information System (INIS)

Shohgase, Takashi; Miyamoto, Atsushi; Kanamori, Katsushi; Kobayashi, Takeshi; Yasuda, Hisakazu

1988-01-01

To assess the potential utility of right atrial function analysis in cardiac disease, reservoir function, pump function, and right atrial peak emptying rate (RAPER) were compared in 10 normal subjects, 32 patients with coronary artery disease, and 4 patients with primary pulmonary hypertension. Right atrial volume curves were obtained using cardiac radionuclide method with Kr-81m. In normal subjects, reservoir function index was 0.41+-0.05; pump function index was 0.25+-0.05. Both types of patients has decreased reservoir funcion and increased pump function. Pump function tended to decrease with an increase of right ventricular end-diastolic pressure. RAPER correlated well with right ventricular peak filling rate, probably reflecting right ventricular diastolic function. Analysis of right atrial function seemed to be of value in evaluating factors regulating right ventricular contraction and diastolic function, and cardiac output. (Namekawa, K)

Effect of CPAP on diastolic function in coronary artery disease patients with nonsleepy obstructive sleep apnea: A randomized controlled trial.

Science.gov (United States)

Glantz, Helena; Johansson, Magnus C; Thunström, Erik; Guron, Cecilia Wallentin; Uzel, Harun; Saygin, Mustafa; Herlitz, Johan; Peker, Yüksel

2017-08-15

Obstructive sleep apnea (OSA) has been associated with worse diastolic function in patients with coronary artery disease (CAD). This analysis determined whether continuous positive airway pressure (CPAP) treatment would improve diastolic function in CAD patients with nonsleepy OSA. Between December 2005 and November 2010, 244 revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index (AHI) ≥15/h, Epworth Sleepiness Scale [ESS] scoreCPAP or no-CPAP. Echocardiographic measurements were obtained at baseline, and after 3 and 12months. A total of 171 patients with preserved left ventricular ejection fraction (≥50%), no atrial fibrillation or severe valve abnormalities, and technically adequate echocardiograms at baseline and follow-up visits were included (CPAP, n=87; no-CPAP, n=84). In the intention-to-treat analysis, CPAP had no significant effect on echocardiographic parameters of mild (enlarged left atrium or decreased diastolic relaxation velocity) or worse (increased E/é filling index [presumed elevated left ventricular filling pressure]) diastolic function. Post-hoc analysis revealed a significant association between CPAP usage for ≥4h/night and an increase in diastolic relaxation velocity at 12months' follow-up (odds ratio 2.3, 95% confidence interval 1.0-4.9; p=0.039) after adjustment for age, sex, body mass index, and left atrium diameter at baseline. CPAP did not improve diastolic dysfunction in CAD patients with nonsleepy OSA. However, good CPAP adherence was significantly associated with an increase in diastolic relaxation velocity after one year. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Non-alcoholic fatty liver disease is associated with left ventricular diastolic dysfunction in essential hypertension.

Science.gov (United States)

Fallo, F; Dalla Pozza, A; Sonino, N; Lupia, M; Tona, F; Federspil, G; Ermani, M; Catena, C; Soardo, G; Di Piazza, L; Bernardi, S; Bertolotto, M; Pinamonti, B; Fabris, B; Sechi, L A

2009-11-01

Insulin resistance is recognized as the pathophysiological hallmark of non-alcoholic fatty liver disease (NAFLD). A relation between insulin sensitivity and left ventricular morphology and function has been reported in essential hypertension, where a high prevalence of NAFLD has been recently found. We investigated the inter-relationship between left ventricular morphology/function, metabolic parameters and NAFLD in 86 never-treated essential hypertensive patients subdivided in two subgroups according to the presence (n = 48) or absence (n = 38) of NAFLD at ultrasonography. The two groups were similar as to sex, age and blood pressure levels. No patient had diabetes mellitus, obesity, hyperlipidemia, or other risk factors for liver disease. Body mass index, waist circumference, triglycerides, glucose, insulin, homeostasis model of assessment index for insulin resistance (HOMA-IR), aspartate aminotransferase and alanine aminotransferase were higher and adiponectin levels were lower in patients with NAFLD than in patients without NAFLD, and were associated with NAFLD at univariate analysis. Patients with NAFLD had similar prevalence of left ventricular hypertrophy compared to patients without NAFLD, but a higher prevalence of diastolic dysfunction (62.5 vs 21.1%, P 220 ms. Diastolic dysfunction (P = 0.040) and HOMA-IR (P = 0.012) remained independently associated with NAFLD at backward multivariate analysis. Non-alcoholic fatty liver disease was associated with insulin resistance and abnormalities of left ventricular diastolic function in a cohort of patients with essential hypertension, suggesting a concomitant increase of metabolic and cardiac risk in this condition.

Left atrial ejection force predicts the outcome after catheter ablation for paroxysmal atrial fibrillation.

Science.gov (United States)

Kishima, Hideyuki; Mine, Takanao; Takahashi, Satoshi; Ashida, Kenki; Ishihara, Masaharu; Masuyama, Tohru

2018-02-01

Left atrium (LA) systolic dysfunction is observed in the early stages of atrial fibrillation (AF) prior to LA anatomical change. We investigated whether LA systolic dysfunction predicts recurrent AF after catheter ablation (CA) in patients with paroxysmal AF. We studied 106 patients who underwent CA for paroxysmal AF. LA systolic function was assessed with the LA emptying volume = Maximum LA volume (LAV max ) - Minimum LA volume (LAV min ), LA emptying fraction = [(LAV max - LAV min )/LAV max ] × 100, and LA ejection force calculated with Manning's method [LA ejection force = (0.5 × ρ × mitral valve area × A 2 )], where ρ is the blood density and A is the late-diastolic mitral inflow velocity. Recurrent AF was detected in 35/106 (33%) during 14.6 ± 9.1 months. Univariate analysis revealed reduced LA ejection force, decreased LA emptying fraction, larger LA diameter, and elevated brain natriuretic peptide as significant variables. On multivariate analysis, reduced LA ejection force and larger LA diameter were independently associated with recurrent AF. Moreover, patients with reduced LA ejection force and larger LA diameter had a higher risk of recurrent AF than preserved LA ejection force (log-rank P = 0.0004). Reduced LA ejection force and larger LA diameter were associated with poor outcome after CA for paroxysmal AF, and could be a new index to predict recurrent AF. © 2017 Wiley Periodicals, Inc.

Atrial Fibrillation associated chromosome 4q25 variants are not associated with PITX2c expression in human adult left atrial appendages.

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Shamone R Gore-Panter

Full Text Available Atrial Fibrillation (AF, the most common sustained arrhythmia, has a strong genetic component, but the mechanism by which common genetic variants lead to increased AF susceptibility is unknown. Genome-wide association studies (GWAS have identified that the single nucleotide polymorphisms (SNPs most strongly associated with AF are located on chromosome 4q25 in an intergenic region distal to the PITX2 gene. Our objective was to determine whether the AF-associated SNPs on chromosome 4q25 were associated with PITX2c expression in adult human left atrial appendages. Analysis of a lone AF GWAS identified four independent AF risk SNPs at chromosome 4q25. Human adult left atrial appendage tissue was obtained from 239 subjects of European Ancestry and used for SNP analysis of genomic DNA and determination of PITX2c RNA expression levels by quantitative PCR. Subjects were divided into three groups based on their history of AF and pre-operative rhythm. AF rhythm subjects had higher PITX2c expression than those with history of AF but in sinus rhythm. PITX2c expression was not associated with the AF risk SNPs in human adult left atrial appendages in all subjects combined or in each of the three subgroups. However, we identified seven SNPs modestly associated with PITX2c expression located in the introns of the ENPEP gene, ∼54 kb proximal to PITX2. PITX2c expression in human adult left atrial appendages is not associated with the chromosome 4q25 AF risk SNPs; thus, the mechanism by which these SNPs are associated with AF remains enigmatic.

Epidemiological study of dilated cardiomyopathy from eastern India with special reference to left atrial size

Directory of Open Access Journals (Sweden)

Rudrajit Paul, Saumen Nandi, Pradip K Sinha

2014-07-01

Full Text Available Dilated cardiomyopathy (DCM is a common cause of emergency visit in our country. The disease is often misdiagnosed and mistreated. There are very few studies on DCM from India. We undertook a small study on DCM patients from Eastern India to find the demographic and echocardiographic characteristics. Patients and methods: We under took this study in a tertiary care Medical College of Eastern India. All patients coming to the emergency with dyspnea were evaluated for cardiac dysfunction. Emergency echocardiography was done to diagnose dilated cardiomyopathy. Patients with DCM were then evaluated as per protocol. After stabilization, echocardiography was repeated to note the study parameters like left atrial diameter. Standard statistical tests were used. Results: we had a total of 70 patients in our study with a male: female ratio of 43:27. Most patients were aged over 40 years. Patients with COPD, history of radiation, malignancy or drug abuse were excluded. Most patients (47% were on NYHA stage 3 at the time of presentation. In our patient cohort, 24% were alcoholic and 46% were smokers. Atrial fibrillation was present in 15.7% of the patients and right and left bundle branch block had been present in 8 and 15 patients respectively. In echocardiography, increased left atrial (LA size (>40 mm was found in 45 patients. Many patients had valvular regurgitation, mitral, aortic or tricuspid. LA size was positively correlated with left ventricular systolic diameter (r=0.403 and negatively correlated with ejection fraction (r= -0.23. Analysis and conclusion: different ECG abnormalities like bundle branch block and arrhythmias like atrial fibrillation are quite common in DCM. In echocardiography, left atrial size is an important prognostic marker and correlates with left ventricular function.

Independent prognostic value of left ventricular mass, diastolic function, and fasting plasma glucose

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Pareek, Manan; Nielsen, Mette Lundgren; Leósdóttir, Margrét

2016-01-01

OBJECTIVE: To explore the independent prognostic value of left ventricular (LV) mass, diastolic function, and fasting plasma glucose (FPG) for the prediction of incident cardiac events in a random population sample. DESIGN AND METHOD: 415 women and 999 men aged 56-79 years, included between 2002...

Comparative efficacy of amiodarone with ivabradin combination or amiodarone with bisoprolol combination in the prevention of atrial fibrillation recurrence in pa- tients with left ventricular diastolic dysfunction

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K. G. Adamyan

2015-01-01

Full Text Available Aim. To study the efficacy of use of amiodarone with ivabradine combination or amiodarone with bisoprolol combination in the prevention of atrial fibrillation (AF recurrence in patients (pts with left ventricular diastolic dysfunction (LVDD after conversion to sinus rhythm. Material and methods. 65 patients (40 males, 25 females aged 53±8 years with persistent AF and LVDD were included into the study and randomized into 3 groups to receive ivabradine and amiodarone (22 pts, bisoprolol and amiodarone (22 pts or amiodarone alone (21 pts. Left atrium (LA volume indices, LA longitudinal strain rate (LASR in systole, LV mass index, mean heart rate (HR, 24-hour HR variability and the incidence of AF by 96 h ECG monitoring were measured after the titration period, and after 3 and 6 months of follow-up. Results. After 6 months of follow-up group 1 revealed significantly lower maximum LA volume index (21.3±2.4 vs 25.2±3.0 and 28.7±3.6 ml/m2 in the 2nd and control groups, respectively, P-wave LA volume index (15.3±3.5 versus 18.1±3.8 and 20.4±4.0 ml/m2 in the 2nd and control groups, respectively, and LA systolic volume index (7.3±1.2 versus 9.4±1.6 and 9.6±1.7 ml/m2 in 2nd and control groups, respectively. The incidence of side effects in group 1 was significantly less than that in group 2 and was not different compared with control group. Conclusion. Ivabradine and amiodarone combination provides better prevention of AF recurrence and less side-effects in pts with LVDD and persistent AF after sinus rhythm restoration as compared with bisoprolol and amiodarone combination, it also reduces LA maximum, conduit and systolic volumes, and increases LASR.

Prognostic implications of left ventricular diastolic dysfunction with preserved systolic function following acute myocardial infarction

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Poulsen, S H; Møller, J E; Nørager, B

2001-01-01

of the mitral and pulmonary venous flow, and the propagation velocity of early mitral flow by color M-mode Doppler echocardiography in 183 consecutive patients at day 5-7 following their first acute MI. Patients were classified into four groups: group A: preserved LV systolic and diastolic function (n = 73......%) and D (38%) compared to A (2%) (p class >or=II (p = 0.006), and age (0.008) as predictors of cardiac death or readmission due to heart failure. The presence of LV diastolic dysfunction with preserved......The contribution of diastolic dysfunction in patients with preserved left ventricular (LV) systolic function to impaired functional status and cardiac mortality in myocardial infarction (MI) is unknown. In the present study, assessment of LV diastolic function was performed by Doppler analysis...

The clot thickens: an incompletely ligated left  atrial appendage

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Merrill Thomas

2018-05-01

Full Text Available Our patient presented with known mechanical mitral valve endocarditis documented by 2D transesophageal echocardiogram (TOE from a recent hospitalization at an outside facility. On admission to our center, there was no prior knowledge of an incompletely ligated left atrial appendage (LAA according to patient- or family-reported history, review of outside records or the outside facility’s 2D TOE report. A 3D TOE performed at our center to assess her pathology, since a month had passed from her prior hospitalization, revealed a LAA ligation with evidence of communication to the left atrium and with clot present in the appendage. This case report highlights the common finding of incomplete closure of the LAA following surgical ligation, thus making it inadequate for stroke prevention in patients with atrial fibrillation, and that 3D TOE plays a valuable role in assessing the durability of LAA ligation.

Left atrial function to identify patients with atrial fibrillation at high risk of stroke: new insights from a large registry.

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Leung, Melissa; van Rosendael, Philippe J; Abou, Rachid; Ajmone Marsan, Nina; Leung, Dominic Y; Delgado, Victoria; Bax, Jeroen J

2018-04-21

Atrial fibrillation (AF) is an independent risk factor for ischaemic stroke. The CHA2DS2-VASc is the most widely used risk stratification model; however, echocardiographic refinement may be useful, particularly in low risk AF patients. The present study examined the association between advanced echocardiographic parameters and ischaemic stroke, independent of CHA2DS2-VASc score. One thousand, three hundred and sixty-one patients (mean age 65±12 years, 74% males) with first diagnosis of AF and baseline transthoracic echocardiogram were followed by chart review for the occurrence of stroke over a mean of 7.9 years. Left atrial (LA) volumes, LA reservoir strain, P-wave to A' duration on tissue Doppler imaging (PA-TDI, reflecting total atrial conduction time), and left ventricular (LV) global longitudinal strain (GLS) were evaluated in patients with and without stroke. The independent association of these echocardiographic parameters with the occurrence of ischaemic stroke was evaluated with Cox proportional hazard models. One-hundred patients (7%) developed an ischaemic stroke, representing an annualized stroke rate of 0.9%. The incident stroke rate in the year following the first diagnosis of AF was 2.6% in the entire population and higher than the remainder of the follow-up period. Left atrial reservoir (14.5% vs. 18.9%, P = 0.005) and conduit strains were reduced (10.5% vs. 13.5%, P = 0.013), and PA-TDI lengthened (166 ms vs. 141 ms, P Left atrial reservoir strain and PA-TDI were independently associated with risk of stroke in a model including CHA2DS2-VASc score, age, and anticoagulant use. The assessment of LA reservoir strain and PA-TDI on echocardiography after initial CHA2DS2-VASc scoring provides additional risk stratification for stroke and may be useful to guide decisions regarding anticoagulation for patients upon first diagnosis of AF.

Left ventricular dysfunction in repaired tetralogy of Fallot: incidence and impact on atrial arrhythmias at long term-follow up.

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Ait Ali, Lamia; Trocchio, GianLuca; Crepaz, Roberto; Stuefer, Josef; Stagnaro, Nicola; Siciliano, Valeria; Molinaro, Sabrina; Sicari, Rosa; Festa, Pierluigi

2016-09-01

Left ventricle (LV) systolic dysfunction in repaired tetralogy of Fallot (TOF) has been identified as a risk factor for functional status and adverse outcome. The aims of this cross-sectional followed by a prospective study were: (1) to evaluate the prevalence of LV systolic dysfunction in a large cohort of adults with repaired tetralogy of Fallot, (2) to test the relationship between LV systolic dysfunction and other known risk factors and (3) to evaluate the impact of LV systolic dysfunction on adverse cardiac events. In a multicenter study, 237 adults repaired TOF (58 % males, age 30 ± 10 years) were evaluated by cardiac magnetic resonance (CMR). Demographics, surgical history, ECG, Echo-Color Doppler and follow-up data were recorded. LV was dilated (Z value >2) in 16 patients (6 %), however 56 patients (23.6 %) had a reduced LV systolic function left ventricle ejection fraction (LVEF) (Z value <-2). Patients with LV systolic dysfunction were mainly males (82 %), had reduced right ventricle ejection fraction (RVEF), and higher right and left Late Gadolinium Enhanced scores. In a multivariate regression analysis male gender and RVEF resulted to be independent factors associated to LV systolic dysfunction. Atrial arrhythmias were the main adverse cardiac event at the follow-up and were associated to higher biventricular volumes and lower biventricular ejection fraction (EF); however multivariable analysis identified age, right ventricle end-diastolic volume (RVEDVi) and tricuspid regurgitation as independents factors associated to atrial arrhythmias. At long term follow-up at least ¼ of repaired TOF has LV dysfunction. Lower LVEF is associated to male gender and lower RVEF.

Prevention of Cerebral Embolism Progression by Emergency Surgery of the Left Atrial Myxoma

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Syuichi Tetsuka

2015-01-01

Full Text Available A 21-year-old woman developed left hemiparesis during work and was hospitalized. Her National Institutes of Health Stroke Scale score was 4. Hyperintense areas in the left basal ganglia, corona radiata, and cortex of the temporal lobe were found by brain diffusion-weighted magnetic resonance imaging, indicating acute cerebral infarction. Echocardiography showed a giant mass of diameter 7 × 4 cm in the left atrium. Therefore, she was diagnosed with cerebral embolism due to a left atrial myxoma. Currently, thrombolytic therapy may continue to be effective because the embolic source may be composed of tumor tissue itself. In case of atrial myxoma, we considered that the use of tPA as emergency treatment in all patients with infarction by atrial myxoma may be questioned. Thus, cardiac tumor extraction was performed the next day after hospitalization without thrombolytic therapy. The excised myxoma measured 7 × 6 × 4 cm. The patient recovered and her neurological symptoms also improved. Furthermore, her National Institutes of Health Stroke Scale score improved to 0. Thirteen days after admission, the patient was discharged from our hospital. Cardiac myxoma is often associated with a high risk of embolic episodes, which emphasizes the need for prompt surgical excision as soon as the diagnosis is confirmed.

Left atrioventricular remodeling in the assessment of the left ventricle diastolic function in patients with heart failure: a review of the currently studied echocardiographic variables

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Köhler Ilmar

2008-11-01

Full Text Available Abstract Multiparametric echocardiographic imaging of the failing heart is now increasingly used and useful in decision making in heart failure. The reasons for this, relies on the need of different strategies of handling these patients, as differentiation of systolic or diastolic dysfunction, as well as on the gamma of approaches available, such as percutaneous and surgical revascularization, devices implantations, and valvular regurgitations and stenosis corrections. Congestive heart failure in patients with normal left ventricular diameters or preserved left ventricular ejection fraction had been pointed out recently as present in a proportion so high as 40 to 50 percent of cases of heart failure, mainly due to the epidemics in well developed countries, as is the problem of not well controlled metabolic states (such as obesity and diabetes, but also due to the real word in developing countries, as is the case of hypertension epidemics and its lack of adequate control. As a matter of public utility, the guidelines in the diagnosis and treatment of such patients will have to be cheap, available, easily reproducible, and ideally will furnish answers for the clinician questions not in a binary "black or white" manner, but with graduations, so if possible it has to be quantitative. The present paper aim to focus on the current clinical applications of tissue Doppler and of left atrial function and remodeling, and its pathophysiologic relationship with the left ventricle, as will be cleared in the documented review of echocardiography that follows, considering that the need of universal data on the syndrome of the failing heart does not mean, unfortunately, that all patients and clinicians in developing countries have at their own health facilities the same imaging tools, since they are, as a general rule, expensive.

Assessment of the left ventricular systolic and diastolic function by the left ventricular density curve derived from intravenous digital subtraction angiography in children

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Horigome, Hitoshi; Satoh, Hideo; Isobe, Takeshi; Takita, Hitoshi

1991-01-01

To evaluate the left ventricular (LV) systolic and diastolic function, fifty-four children with various heart diseases underwent intravenous digital subtraction angiography (IV-DSA). Global left ventricular density curve was obtained through densitometry of the DSA images. The curve was smoothed by a third-degree Fourier transformation and systolic and diastolic indexes were obtained. In the control group, consisting of Kawasaki disease without coronary lesion and mild pulmonary stenosis, the peak ejection rate (PER) and the peak filling rate in early diastole (PFR-E) correlated positively with the heart rate (HR) in a quadratic curve manner [PER: r= 0.93 p<0.01, PFR-E: r= 0.94 p<0.01]. Time from end-diastolic to PER (T-PER) and time from end-systolic to PFR (T-PFR) were correlated negatively with HR [T-PER: r=-0.86 p<0.01, T-PFR: r=-0.91 p<0.01]. However, T-PER/RR and T-PFR/RR values were rather constant (20.9±3.2%, 17.0±2.6%, respectively). We also found significant correlations of PER and PFR-E with left ventricular ejection fraction (LVEF). Patients with corrected tetralogy of Fallot and with cardiomyopaties showed not only abnormal systolic indexes but some depressed diastolic indexes. LV density curve also disclosed isolated diastolic dysfunction in a group of aortic stenosis and in two patients with coronary lesions. A correlation of LVEF derived from the density curve and conventional area-length method was high [r= 0.91 p<0.001]. To evaluate the reproducibility, we were able to obtain the digital data twice with over one month interval on 24 patients. The intraobserver correlation was satisfactory. We applied the remasking method, resulting in improving the quality of digital images under spontaneous breathing. Our results indicated that IV-DSA was a less-invasive and clinically reliable method for assessment of LV function in children. (author)

Assessment of the left ventricular systolic and diastolic function by the left ventricular density curve derived from intravenous digital subtraction angiography in children

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Horigome, Hitoshi; Satoh, Hideo; Isobe, Takeshi; Takita, Hitoshi (Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine)

1991-05-01

To evaluate the left ventricular (LV) systolic and diastolic function, fifty-four children with various heart diseases underwent intravenous digital subtraction angiography (IV-DSA). Global left ventricular density curve was obtained through densitometry of the DSA images. The curve was smoothed by a third-degree Fourier transformation and systolic and diastolic indexes were obtained. In the control group, consisting of Kawasaki disease without coronary lesion and mild pulmonary stenosis, the peak ejection rate (PER) and the peak filling rate in early diastole (PFR-E) correlated positively with the heart rate (HR) in a quadratic curve manner (PER: r= 0.93 p<0.01, PFR-E: r= 0.94 p<0.01). Time from end-diastolic to PER (T-PER) and time from end-systolic to PFR (T-PFR) were correlated negatively with HR (T-PER: r=-0.86 p<0.01, T-PFR: r=-0.91 p<0.01). However, T-PER/RR and T-PFR/RR values were rather constant (20.9+-3.2%, 17.0+-2.6%, respectively). We also found significant correlations of PER and PFR-E with left ventricular ejection fraction (LVEF). Patients with corrected tetralogy of Fallot and with cardiomyopaties showed not only abnormal systolic indexes but some depressed diastolic indexes. LV density curve also disclosed isolated diastolic dysfunction in a group of aortic stenosis and in two patients with coronary lesions. A correlation of LVEF derived from the density curve and conventional area-length method was high (r= 0.91 p<0.001). To evaluate the reproducibility, we were able to obtain the digital data twice with over one month interval on 24 patients. The intraobserver correlation was satisfactory. We applied the remasking method, resulting in improving the quality of digital images under spontaneous breathing. Our results indicated that IV-DSA was a less-invasive and clinically reliable method for assessment of LV function in children. (author).

Assessment of left atrial volume and function in patients with permanent atrial fibrillation

DEFF Research Database (Denmark)

Agner, Bue F Ross; Kühl, Jørgen Tobias; Linde, Jesper James

2014-01-01

Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with substantial morbidity and mortality. AF is associated with enlargement of the left atrium (LA), and the LA volume has important prognostic implications for the disease. The objective of the study was to determine how...... measurements of LA volume and function obtained by transthoracic echocardiography (TTE), cardiac magnetic resonance (CMR), and 320-slice multi-detector computed tomography (MDCT) correlate in patients with permanent AF....

Left atrial appendage thrombosis during therapy with rivaroxaban in elective cardioversion for permanent atrial fibrillation

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Walter Serra

2015-09-01

Full Text Available Electric external cardioversion (EEC for permanent atrial fibrillation (AF carries a risk of thromboembolic events (TE. The use of transesophageal echocardiography (TEE to guide the management of atrial fibrillation may be considered a clinically effective alternative strategy to conventional therapy for patients in whom elective cardioversion is planned. Therapeutic anticoagulation with novel oral anticoagulants (NOAC is recommended for 3 to 4 weeks before and an anticoagulation life-long therapy is recommended after EEC to reduce TE, in patients with high CHA2DS2-VASc score; however, only few data are currently available about safety of shortterm anticoagulation with NOAC in the setting of EEC. Patients with increased risk of thromboembolism have not been adequately studied and the monitoring of anticoagulant effects can also have important benefits in case of drug interactions. We report a case of a 68-year old man with AF from September 2014. Moderate depression of global left ventricular systolic function was detected by echocardiographic exam. On the basis of a high thromboembolic risk, an anticoagulant therapy with rivaroxaban, at the dose of 20 mg/day, was started. TEE showed a thrombus in the left atrial appendage. This case demonstrates the utility of performing TEE prior than EEC in patients with hypokinetic cardiomyopathy other than AF in therapy with NOAC. We underline the presence of significant pharmacodynamic interference of rivaroxaban with other drugs such as oxcarbazepine.

Structural and functional changes in the heart and clinical features of heart failure with preserved left ventricular ejection fraction in patients after myocardial infarction, comorbided with arterial hypertension

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V. D. Syvolap

2013-12-01

class I, 32% - NYHA class II, 48% - NYHA class III and 10% have NYHA class IV. In the first group revealed a significant increase of left ventricular end diastolic volume (13,8%, p <0,05, left ventricular end systolic volume (14,9%, p <0,05 and left atrial volume index (35%, p <0,05 compared with patients from the second group. Patients from the second group had a significant increase of left ventricular mass index (15,2%, p <0,05, left ventricular posterior wall ( 12,8%, p <0,05 and interventricular septum (10%, p <0,05 compared with patients from the third group. Patients from the first group had a higher E/E ' ratio (26%, p <0,05 compared with patients from the second group. In patients from the second group revealed decreased E/A (30,8%, p <0,05, E '(35,7%, p <0,05 and increased E/E' (13, 3%, p <0,05 compared with patients from the third group. Patients after myocardial infarction with arterial hypertension and diastolic heart failure had diastolic dysfunction mainly on the type of violation of relaxation (74%. 22% of these patients had pseudonormal type of diastolic dysfunction and 4% had restrictive LV filling type. Conclusion: In patients with post-infarction cardiosclerosis and diastolic heart failure with arterial hypertension severity of clinical manifestations of heart failure correlates with left atrial volume index and markers of diastolic dysfunction such as E' and E/E'. In patients with post-infarction cardiosclerosis and arterial hypertension with diastolic heart failure had predominantly concentric hypertrophy with increased left atrial volume index and moderate left ventricular dilatation and mild diastolic dysfunction. In patients after myocardial infarction with arterial hypertension and asymptomatic diastolic dysfunction observed structural and functional changes in the type of concentric hypertrophy with thickened walls and increased left ventricular mass index.

Peak negative myocardial velocity gradient in early diastole as a noninvasive indicator of left ventricular diastolic function: comparison with transmitral flow velocity indices.

Science.gov (United States)

Shimizu, Y; Uematsu, M; Shimizu, H; Nakamura, K; Yamagishi, M; Miyatake, K

1998-11-01

We sought to assess the clinical significance of peak negative myocardial velocity gradient (MVG) in early diastole as a noninvasive indicator of left ventricular (LV) diastolic function. Peak systolic MVG has been shown useful for the quantitative assessment of regional wall motion abnormalities, but limited data exist regarding the diastolic MVG as an indicator of LV diastolic function. Peak negative MVG was obtained from M-mode tissue Doppler imaging (TDI) in 43 subjects with or without impairment of systolic and diastolic performance: 12 normal subjects, 12 patients with hypertensive heart disease (HHD) with normal systolic performance and 19 patients with dilated cardiomyopathy (DCM), and was compared with standard Doppler transmitral flow velocity indices. In a subgroup of 30 patients, effects of preload increase on these indices were assessed by performing passive leg lifting. In an additional 11 patients with congestive heart failure at the initial examination, the measurements were repeated after 26+/-16 days of volume-reducing therapy. Peak negative MVG was significantly depressed both in HHD (-3.9+/-1.3/s, p indices failed to distinguish DCM from normal due to the pseudonormalization. Transmitral flow velocity indices were significantly altered (peak early/late diastolic filling velocity [E/A]=1.1+/-0.5 to 1.5+/-0.7, p indicator of LV diastolic function that is less affected by preload alterations than the transmitral flow velocity indices, and thereby could be used for the follow-up of patients with nonischemic LV dysfunction presenting congestive heart failure.

Left atrial appendage closure: Six reasons why I wouldn't choose a percutaneous closure for my appendage.

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Ferlini, Marco; Rossini, Roberta

2018-01-15

Left atrial appendage has been shown as a primary source of thrombi in patients with non-valvular atrial fibrillation (AF). Non vitamin k oral anticoagulants (NOAC) have been shown to be safe and effective in the prevention of embolic complications. Current guidelines on AF state that percutaneous left atrial appendage closure (LAAC) might be considered in patients with contraindication to long term oral anticoagulant therapy (OAC). An overview of the main trials on NOAC and LAAC is provided. Copyright © 2017 Elsevier B.V. All rights reserved.

Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus

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Preetham R Muskula

2017-04-01

Full Text Available An 84-year-old man presented 5 years after bioprosthetic mitral valve replacement with three months of worsening dyspnea on exertion. A new mitral stenosis murmur was noted on physical examination, and an electrocardiogram revealed newly recognized atrial fibrillation. Severe mitral stenosis (mean gradient = 13 mmHg was confirmed by transthoracic echocardiography. Transesophageal echocardiography revealed markedly thickened mitral bioprosthetic leaflets with limited mobility, and a massive left atrial thrombus (>4 cm in diameter (Fig. 1A, B, C, D and Videos 1, 2, 3 and 4. Intravenous heparin was initiated, and 5 days later, he was taken to the operating room for planned redo mitral valve replacement and left atrial thrombus extraction. Intraoperative transesophageal echocardiography revealed near-complete resolution of the bioprosthetic leaflet thickening, and a mean mitral gradient of only 3 mmHg (Fig. 2A, B, C and Videos 5, 6 and 7. The patient underwent resection of the massive left atrial thrombus (Fig. 2D but did not require redo mitral valve replacement. He was initiated on heparin (and transitioned to warfarin early in the post-operative period, with complete resolution of dyspnea on exertion at 3-month follow-up. Bioprosthetic valve thrombosis is increasingly recognized as a cause of early prosthetic valve dysfunction (1, 2. This case illustrates that bioprosthetic valve thrombosis may occur years after valve replacement; therefore, any deterioration in a patient’s clinical status (new-onset dyspnea, heart failure or atrial fibrillation warrants a thorough evaluation of the bioprosthetic valve with transesophageal echocardiography. In this case, initiation of anticoagulation obviated the need for redo mitral valve replacement.

Obese Hypertensive Men Have Lower Circulating Proatrial Natriuretic Peptide Concentrations Despite Greater Left Atrial Size

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Asferg, Camilla L; Andersen, Ulrik B; Linneberg, Allan

2018-01-01

BACKGROUND: Obese persons have lower circulating natriuretic peptide (NP) concentrations. It has been proposed that this natriuretic handicap plays a role in obesity-related hypertension. In contrast, hypertensive patients with left atrial enlargement have higher circulating NP concentrations....... On this background, we investigated whether obese hypertensive men could have lower circulating NP concentrations despite evidence of pressure-induced greater left atrial size. METHODS: We examined 98 obese men (body mass index [BMI] ≥ 30.0 kg/m2) and 27 lean normotensive men (BMI 20.0-24.9 kg/m2). All men were...... using echocardiography, and we measured fasting serum concentrations of midregional proatrial NP (MR-proANP). RESULTS: Of the 98 obese men, 62 had hypertension and 36 were normotensive. The obese hypertensive men had greater left atrial size (mean ± SD: 28.7 ± 6.0 ml/m2) compared with the lean...

Relationship between occupational exposure to lead and local arterial stiffness and left ventricular diastolic function in individuals with arterial hypertension

International Nuclear Information System (INIS)

Poreba, Rafal; Gac, Pawel; Poreba, Malgorzata; Antonowicz-Juchniewicz, Jolanta; Andrzejak, Ryszard

2011-01-01

Relationship between occupational exposure to lead and frequency of complications in persons with arterial hypertension has been poorly investigated. This study aimed at evaluation of the relationship between occupational exposure to lead and manifestation of an increased local arterial stiffness and left ventricular diastolic dysfunction. The studies included 105 men (mean age: 44.47 ± 9.12 years) with arterial hypertension, treated with hypotensive drugs: group I - men occupationally exposed to lead (n = 53), and group II - men not exposed to lead (n = 52). In echocardiographic examination, the left ventricular diastolic dysfunction was diagnosed significantly more frequently in group I than in group II. In eTracking examination mean values of stiffness parameter (β), augmentation index (AI) and one-point pulse wave velocity (PWV-β) were significantly higher and mean values of arterial compliance (AC) were significantly lower in group I than in group II. The logistic regression showed that in the group of persons with arterial hypertension occupationally exposed to lead a more advanced age, higher blood lead concentration and higher mean values of augmentation index represent independent risk factors of left ventricular diastolic dysfunction. The multifactorial regression showed that amongst persons with arterial hypertension occupationally exposed to lead higher blood zinc protoporphyrin concentration, a more advanced age and higher value of body mass index (BMI) represent independent risk factors of an increased local arterial stiffness. In summary, we should note that in the group of persons with arterial hypertension occupationally exposed to lead the study has demonstrated a significantly more frequent manifestation of left ventricular diastolic dysfunction and an increase in local arterial stiffness. - Highlights: → Amongst persons with AH exposed to Pb higher ZnPP represent independent risk factor of increased local arterial stiffness. → Higher Pb

Long-term survival of quiescent left atrial myxoma in an elderly patient.

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Kay, Jay F L; Chow, Wing Hing

2002-01-01

Left atrial myxoma, if left untreated, is inexorably progressive and usually fatal. The classical management of this disease is prompt surgical removal. However, there may be exceptions to this traditional dogma. The authors report an 85-year-old man who presented with features of chronic obstructive airway disease and congestive heart failure 15 years previously. Auscultation of the heart showed a pansystolic murmur. Two-dimensional echocardiography revealed a nonobstructive, calcified, and well circumscribed mass in the left atrium, with a pedicle attached to the interatrial septum. Because the patient refused high-risk cardiac surgery related to his comorbidity, he was managed medically with a bronchodilator, diuretics, and digoxin. There have been no features of embolism or intracardiac obstruction, and serial echocardiography demonstrates no disease progression over this long period of time. This case illustrates that calcified left atrial myxoma may exhibit a quiescent phase. Tumor calcification, slow growth potential, and the absence of intracardiac obstruction may correlate with a better outcome in the elderly patient. (c)2002 CVRR, Inc.

Assessment of ventriculo-vascular properties in repaired coarctation using cardiac magnetic resonance-derived aortic, left atrial and left ventricular strain

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Shang, Quanliang [University of Nebraska College of Medicine and Children' s Hospital and Medical Center, Division of Pediatric Cardiology, Omaha, NE (United States); Central South University, Department of Radiology, Second Xiangya Hospital, Changsha, Hunan Province (China); Sarikouch, Samir; Beerbaum, Philipp [Hannover Medical School, Hannover (Germany); Patel, Shivani; Danford, David A.; Kutty, Shelby [University of Nebraska College of Medicine and Children' s Hospital and Medical Center, Division of Pediatric Cardiology, Omaha, NE (United States); Schuster, Andreas [Department of Cardiology and Pneumonology, Georg-August-University and German Center for Cardiovascular Research (DZHK, Partner Site), Goettingen (Germany); Steinmetz, Michael [Department of Pediatric Cardiology, Georg-August-University and German Center for Cardiovascular Research (DZHK, Partner Site), Goettingen (Germany); Ou, Phalla [University Paris Diderot, Department of Radiology, Hospital Bichat, APHP, Paris (France)

2017-01-15

In patients with repaired coarctation of aorta (CoA), we assessed ventriculo-vascular characteristics using CMR-derived aortic area strain (AAS), left atrial (LA) and left ventricular (LV) longitudinal and circumferential strain (LS, CS). Seventy-five subjects including 50 with repaired CoA divided into hypertensive (n = 25), normotensive (n = 25) and 25 controls were studied. AAS was measured at 3 levels: ascending aorta, proximal descending and descending aorta. LA and LV LS were measured using CMR-feature tracking. LA and LV end-diastolic volumes, ejection fraction (EF) and mass were measured. Mean patient age was 19.7 ± 6.7 and controls 23 ± 15 (years). All strains (LA, LV, ascending and descending aortic) were lower in CoA subgroups compared to controls except the AAS at diaphragm, which was not different. Comparisons between hypertensive and normotensive CoA showed no differences in LV mass, LV volumetric indices, and LA and LV strain indices; however, ascending AAS was lower in hypertensive subgroup (p = 0.02). Ascending AAS was correlated with LV mass (r = -0.4, p = 0.005), LVEF (r = -0.4, p = 0.004), systolic blood pressure (r = -0.5, p = 0.0001) and LVLS (r = 0.5, p = 0.001). Ascending AAS correlated with LV mass, EF and LVLS. In hypertensive CoA, ascending AAS was reduced compared to normotensive CoA and controls, indicating vascular remodelling differences influenced by ongoing hypertension. (orig.)

Left atrial spindle cell sarcoma – Case report

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Nihar Mehta

2012-07-01

Full Text Available Primary spindle cell sarcoma of the left atrium is an extremely rare tumour. Surgical excision is the mainstay of treatment since it responds poorly to chemotherapy or radiotherapy. In spite of all the treatment, the prognosis remains poor due to inadvertent delay in diagnosis, few therapeutic options and propensity to metastasize. We present a 47-year-old male who underwent a surgical excision of a left atrial mass in February 2010. It was proved to be a high-grade spindle cell sarcoma on histopathology. He presented again in October 2010 with recurrence of the tumour for which he was re-operated. However, the tumour recurred again within one month, to which the patient succumbed.

A Case of Atrial Tachycardia Circulating around a Left Atrial Roof Scar with Diabetes Mellitus and Renal Failure on Hemodialysis

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Naoko Hijioka

2016-01-01

Full Text Available Introduction. Little is known about the effects of volume change by hemodialysis (HD and mechanical stress caused by an anatomical structure being in contact with the left atrium on the progression of atrial remodeling. We experienced a case of atrial tachycardia (AT in a patient who had left atrial (LA scarring at the LA roof and a low-voltage area with slow conduction around the LA scar as components of AT circuit. Here, we present the conceivable hypothesis of the LA scar and the low-voltage area formation. Our concept can be useful in developing a strategy for ablation in a patient with chronic renal failure (CRF on HD. Case Report. A 65-year-old man with CRF on HD was referred for AT ablation. Three-dimensional electroanatomical mapping revealed that the AT conducted around an LA scar in a counterclockwise fashion. There was a slow conduction area at the superior side of the LA scar, where the AT was terminated during the ablation. Computed tomography indicated a close relationship between the LA and the anatomical structures (ascending aorta and pulmonary artery. Conclusion. Volume change by HD and close contact of anatomical structures to the LA can promote atrial remodeling, resulting in AT occurrence.

Atrial Function in Patients with Breast Cancer After Treatment with Anthracyclines

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Yalin Tolga Yaylali

Full Text Available Abstract Background: Atrial electromechanical delay (EMD is used to predict atrial fibrillation, measured by echocardiography. Objectives: The aim of this study was to assess atrial EMD and mechanical function after anthracycline-containing chemotherapy. Methods: Fifty-three patients with breast cancer (48 ± 8 years old who received 240 mg/m2of Adriamycin, 2400 mg/m2 of cyclophosphamide, and 960 mg/m2 of paclitaxel were included in this retrospective study, as were 42 healthy subjects (47 ± 9 years old. Echocardiographic measurements were performed 11 ± 7 months (median 9 months after treatment with anthracyclines. Results: Left intra-atrial EMD (11.4 ± 6.0 vs. 8.1 ± 4.9, p=0.008 and inter-atrial EMD (19.7 ± 7.4 vs. 14.7 ± 6.5, p=0.001 were prolonged; LA passive emptying volume and fraction were decreased (p=0.0001 and p=0.0001; LA active emptying volume and fraction were increased (p=0.0001 and p=0.0001; Mitral A velocity (0.8 ± 0.2 vs. 0.6 ± 0.2, p=0.0001 and mitral E-wave deceleration time (201.2 ± 35.6 vs. 163.7 ± 21.8, p=0.0001 were increased; Mitral E/A ratio (1.0 ± 0.3 vs. 1.3 ± 0.3, p=0.0001 and mitral Em (0.09 ± 0.03 vs. 0.11 ± 0.03, p=0.001 were decreased; Mitral Am (0.11 ± 0.02 vs. 0.09 ± 0.02, p=0.0001 and mitral E/Em ratio (8.8 ± 3.2 vs. 7.6 ± 2.6, p=0.017 were increased in the patients. Conclusions: In patients with breast cancer after anthracycline therapy: Left intra-atrial, inter-atrial electromechanical intervals were prolonged. Diastolic function was impaired. Impaired left ventricular relaxation and left atrial electrical conduction could be contributing to the development of atrial arrhythmias.

Correlation of right atrial appendage velocity with left atrial appendage velocity and brain natriuretic Peptide.

Science.gov (United States)

Kim, Bu-Kyung; Heo, Jung-Ho; Lee, Jae-Woo; Kim, Hyun-Soo; Choi, Byung-Joo; Cha, Tae-Joon

2012-03-01

Left atrial appendage (LAA) anatomy and function have been well characterized both in healthy and diseased people, whereas relatively little attention has been focused on the right atrial appendage (RAA). We sought to evaluate RAA flow velocity and to compare these parameters with LAA indices and with a study of biomarkers, such as brain natriuretic peptide, among patients with sinus rhythm (SR) and atrial fibrillation (AF). In a series of 79 consecutive patients referred for transesophageal echocardiography, 43 patients (23 with AF and 20 controls) were evaluated. AF was associated with a decrease in flow velocity for both LAA and RAA [LAA velocity-SR vs. AF: 61 ± 22 vs. 29 ± 18 m/sec (p vs. AF: 46 ± 20 vs. 19 ± 8 m/sec (p brain natriuretic peptide (BNP). AF was associated with decreased RAA and LAA flow velocities. RAA velocity was found to be positively correlated with LAA velocity and negatively correlated with BNP. The plasma BNP concentration may serve as a determinant of LAA and RAA functions.

Rotational Angiography Based Three-Dimensional Left Atrial Reconstruction: A New Approach for Transseptal Puncture.

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Koektuerk, Buelent; Yorgun, Hikmet; Koektuerk, Oezlem; Turan, Cem H; Gorr, Eduard; Horlitz, Marc; Turan, Ramazan G

2016-02-01

Rotational angiography is a well-known method for the three-dimensional (3-D) reconstruction of left atrium and pulmonary veins during left-sided atrial arrhythmia ablation procedures. In our study, we aimed to review our experience in transseptal puncture (TSP) using 3-D rotational angiography. We included a total of 271 patients who underwent atrial fibrillation ablation using cryoballoon. Rotational angiography was performed to get the three-dimensional left atrial and pulmonary vein reconstructions using cardiac C-arm computed tomography. The image reconstruction was made using the DynaCT Cardiac software (Siemens, Erlangen, Germany). The mean age of the study population was 61 ± 10 years. The indications for left atrial arrhythmia ablation were paroxysmal AF in 140 patients (52%) and persistent AF patients in 131 (48%) patients. The success rate of TSP using only rotational guidance was (264/271 patients, 97.4%). In the remaining seven patients, transesophageal guidance was used after the initial attempt due to thick interatrial septum in five patients and difficult TSP due to abnormal anatomy and mild pericardial effusion in the remaining two patients. Mean fluoroscopy dosage of the rotational angiography was 4896.4 ± 825.3 μGym(2). The mean time beginning from femoral vein puncture to TSP was 12.3 ± 5.5 min. TSP guided by rotational angiography is a safe and effective method. Our results indicate that integration of rotational angiographic images into the real-time fluoroscopy can guide the TSP during the procedure. © 2015 John Wiley & Sons Ltd.

HbA1c Identifies Subjects With Prediabetes and Subclinical Left Ventricular Diastolic Dysfunction.

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Di Pino, Antonino; Mangiafico, Sarah; Urbano, Francesca; Scicali, Roberto; Scandura, Salvatore; D'Agate, Veronica; Piro, Salvatore; Tamburino, Corrado; Purrello, Francesco; Rabuazzo, Agata Maria

2017-10-01

Prediabetes is associated with subclinical cardiac changes associated with heart failure development. We investigated diastolic function and its association with markers of glycation and inflammation related to cardiovascular disease in patients with prediabetes. We focused on individuals with prediabetes identified only by glycated hemoglobin A1c [HbA1c; 5.7% to 6.4% and normal fasting glucose (NFG) and normal glucose tolerance (NGT) after an oral glucose tolerance test (OGTT)]. Cross-sectional study. Departments of Clinical and Experimental Medicine and Cardiology, University of Catania, Catania, Italy. HbA1c, OGTT, Doppler echocardiography, soluble receptor for advanced glycation end products (sRAGEs), and endogenous secretory RAGE (esRAGE) were evaluated. We recruited 167 subjects with NFG/NGT who were stratified according to HbA1c level: controls (HbA1c prediabetes (HbA1c 5.7% to 6.4%). Patients with HbA1c prediabetes (n = 106) showed a lower peak mitral inflow in early diastole (E wave) to late diastolic atrial filling velocity (A wave) ratio (E/A ratio) than controls (n = 61) (1.10 ± 0.24 vs 1.18 ± 0.23; P prediabetes exhibited subclinical cardiac alterations associated with sRAGE, esRAGE, and HbA1c. These subjects would not have been classified as having prediabetes on the basis of fasting glycemia or post-OGTT values. Copyright © 2017 Endocrine Society

[Structural and functional changes of myocardium in Chernobyl disaster clean-up workers with atrial fibrillation].

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Khomaziuk, I M; Habulavichene, Zh M; Khomaziuk, V A

2011-01-01

Particularities and clinical importance of the structural and functional changes of myocardium were estimated in Chernobyl disaster clean-up workers with atrial fibrillation (AF). We examined 122 men with AF, which was associated with ischemic heart disease and arterial hypertension. Paroxysmal AF was diagnosed in 42 patients, 80 patients had permanent AE Control group comprised 80 men without AF. Echocardiography and Doppler studies were performed using ultrasound scanner Aloka SSD-630 (Japan). Significant structural and functional changes of the heart were revealed already in paroxysmal AF and became more pronounced in permanent AF. Increased left atrial size, its ratio to left ventricular end diastolic diameter, diastolic dysfunction were important echocardiographic predictors of AF. Heart walls thickening was accompanied by disorders of myocardial relaxation, increase in myocardial mass led to ischemia, and together they promoted overload, dysfunction of atrium and development of AF. Obligatory echocardiographic examination of the Chernobyl disaster clean-up workers with ischemic heart disease and arterial hypertension is necessary for predicting AF early, ordering adequate therapy in proper time and improving prognosis.

Assessment of atrial fibrillation and vulnerability in patients with Wolff-Parkinson-White syndrome using two-dimensional speckle tracking echocardiography.

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Jing-Jie Li

Full Text Available PURPOSE: The aim was to assess atrial fibrillation (AF and vulnerability in Wolff-Parkinson-White (WPW syndrome patients using two-dimensional speckle tracking echocardiography (2D-STE. METHODS: All patients were examined via transthoracic echocardiography and 2D-STE in order to assess atrial function 7 days before and 10 days after RF catheter ablation. A postoperative 3-month follow-up was performed via outpatient visit or telephone calls. RESULTS: Results showed significant differences in both body mass index (BMI and supraventricular tachycardia (SVT duration between WPW patients and DAVNP patients (both P<0.05. Echocardiography revealed that the maximum left atrial volume (LAVmax and the left ventricular mass index (LVMI in diastole increased noticeably in patients with WPW compared to patients with DAVNP both before and after ablation (all P<0.05. Before ablation, there were obvious differences in the levels of SRs, SRe, and SRa from the 4-chamber view (LA in the WPW patients group compared with patients in the DAVNP group (all P<0.05. In the AF group, there were significant differences in the levels of systolic strain rate (SRs, early diastolic strain rate (SRe, and late diastolic strain rate (SRa from the 4-chamber view (LA both before and after ablation (all P<0.05. In the non-AF group, there were decreased SRe levels from the 4-chamber view (LA/RA pre-ablation compared to post-ablation (all P<0.05. CONCLUSION: Our findings provide convincing evidence that WPW syndrome may result in increased atrial vulnerability and contribute to the development of AF. Further, RF catheter ablation of AAV pathway can potentially improve atrial function in WPW syndrome patients. Two-dimensional speckle tracking echocardiography imaging in WPW patients would be necessary in the evaluation and improvement of the overall function of RF catheter ablation in a long-term follow-up period.

A STUDY TO CORRELATE HBA1C LEVELS AND LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN NEWLY DIAGNOSED TYPE II DIABETES MELLITUS

OpenAIRE

Vasanthi; Namitha; Jayanthi; Elangumanan; Mohamed; Uma Maheshwari; Pravin Selvam; Santhi

2016-01-01

AIM To assess the correlation of HBA1C levels with left ventricular diastolic dysfunction in newly diagnosed Type 2 diabetic patient. This prospective study was done at Department of General Medicine, OPD, Medical Wards, Stanley Medical College and Hospital, Chennai. RESULT The mean HBA1C levels were meaningfully more in Left Ventricular Diastolic Dysfunction (LVDD) positive group compared to the LVDD negative group by 1.33%. This significant difference of 15% increase in...

Assessments of pulmonary vein and left atrial anatomical variants in atrial fibrillation patients for catheter ablation with cardiac CT

International Nuclear Information System (INIS)

Chen, Jing; Yang, Zhi-Gang; Xu, Hua-Yan; Shi, Ke; Long, Qi-Hua; Guo, Ying-Kun

2017-01-01

To provide a road map of pulmonary vein (PV) and left atrial (LA) variants in patients with atrial fibrillation (AF) before catheter ablation procedure using cardiac CT. Cardiac CT was performed in 1420 subjects for accurate anatomical information, including 710 patients with AF and 710 matched controls without AF. PV variants, PV ostia and spatial orientation, LA enlargement, and left atrial diverticulum (LAD) were measured, respectively. Differences between these two groups were also respectively compared. Some risk factors for the occurrence of LAD were analyzed. In total, PV variants were observed in 202 (28.5 %) patients with AF patients and 206 (29.0 %) controls without AF (p = 0.8153). The ostial sizes of all accessory veins were generally smaller than those of the typical four PVs (p = 0.0153 to 0.3958). There was a significant difference of LA enlargement between the AF and control groups (36.3 % vs. 12.5 %, p < 0.0001), while the prevalence of LAD was similar in these two groups (43.2 % vs. 41.9 %, p = 0.6293). PV variants are common. Detailed knowledge of PVs and LA variants are helpful for providing anatomical road map to determine ablation strategy. (orig.)

Assessments of pulmonary vein and left atrial anatomical variants in atrial fibrillation patients for catheter ablation with cardiac CT

Energy Technology Data Exchange (ETDEWEB)

Chen, Jing; Yang, Zhi-Gang; Xu, Hua-Yan; Shi, Ke; Long, Qi-Hua [Sichuan University, Department of Radiology, West China Hospital, Chengdu, Sichuan (China); Guo, Ying-Kun [Sichuan University, Department of Radiology, West China Second University Hospital, Chengdu (China)

2017-02-15

To provide a road map of pulmonary vein (PV) and left atrial (LA) variants in patients with atrial fibrillation (AF) before catheter ablation procedure using cardiac CT. Cardiac CT was performed in 1420 subjects for accurate anatomical information, including 710 patients with AF and 710 matched controls without AF. PV variants, PV ostia and spatial orientation, LA enlargement, and left atrial diverticulum (LAD) were measured, respectively. Differences between these two groups were also respectively compared. Some risk factors for the occurrence of LAD were analyzed. In total, PV variants were observed in 202 (28.5 %) patients with AF patients and 206 (29.0 %) controls without AF (p = 0.8153). The ostial sizes of all accessory veins were generally smaller than those of the typical four PVs (p = 0.0153 to 0.3958). There was a significant difference of LA enlargement between the AF and control groups (36.3 % vs. 12.5 %, p < 0.0001), while the prevalence of LAD was similar in these two groups (43.2 % vs. 41.9 %, p = 0.6293). PV variants are common. Detailed knowledge of PVs and LA variants are helpful for providing anatomical road map to determine ablation strategy. (orig.)

Left atrial remodelling in patients with myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: the VALIANT Echo study

DEFF Research Database (Denmark)

Meris, Alessandra; Amigoni, Maria; Uno, Hajime

2009-01-01

AIMS: To assess the relationship between left atrial (LA) size and outcome after high-risk myocardial infarction (MI) and to study dynamic changes in LA size during long-term follow-up. METHODS AND RESULTS: The VALIANT Echocardiography study prospectively enrolled 610 patients with left ventricul...

Characteristics of Left Atrial Deformation Parameters and Their Prognostic Impact in Patients with Pathological Left Ventricular Hypertrophy: Analysis by Speckle Tracking Echocardiography.

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Iio, Chiharuko; Inoue, Katsuji; Nishimura, Kazuhisa; Fujii, Akira; Nagai, Takayuki; Suzuki, Jun; Okura, Takafumi; Higaki, Jitsuo; Ogimoto, Akiyoshi

2015-12-01

The pathological process of left ventricular (LV) hypertrophy is associated with left atrial (LA) remodeling. This study was aimed to evaluate the prognostic value of LA strain parameters in patients with pathological LV hypertrophy. This study included 95 patients with hypertensive heart disease (HHD: n = 24), hypertrophic cardiomyopathy (HCM: n = 56), cardiac amyloidosis (CA: n = 15), and control subjects (n = 20). We used two-dimensional speckle tracking echocardiography (STE) to analyze LA global strain. LA electromechanical conduction time (EMT) at the septal (EMT-septal) and lateral wall (EMT-lateral), and their time difference (EMT-diff) were calculated. The incidence of cardiac death and heart failure hospitalization was defined as major cardiac events and that of atrial fibrillation as secondary outcome. Left atrial volume index was increased and LA booster strain was decreased in the HCM and CA groups compared with the HHD group. EMT-lateral was increased in the diseased groups compared with the control. EMT-diff was prolonged in the CA group compared with the HCM group. During the follow-up period (mean 3.4 years), major cardiac events and atrial fibrillation occurred in 17 and 13 patients, respectively. The occurrence of atrial fibrillation was associated with CA etiology, E/e', LA volume index, LAa, and EMT-lateral. The incidence of major cardiac events was independently correlated with LA volume index and EMT-diff in multivariate analysis. This study suggested that the EMT-diff could discriminate patients with a high risk of cardiac events among patients with pathological LV hypertrophy. © 2015, Wiley Periodicals, Inc.

Oclusão percutânea do apêndice atrial esquerdo com o Amplatzer Cardiac PlugTM na fibrilação atrial Percutaneous occlusion of left atrial appendage with the Amplatzer Cardiac PlugTM in atrial fibrillation

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Márcio José Montenegro

2012-02-01

, anticoagulation has several limitations and has been widely underutilized. Over 90% of thrombi identified in patients with atrial fibrillation without valvular disease originate in the left atrial appendage, whose occlusion is investigated as an alternative to anticoagulation. Objective: To determine the feasibility of percutaneous occlusion of the left atrial appendage in patients at high risk of embolic events and limitations to the use of anticoagulation. Methods: We report our initial experience with Amplatzer Cardiac PlugTM (St. Jude Medical Inc., Saint Paul, Estados Unidos in patients with nonvalvular atrial fibrillation. We selected patients at high risk of thromboembolism, major bleeding, contraindications to the use or major instability in response to the anticoagulant. The procedures were performed percutaneously under general anesthesia and transesophageal echocardiography. The primary outcome was the presence of periprocedural complications and follow-up program included clinical and echocardiographic review within 30 days and by telephone contact after nine months. Results: In five selected patients it was possible to occlude the left atrial appendage without periprocedural complications. There were no clinical events in follow-up. Conclusion: Controlled clinical trials are needed before percutaneous closure of the left atrial appendage should be considered an alternative to anticoagulation in nonvalvular atrial fibrillation. But the device has shown to be promissory in patients at high risk of embolism and restrictions on the use of anticoagulants.

Longitudinal changes and prognostic implications of left ventricular diastolic function in first acute myocardial infarction

DEFF Research Database (Denmark)

Poulsen, S H; Jensen, S E; Egstrup, K

1999-01-01

BACKGROUND: Left ventricular (LV) diastolic dysfunction contributes to signs and symptoms of clinical heart failure and may be related to prognosis in heart diseases. LV diastolic dysfunction is reported to be present in acute myocardial infarction (MI); however, little is known about the time...... demonstrated a significant LV dilation during 1-year follow-up. Patients with initial pseudonormal/restrictive LV filling pattern were more frequently readmitted to the hospital for heart failure and had significant higher New York Heart Association class score compared with patients with normal or impaired...

Cine MR imaging in mitral valve prolapse; Study on mitral regurgitation and left atrial volume

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Kumai, Toshihiko [Chiba Univ. (Japan). School of Medicine

1993-02-01

This study was undertaken to assess the ability of cine MR imaging to evaluate the direction, timing, and severity of mitral regurgitation in patients with mitral valve prolapse (MVP). The population of this study was 33 patients with MVP diagnosed by two-dimensional echocardiography and 10 patients with rheumatic mitral valve disease (MSR) for comparison. 7 patients with MVP and 5 with MSR had atrial fibrillation and/or history of congestive heart failure as complications. Mitral regurgitation was graded for severity by color Doppler flow imaging in all patients. Direction and size of systolic flow void in the left atrium were analyzed by contiguous multilevel cine MR images and the maximum volumes of flow void and left atrium were measured. Although flow void was found at the center of the left atrium in most of MSR, it was often directed along the postero-caudal atrial wall in anterior leaflet prolapse and along the anterocranial atrial wall in posterior leaflet prolapse. In MVP, the maximum volume of flow void was often seen in late systole. The maximum volume of flow void and that of left atrium were significantly larger in patients with atrial fibrillation and/or history of congestive heart failure. The length and volume of flow void were increased with clinical severity and degree of regurgitation determined by color Doppler flow imaging. Thus cine MR imaging provides a useful means for detection and semiquantitative evaluation of mitral regurgitation in subjects with MVP. (author).

Left ventricular beat-to-beat performance in atrial fibrillation: Contribution of Frank-Starling mechanism after short rather than long intervals

NARCIS (Netherlands)

Gosselink, A.T.M.; Blanksma, P.K.; Crijns, H.J.G.M.; Gelder, I.C. van; Kam, P.J. de; Hillege, H.L.; Niemeijer, M.G.; Lie, K.I.; Meijler, F.L.

1995-01-01

This study sought to evaluate control mechanisms of the varying left ventricular performance in atrial fibrillation. Atrial fibrillation is characterized by a randomly irregular ventricular response, resulting in continuous variation in left ventricular beat-to-beat mechanical behavior and

[Echocardiographic factors predictive of restoration and maintenance of sinus rhythm after reduction of atrial fibrillation].

Science.gov (United States)

Ben Khalfallah, A; Sanaa, I

2007-09-01

Atrial fibrillation (AF) is the most common cardiac arrhythmia. While the arrhythmia was initially thought to be little more than a nuisance, it is now clear that AF has a significant negative impact on quality of life and a corresponding increase in both morbidity and mortality. The aim of this study was to identify Doppler echographic patterns that allow prediction of atrial fibrillation reduction and maintenance of sinus rhythm within 12 months. One hundred and thirty patients having permanent atrial fibrillation, recent (51) or chronic (79) are included in the study, excepting those with valvular heart disease or thyroid dysfunction. The mean age was 63.5 +/- 11.3 years. Both transthoracic and transoesophageal echocardiography was performed using a Philips SONOS 5500 Echograph, before cardioversion. Were studied: end diastolic and systolic left ventricular diameters, left ventricular ejectionnal fraction, left atrial area (LAA), left atrial diameter, left atrial appendage area and peak emptying velocities of the left atrial appendage (PeV). Sinus rhythm was re-established in 102 patients (44 having recent and 58 chronic atrial fibrillation). Sinus rhythm was maintained for 12 months in 79 patients. Within the echographic parameters studied, the left atrial area (LAA) and peak emptying velocities of left atrial appendage (PeV) before cardioversion were the best predictors of restoration of sinus rhythm. On monovariate analysis, SOG is significantly lower and PicV is significantly higher in patients whose sinus rhythm had been restored in comparison with those with permanent atrial fibrillation. (Mean SOG: 27.7 +/- 7.62 vs. 34 +/- 7,6 cm2, ppredict on mono and multivariate analysis (p=0.05, OR=0.5, IC=0.36 à 3.56), re-establishing of sinus rhythm whereas in patients with chronic atrial fibrillation, peak emptying velocity of left atrial appendage predict better re-establishing of sinus rhythm (p=0.04, OR=1.29, IC=0.12 à 4.23). The threshold values of LAA and Pe

Routine evaluation of left ventricular diastolic function by cardiovascular magnetic resonance: A practical approach

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Vido Diane

2008-07-01

Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR has excellent capabilities to assess ventricular systolic function. Current clinical scenarios warrant routine evaluation of ventricular diastolic function for complete evaluation, especially in congestive heart failure patients. To our knowledge, no systematic assessment of diastolic function over a range of lusitropy has been performed using CMR. Methods and Results Left ventricular diastolic function was assessed in 31 subjects (10 controls who underwent CMR and compared with Transthoracic echocardiogram (TTE evaluation of mitral valve (MV and pulmonary vein (PV blood flow. Blood flow in the MV and PV were successfully imaged by CMR for all cases (31/31,100% while TTE evaluated flow in all MV (31/31,100% but only 21/31 PV (68% cases. Velocities of MV flow (E and A measured by CMR correlated well with TTE (r = 0.81, p Conclusion We have shown that there is homology between CMR and TTE for the assessment of diastolic inflow over a wide range of conditions, including normal, impaired relaxation and restrictive. There is excellent agreement of quantitative velocity measurements between CMR and TTE. Diastolic blood flow assessment by CMR can be performed in a single scan, with times ranging from 20 sec to 3 min, and we show that there is good indication for applying CMR to assess diastolic conditions, either as an adjunctive test when evaluating systolic function, or even as a primary test when TTE data cannot be obtained.

Paroxysmal postprandial atrial fibrilation suppressed by laparoscopic repair of a giant paraesophageal hernia compressing the left atrium.

Science.gov (United States)

Cristian, Daniel A; Constantin, Alin S; Barbu, Mariana; Spătaru, Dan; Burcoș, Traean; Grama, Florin A

2015-03-01

We present the case of a patient with a giant paraesophageal hernia associated with paroxysmal postprandial atrial fibrillation that was suppressed after surgery. The imaging investigations showed the intrathoracic displacement of a large part of the stomach, which pushed the left atrial wall causing atrial fibrillation. The laparoscopic surgical repair acted as sole treatment for this condition.

Association of left ventricular longitudinal and circumferential systolic dysfunction with diastolic function in hypertension: a nonlinear analysis focused on the interplay with left ventricular geometry.

Science.gov (United States)

Ballo, Piercarlo; Nistri, Stefano; Cameli, Matteo; Papesso, Barbara; Dini, Frank Lloyd; Galderisi, Maurizio; Zuppiroli, Alfredo; Mondillo, Sergio

2014-02-01

The relationships of left ventricular (LV) longitudinal and circumferential systolic dysfunction with diastolic performance in hypertensive patients have never been compared. In 532 asymptomatic hypertensive patients, circumferential function was assessed with the use of midwall fractional shortening (mFS) and stress-corrected mFS (SCmFS), whereas longitudinal function was assessed with the use of left atrioventricular plane displacement (AVPD) and systolic mitral annulus velocity (s'). Early diastolic annular velocity (e') and the E/e' ratio were measured. Global longitudinal and circumferential strain were determined in a subset of 210 patients. e' was linearly related to all systolic indexes (AVPD: R = 0.40; s': R = 0.39; mFS: R = 0.16; SCmFS: R = 0.17; all P SCmFS. Longitudinal indexes were superior to circumferential ones in predicting e' <8 cm/s, E/e' <8, and E/e' ≥13. The effect of LV geometry on LV diastolic function was evident among patients with preserved systolic longitudinal function, but was blunted among patients with impaired longitudinal function. In multivariable analyses, only longitudinal indexes remained associated with e' and E/e'. Analyses using strains provided similar results. In asymptomatic hypertensive subjects, LV diastolic performance is independently associated with longitudinal systolic dysfunction, but not with circumferential systolic dysfunction. Subtle longitudinal systolic impairment plays a role in mediating the effect of LV geometry on diastolic performance. These findings may support the need of critically revising the concept of isolated diastolic dysfunction in these patients. Copyright © 2014 Elsevier Inc. All rights reserved.

Application of a simplified definition of diastolic function in severe sepsis and septic shock.

Science.gov (United States)

Lanspa, Michael J; Gutsche, Andrea R; Wilson, Emily L; Olsen, Troy D; Hirshberg, Eliotte L; Knox, Daniel B; Brown, Samuel M; Grissom, Colin K

2016-08-04

Left ventricular diastolic dysfunction is common in patients with severe sepsis or septic shock, but the best approach to categorization is unknown. We assessed the association of common measures of diastolic function with clinical outcomes and tested the utility of a simplified definition of diastolic dysfunction against the American Society of Echocardiography (ASE) 2009 definition. In this prospective observational study, patients with severe sepsis or septic shock underwent transthoracic echocardiography within 24 h of onset of sepsis (median 4.3 h). We measured echocardiographic parameters of diastolic function and used random forest analysis to assess their association with clinical outcomes (28-day mortality and ICU-free days to day 28) and thereby suggest a simplified definition. We then compared patients categorized by the ASE 2009 definition and our simplified definition. We studied 167 patients. The ASE 2009 definition categorized only 35 % of patients. Random forest analysis demonstrated that the left atrial volume index and deceleration time, central to the ASE 2009 definition, were not associated with clinical outcomes. Our simplified definition used only e' and E/e', omitting the other measurements. The simplified definition categorized 87 % of patients. Patients categorized by either ASE 2009 or our novel definition had similar clinical outcomes. In both definitions, worsened diastolic function was associated with increased prevalence of ischemic heart disease, diabetes, and hypertension. A novel, simplified definition of diastolic dysfunction categorized more patients with sepsis than ASE 2009 definition. Patients categorized according to the simplified definition did not differ from patients categorized according to the ASE 2009 definition in respect to clinical outcome or comorbidities.

Effects of long-term adrenergic beta-blockade on left ventricular diastolic filling in patients with acute myocardial infarction

DEFF Research Database (Denmark)

Poulsen, S H; Jensen, S E; Egstrup, K

1999-01-01

BACKGROUND: Left ventricular (LV) systolic and diastolic function are known to be affected in the wake of a myocardial infarction (MI). beta-Adrenergic blocking agents have demonstrated improvement of LV systolic and diastolic function in patients with dilated cardiomyopathy and theoretically would...... have same beneficial effects in MI. beta-Adrenergic blocking agents are widely used in MI; however only few reports on changes of LV systolic and diastolic function during long-term treatment after acute MI are available. METHODS: Two-dimensional and Doppler echocardiography were used to evaluate LV...

Study of the association between left ventricular diastolic impairment and cardiac autonomic neuropathy in diabetic patients using [123I] metaiodobenzylguanidine scintigraphy

International Nuclear Information System (INIS)

Suzuki, Rokuro; Tanaka, Shiro; Tojo, Osamu; Ishii, Tomofusa; Sato, Toshihiko; Fujii, Satoru; Tumura, Kei.

1994-01-01

The association between left ventricular (LV) diastolic dysfunction and myocardial MIBG accumulation was investigated. The subjects were 14 Type II diabetic patients who had no evidence of ischemic heat disease, LV hypertrophy or dilated cardiomyopathy as determined by exercise Tl-201 myocardial scintigraphy and echocardiography. In 14 diabetic patients, isovolumic relaxation time (IRT) was measured by M-mode echocardiography, and the subjects were subdivided into two groups: Group1, 8 patients with impaired left ventricular diastolic function (IRT≥80 msec), and Group 2, 6 patients with normal left ventricular diastolic function (IRT 123 I-MIBG myocardial scintigraphy was performed, and the myocardial accumulation of 123 I-MIBG was investigated. The ratio of myocardial to mediastinal MIBG uptake was significantly (p<0.01) lower in Group 1 than in Group 2. And scintigraphic defects were significantly (p<0.05) more numerous in Group 1 than in Group 2. Patients in Group 1 had a greater frequency of cardiac autonomic neuropathy evaluated by QTc interval and coefficient of variation of R-R interval, when compared with Group 2. These data suggest that, in diabetic patients with no evidence of ischemic heart disease, LV hypertrophy or dilated cardiomyopathy, impairment of left ventricular diastolic function is associated with cardiac autonomic neuropathy. (author)

Percutaneous closure of patent ductus arteriosus in children: Immediate and short-term changes in left ventricular systolic and diastolic function

OpenAIRE

Gupta, Saurabh Kumar; Krishnamoorthy, KM; Tharakan, Jaganmohan A; Sivasankaran, S; Sanjay, G; Bijulal, S; Anees, T

2011-01-01

Objective: To evaluate the effect of percutaneous closure of patent ductus arteriosus (PDA) on left ventricular (LV) systolic and diastolic function in children. Background: Limited studies are available on alteration in LV hemodynamics, especially diastolic function, after PDA closure. Methods: Thirty-two consecutive children with isolated PDA treated by trans-catheter closure were studied. The LV systolic and diastolic function were assessed by two-dimensional (2D) echocardiography ...

LEFT-VENTRICULAR BEAT-TO-BEAT PERFORMANCE IN ATRIAL-FIBRILLATION - CONTRIBUTION OF FRANK-STARLING MECHANISM AFTER SHORT RATHER THAN LONG RR INTERVALS

NARCIS (Netherlands)

GOSSELINK, ATM; BLANKSMA, PK; CRIJNS, HJGM; VANGELDER, IC; DEKAM, PJ; HILLEGE, HL; NIEMEIJER, MG; LIE, KI; MEIJLER, FL

1995-01-01

Objectives. This study sought to evaluate control mechanisms of the varying left ventricular performance in atrial fibrillation. Background. Atrial fibrillation is characterized by a randomly irregular ventricular response, resulting in continuous variation in left ventricular beat-to-beat

Left and right atrial feature tracking in acute myocarditis: A feasibility study

International Nuclear Information System (INIS)

Dick, Anastasia; Schmidt, Björn; Michels, Guido; Bunck, Alexander C.; Maintz, David; Baeßler, Bettina

2017-01-01

Purpose: The present study aims at evaluating the feasibility and reproducibility of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain and strain rate (SR) parameters of the left and right atrium (LA, RA) in patients with acute myocarditis as well as their potential to detect diastolic dysfunction. In addition, the diagnostic value of LA and RA strain parameters in the setting of acute myocarditis is investigated. Methods: CMR cine data of 30 patients with CMR-positive acute myocarditis were retrospectively analyzed. 25 age- and gender-matched healthy individuals served as a control. Analysis of longitudinal strain and SR of both atria was performed in two long-axis views using a dedicated FT-software. LA and RA deformation was analyzed including reservoir function (total strain [ε s ], peak positive SR [SR s ]), conduit function (passive strain [ε e ], peak early negative SR [SR e ]) and booster pump function (active strain [ε a ], peak late negative SR [SR a ]). Intra- and inter-observer reproducibility was assessed for all strain and SR parameters using Bland-Altman analyses, intra-class correlation coefficients (ICCs) and coefficients of variation (CV). Results: FT analyses of both atria were feasible in all patients and controls. Reproducibility was good for reservoir and conduit function parameters and moderate for booster pump function parameters. Myocarditis patients demonstrated an impaired LA reservoir and conduit function when compared to healthy controls (LA ε s : 32 ± 17 vs. 46 ± 13, p = 0.019; LA SR s : 1.5 ± 0.5 vs. 1.8 ± 0.5, p = 0.117; LA SR e : −1.3 ± 0.5 vs. −1.9 ± 0.5, p < 0.001), while LA booster pump function was preserved. In logistic regression and ROC-analyses, LA SR e proved to be the best independent predictor of acute myocarditis (AUC 0.80), and using LA SR e with a cut-off of −1.6 s −1 resulted in a diagnostic sensitivity of 83% and a specificity of 80%. Changes in RA phasic function parameters

Left and right atrial feature tracking in acute myocarditis: A feasibility study

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Dick, Anastasia, E-mail: anastasia-dick@web.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Schmidt, Björn, E-mail: bjoernschmidt1989@gmx.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Michels, Guido, E-mail: guido.michels@uk-koeln.de [Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Bunck, Alexander C., E-mail: alexander.bunck@uk-koeln.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Maintz, David, E-mail: david.maintz@uk-koeln.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Baeßler, Bettina, E-mail: bettina.baessler@uk-koeln.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany)

2017-04-15

Purpose: The present study aims at evaluating the feasibility and reproducibility of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain and strain rate (SR) parameters of the left and right atrium (LA, RA) in patients with acute myocarditis as well as their potential to detect diastolic dysfunction. In addition, the diagnostic value of LA and RA strain parameters in the setting of acute myocarditis is investigated. Methods: CMR cine data of 30 patients with CMR-positive acute myocarditis were retrospectively analyzed. 25 age- and gender-matched healthy individuals served as a control. Analysis of longitudinal strain and SR of both atria was performed in two long-axis views using a dedicated FT-software. LA and RA deformation was analyzed including reservoir function (total strain [ε{sub s}], peak positive SR [SR{sub s}]), conduit function (passive strain [ε{sub e}], peak early negative SR [SR{sub e}]) and booster pump function (active strain [ε{sub a}], peak late negative SR [SR{sub a}]). Intra- and inter-observer reproducibility was assessed for all strain and SR parameters using Bland-Altman analyses, intra-class correlation coefficients (ICCs) and coefficients of variation (CV). Results: FT analyses of both atria were feasible in all patients and controls. Reproducibility was good for reservoir and conduit function parameters and moderate for booster pump function parameters. Myocarditis patients demonstrated an impaired LA reservoir and conduit function when compared to healthy controls (LA ε{sub s}: 32 ± 17 vs. 46 ± 13, p = 0.019; LA SR{sub s}: 1.5 ± 0.5 vs. 1.8 ± 0.5, p = 0.117; LA SR{sub e}: −1.3 ± 0.5 vs. −1.9 ± 0.5, p < 0.001), while LA booster pump function was preserved. In logistic regression and ROC-analyses, LA SR{sub e} proved to be the best independent predictor of acute myocarditis (AUC 0.80), and using LA SR{sub e} with a cut-off of −1.6 s{sup −1} resulted in a diagnostic sensitivity of 83% and a specificity of

State of Left Ventricular Systolic and Diastolic Function in Patients with Postinfarction Cardiosclerosis and Obesity

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P.P. Kravchun

2014-09-01

Conclusions. Comorbidity of obesity and postinfarction remodeling potentiate the increase of the heart size, dilatation of the heart cavities on the background of inotropic myocardial function reduction. In most patients with postinfarction cardiosclerosis and obesity, left ventricular diastolic dysfunction manifested by a type of relaxation disturbance.

Arterial stiffness and wave reflection: sex differences and relationship with left ventricular diastolic function.

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Russo, Cesare; Jin, Zhezhen; Palmieri, Vittorio; Homma, Shunichi; Rundek, Tatjana; Elkind, Mitchell S V; Sacco, Ralph L; Di Tullio, Marco R

2012-08-01

Increased arterial stiffness and wave reflection have been reported in heart failure with normal ejection fraction (HFNEF) and in asymptomatic left ventricular (LV) diastolic dysfunction, a precursor of HFNEF. It is unclear whether women, who have higher frequency of HFNEF, are more vulnerable than men to the deleterious effects of arterial stiffness on LV diastolic function. We investigated, in a large community-based cohort, whether sex differences exist in the relationship among arterial stiffness, wave reflection, and LV diastolic function. Arterial stiffness and wave reflection were assessed in 983 participants from the Cardiovascular Abnormalities and Brain Lesions study using applanation tonometry. The central pulse pressure/stroke volume index, total arterial compliance, pulse pressure amplification, and augmentation index were used as parameters of arterial stiffness and wave reflection. LV diastolic function was evaluated by 2-dimensional echocardiography and tissue-Doppler imaging. Arterial stiffness and wave reflection were greater in women compared with men, independent of body size and heart rate (all Pfunction in both sexes. Further adjustment for cardiovascular risk factors attenuated these relationships; however, a higher central pulse pressure/stroke volume index predicted LV diastolic dysfunction in women (odds ratio, 1.54; 95% confidence intervals, 1.03 to 2.30) and men (odds ratio, 2.09; 95% confidence interval, 1.30 to 3.39), independent of other risk factors. In conclusion, in our community-based cohort study, higher arterial stiffness was associated with worse LV diastolic function in men and women. Women's higher arterial stiffness, independent of body size, may contribute to their greater susceptibility to develop HFNEF.

Determinants of left ventricular diastolic dysfunction in hypertensive patients.

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Nazário Leão, R; Marques da Silva, P; Marques Pocinho, R; Alves, M; Virella, D; Palma Dos Reis, R

2018-02-02

The progression of hypertensive heart disease leads to the left ventricular diastolic dysfunction (LVDD), which is associated with increased cardiovascular morbidity and mortality. The purpose of this analysis is to explore the determinants for LVDD in patients with hypertension. This is a secondary analysis of data of Impedance Cardiography in the Evaluation of Left Ventricular Diastolic Dysfunction in Patients with Arterial Hypertension (IMPEDDANS) Study. Mann-Whitney and Chi-square tests were used for univariable analysis. Multiple logistic regression was used to model for LVDD occurrence and discriminative capacity of the model assessed by the value of the area under the curve given by the receiver-operating characteristic curve. Older age (65 vs. 58 years, p<0.001), longer duration of hypertension (160 vs. 48 months, p<0.001), uncontrolled hypertension (59.8 vs. 15.9%, p<0.001), tobacco smoking (17.8 vs. 3.8%, p=0.016), higher systolic blood pressure (133 vs. 124mmHg, p=0.001) and slower heart rate (62 vs. 66bpm, p=0.023) were associated with LVDD. Multivariate model identified uncontrolled hypertension (AdjOR 36.90; 95% CI 7.94-171.58; p<0.001), smoking (AdjOR 6.66; 95% CI 1.63-27.26; p=0.008), eccentric hypertrophy (AdjOR 3.59; 95% CI 0.89-14.39; p=0.072), duration of hypertension (AdjOR 1.03; 95% CI 1.02-1.05; p<0.001) and concentric remodeling (AdjOR 0.19; 95% CI 0.04-0.93; p=0.041) as the more determinant for occurrence of LVDD. The discriminative capacity of the model was AUC=0.95 (95% CI 0.91-0.98). The occurrence of LVDD in hypertensive patients was strongly associated to long-lasting, uncontrolled hypertension, tobacco smoking, concentric remodeling and eccentric hypertrophy. Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

Correlation between left ventricular diastolic function before and after valve replacement surgery and myocardial ultrastructural changes in patients with left ventricular volume-overloaded valvular heart diseases

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Okada, Tomiro

1993-01-01

Left ventricular (LV) diastolic functions in 23 patients with aortic regurgitation (AR) and 22 patients with mitral regurgitation (MR) were evaluated by gated blood pool scintigraphy. LV myocardial biopsy was performed during open heart surgery, and LV myocardial ultrastructural changes were evaluated by electron microscope. Correlation between LV diastolic function and myocardial ultrastructural changes was examined. It was suggested that preoperative LV diastolic dysfunction occurred earlier than LV systolic dysfunction in patients with AR and MR. LV early diastolic dysfunction was especially significant in patients with AR. LV systolic function was significantly improved postoperatively compared with LV diastolic function in patients with AR and MR. It was suggested that LV interstitial fibrosis caused LV diastolic dysfunction in patients with AR and MR, and insufficiency of myocardial thickening as compensation in patients with MR. It was presumed that LV diastolic dysfunction was irreversible in patients with AR and MR in the distant postoperative period due to persistence of the preoperative myocardial ultrastructural change, e.g., interstitial fibrosis. These LV diastolic indices measured by gated pool scintigraphy were useful in predicting LV ultrastructural changes and postoperative LV dysfunction in patients with LV volume-overloaded valvular heart disease. (author)

Efficiency evaluation of treatment of atrial rhythm disorders on the left ventricular function

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Alberini, J.L.; Mansour, H.; Victor, F.; De Place, C.; Carre, F.; Daubert, J.C.; Borguet, P.

1997-01-01

The goal of this prospective study was to evaluate the development and evolution of the LV function after treatment of atrial arrhythmias, evolving for at least three months, associated to an alteration of the LV function. Twelve patients (61.3 ± 13.9 years) were divided into two groups: Gr1 - treatment by cardio-version or radiofrequency; Gr2 - pharmacological treatment or ablation of atrial-ventricular junction and implantation of a cardiac pacemaker. An examination including ECG, Holter, test-to-effort, echocardiography, cavitary angio-scintigraphy was effectuated 48 h and 6 weeks after reduction. A net clinic amelioration was observed in the evolution, confirmed by results of the echocardiographic and angio-scintigraphic examinations (with a correlation coefficient of 0.87). In exchange, between the two examinations, there is no significant difference for the test-to-effort with medium or maximal cardiac frequencies and the diameters or tele-diastolic and tele-systolic volumes for echography. After the multi-variable analysis the initial angio-scintigraphic measurement of the LV function is a good predictive factor in ameliorating the LV function in patients maintained in sinusal rhythm. In conclusion, the angio-scintigraphy permits predicting the treatment efficiency of the atrial arrhythmias on the LV function

Percutaneous closure of the left atrial appendage with Watchman device: An option for patients with atrial fibrilation and high risk of bleeding with anticoagulation

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Sénior, Juan

2015-07-01

Full Text Available Atrial fibrillation is the most common arrhythmia found in clinical practice, with a population prevalence of 1% to 2%. Anticoagulation remains a fundamental part of treatment for the prevention of cerebrovascular events (stroke, but it is contraindicated in approximately 20% of patients. We report a case of non-valvular atrial fibrillation with high-risk score for stroke, a history of intracerebral bleeding, and very high risk of bleeding with long-term anticoagulation. Percutaneous closure of the left atrial appendage with the Watchman device was performed successfully without complications.

Predictors and prognostic value of left atrial remodelling after acute myocardial infarction

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Kyhl, Kasper; Vejlstrup, Niels; Lønborg, Jacob

2015-01-01

PURPOSE: Left atrial (LA) volume is a strong prognostic predictor in patients following ST-segment elevation myocardial infarction (STEMI). However, the change in LA volume over time (LA remodelling) following STEMI has been scarcely studied. We sought to identify predictors for LA remodelling an...

Left Atrial Systolic Force in Asymptomatic Aortic Stenosis

DEFF Research Database (Denmark)

Cioffi, Giovanni; Cramariuc, Dana; Dalsgaard, Morten

2011-01-01

LASF in the total study population was 21 ± 14 kdynes/cm(2) . The determinants of LASF were higher age, heart rate, body mass index, systolic blood pressure, left ventricular (LV) mass, mitral peak early velocity, maximal LA volume, and longer mitral deceleration time (multiple R(2) = 0.37, P ...Background: There is a limited knowledge about left atrial (LA) systolic force (LASF) and its key determinants in patients with asymptomatic mild-moderate aortic stenosis (AS). Methods: We used baseline clinic and echocardiographic data from 1,566 patients recruited in the simvastatin ezetimibe...... in aortic stenosis study evaluating the effect of placebo-controlled combined simvastatin and ezetimibe treatment in asymptomatic AS. The LASF was calculated by Manning's method. Low and high LASF were defined as 95th percentile of the distribution within the study population, respectively. Results: Mean...

[Comparison of ablation of left-sided accessory pathway by atrial septal and retrograde arterial approach].

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Zhu, J G; Bao, Z Y; Gu, X

2017-03-07

Objective: To compare the advantages and disadvantages of radiofrequency ablation of left-sided accessory pathways by via atrial septal approach with retrograde through aortic approach. Methods: A total of 184 patients of left-side accessory pathways were treated in Taizhou People's Hospital and the Subei People's Hospital from March 2012 to August 2015.A total of 103 cases were treated by aortic retrograde approach as through arterial group, 81 cases were treated by punctured atrial septal to left atrial for mapping and ablation as through atrial septal group.Comparison of ablation procedure time, total and pathways of different parts(subgroup) at instant success and relapse rates, safety (serious complications), and statistics other complications in operation and postoperative. Results: Through arterial group and through atrial septal group were no significant difference ( P >0.05) in the ablation procedure time((25±18 ) vs (22±15)min ), instant success(98.1% vs 97.5%) and relapse rates(1.0% vs 1.2%), security(1 vs 0 case). There was no statistical difference in septal part subgroups (all P >0.05) in the ablation procedure time((22±18)vs (25±19)min), instant success(91.7% vs 89.9 %) and relapse rates(0 vs 11.1%); posterior wall subgroup had no statistical difference in the ablation procedure time((18±15)vs (16±12)min), instant success(100% vs 100 %) and relapse rates(0 vs 0)(all P >0.05); side wall subgroup had no statistical difference in the ablation procedure time((29±20)vs (21±18) min), instant success (98.3% vs 98.1%)and relapse rates(1.7% vs 0%)(all P >0.05). Conclusion: Ablation of left-sided accessory pathways by transseptal approach and transaortic approach has no statistical difference in the procedure time, instant success and relapse rates, security.In a particular case, there is a certain complementarity between the two methods.

Pulmonary thallium uptake: Correlation with systolic and diastolic left ventricular function at rest and during exercise

International Nuclear Information System (INIS)

Mannting, F.

1990-01-01

Quantified pulmonary 201-thallium uptake, assessed as pulmonary/myocardial ratios (PM) and body surface area-corrected absolute pulmonary uptake (Pc), was determined from single photon emission computed tomography studies in 22 normal subjects and 46 consecutive patients with coronary artery disease (CAD). By means of equilibrium radionuclide angiography (ERNA), ejection fraction (EF), peak ejection rate (PER) in end-diastolic volume (EDV/sec) and peak filling rate (PFR) in EDV/sec and stroke volume (SV/sec) units, PFR/PER ratio, and time to peak filling rate (TPFR) in milliseconds were computed at rest and during exercise (n = 35). Left ventricular response to exercise was assessed as delta EF, relative delta EF, delta EDV, and delta ESV. In normal subjects the PM ratios showed significant inverse correlation with PER at rest and with EF, PER, and PFRedv during exercise. For the left ventricular response to exercise, delta ESV showed significant correlation with the PM ratios. The body surface area-corrected pulmonary uptake values showed no correlation with any of the variables. In patients with CAD the PM ratios and Pc uptake showed significant inverse correlation with EF, PER, PFRedv and to exercise EF, exercise PER, and exercise PFRedv. For the left ventricular response to exercise, delta EF showed significant inverse correlation with the PM ratios but not with the Pc uptake. Neither in normal subjects nor in patients with CAD did any of the independent diastolic variables show significant correlation with the PM ratios or Pc values. Thus pulmonary thallium uptake is correlated with systolic left ventricular function at rest and during exercise in normal subjects and in patients with CAD but not with diastolic function. In normal subjects delta ESV and in patients with CAD, delta EF showed correlation with pulmonary thallium uptake

Cost-effectiveness analysis of left atrial appendage occlusion compared with pharmacological strategies for stroke prevention in atrial fibrillation.

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Lee, Vivian Wing-Yan; Tsai, Ronald Bing-Ching; Chow, Ines Hang-Iao; Yan, Bryan Ping-Yen; Kaya, Mehmet Gungor; Park, Jai-Wun; Lam, Yat-Yin

2016-08-31

Transcatheter left atrial appendage occlusion (LAAO) is a promising therapy for stroke prophylaxis in non-valvular atrial fibrillation (NVAF) but its cost-effectiveness remains understudied. This study evaluated the cost-effectiveness of LAAO for stroke prophylaxis in NVAF. A Markov decision analytic model was used to compare the cost-effectiveness of LAAO with 7 pharmacological strategies: aspirin alone, clopidogrel plus aspirin, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban. Outcome measures included quality-adjusted life years (QALYs), lifetime costs and incremental cost-effectiveness ratios (ICERs). Base-case data were derived from ACTIVE, RE-LY, ARISTOTLE, ROCKET-AF, PROTECT-AF and PREVAIL trials. One-way sensitivity analysis varied by CHADS2 score, HAS-BLED score, time horizons, and LAAO costs; and probabilistic sensitivity analysis using 10,000 Monte Carlo simulations was conducted to assess parameter uncertainty. LAAO was considered cost-effective compared with aspirin, clopidogrel plus aspirin, and warfarin, with ICER of US$5,115, $2,447, and $6,298 per QALY gained, respectively. LAAO was dominant (i.e. less costly but more effective) compared to other strategies. Sensitivity analysis demonstrated favorable ICERs of LAAO against other strategies in varied CHADS2 score, HAS-BLED score, time horizons (5 to 15 years) and LAAO costs. LAAO was cost-effective in 86.24 % of 10,000 simulations using a threshold of US$50,000/QALY. Transcatheter LAAO is cost-effective for prevention of stroke in NVAF compared with 7 pharmacological strategies. The transcatheter left atrial appendage occlusion (LAAO) is considered cost-effective against the standard 7 oral pharmacological strategies including acetylsalicylic acid (ASA) alone, clopidogrel plus ASA, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban for stroke prophylaxis in non-valvular atrial fibrillation management.

Effects of Acetylcholine and Noradrenalin on Action Potentials of Isolated Rabbit Sinoatrial and Atrial Myocytes

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Verkerk, Arie O.; Geuzebroek, Guillaume S. C.; Veldkamp, Marieke W.; Wilders, Ronald

2012-01-01

The autonomic nervous system controls heart rate and contractility through sympathetic and parasympathetic inputs to the cardiac tissue, with acetylcholine (ACh) and noradrenalin (NA) as the chemical transmitters. In recent years, it has become clear that specific Regulators of G protein Signaling proteins (RGS proteins) suppress muscarinic sensitivity and parasympathetic tone, identifying RGS proteins as intriguing potential therapeutic targets. In the present study, we have identified the effects of 1 μM ACh and 1 μM NA on the intrinsic action potentials of sinoatrial (SA) nodal and atrial myocytes. Single cells were enzymatically isolated from the SA node or from the left atrium of rabbit hearts. Action potentials were recorded using the amphotericin-perforated patch-clamp technique in the absence and presence of ACh, NA, or a combination of both. In SA nodal myocytes, ACh increased cycle length and decreased diastolic depolarization rate, whereas NA decreased cycle length and increased diastolic depolarization rate. Both ACh and NA increased maximum upstroke velocity. Furthermore, ACh hyperpolarized the maximum diastolic potential. In atrial myocytes stimulated at 2 Hz, both ACh and NA hyperpolarized the maximum diastolic potential, increased the action potential amplitude, and increased the maximum upstroke velocity. Action potential duration at 50 and 90% repolarization was decreased by ACh, but increased by NA. The effects of both ACh and NA on action potential duration showed a dose dependence in the range of 1–1000 nM, while a clear-cut frequency dependence in the range of 1–4 Hz was absent. Intermediate results were obtained in the combined presence of ACh and NA in both SA nodal and atrial myocytes. Our data uncover the extent to which SA nodal and atrial action potentials are intrinsically dependent on ACh, NA, or a combination of both and may thus guide further experiments with RGS proteins. PMID:22754533

Left atrial appendage myxofibrosarcoma: A rare masquerader of myxoma and thrombus-"all that glitters is not gold".

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Khan, Muhammad Shoaib; Reddy, Sahadev; Lombardi, Richard; Isabel, Pitti; Mcgregor, Walter E; Tang, Bang; Gabriel, George; Biederman, Robert W

2018-02-01

Left atrial appendage mass can occasionally pose a serious challenge to physicians to identify the nature of the mass with the aid of imaging techniques. We present a case of 67-year-old man, who was evaluated for suspected left atria myxoma. Transesophageal echocardiography revealed a heterogeneous density originating from left atrial appendage, thought to be most consistent with a myxoma. Cardiac magnetic resonance imaging, uncharacteristically, gave an equivocal picture, suggesting the mass to be a myxoma on initial imaging and a thrombus with evidence of liquefaction necrosis following postcontrast enhancement. Surprisingly, histopathology of the mass following its surgical excision yielded a rare diagnosis of myxofibrosarcoma. © 2017, Wiley Periodicals, Inc.

Effect of mitral regurgitation on cerebrovascular accidents in patients with atrial fibrillation and left atrial thrombus.

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Nair, Chandra K; Aronow, Wilbert S; Shen, Xuedong; Anand, Kishlay; Holmberg, Mark J; Esterbrooks, Dennis J

2009-11-01

The effect of mitral regurgitation (MR) on the incidence of new cerebrovascular accidents (CVA) and mortality in patients with atrial fibrillation (AF) and left atrial thrombus (LAT) is unknown. To investigate the effect of MR in patients with AF and LAT on new CVA and mortality. Eighty nine consecutive patients, mean age 71 years, with AF and LAT documented by transesophageal echocardiography were investigated to determine the prevalence and severity of MR and the association of the severity of MR with new cerebrovascular accidents (CVA) and mortality at 34-mo follow-up. Of 89 patients, 1 + MR was present in 23 patients (26%), 2 + MR in 44 patients (50%), 3 + MR in 17 patients (19%), and 4 + MR in 3 patients (4%). Mean follow-up was 34 +/- 28 mo. The Cox proportional hazards model showed that the severity of increased MR did not significantly increase new CVA or mortality at 34-mo follow-up. The only variable predictive of mortality was left ventricular ejection fraction (LVEF), and with every unit increase in LVEF, the risk decreased by 3%. MR occurred in 87 of 89 patients (98%) with AF and LAT. There was no association between the severity of MR and the incidence of CVA or mortality.

The application and value of 64 multislice spiral CT of left atrium and pulmonary vein in radio-frequency ablation of atrial fibrillation

International Nuclear Information System (INIS)

Guo Xi; Lv Biao; Zhang Zhaoqi; Zhao Yike; Jiang Hong; Ma Changsheng; Yu Ronghui; Wang Xue; Cao Hainian

2008-01-01

Objective: Analyzing the left atrium and pulmonary vein morphologically by 64 multislice spiral CT (MSCT) scan to guide the catheter ablation of Atrial fibrillation. Methods: Two hundred and thirty-two patients (146 cases in atrial fibrillation group and 86 cases in control group) received 64 MSCT examination of the left atrium and pulmonary vein. The incidence of anatomical variation of pulmonary vein was compared between atrial fibrillation group and control group. For each group, the anatomical morphology of every pulmonary vein and the auricle of left atrium was analyzed, the diameter of the orifice of each pulmonary vein and the size of left atrium were measured. Results: Sixty-four MSCT of left atrium and pulmonary vein could demonstrate detailed connecting type between left atrium and pulmonary veins and the possible anatomical variation. Anatomical variation of pulmonary vein in this study accounted for 16.8% (39/232) of total sample. For both groups, orifices of pulmonary veins appeared oval and their superoinferior diameters were larger than their anteroposterior diameters. There was significant difference in the inner diameter of left atrium between atrial fibrillation group and control group [atrial fibrillation group: (39.47 ± 8.98) mm, control group: (36.94±5.49) mm, P=0.02], while there was no difference in the diameters of orifices of pulmonary veins between two groups [superoinferior diameters of pulmonary veins in atrial fibrillation group: left-up (18.15±1.35) mm, left-down (16.96±1.18) mm, right-up (17.50±1.12) mm, fight-down (17.65±0.94) mm, superoinferior diameters of pulmonary veins in control group: left-up (18.07±0.94) mm, left-down (17.50±0.57) mm, right-up (18.03±1.02) mm, fight-down (17.94±0.76) mm, the corresponding P>0.05, respectively, anteroposterior diameters of pulmonary veins in atrial fibrillation group: left-up (12.26±1.89) mm, left-down (11.96±0.61) mm, right-up (12.32± 1.08) mm, fight-down (12.39±0.95) mm

Effect of changes in contractility on the index of myocardial performance in the dysfunctional left ventricle

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Lavine Steven J

2006-11-01

Full Text Available Abstract Background The index of myocardial performance has prognostic power in patients with cardiomyopathy and following myocardial infarction. As the index of myocardial performance has been shown to be preload and afterload dependent, the effect of altering contractility on IMP and its components with left ventricular dysfunction has been incompletely delineated. Methods Chronic left ventricular dysfunction was induced in 10 canines using coronary microsphere embolization. Each dog was instrumented and imaged with 2D echo and Doppler. At the same atrially paced rate, contractility was increased with a dobutamine infusion and then following 4 weeks of oral digoxin. Results With chronic left ventricular dysfunction, a reduced left ventricular ejection fraction (42 ± 3%, p Conclusion Increased inotropy with digoxin and dobutamine reduced the index of myocardial performance in dogs with left ventricular dysfunction. Shortened isovolumic contraction time, increased diastolic filling period, and reduced left ventricular end diastolic pressure with digoxin may provide insight into its efficacy in heart failure.

Maternal left ventricular hypertrophy and diastolic dysfunction and brain natriuretic peptide concentration in early- and late-onset pre-eclampsia.

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Borges, V T M; Zanati, S G; Peraçoli, M T S; Poiati, J R; Romão-Veiga, M; Peraçoli, J C; Thilaganathan, B

2018-04-01

Pre-eclampsia (PE) is associated with maternal cardiac remodeling and diastolic dysfunction. The aim of this study was to assess and compare maternal left ventricular structure and diastolic function and levels of brain natriuretic peptide (BNP) in women with early-onset (< 34 weeks' gestation) vs those with late-onset (≥ 34 weeks' gestation) PE. This was a prospective, cross-sectional, observational study of 30 women with early-onset PE, 32 with late-onset PE and 23 normotensive controls. Maternal cardiac structure and diastolic function were assessed by echocardiography and plasma levels of BNP were measured by enzyme immunoassay. Early- and late-onset PE were associated with increased left ventricular mass index and relative wall thickness compared with normotensive controls. In women with early-onset PE, the prevalence of concentric hypertrophy (40%) and diastolic dysfunction (23%) was also significantly higher (both P < 0.05) compared with women with late-onset PE (16% for both). Maternal serum BNP levels were significantly higher (P < 0.05) in women with early-onset PE and correlated with relative wall thickness and left ventricular mass index. Early-onset PE is associated with more severe cardiac impairment than is late-onset PE, as evidenced by an increased prevalence of concentric hypertrophy, diastolic dysfunction and higher levels of BNP. These findings suggest that early-onset PE causes greater myocardial damage, increasing the risk of both peripartum and postpartum cardiovascular morbidity. Although these cardiovascular effects are easily identified by echocardiographic parameters and measuring BNP, further studies are needed to assess their clinical utility. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Interatrial septum pacing decreases atrial dyssynchrony on strain rate imaging compared with right atrial appendage pacing.

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Yasuoka, Yoshinori; Abe, Haruhiko; Umekawa, Seiko; Katsuki, Keiko; Tanaka, Norio; Araki, Ryo; Imanaka, Takahiro; Matsutera, Ryo; Morisawa, Daisuke; Kitada, Hirokazu; Hattori, Susumu; Noda, Yoshiki; Adachi, Hidenori; Sasaki, Tatsuya; Miyatake, Kunio

2011-03-01

Interatrial septum pacing (IAS-P) decreases atrial conduction delay compared with right atrial appendage pacing (RAA-P). We evaluate the atrial contraction with strain rate of tissue Doppler imaging (TDI) during sinus activation or with IAS-P or RAA-P. Fifty-two patients with permanent pacemaker for sinus node disease were enrolled in the study. Twenty-three subjects were with IAS-P and 29 with RAA-P. The time from end-diastole to peak end-diastolic strain rate was measured and corrected with RR interval on electrocardiogram. It was defined as the time from end-diastole to peak end-diastolic strain rate (TSRc), and the balance between maximum and minimum TSRc at three sites (ΔTSRc) was compared during sinus activation and with pacing rhythm in each group. There were no significant differences observed in general characteristics and standard echocardiographic parameters except the duration of pacing P wave between the two groups. The duration was significantly shorter in the IAS-P group compared with the RAA-P group (95 ± 34 vs 138 ± 41; P = 0.001). TSRc was significantly different between sinus activation and pacing rhythm (36.3 ± 35.7 vs 61.6 ± 36.3; P = 0.003) in the RAA-P group, whereas no significant differences were observed in the IAS-P group (25.4 ± 12.1 vs 27.7 ± 14.7; NS). During the follow-up (mean 2.4 ± 0.7 years), the incidence of paroxysmal atrial fibrillation (AF) conversion to permanent AF was not significantly different between the two groups. IAS-P decreased the contraction delay on atrial TDI compared to RAA-P; however, it did not contribute to the reduction of AF incidence in the present study. ©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.

Correlation of radiological assessment of congestive heart failure with left ventricular end-diastolic pressure

International Nuclear Information System (INIS)

Herman, P.G.; Kahn, A.; Kallman, C.E.; Rojas, K.A.; Bodenheimer, M.M.

1988-01-01

Left ventricular end-diastolic pressure (LVEDP) has been considered a reliable indicator of left ventricular function. The purpose of this study was to correlate the radiologic assessment of congestive heart failure with LVEDP. The population of the study consisted of 85 consecutive cases in four ranges of LVEDP ( 24). The PA chest radiographs obtained 1 day prior to cardiac catherization were assessed for radiological evidence of congestive heart failure and were graded from normal to abnormal (0-3). The results will be summarized in the authors' presentation. The discordance of radiological assessment of congestive heart failure in patients with elevated LVEDP will be discussed in light of recent advances in pathophysiologic understanding of left ventricular function and the impact of new classes of drugs in the management of these patients

Hemostasis of Left Atrial Appendage Bleed With Lariat Device

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Amena Hussain, MD

2014-09-01

Full Text Available New devices designed for minimally invasive closure of the left atrial appendage (LAA may be a viable alternative for patients in whom anticoagulation is considered high risk. The Lariat (Sentreheart, Redwood City, CA, which is currently FDA-approved for percutaneous closure of tissue, requires both trans-septal puncture and epicardial access. However it requires no anticoagulation after the procedure. Here we describe a case of effusion and tamponade during a Lariat procedure with successful completion of the case and resolution of the effusion.

Left ventricular structure and diastolic function in subjects with two hypertensive parents

DEFF Research Database (Denmark)

Andersen, U B; Steensgaard-Hansen, F; Rokkedal, J

2001-01-01

hypertension and 26 matched controls with normotensive parents. Families with non-insulin-dependent diabetes or morbid obesity were excluded. (i) Echocardiography; (ii) plasma concentrations of renin, angiotensin-II, aldosterone, epinephrine and norepinephrine; (iii) euglycaemic, hyperinsulinemic clamp study......PURPOSE: To examine the influence of (i) strong predisposition to essential hypertension and (ii) insulin sensitivity and plasma levels of cardiomyotrophic hormones on echocardiographic parameters of left ventricular structure and function. METHODS: 26 normotensive subjects (age 18-35) with bi-parental....... RESULTS (means +/- SD): Hypertension-prone subjects vs controls had (i) higher resting systolic (117.0 +/- 14.0 vs 107.1 +/- 11.9 mmHg), and 24-h diastolic blood pressure (77.9 +/- 7.1 vs 72.9 +/- 7.2 mmHg), (ii) higher relative wall thickness (RWT) (0.39 +/- 0.09 vs 0.34 +/- 0.06). They had similar left...

Brain ischemia as initial sign of a left atrial myxoma Report of one case

International Nuclear Information System (INIS)

Osio, Luis F; Velasquez, Jorge E; Tobon, Gabriel J; Posada, Gloria; Contreras, Eduardo; Sanchez, Jairo; Gutierrez, Javier

2008-01-01

Primary heart tumors are rare; 75% of them are benign and almost half of the benign ones are myxomas that in most cases are located in the left cavities. Clinical manifestations of myxomas depend on its localization site. Nevertheless, it is accepted that brain ischemia is the initial clinical manifestation in a third of atrial myxomas. The case of a 65 years ald male patient in whom the first clinical manifestation of an atrial myxoma was an ischemic cerebrovascular event, is presented

Effects of Prolonged Spaceflight on Atrial Size, Atrial Electrophysiology, and Risk of Atrial Fibrillation.

Science.gov (United States)

Khine, Htet W; Steding-Ehrenborg, Katarina; Hastings, Jeffrey L; Kowal, Jamie; Daniels, James D; Page, Richard L; Goldberger, Jeffery J; Ng, Jason; Adams-Huet, Beverley; Bungo, Michael W; Levine, Benjamin D

2018-05-01

The prevalence of atrial fibrillation (AF) in active astronauts is ≈5%, similar to the general population but at a younger age. Risk factors for AF include left atrial enlargement, increased number of premature atrial complexes, and certain parameters on signal-averaged electrocardiography, such as P-wave duration, root mean square voltage for the terminal 20 ms of the signal-averaged P wave, and P-wave amplitude. We aimed to evaluate changes in atrial structure, supraventricular beats, and atrial electrophysiology to determine whether spaceflight could increase the risk of AF. Thirteen astronauts underwent cardiac magnetic resonance imaging to assess atrial structure and function before and after 6 months in space and high-resolution Holter monitoring for multiple 48-hour time periods before flight, during flight, and on landing day. Left atrial volume transiently increased after 6 months in space (12±18 mL; P =0.03) without changing atrial function. Right atrial size remained unchanged. No changes in supraventricular beats were noted. One astronaut had a large increase in supraventricular ectopic beats but none developed AF. Filtered P-wave duration did not change over time, but root mean square voltage for the terminal 20 ms decreased on all fight days except landing day. No changes in P-wave amplitude were seen in leads II or V 1 except landing day for lead V 1 . Six months of spaceflight may be sufficient to cause transient changes in left atrial structure and atrial electrophysiology that increase the risk of AF. However, there was no definite evidence of increased supraventricular arrhythmias and no identified episodes of AF. © 2018 American Heart Association, Inc.

Evaluation of P-Wave Dispersion, Diastolic Function, and Atrial Electromechanical Conduction in Pediatric Patients with Subclinical Hypothyroidism.

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Irdem, Ahmet; Aydın Sahin, Derya; Kervancioglu, Mehmet; Baspinar, Osman; Sucu, Murat; Keskin, Mehmet; Kilinc, Metin

2016-09-01

This study aimed to evaluate ventricular diastolic dysfunction, inter- and intraatrial conduction delay, and P-wave dispersion in pediatric patients with subclinical hypothyroidism. The study comprised a total of 30 pediatric patients with subclinical hypothyroidism (SH) (mean age 7.8 ± 3.2 years) and 30 healthy children (mean age 8.4 ± 3.6 years) as the control group. A SH diagnosis was made in the event of increased serum thyroid-stimulating hormone (TSH) and decreased serum free triiodothyronine (T3 ) and free thyroxine (T4 ) concentrations. Conventional Doppler imaging (TDI) showed low mitral early diastolic E-wave velocity and E/A ratio (P wave velocity (P = 0.001) in hypothyroidism patients. Moreover, patients with hypothyroidism had significantly lower left ventricular (LV) septal Em velocity and Em /Am ratios compared with the control group (P wave dispersion was significantly different in the pediatric patients with hypothyroidism (P wave dispersion, and ventricle diastolic dysfunction in pediatric patients with hypothyroidism. © 2016, Wiley Periodicals, Inc.

Left atrial volume assessment in atrial fibrillation using multimodality imaging: a comparison of echocardiography, invasive three-dimensional CARTO and cardiac magnetic resonance imaging.

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Rabbat, Mark G; Wilber, David; Thomas, Kevin; Malick, Owais; Bashir, Atif; Agrawal, Anoop; Biswas, Santanu; Sanagala, Thriveni; Syed, Mushabbar A

2015-06-01

Left atrial size in atrial fibrillation is a strong predictor of successful ablation and cardiovascular events. Cardiac magnetic resonance multislice method (CMR-MSM) is the current gold standard for left atrial volume (LAV) assessment but is time consuming. We investigated whether LAV with more rapid area-length method by echocardiography (Echo-AL) or cardiac magnetic resonance (CMR-AL) and invasive measurement by 3D-CARTO mapping during ablation correlate with the CMR-MSM. We studied 250 consecutive patients prior to atrial fibrillation ablation. CMR images were acquired on 3T scanner to measure LAV by MSM and biplane area-length method. Standard echocardiography views were used to calculate LAV by biplane area-length method. LAV during ablation was measured by 3D-CARTO mapping. LAV was compared using intra-class correlation (ICC), Pearson's correlation and Bland-Altman plots. CMR-MSM was used as the reference standard. Mean LAV using CMR-MSM was 112.7 ± 36.7 ml. CMR-AL method overestimated LAV by 13.3 ± 21.8 ml (11.2%, p atrial fibrillation. CMR-AL and 3D-CARTO correlated and agreed well with CMR-MSM (r = 0.87 and 0.74, ICC = 0.80 and 0.77 respectively). However, Echo-AL had poor correlation and agreement with CMR-MSM (r = 0.66 and ICC = 0.48). Bland-Altman plots confirmed these findings. CMR-AL method may be used as an alternative to CMR-MSM, as it is non-invasive, rapid, and correlates well with CMR-MSM. LAV by different modalities should not be used interchangeably.

Epicardial fat thickness correlates with P-wave duration, left atrial size and decreased left ventricular systolic function in morbid obesity.

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Fernandes-Cardoso, A; Santos-Furtado, M; Grindler, J; Ferreira, L A; Andrade, J L; Santo, M A

2017-08-01

Epicardial fat (EF) is increased in obesity and has important interactions with atrial and ventricular myocardium. Most of the evidence in this scenario can be confused by the presence of comorbidities such as hypertension, diabetes and dyslipidemia, which are very common in this population. The influence of EF on atrial remodeling and cardiac function demands further investigation on morbidly obese without these comorbidities. We prospectively recruited 20 metabolically healthy morbidly obese and 20 normo-weights controls. The maximum P-wave duration (PWD) was analyzed by 12-lead electrocardiogram. Left atrial diameter (LAD), left ventricular ejection fraction (LVEF) and EF thickness (EFT) were evaluated by two-dimensional echocardiography. The mean of maximum PWD and LAD were significantly larger in the obese group as compared to the control group: 109.55 ± 11.52 ms × 89.38 ± 11.19 ms and 36.12 ± 3.46 mm × 31.45 ± 2.64 mm, (p function. Copyright © 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Percutaneous Occlusion of the Left Atrial Appendage with the Watchman Device in an Active Duty Sailor with Atrial Fibrillation and Recurrent Thromboembolism Despite Appropriate Use of Oral Anticoagulation.

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Cox, Justin M; Choi, Anthony J; Oakley, Luke S; Francisco, Gregory M; Nayak, Keshav R

2018-05-23

Atrial fibrillation is the most common significant cardiac arrhythmia and is associated with a five-fold increased risk of stroke from thromboembolism. Over 94% of these emboli arise from the left atrial appendage. Systemic embolic phenomena are rare, accounting for less than 1 out of 10 of all embolic events, but have a similar prevention strategy. Anticoagulation significantly reduces the risk of these events, and thus forms the cornerstone of therapy for most patients with atrial fibrillation. Left atrial appendage occlusion with the Watchman device is a recently approved alternative for stroke prevention in selected patients. We present a case of an active duty U.S. Navy sailor at low risk for thromboembolism who nonetheless suffered recurrent thromboembolic events despite appropriate anticoagulation, and thus underwent Watchman implantation. The therapy in this case will ideally provide a lifetime of protection from recurrent systemic embolization while allowing the patient to continue his active duty military career without restriction due to oral anticoagulation.

Impaired atrial electromechanical function and atrial fibrillation promotion in alloxan-induced diabetic rabbits.

Science.gov (United States)

Fu, Huaying; Liu, Changle; Li, Jian; Zhou, Changyu; Cheng, Lijun; Liu, Tong; Li, Guangping

2013-01-01

Diabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). However, the underlying mechanisms are still not clearly elucidated. The aim of this study was to evaluate the atrial electromechanical function, atrial electrophysiological changes and AF inducibility in alloxan-induced diabetic rabbits. In 8 alloxan-induced diabetic rabbits and 8 controls, we evaluated atrial electromechanical function by tissue Doppler imaging. Isolated Langendorff-perfused rabbit hearts were prepared to measure atrial refractory effective period (AERP) and its dispersion (AERPD), interatrial conduction time (IACT) and vulnerability to AF. Atrial interstitial fibrosis was evaluated by Sirius-Red staining. Compared with controls, left atrial lateral wall Pa'-start interval (Pastart) and right atrial wall Pastart were increased in diabetic rabbits. AERPD was increased and IACT was prolonged in diabetic rabbits. Inducibility of AF in diabetic group was significant higher than controls (6/8 vs. 1/8, p TEMA); left atrial lateral wall Papeak and TEMA, left atrial posterior wall TEMA, and IACT were correlated with atrial areas of fibrosis. Atrial electromechanical function is impaired in diabetic rabbits, and is associated with atrial fibrosis and interatrial electrical conduction delay.

Prognostic value of CT-derived left atrial and left ventricular measures in patients with acute chest pain

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Takx, Richard A.P. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, University Medical Center Utrecht (Netherlands); Vliegenthart, Rozemarijn [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); University of Groningen/University Medical Center Groningen, Center for Medical Imaging − North East Netherlands, Department of Radiology, Groningen (Netherlands); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); Nance, John W. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Bamberg, Fabian [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen (Germany); Abro, Joseph A. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Carr, Christine M. [Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); Litwin, Sheldon E. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); and others

2017-01-15

Highlights: • LV mass and LA diameter are independent prognostic factor for composite MACE. • LV mass and LA diameter were not significant prognostic factors for MACE in African Americans. • Assessment of LV mass by CT may have a role in the management of patients. - Abstract: Purpose: To determine which left atrial (LA) and left ventricular (LV) parameters are associated with future major adverse cardiac event (MACE) and whether these measurements have independent prognostic value beyond risk factors and computed tomography (CT)-derived coronary artery disease measures. Materials and methods: This retrospective analysis was performed under an IRB waiver and in HIPAA compliance. Subjects underwent coronary CT angiography (CCTA) using a dual-source CT system for acute chest pain evaluation. LV mass, LV ejection fraction (EF), LV end-systolic volume (ESV) and LV end-diastolic volume (EDV), LA ESV and LA diameter, septal wall thickness and cardiac chamber diameters were measured. MACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, or late revascularization. The association between cardiac CT measures and the occurrence of MACE was quantified using Cox proportional hazard analysis. Results: 225 subjects (age, 56.2 ± 11.2; 140 males) were analyzed, of whom 42 (18.7%) experienced a MACE during a median follow-up of 13 months. LA diameter (HR:1.07, 95%CI:1.01–1.13 per mm) and LV mass (HR:1.05, 95%CI:1.00–1.10 per g) remained significant prognostic factor of MACE after controlling for Framingham risk score. LA diameter and LV mass were also found to have prognostic value independent of each other. The other morphologic and functional cardiac measures were no significant prognostic factors for MACE. Conclusion: CT-derived LA diameter and LV mass are associated with future MACE in patients undergoing evaluation for chest pain, and portend independent prognostic value beyond traditional risk factors, coronary calcium score, and

Assessment of left atrial volume and function: a comparative study between echocardiography, magnetic resonance imaging and multi slice computed tomography.

Science.gov (United States)

Kühl, J Tobias; Lønborg, Jacob; Fuchs, Andreas; Andersen, Mads J; Vejlstrup, Niels; Kelbæk, Henning; Engstrøm, Thomas; Møller, Jacob E; Kofoed, Klaus F

2012-06-01

Measurement of left atrial (LA) maximal volume (LA(max)) using two-dimensional transthoracic echocardiography (TTE) provides prognostic information in several cardiac diseases. However, the relationship between LA(max) and LA function is poorly understood and TTE is less well suited for measuring dynamic LA volume changes. Conversely, cardiac magnetic resonance imaging (CMR) and multi-slice computed tomography (MSCT) appears more appropriate for such measures. We sought to determine the relationship between LA size assessed with TTE and LA size and function assessed with CMR and MSCT. Fifty-four patients were examined 3 months post myocardial infarction with echocardiography, CMR and MSCT. Left atrial volumes and LA reservoir function were assessed by TTE. LA time-volume curves were determined and LA reservoir function (cyclic change and fractional change), passive emptying function (reservoir volume) and pump function (left atrial ejection fraction-LAEF) were derived using CMR and MSCT. Left atrial fractional change and left atrial ejection fraction (LAEF) determined with CMR and MSCT were unrelated to LA(max) enlargement by echocardiography (P = NS). There was an overall good agreement between CMR and MSCT, with a small to moderate bias in LA(max) (4.9 ± 10.4 ml), CC (3.1 ± 9.1 ml) and reservoir volume (3.4 ± 9.1 ml). TTE underestimates LA(max) with up to 32% compared with CMR and MSCT (P fractional change and LAEF is not significantly related to LA(max) measured by TTE. TTE systematically underestimated LA volumes, whereas there are good agreements between MSCT and CMR for volumetric and functional properties.

Sympathetic stimulation alters left ventricular relaxation and chamber size.

Science.gov (United States)

Burwash, I G; Morgan, D E; Koilpillai, C J; Blackmore, G L; Johnstone, D E; Armour, J A

1993-01-01

Alterations in left ventricular (LV) contractility, relaxation, and chamber dimensions induced by efferent sympathetic nerve stimulation were investigated in nine anesthetized open-chest dogs in sinus rhythm. Supramaximal stimulation of acutely decentralized left stellate ganglia augmented heart rate, LV systolic pressure, and rate of LV pressure rise (maximum +dP/dt, 1,809 +/- 191 to 6,304 +/- 725 mmHg/s) and fall (maximum -dP/dt, -2,392 +/- 230 to -4,458 +/- 482 mmHg/s). It also reduced the time constant of isovolumic relaxation, tau (36.5 +/- 4.8 to 14.9 +/- 1.1 ms). Simultaneous two-dimensional echocardiography recorded reductions in end-diastolic and end-systolic LV cross-sectional chamber areas (23 and 31%, respectively), an increase in area ejection fraction (32%), and increases in end-diastolic and end-systolic wall thicknesses (14 and 13%, respectively). End-systolic and end-diastolic wall stresses were unchanged by stellate ganglion stimulation (98 +/- 12 to 95 +/- 9 dyn x 10(3)/cm2; 6.4 +/- 2.4 to 2.4 +/- 0.3 dyn x 10(3)/cm2, respectively). Atrial pacing to similar heart rates did not alter monitored indexes of contractility. Dobutamine and isoproterenol induced changes similar to those resulting from sympathetic neuronal stimulation. These data indicate that when the efferent sympathetic nervous system increases left ventricular contractility and relaxation, concomitant reductions in systolic and diastolic dimensions of that chamber occur that are associated with increasing wall thickness such that LV wall stress changes are minimized.

Akut Anteriyor Miyokard İnfarktüsünde Sol Atriyal Volüm Değişiklikleri

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Kenan İltümür

2005-01-01

Full Text Available Prognostic value of left atrial volume after acute myocardial infarction (AMIis well known. This study was planned to evaluate left atrial volume changes and the effect of these changes on diastolic parameters in patients with anterior myocardial infarction with preserved ejection fraction.Thirty-four consecutive patients with anterior AMI were enrolled in this study along with sex and age matched 20 normal controls. In addition, to the standard echocardiographic evaluation, left atrial (LA volume measurements and tissue doppler analysis were done.Left atrial maximal volume (43.6±8.8 vs 38.7±5.3 ml; p0.05 and total emptying volume (24.1±4.1 vs 22.1±2.9; p>0.05 were not significant between two groups. In AMI group, passive emptying volume and its fraction was lower, although active emptying volume and its fraction was higher than controls. At the same time pulmonary vein systolic and diastolic flows were lower in AMI group. There was a significant relationship between left ventricular diastolic parameters (mitral E/A and mitral tissue E’/A’ and LA active emptying volume in AMI group ( r= -0,35 and r=-0,36 p<0,05, respectively.Our study suggested that left atrial volume changes are significant in the AMI. In addition, these changes are parallel to diastolic dysfunction. Left atrial volume changes may be used more confidently compared to mitral valve’s diastolic parameters that are variable.

Diastolic mitral and tricuspid regurgitation by Doppler echocardiography in patients with atrioventricular block: new insight into the mechanism of atrioventricular valve closure.

Science.gov (United States)

Schnittger, I; Appleton, C P; Hatle, L K; Popp, R L

1988-01-01

The purpose of this study was to prospectively determine the incidence of diastolic mitral and tricuspid regurgitation in atrioventricular (AV) block using Doppler echocardiography. The temporal relation between mitral and tricuspid diastolic insufficiency and the diastolic murmur recorded in patients with complete heart block was also investigated. Twenty-two consecutive patients with AV block (referred to the Echo-Doppler laboratory for routine clinical studies), aged 18 to 87 years, were enrolled in the study. Eleven patients had third degree AV block and a ventricular-inhibited (VVI) pacemaker, two patients had second degree AV block, seven patients had first degree AV block, one patient had blocked premature atrial complexes and one patient had atrial flutter with 4:1 AV block. Diastolic mitral regurgitation was detected in 20 patients, and diastolic tricuspid regurgitation in 21. A mid-diastolic murmur was detected in all patients except in the three youngest. The murmur occurred before diastolic regurgitation and coincided with peak forward flow through the AV valve after atrial contraction. M-mode mitral valve echocardiograms obtained in nine patients demonstrated near closure of some portions of the mitral valve after atrial contraction. Effective closure of the valve, however, did not occur unless ventricular systole supervened. In conclusion, diastolic mitral and tricuspid regurgitation are almost universally present in patients with AV block and are associated with a diastolic murmur. The murmur coincides with forward AV valve flow. Diastolic regurgitation is silent. Effective AV valve closure is not established until ventricular systole occurs, as demonstrated by M-mode echocardiographic recording of the mitral valve.

Churg-Strauss syndrome associated with rapid deterioration of left ventricular diastolic dysfunction and conduction disturbance.

Science.gov (United States)

Chin, Jung Yeon; Yi, Jeong Eun; Youn, Ho-Joong

2013-10-01

Cardiac involvement in Churg-Strauss syndrome (CSS) is a major cause of mortality. Here we report a case of a 75-year-old woman with eosinophilic endomyocarditis due to CSS. An electrocardiogram showed intraventricular conduction delay, and echocardiography showed an impaired relaxation pattern and biventricular apical thickening. Magnetic resonance imaging revealed subendocardial delayed enhancement with biventricular apical thrombi. Endomyocardial biopsy showed perivascular eosinophilic infiltration. Despite resolution of the hypereosinophilia after steroid therapy, her left ventricular (LV) diastolic function worsened into a restrictive pattern and she died with a ventricular escape rhythm on her 14th day in the hospital. This case is unusual in that there was rapid progression of the LV diastolic dysfunction and conduction disturbance due to CSS. © 2013, Wiley Periodicals, Inc.

Clinical impact of quantitative left atrial vortex flow analysis in patients with atrial fibrillation: a comparison with invasive left atrial voltage mapping.

Science.gov (United States)

Lee, Jung Myung; Hong, Geu-Ru; Pak, Hui-Nam; Shim, Chi Young; Houle, Helene; Vannan, Mani A; Kim, Minji; Chung, Namsik

2015-08-01

Recently, left atrial (LA) vortex flow analysis using contrast transesophageal echocardiography (TEE) has been shown to be feasible and has demonstrated significant differences in vortex flow morphology and pulsatility between normal subjects and patients with atrial fibrillation (AF). However, the relationship between LA vortex flow and electrophysiological properties and the clinical significance of LA vortex flow are unknown. The aims of this study were (1) to compare LA vortex flow parameters with LA voltage and (2) to assess the predictive value of LA vortex flow parameters for the recurrence of AF after radiofrequency catheter ablation (RFCA). Thirty-nine patients with symptomatic non-valvular AF underwent contrast TEE before undergoing RFCA for AF. Quantitative LA vortex flow parameters were analyzed by Omega flow (Siemens Medical Solution, Mountain View, CA, USA). The morphology and pulsatility of LA vortex flow were compared with electrophysiologic parameters that were measured invasively. Hemodynamic, electrophysiological, and vortex flow parameters were compared between patients with and without early recurrence of AF after RFCA. Morphologic parameters, including LA vortex depth, length, width, and sphericity index were not associated with LA voltage or hemodynamic parameters. The relative strength (RS), which represents the pulsatility power of LA, was positively correlated with LA voltage (R = 0.53, p = 0.01) and LA appendage flow velocity (R = 0.73, p vortex flow analysis, especially RS, correlated well with LA voltage. Decreased pulsatility strength in the LA was associated with recurrent AF. LA vortex may have incremental value in predicting the recurrence of AF.

5-Year Outcomes After Left Atrial Appendage Closure: From the PREVAIL and PROTECT AF Trials.

Science.gov (United States)

Reddy, Vivek Y; Doshi, Shephal K; Kar, Saibal; Gibson, Douglas N; Price, Matthew J; Huber, Kenneth; Horton, Rodney P; Buchbinder, Maurice; Neuzil, Petr; Gordon, Nicole T; Holmes, David R

2017-12-19

The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) trial demonstrated that left atrial appendage closure (LAAC) with the Watchman device (Boston Scientific, St. Paul, Minnesota) was equivalent to warfarin for preventing stroke in atrial fibrillation, but had a high rate of complications. In a second randomized trial, PREVAIL (Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy), the complication rate was low. The warfarin cohort experienced an unexpectedly low ischemic stroke rate, rendering the efficacy endpoints inconclusive. However, these outcomes were based on relatively few patients followed for a relatively short time. The final results of the PREVAIL trial, both alone and as part of a patient-level meta-analysis with the PROTECT AF trial, are reported with patients in both trials followed for 5 years. PREVAIL and PROTECT AF are prospective randomized clinical trials with patients randomized 2:1 to LAAC or warfarin; together, they enrolled 1,114 patients for 4,343 patient-years. Analyses are by intention-to-treat, and rates are events per 100 patient-years. For the PREVAIL trial, the first composite coprimary endpoint of stroke, systemic embolism (SE), or cardiovascular/unexplained death did not achieve noninferiority (posterior probability for noninferiority = 88.4%), whereas the second coprimary endpoint of post-procedure ischemic stroke/SE did achieve noninferiority (posterior probability for noninferiority = 97.5%); the warfarin arm maintained an unusually low ischemic stroke rate (0.73%). In the meta-analysis, the composite endpoint was similar between groups (hazard ratio [HR]: 0.820; p = 0.27), as were all-stroke/SE (HR: 0.961; p = 0.87). The ischemic stroke/SE rate was numerically higher with LAAC, but this difference did not reach statistical significance (HR: 1.71; p = 0.080). However, differences in

Comparison of biatrial and left atrial radiofrequency ablation in patients with heart valves diseases

Directory of Open Access Journals (Sweden)

А. В. Богачев-прокофьев

2015-10-01

Full Text Available We analysed results of left atrial and biatrial anatomic scheme of radiofrequency (RF ablation of the atria in patients with valvular heart. From 2007 to 2011, RF ablation procedure performed 283 patients with atrial fibrillation and heart valve disease. Patients were divided into two groups - group I performed a complete circuit biatrial procedure (procedure maze IV - 131 patients, in group II only ablation of the left atrium -152 patients. Most of the patients had long-term persistent AF. The main problem of early postoperative period is dysfunction of pacemaker complex, which observed in 64.9% and 50.7% patients for group I and II, respectively (p = 0.031. Permanent dysfunction of pacemaker complex required implantation of permanent pacemaker (9.2% and 4.6% of cases for group I and II, respectively, p = 0,023. Predictors of dysfunction of the pacemaker complex were biatrial execution method and duration of AF. Freedom from AF and AT during 36 months after surgery was 80.4% for patients in group I and 78.5% for patients in group II, with no statistically significant difference (log-rank test, p = 0.621. Atrial transport function has not revealed that the active fraction of the right atrium was 29.8% higher than in group II in the early postoperative phase and by 17.9% in the long term, with no difference between groups for the left atrium has been received.

Simulation of left atrial function using a multi-scale model of the cardiovascular system.

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Antoine Pironet

Full Text Available During a full cardiac cycle, the left atrium successively behaves as a reservoir, a conduit and a pump. This complex behavior makes it unrealistic to apply the time-varying elastance theory to characterize the left atrium, first, because this theory has known limitations, and second, because it is still uncertain whether the load independence hypothesis holds. In this study, we aim to bypass this uncertainty by relying on another kind of mathematical model of the cardiac chambers. In the present work, we describe both the left atrium and the left ventricle with a multi-scale model. The multi-scale property of this model comes from the fact that pressure inside a cardiac chamber is derived from a model of the sarcomere behavior. Macroscopic model parameters are identified from reference dog hemodynamic data. The multi-scale model of the cardiovascular system including the left atrium is then simulated to show that the physiological roles of the left atrium are correctly reproduced. This include a biphasic pressure wave and an eight-shaped pressure-volume loop. We also test the validity of our model in non basal conditions by reproducing a preload reduction experiment by inferior vena cava occlusion with the model. We compute the variation of eight indices before and after this experiment and obtain the same variation as experimentally observed for seven out of the eight indices. In summary, the multi-scale mathematical model presented in this work is able to correctly account for the three roles of the left atrium and also exhibits a realistic left atrial pressure-volume loop. Furthermore, the model has been previously presented and validated for the left ventricle. This makes it a proper alternative to the time-varying elastance theory if the focus is set on precisely representing the left atrial and left ventricular behaviors.

Problems in clinical assessment of left ventricular peak filling rate with radionuclide ventriculography

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Ishida, Yoshio; Kim, Bong-Ha; Tsuneoka, Yutaka

1987-02-01

With an increased clinical application of early peak diastolic filling rate (PFR) using radionuclide ventriculography, problems of its clinical significance have emerged. The study was designed to answer the following questions: 1) accuracy of PFR measurement, 2) normalization of PFR, and 3) whether PFR may reflect left ventricular relaxation rate (LVRR). In measuring PFR, an elevated framing rate was required, and the optimal rate was 20 msec/F. Second sound heart gating technique proved to be complementary to conventional ECG R wave gating technique in the evaluation of left ventricular diastolic volume curves and mean filling rate associated with changes in the range of R-R interval. PFR which was normalized with end-diastolic volume (EDV) did not necessarily reflect measured PFR because of individual differences of EDV. An experiment on the relationship of mitral valve pressure to blood flow in dogs revealed that PFR was influenced by not only LVRR but also left atrial pressure. These results may raise a question of the rationale for using the measurement of PFR, as well as its technical problems, in the objective evaluation of LVRR. (Namekawa, K.).

Clinical study on left atrial thrombi. Comparative study between echocardiography and CT scan

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Shimada, E; Asano, H; Kurasawa, T; Mitsumoto, K; Yamane, Y [Tokyo Kosei-Nenkin Hospital (Japan)

1981-09-01

We studied left atrial thrombi (LAT) by both echocardiography and computed tomography (CT) and compared the features of the 2 methods. A total of 15 patients with mitral stenosis complicated by atrial fibrillation were selected as the subjects. LAT were noted on the M-mode echocardiograms in 2 patients including a questionably positive one, on the two-dimensional echocardiograms in 5, and on the CT scans in 6 of 15. The history of thromboembolism was rather frequent and was found in 7 of 15 patients. However, LAT was found in only 3 of these on the CT scans. A shaggy or fuzzy pattern on the M-mode echocardiogram cannot be regarded as representing thrombi, while a laminar pattern undoubtedly represented thrombi. Two-dimensional echocardiography has considerably contributed to the improved detection rate of LAT. For the characteristic properties of ultrasound beams, however, it was impossible to investigate the entire left atrium. The detection of the thrombi in the appendage was especially difficult. However, computed tomography, permitting transverse cross-sectional tomography, was capable of sectioning the heart even in the presence of air and bones. The measurement of CT values was suggestive of the properties of the substance or substances involved, and also allowed the presumption as to whether the thrombus has been fibrosed. Furthermore, it was possible to estimate more accurately as well as 3-dimensionally the location, shape and dimensions of the thrombi by the reconstruction of the heart according to the CT values. It was concluded that echocardiography and computed tomography are the mutual aid to further improvement in the detection rate of left atrial thrombi.

Prognostic significance of radionuclide-assessed diastolic function in hypertrophic cardiomyopathy

International Nuclear Information System (INIS)

Chikamori, T.; Dickie, S.; Poloniecki, J.D.; Myers, M.J.; Lavender, J.P.; McKenna, W.J.

1990-01-01

To evaluate the prognostic significance of diastolic function in hypertrophic cardiomyopathy (HC), technetium-99m gated equilibrium radionuclide angiography, acquired in list mode, was performed in 161 patients. Five diastolic indexes were calculated. During 3.0 +/- 1.9 years, 13 patients had disease-related deaths. With univariate analysis, these patients were younger (29 +/- 20 vs 42 +/- 16 years; p less than 0.05), had a higher incidence of syncope (p less than 0.025), dyspnea (p less than 0.001), reduced peak filling rate (2.9 +/- 0.9 vs 3.4 +/- 1.0 end-diastolic volume/s; p = 0.09) with increased relative filling volume during the rapid filling period (80 +/- 7 vs 75 +/- 12%; p = 0.06) and decreased atrial contribution (17 +/- 7 vs 22 +/- 11%; p = 0.07). Stepwise discriminant analysis revealed that young age at diagnosis, syncope at diagnosis, reduced peak ejection rate, positive family history, reduced peak filling rate, increased relative filling volume by peak filling rate and concentric left ventricular hypertrophy were the most statistically significant (p = 0.0001) predictors of disease-related death (sensitivity 92%, specificity 76%, accuracy 77%, positive predictive value 25%). Discriminant analysis excluding the diastolic indexes, however, showed similar predictability (sensitivity 92%, specificity 76%, accuracy 78%, positive predictive value 26%). To obtain more homogeneous groups for analysis, patients were classified as survivors or electrically unstable, including sudden death, out-of-hospital ventricular fibrillation and nonsustained ventricular tachycardia during 48-hour ambulatory electrocardiography, and heart failure death or cardiac transplant

Left atrial passive emptying function is preserved in patients with permanent atrial fibrillation--a 320-slice multidetector computed tomography study

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Agner, Bue Fridolin Ross; Kühl, Jørgen Tobias; Kofoed, Klaus Fuglsang

2014-01-01

OBJECTIVE: Left atrial (LA) mechanical function is thought to be virtually inexistent in patients with permanent atrial fibrillation (AF). Due to recent advances in multidetector computed tomography (MDCT) technology, it is now possible to acquire images of the entire heart in a single heartbeat....... The objective of this study was to compare individual components of LA function assessed by MDCT in patients with permanent AF and patients in sinus rhythm (SR). METHODS: 320-slice MDCT was performed in 30 patients with permanent AF. Measurements of LA volumes during the cardiac cycle were compared to 30......; 71 vs. 30 ml/m(2), p permanent AF have significantly increased LA volumes throughout the cardiac...

Rationale and Design of the Reduce Elevated Left Atrial Pressure in Patients With Heart Failure (Reduce LAP-HF) Trial

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Hasenfuss, Gerd; Gustafsson, Finn; Kaye, David

2015-01-01

OBJECTIVE: Heart failure with preserved ejection fraction (HFpEF) is characterized by elevated left atrial pressure during rest and/or exercise. The Reduce LAP-HF (Reduce Elevated Left Atrial Pressure in Patients With Heart Failure) trial will evaluate the safety and performance of the Interatrial...... Shunt Device (IASD) System II, designed to directly reduce elevated left atrial pressure, in patients with HFpEF. METHODS: The Reduce LAP-HF Trial is a prospective, nonrandomized, open-label trial to evaluate a novel device that creates a small permanent shunt at the level of the atria. A minimum of 60...... patients with ejection fraction ≥40% and New York Heart Association functional class III or IV heart failure with a pulmonary capillary wedge pressure (PCWP) ≥15 mm Hg at rest or ≥25 mm Hg during supine bike exercise will be implanted with an IASD System II, and followed for 6 months to assess the primary...

Characteristics of complex fractionated atrial electrogram in the electroanatomically remodeled left atrium of patients with atrial fibrillation

International Nuclear Information System (INIS)

Park, Jae-Hyung; Kim, Jong-Youn; Park, Sang-Weon

2010-01-01

Complex fractionated atrial electrogram (CFAE) guided ablation is effective in some patients with persistent atrial fibrillation (PeAF), but the pattern of CFAE may be different in the remodeled left atrium (LA). In 100 AF patients (83 males, 55.0±10.6 years old) with AF (51 paroxysmal AF (PAF), 49 PeAF) who underwent catheter ablation, CFAE cycle length (CL) and distribution (NavX 3D map) were compared according to the LA volume (3D-CT) and endocardial voltage (during high right atrial pacing 500-ms (Vol PACE ) and AF (Vol AF ; NavX). The mean CFAE-CL was longer (P=0.003) and the % area CFAE was smaller (P=0.006) in patients with LA ≥125 ml than those with PACE AF PACE <1.7 mV than those with ≥1.7 mV (P=0.006). The incidence of septal CFAE was consistently high, regardless of the degree of LA remodeling. In the AF patients with an electroanatomically remodeled LA, the % area of CFAE was smaller and mean CFAE-CL was longer than in those with a less remodeled LA. However, the majority of CFAE are consistently positioned on the septum in the remodeled LA. (author)

[Diastolic dysfunction in the elderly subjects. Disease or a physiological manifestation of ageing?].

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Meluzín, J; Podroužková, H; Gregorová, Z; Panovský, R

2013-05-01

The purpose of this summary paper is to discuss the current knowledge of the impact of age on diastolic function of the left ventricle. Data from the literature: Reports published till this time have convincingly demonstrated a significant relationship of age to diastolic function of the left ventricle. Ageing is a physiological process accompanied by structural changes in both myocardium and arterial bed resulting in worsening of parameters characterizing the left ventricular diastolic function. This "physiological" diastolic dysfunction in the elderly subjects can be explained by the deterioration of passive left ventricular filling properties and by worsening of left ventricular relaxation. The detailed analysis of published reports shows problems in distiguishing this "physiological" diastolic dysfunction resulting from physiological tissue ageing from "pathological" diastolic dysfunction reflecting a disease of cardiovascular system. To interprete correctly values of parameters quantifying diastolic function of the left ventricle, one should take into account the age of subjects under the examination. Further studies are necessary to distinguish exactly "physiological" deterioration of diastolic function associated with ageing from really "pathological" diastolic dysfunction in the elderly subjects.

Left ventricular remodeling and fibrosis: Sex differences and relationship with diastolic function in hypertrophic cardiomyopathy

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Chen, You-Zhou; Qiao, Shu-Bin; Hu, Feng-Huan; Yuan, Jian-Song; Yang, Wei-Xian; Cui, Jin-Gang; Zhang, Yan; Zhang, Chang-Lin

2015-01-01

Highlights: • There are significant differences in LV remodeling and fibrosis as divided by sex. • Women have worse diastolic dysfunction compared to men measured by CMR. • LV remodeling and fibrosis correlate with markers of diastolic dysfunction. - Abstract: Objectives: We investigated sex differences in left ventricular (LV) remodeling and fibrosis and their relationship with LV diastolic dysfunction by cardiovascular magnetic resonance (CMR). Methods: CMR imaging was performed simultaneously in 152 age-matched patients (76 men, 76 women; mean age: 49 ± 9 years) without LV systolic dysfunction. LV remodeling index (LVRI) was calculated as the ratio of LV mass and end-diastolic volume. Diastolic function indexes including peak filling rate (PFR) and time to PFR (tPFR) were evaluated. Extent of late gadolinium enhancement (LGE) was measured. Results: LVRI and extent of LGE were greater in women compared with men (1.48 ± 0.22 vs. 1.36 ± 0.28 g/ml; 13.15 ± 2.48 vs. 11.35 ± 2.34 g, respectively, both P < 0.001). Women had lower PFR and higher tPFR (both P < 0.001) than men. LVRI and the extent of LGE showed significant relationships with parameters of diastolic function in both sex. In a multivariate analysis, LVRI remained a strong independent predictor of PFR and TPFR in women (β = −0.272, P = 0.032; β = 0.348, P = 0.016, respectively), and in men (β = −0.374, P < 0.001; β = 0.660, P < 0.001, respectively). Furthermore, the extent of LGE also remained an independent predictor of PFR in women (β = −0.283, P = 0.033) and men (β = −0.492, P < 0.001). Conclusions: There are prominent sex differences in LV remodeling and myocardial fibrosis. We suggest that the effects of LV remodeling and fibrosis may lead to diastolic dysfunction with greater susceptibility to worse clinical outcome in women

Left ventricular remodeling and fibrosis: Sex differences and relationship with diastolic function in hypertrophic cardiomyopathy

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Chen, You-Zhou [Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Qiao, Shu-Bin, E-mail: qsbfw@sina.com [Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Hu, Feng-Huan; Yuan, Jian-Song; Yang, Wei-Xian; Cui, Jin-Gang [Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Zhang, Yan [Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Zhang, Chang-Lin [Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China)

2015-08-15

Highlights: • There are significant differences in LV remodeling and fibrosis as divided by sex. • Women have worse diastolic dysfunction compared to men measured by CMR. • LV remodeling and fibrosis correlate with markers of diastolic dysfunction. - Abstract: Objectives: We investigated sex differences in left ventricular (LV) remodeling and fibrosis and their relationship with LV diastolic dysfunction by cardiovascular magnetic resonance (CMR). Methods: CMR imaging was performed simultaneously in 152 age-matched patients (76 men, 76 women; mean age: 49 ± 9 years) without LV systolic dysfunction. LV remodeling index (LVRI) was calculated as the ratio of LV mass and end-diastolic volume. Diastolic function indexes including peak filling rate (PFR) and time to PFR (tPFR) were evaluated. Extent of late gadolinium enhancement (LGE) was measured. Results: LVRI and extent of LGE were greater in women compared with men (1.48 ± 0.22 vs. 1.36 ± 0.28 g/ml; 13.15 ± 2.48 vs. 11.35 ± 2.34 g, respectively, both P < 0.001). Women had lower PFR and higher tPFR (both P < 0.001) than men. LVRI and the extent of LGE showed significant relationships with parameters of diastolic function in both sex. In a multivariate analysis, LVRI remained a strong independent predictor of PFR and TPFR in women (β = −0.272, P = 0.032; β = 0.348, P = 0.016, respectively), and in men (β = −0.374, P < 0.001; β = 0.660, P < 0.001, respectively). Furthermore, the extent of LGE also remained an independent predictor of PFR in women (β = −0.283, P = 0.033) and men (β = −0.492, P < 0.001). Conclusions: There are prominent sex differences in LV remodeling and myocardial fibrosis. We suggest that the effects of LV remodeling and fibrosis may lead to diastolic dysfunction with greater susceptibility to worse clinical outcome in women.

ACE inhibition with spirapril improves diastolic function at rest independent of vasodilation during treatment with spirapril in mild to moderate hypertension

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Petersen, J R; Drabaek, H; Gleerup, Christian Peter-Ole G.

1996-01-01

the patients entered three periods lasting four weeks each, wherein they were treated with placebo, spirapril, or hydrochlorothiazide. Blood pressure, hemodynamic variables (stroke volume, heart rate, cardiac output, index of contractility, and systemic vascular resistance), echocardiography (left ventricular...... mass), and Doppler-derived atrial to early (A/E)-ratio velocity time integrals (VTI) were measured at the end of each of the four periods. Spirapril lowered the A/E-ratio VTIs (0.57, 0.12-1.00) (P ... indicate that spirapril lowers A/E ratio within four weeks in patients with mild to moderate essential hypertension. It thereby seems able to improve left ventricular diastolic function. The effect is not dependent upon changes in hemodynamic variables, blood pressure, left ventricular mass, or end...

Left atrial appendage thrombus with resulting stroke post-RF ablation for atrial fibrillation in a patient on dabigatran.

LENUS (Irish Health Repository)

Lobo, R

2015-11-01

Dabigatran etexilate is licensed for use in prevention of deep venous thromboembolism and in prevention of stroke and systemic embolism in nonvalvular atrial fibrillation (AF). It has also been used in patients for other indications as a substitute for warfarin therapy because it requires no monitoring; one group being patients undergoing radiofrequency (RF), ablation for AF, although there have been no consensus guidelines with regards to dosage and timing of dose. We report the case of a patient with documentary evidence of left atrial appendage (LAA) thrombus formation and neurological sequelae post-RF ablation despite being on dabigatran. This case highlights the concern that periprocedural dabigatran may not provide adequate protection from development of LAA thrombus and that a standardised protocol will need to be developed and undergo large multicentre trials before dabigatran can be safely used for patients undergoing RF-ablation.

Assessment of early diastolic intraventricular pressure gradient in the left ventricle among patients with repaired tetralogy of Fallot.

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Kobayashi, Maki; Takahashi, Ken; Yamada, Mariko; Yazaki, Kana; Matsui, Kotoko; Tanaka, Noboru; Shigemitsu, Sachie; Akimoto, Katsumi; Kishiro, Masahiko; Nakanishi, Keisuke; Kawasaki, Shiori; Nii, Masaki; Itatani, Keiichi; Shimizu, Toshiaki

2017-11-01

Assessment of left ventricular (LV) dysfunction is vital in patients with repaired tetralogy of Fallot (rTOF). The early diastolic intraventricular pressure gradient (IVPG) in the LV plays an important role in diastolic function. IVPG is calculated as the intraventricular pressure difference divided by the LV length, which allows to account for differences in LV size and therefore calculate IVPG in children. We aimed to investigate the mechanisms of LV diastolic dysfunction by measuring mid-to-apical IVPG as an indicator of the active suction force sucking blood from the left atrium into the LV. We included 38 rTOF patients and 101 healthy controls. The study population was stratified based on age group into children (4-9 years), adolescents (10-15 years), and adults (16-40 years). IVPGs were calculated based on mitral inflow measurements obtained using color M-mode Doppler echocardiography. Although total IVPGs did not differ between rTOF patients and controls, mid-to-apical IVPGs in adolescents and adults were smaller among rTOF patients than among controls (0.15 ± 0.05 vs. 0.21 ± 0.06 mmHg/cm, p < 0.05; 0.09 ± 0.07 vs. 0.17 ± 0.05 mmHg/cm, p < 0.001; respectively). Additionally, only mid-to-apical IVPG correlated linearly with peak circumferential strain (ρ = 0.217, p = 0.011), longitudinal strain (ρ = -0.231, p = 0.006), torsion (ρ = -0.200, p = 0.018), and untwisting rate in early diastole (ρ = -0.233, p = 0.006). In rTOF, the mechanisms underlying diastolic dysfunction involve reduced active suction force, which correlates with reduced LV deformation in all directions.

Diastolic Backward-Traveling Decompression (Suction) Wave Correlates With Simultaneously Acquired Indices of Diastolic Function and Is Reduced in Left Ventricular Stunning.

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Ladwiniec, Andrew; White, Paul A; Nijjer, Sukhjinder S; O'Sullivan, Michael; West, Nick E J; Davies, Justin E; Hoole, Stephen P

2016-09-01

Wave intensity analysis can distinguish proximal (propulsion) and distal (suction) influences on coronary blood flow and is purported to reflect myocardial performance and microvascular function. Quantifying the amplitude of the peak, backwards expansion wave (BEW) may have clinical utility. However, simultaneously acquired wave intensity analysis and left ventricular (LV) pressure-volume loop data, confirming the origin and effect of myocardial function on the BEW in humans, have not been previously reported. Patients with single-vessel left anterior descending coronary disease and normal ventricular function (n=13) were recruited prospectively. We simultaneously measured LV function with a conductance catheter and derived wave intensity analysis using a pressure-low velocity guidewire at baseline and again 30 minutes after a 1-minute coronary balloon occlusion. The peak BEW correlated with the indices of diastolic LV function: LV dP/dtmin (rs=-0.59; P=0.002) and τ (rs=-0.59; P=0.002), but not with systolic function. In 12 patients with paired measurements 30 minutes post balloon occlusion, LV dP/dtmax decreased from 1437.1±163.9 to 1299.4±152.9 mm Hg/s (median difference, -110.4 [-183.3 to -70.4]; P=0.015) and τ increased from 48.3±7.4 to 52.4±7.9 ms (difference, 4.1 [1.3-6.9]; P=0.01), but basal average peak coronary flow velocity was unchanged, indicating LV stunning post balloon occlusion. However, the peak BEW amplitude decreased from -9.95±5.45 W·m(-2)/s(2)×10(5) to -7.52±5.00 W·m(-2)/s(2)×10(5) (difference 2.43×10(5) [0.20×10(5) to 4.67×10(5); P=0.04]). Peak BEW assessed by coronary wave intensity analysis correlates with invasive indices of LV diastolic function and mirrors changes in LV diastolic function confirming the origin of the suction wave. This may have implications for physiological lesion assessment after percutaneous coronary intervention. URL: http://www.isrctn.org. Unique identifier: ISRCTN42864201. © 2016 American Heart

Percutaneous closure of patent ductus arteriosus in children: Immediate and short-term changes in left ventricular systolic and diastolic function

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Saurabh Kumar Gupta

2011-01-01

Full Text Available Objective: To evaluate the effect of percutaneous closure of patent ductus arteriosus (PDA on left ventricular (LV systolic and diastolic function in children. Background: Limited studies are available on alteration in LV hemodynamics, especially diastolic function, after PDA closure. Methods: Thirty-two consecutive children with isolated PDA treated by trans-catheter closure were studied. The LV systolic and diastolic function were assessed by two-dimensional (2D echocardiography and tissue Doppler imaging 1 day before the PDA closure, on day 1, and on follow-up. Results: At baseline, none of the patients had LV systolic dysfunction. On day 1 post-PDA closure, 8 (25% children developed LV systolic dysfunction. The baseline LV ejection fraction (LVEF, LV end-systolic dimension (LVESD, and PDA diastolic gradient predicted the post-closure LVEF. Patients who developed post-closure LV systolic dysfunction had poorer LV diastolic function than those who did not. LV diastolic properties improved after PDA closure; however, the improvement in LV diastolic properties lagged behind the improvement in the LV systolic function. All children were asymptomatic and had normal LVEF on follow up of >3 months. Conclusions: Percutaneous closure of PDA is associated with the reversible LV systolic dysfunction. Improvement in the LV diastolic function lags behind that in the LV systolic function.

Percutaneous closure of patent ductus arteriosus in children: Immediate and short-term changes in left ventricular systolic and diastolic function.

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Gupta, Saurabh Kumar; Krishnamoorthy, Km; Tharakan, Jaganmohan A; Sivasankaran, S; Sanjay, G; Bijulal, S; Anees, T

2011-07-01

To evaluate the effect of percutaneous closure of patent ductus arteriosus (PDA) on left ventricular (LV) systolic and diastolic function in children. Limited studies are available on alteration in LV hemodynamics, especially diastolic function, after PDA closure. Thirty-two consecutive children with isolated PDA treated by trans-catheter closure were studied. The LV systolic and diastolic function were assessed by two-dimensional (2D) echocardiography and tissue Doppler imaging 1 day before the PDA closure, on day 1, and on follow-up. At baseline, none of the patients had LV systolic dysfunction. On day 1 post-PDA closure, 8 (25%) children developed LV systolic dysfunction. The baseline LV ejection fraction (LVEF), LV end-systolic dimension (LVESD), and PDA diastolic gradient predicted the post-closure LVEF. Patients who developed post-closure LV systolic dysfunction had poorer LV diastolic function than those who did not. LV diastolic properties improved after PDA closure; however, the improvement in LV diastolic properties lagged behind the improvement in the LV systolic function. All children were asymptomatic and had normal LVEF on follow up of >3 months. Percutaneous closure of PDA is associated with the reversible LV systolic dysfunction. Improvement in the LV diastolic function lags behind that in the LV systolic function.

Use of computed tomography to identify atrial fibrillation associated differences in left atrial wall thickness and density.

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Dewland, Thomas A; Wintermark, Max; Vaysman, Anna; Smith, Lisa M; Tong, Elizabeth; Vittinghoff, Eric; Marcus, Gregory M

2013-01-01

Left atrial (LA) tissue characteristics may play an important role in atrial fibrillation (AF) induction and perpetuation. Although frequently used in clinical practice, computed tomography (CT) has not been employed to describe differences in LA wall properties between AF patients and controls. We sought to noninvasively characterize AF-associated differences in LA tissue using CT. CT images of the LA were obtained in 98 consecutive patients undergoing AF ablation and in 89 controls. A custom software algorithm was used to measure wall thickness and density in four prespecified regions of the LA. On average, LA walls were thinner (-15.5%, 95% confidence interval [CI] -23.2 to -7.8%, P identified significant thinning of the LA wall and regional alterations in tissue density in patients with a history of AF. These findings suggest differences in LA tissue composition can be noninvasively identified and quantified using CT. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

Early diastolic mitral annular velocity at the interventricular septal annulus correctly reflects left ventricular longitudinal myocardial relaxation.

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Okada, Kazunori; Mikami, Taisei; Kaga, Sanae; Onozuka, Hisao; Inoue, Mamiko; Yokoyama, Shinobu; Nishino, Hisao; Nishida, Mutsumi; Matsuno, Kazuhiko; Iwano, Hiroyuki; Yamada, Satoshi; Tsutsui, Hiroyuki

2011-12-01

Early diastolic mitral annular velocity (e') obtained by tissue Doppler imaging (TDI) is widely used to evaluate left ventricular (LV) diastolic function based on the assumption that it reflects myocardial relaxation in the long-axis direction. In this study, we aimed to determine whether or not e' truly reflects early diastolic longitudinal myocardial relaxation, and which is the most useful for evaluating LV diastolic function among e' measured at the interventricular-septal annulus (IS-e'), that measured at the lateral annulus (LW-e') or their mean value (M-e'). IS-e', LW-e', and M-e' were measured using colour TDI in 15 patients with hypertrophic cardiomyopathy, 13 patients with hypertension, and 19 control subjects. Using two-dimensional speckle-tracking imaging, early diastolic myocardial strain rates (SR(E)) were measured for the IS (IS-SR(E)), LW (LW-SR(E)), and entire LV myocardium (G-SR(E)). IS-e' was excellently correlated with IS-SR(E) (r = 0.90, P < 0.001); the correlation was better than that between LW-e' and LW-SR(E) (r = 0.75, P < 0.001). IS-e' and M-e' were well correlated with G-SR(E) (r = 0.88, P < 0.001 and r = 0.86, P< 0.001, respectively) and with LV early diastolic flow propagation velocity (FPV) (r = 0.77, P < 0.001 and r = 0.78, P < 0.001, respectively). The correlations of LW-e' to G-SR(E) (r = 0.80, P < 0.001) and FPV (r = 0.75, P < 0.001) did not reach this level. IS-e' well reflected LV longitudinal myocardial relaxation and LV diastolic function, and was found to be more useful in evaluating LV diastolic function than LW-e'.

Evaluation of Left Ventricular Diastolic Dysfunction with Early Systolic Dysfunction Using Two-Dimensional Speckle Tracking Echocardiography in Canine Heart Failure Model.

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Wu, Wei-Chun; Ma, Hong; Xie, Rong-Ai; Gao, Li-Jian; Tang, Yue; Wang, Hao

2016-04-01

This study evaluated the role of two-dimensional speckle tracking echocardiography (2DSTE) for predicting left ventricular (LV) diastolic dysfunction in pacing-induced canine heart failure. Pacing systems were implanted in 8 adult mongrel dogs, and continuous rapid right ventricular pacing (RVP, 240 beats/min) was maintained for 2 weeks. The obtained measurements from 2DSTE included global strain rate during early diastole (SRe) and during late diastole (SRa) in the longitudinal (L-SRe, L-SRa), circumferential (C-SRe, C-SRa), and radial directions (R-SRe, R-SRa). Changes in heart morphology were observed by light microscopy and transmission electron microscopy at 2 weeks. The onset of LV diastolic dysfunction with early systolic dysfunction occurred 3 days after RVP initiation. Most of the strain rate imaging indices were altered at 1 or 3 days after RVP onset and continued to worsen until heart failure developed. Light and transmission electron microscopy showed myocardial vacuolar degeneration and mitochondrial swelling in the left ventricular at 2 weeks after RVP onset. Pearson's correlation analysis revealed that parameters of conventional echocardiography and 2DSTE showed moderate correlation with LV pressure parameters, including E/Esep' (r = 0.58, P echocardiography and strain rate imaging could effectively predict LV diastolic dysfunction (area under the curve: E/Esep' 0.78; L-SRe 0.84; E/L-SRe 0.80; R-SRe 0.80). 2DSTE was a sensitive and accurate technique that could be used for predicting LV diastolic dysfunction in canine heart failure model. © 2015, Wiley Periodicals, Inc.

[Echocardiographic diagnosis of atrial thrombosis].

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Pinto Tortolero, R; Vargas Barrón, J; Rodas, M A; Díaz de la Vega, V; Horwitz, S

1982-01-01

Seventy patients with rheumatic mitral disease were studied by M-Mode and 2D echocardiography in order to detect left atrial thrombosis before surgery. Thrombosis were suspected by the observation of abnormal echoes in the left atrium. During surgery 17 (24%) patients had atrial thrombosis. It had been suspected by echocardiography in 12 (sensitivity 70%). In 53 patients thrombosis were not found during surgery; in 46 the echo had been also negative (specificity 86%). There was a false positive detection of thrombosis by echo in 7 patients (14%) and false negativity in 5 (30%). Patients with atrial thrombosis had atrial fibrilation in 91% of cases; and the most frequent valvular disease was mitral stenosis. There was not a direct relationship among existence of left atrial thrombosis and the anteroposterior diameter of the left atrium as measured by echo. We conclude that echocardiography has good specificity to rule out atrial thrombosis and moderate sensitivity to detect it in rheumatic mitral disease.

Left Atrial Mechanical Function and Global Strain in Hypertrophic Cardiomyopathy.

Directory of Open Access Journals (Sweden)

Kyung-Jin Kim

Full Text Available Atrial fibrillation is the most common arrhythmia and is associated with adverse outcomes in hypertrophic cardiomyopathy (HCM. Although left atrial (LA remodeling and dysfunction are known to associate with the development of atrial fibrillation in HCM, the changes of the LA in HCM patients remain unclear. This study aimed to evaluate the changes in LA size and mechanical function in HCM patients compared to control subjects and to determine the characteristics of HCM associated with LA remodeling and dysfunction.Seventy-nine HCM patients (mean age, 54 ± 11 years; 76% were men were compared to 79 age- and sex-matched controls (mean age, 54 ± 11 years; 76% were men and 20 young healthy controls (mean age, 33 ± 5 years; 45% were men. The LA diameter, volume, and mechanical function, including global strain (ε, were evaluated by 2D-speckle tracking echocardiography. The phenotype of HCM, maximal left ventricular (LV wall thickness, LV mass, and presence and extent of late gadolinium enhancement (LGE were evaluated with cardiac magnetic resonance imaging.HCM patients showed increased LA volume index, impaired reservoir function, and decreased LA ε compared to the control subjects. When we divided the HCM group according to a maximal LA volume index (LAVImax of 38.7 ml/m2 or LA ε of 21%, no significant differences in the HCM phenotype and maximal LV wall thickness were observed for patients with LAVImax >38.7 ml/m2 or LA ε ≤21%. Conversely, the LV mass index was significantly higher both in patients with maximal LA volume index >38.7 ml/m2 and with LA ε ≤21% and was independently associated with LAVImax and LA ε. Although the LGE extent was increased in patients with LA ε ≤21%, it was not independently associated with either LAVImax or LA ε.HCM patients showed progressed LA remodeling and dysfunction; the determinant of LA remodeling and dysfunction was LV mass index rather than LV myocardial fibrosis by LGE-magnetic resonance

Cost-Effectiveness of Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation Based on Results From PROTECT AF Versus PREVAIL.

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Freeman, James V; Hutton, David W; Barnes, Geoffrey D; Zhu, Ruo P; Owens, Douglas K; Garber, Alan M; Go, Alan S; Hlatky, Mark A; Heidenreich, Paul A; Wang, Paul J; Al-Ahmad, Amin; Turakhia, Mintu P

2016-06-01

Randomized trials of left atrial appendage (LAA) closure with the Watchman device have shown varying results, and its cost effectiveness compared with anticoagulation has not been evaluated using all available contemporary trial data. We used a Markov decision model to estimate lifetime quality-adjusted survival, costs, and cost effectiveness of LAA closure with Watchman, compared directly with warfarin and indirectly with dabigatran, using data from the long-term (mean 3.8 year) follow-up of Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation (PROTECT AF) and Prospective Randomized Evaluation of the Watchman LAA Closure Device in Patients With Atrial Fibrillation (PREVAIL) randomized trials. Using data from PROTECT AF, the incremental cost-effectiveness ratios compared with warfarin and dabigatran were $20 486 and $23 422 per quality-adjusted life year, respectively. Using data from PREVAIL, LAA closure was dominated by warfarin and dabigatran, meaning that it was less effective (8.44, 8.54, and 8.59 quality-adjusted life years, respectively) and more costly. At a willingness-to-pay threshold of $50 000 per quality-adjusted life year, LAA closure was cost effective 90% and 9% of the time under PROTECT AF and PREVAIL assumptions, respectively. These results were sensitive to the rates of ischemic stroke and intracranial hemorrhage for LAA closure and medical anticoagulation. Using data from the PROTECT AF trial, LAA closure with the Watchman device was cost effective; using PREVAIL trial data, Watchman was more costly and less effective than warfarin and dabigatran. PROTECT AF enrolled more patients and has substantially longer follow-up time, allowing greater statistical certainty with the cost-effectiveness results. However, longer-term trial results and postmarketing surveillance of major adverse events will be vital to determining the value of the Watchman in clinical

Atrial function, atrial volume and cardiovascular clinical outcomes in patients with end-stage renal disease - A study of cardiac computed tomography

DEFF Research Database (Denmark)

Rasmussen, Laust Dupont; Winther, Simon; Jørgensen, Hanne Skou

2017-01-01

and mortality data were extracted from the Western Denmark Heart Registry, a review of patient records and patient interviews. RESULTS: Baseline patient characteristics did not differ between LAEDV tertiles. LAEDV was positively associated with measures of LV function - both LVEDV (β = 0.36, p ... mass (β = 0.30, p positively and LAEF negatively associated with NT-PRO-BNP (LAEDV: β = 10.28, p patients died and 19 (16.2%) patients suffered......BACKGROUND: Patients with chronic kidney disease (CKD) have an increased risk of cardiovascular events. Previous studies using 2-dimensional echocardiography show that left atrial end-diastolic volume (LAEDV) predicts cardiovascular outcomes and mortality in patients with CKD. However, contrast...

The estimation diastolic properties of the right and left heart's ventricles by a magnetic resonance imaging

International Nuclear Information System (INIS)

Myagkov, A.P.; Cherepok, A.A.

2003-01-01

On the basis of comparison of data heart's catheterization nd magnetic resonance imaging the technique of determination initial and enddiastolic pressure in heart's ventricles is developed. It has allowed to determine a diastolic extensibility, hardness, initial and enddiastolic pressure gradients for right and left ventricle. All necessary formulas and calculations techniques, control data of the models, received at the research of healthy subjects are described

ACE inhibition with spirapril improves diastolic function at rest independent of vasodilation during treatment with spirapril in mild to moderate hypertension

DEFF Research Database (Denmark)

Petersen, J R; Drabaek, H; Fornitz, Gitte Gleerup

1996-01-01

mass), and Doppler-derived atrial to early (A/E)-ratio velocity time integrals (VTI) were measured at the end of each of the four periods. Spirapril lowered the A/E-ratio VTIs (0.57, 0.12-1.00) (P ....44-1.25), and the drug normalized the A/E-ratio VTI in those patients with elevated values. The hemodynamic variables, left ventricular mass, and end-systolic wall stress were unchanged during all three treatments. There were no significant changes in mean blood pressure during the treatment periods. These results...... indicate that spirapril lowers A/E ratio within four weeks in patients with mild to moderate essential hypertension. It thereby seems able to improve left ventricular diastolic function. The effect is not dependent upon changes in hemodynamic variables, blood pressure, left ventricular mass, or end...

Association Between Local Bipolar Voltage and Conduction Gap Along the Left Atrial Linear Ablation Lesion in Patients With Atrial Fibrillation.

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Masuda, Masaharu; Fujita, Masashi; Iida, Osamu; Okamoto, Shin; Ishihara, Takayuki; Nanto, Kiyonori; Kanda, Takashi; Sunaga, Akihiro; Tsujimura, Takuya; Matsuda, Yasuhiro; Mano, Toshiaki

2017-08-01

A bipolar voltage reflects a thick musculature where formation of a transmural lesion may be hard to achieve. The purpose of this study was to explore the association between local bipolar voltage and conduction gap in patients with persistent atrial fibrillation (AF) who underwent atrial roof or septal linear ablation. This prospective observational study included 42 and 36 consecutive patients with persistent AF who underwent roof or septal linear ablations, respectively. After pulmonary vein isolation, left atrial linear ablations were performed, and conduction gap sites were identified and ablated after first-touch radiofrequency application. Conduction gap(s) after the first-touch roof and septal linear ablation were observed in 13 (32%) and 19 patients (53%), respectively. Roof and septal area voltages were higher in patients with conduction gap(s) than in those without (roof, 1.23 ± 0.77 vs 0.73 ± 0.42 mV, p = 0.010; septal, 0.96 ± 0.43 vs 0.54 ± 0.18 mV, p = 0.001). Trisected regional analyses revealed that the voltage was higher at the region with a conduction gap than at the region without. Complete conduction block across the roof and septal lines was not achieved in 3 (7%) and 6 patients (17%), respectively. Patients in whom a linear conduction block could not be achieved demonstrated higher ablation area voltage than those with a successful conduction block (roof, 1.91 ± 0.74 vs 0.81 ± 0.51 mV, p = 0.001; septal, 1.15 ± 0.56 vs 0.69 ± 0.31 mV, p = 0.006). In conclusion, a high regional bipolar voltage predicts failure to achieve conduction block after left atrial roof or septal linear ablation. In addition, the conduction gap was located at the preserved voltage area. Copyright © 2017 Elsevier Inc. All rights reserved.

Assessment of left atrial volume and function

DEFF Research Database (Denmark)

Kühl, J Tobias; Lønborg, Jacob; Fuchs, Andreas

2012-01-01

dynamic LA volume changes. Conversely, cardiac magnetic resonance imaging (CMR) and multi-slice computed tomography (MSCT) appears more appropriate for such measures. We sought to determine the relationship between LA size assessed with TTE and LA size and function assessed with CMR and MSCT. Fifty......-four patients were examined 3 months post myocardial infarction with echocardiography, CMR and MSCT. Left atrial volumes and LA reservoir function were assessed by TTE. LA time-volume curves were determined and LA reservoir function (cyclic change and fractional change), passive emptying function (reservoir...... between CMR and MSCT, with a small to moderate bias in LA(max) (4.9 ± 10.4 ml), CC (3.1 ± 9.1 ml) and reservoir volume (3.4 ± 9.1 ml). TTE underestimates LA(max) with up to 32% compared with CMR and MSCT (P ...

Left cardiac chambers reverse remodeling after percutaneous mitral valve repair with the MitraClip system.

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Scandura, Salvatore; Ussia, Gian Paolo; Capranzano, Piera; Caggegi, Anna; Sarkar, Kunal; Cammalleri, Valeria; Mangiafico, Sarah; Chiarandà, Marta; Immè, Sebastiano; Di Pasqua, Fabio; Pistritto, Anna Maria; Millan, Giovanni; Tamburino, Corrado

2012-10-01

Successful mitral valve surgical repair, decreasing volume overload, has been shown to provide reverse left ventricular (LV) and/or left atrial remodeling in most patients. Percutaneous mitral valve repair with the MitraClip system (Abbott, Abbott Park, IL) has been associated with favorable clinical outcomes in patients with mitral regurgitation at high risk of surgery. However, specific data on left cardiac chambers reverse remodeling after such procedures are limited. This was a prospective observational study of consecutive patients at high risk of surgery, with moderate-to-severe or severe mitral regurgitation undergoing MitraClip system implantation. Follow-up echocardiography was performed at 6 months. The evaluated parameters were the LV end-diastolic and end-systolic volume indexes, LV sphericity index, LV ejection fraction, and left atrial volume index. Reverse LV remodeling was defined as a decrease of 10% in the LV end-diastolic volume index. The study population included 44 patients: 14 with degenerative and 30 with functional mitral regurgitation. At 6 months of follow-up, significant reductions in the median and interquartile range of the sphericity index (from 0.57 [interquartile range 0.54-0.62] to 0.54 [interquartile range 0.50-0.58]; P interquartile range 63.0-102.2] to 60.7 mL/m(2) [50.8-84.4]; P interquartile range 28.2-70.5] to 28.9 mL/m(2) [interquartile range 22.2-55.8]; P interquartile range 30.0-55.0%] to 46.0% [interquartile range 35.0-58.0%]; P < .001) from baseline to 6 months. Minor differences in the left atrial volume index were observed. Reverse remodeling, according to the specified definition, was observed in 77.3% of the patients. The present study reports positive LV reshape effects after mitral valve repair with the MitraClip system, showing significant improvements in LV size and function. Copyright © 2012 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

Effects of calcium antagonists on hypertension and diastolic function

African Journals Online (AJOL)

1989-08-05

Aug 5, 1989 ... and improve myocardial function. Digitalis compounds such as digoxin are not appropriate therapy for diastolic dysfunction and should be avoided. REFERENCES. I. Fouad FM, Slominski JM, Tarazi RC. Left ventricular diastolic function in hypertension: relation to left ventricular mass and systolic function.

Noninvasive assessment of left atrial maximum dP/dt by a combination of transmitral and pulmonary venous flow.

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Nakatani, S; Garcia, M J; Firstenberg, M S; Rodriguez, L; Grimm, R A; Greenberg, N L; McCarthy, P M; Vandervoort, P M; Thomas, J D

1999-09-01

The study assessed whether hemodynamic parameters of left atrial (LA) systolic function could be estimated noninvasively using Doppler echocardiography. Left atrial systolic function is an important aspect of cardiac function. Doppler echocardiography can measure changes in LA volume, but has not been shown to relate to hemodynamic parameters such as the maximal value of the first derivative of the pressure (LA dP/dt(max)). Eighteen patients in sinus rhythm were studied immediately before and after open heart surgery using simultaneous LA pressure measurements and intraoperative transesophageal echocardiography. Left atrial pressure was measured with a micromanometer catheter, and LA dP/dt(max) during atrial contraction was obtained. Transmitral and pulmonary venous flow were recorded by pulsed Doppler echocardiography. Peak velocity, and mean acceleration and deceleration, and the time-velocity integral of each flow during atrial contraction was measured. The initial eight patients served as the study group to derive a multilinear regression equation to estimate LA dP/dt(max) from Doppler parameters, and the latter 10 patients served as the test group to validate the equation. A previously validated numeric model was used to confirm these results. In the study group, LA dP/dt(max) showed a linear relation with LA pressure before atrial contraction (r = 0.80, p LA. Among transmitral flow parameters, mean acceleration showed the strongest correlation with LA dP/dt(max) (r = 0.78, p LA dP/dt(max) with an r2 > 0.30. By stepwise and multiple linear regression analysis, LA dP/dt(max) was best described as follows: LA dP/dt(max) = 0.1 M-AC +/- 1.8 P-V - 4.1; r = 0.88, p LA dP/dt(max) correlated well (r = 0.90, p LA dP/dt(max) predicted by the above equation with r = 0.94. A combination of transmitral and pulmonary venous flow parameters can provide a hemodynamic assessment of LA systolic function.

Left ventricular diastolic function in patients with coronary artery disease

International Nuclear Information System (INIS)

Brugger, P.T.

1986-01-01

In 302 patients with confirmed coronary disease we determined the left ventricular diastolic function with the Nuclear Stethoscope by the aid of the Peak Filling Rate (PFR) and the Time to Peak Filling Rate (TPFR). Moreover we investigated the ejection fraction (EF). 201 patients had already suffered a myocardial infarction, of these 99 an anterior wall and 102 an inferior wall infarction. The remaining 101 patients had a CAD without a history of myocardial infarction. The PFR was 2.19 ± 0.65 EDV/sec in the 99 patients after anterior wall infarction and 2.62 ± 0.85 EDV/sec in the 102 patients after inferior wall infarction and 2.79 ± 0.85 EDV/sec in 101 patients with coronary artery disease without a history of myocardial infarction. For the PFR there could be found a statistically significant difference between normal patients and patients after anterior wall infarction (p [de

Infective Endocarditis of the Left Main to Right Atrial Coronary Cameral Fistula

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Mishra, Ramesh Chandra; Barik, Ramachandra; Patnaik, Amar Narayana

2016-01-01

A 7-year-old female child presented with pyrexia of unknown origin. She had received an empirical regimen of antibiotic for possible endocarditis. Evaluation included multiple imaging supports and blood culture. She had left main coronary artery to right atrium coronary cameral fistula, restricted patent ductus arteriosus, vegetation at the right atrial exit of fistula and negative blood culture. Ongoing fever more than 2 weeks, oscillating vegetation in the echo and histopathological evidence of healing vegetation suggested definite diagnosis of infective endocarditis. She was treated successfully by surgical closure of fistula from the right atrial approach. Device closure in this case would have resulted in a large residual cul-de-sac with or without tiny residual high-velocity jets, either being a threat for future enlargement, rupture of the residual aneurysmal sac, thromboembolism, prolonged anticoagulation, and infective endocarditis. PMID:28465978

Assessment of left ventricular function in patients with atrial fibrillation by left ventricular filling and function curves determined by ECG gated blood pool scintigraphy

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Inagaki, Suetsugu

1986-06-01

Accurate cardiac function in patients with atrial fibrillation (Af) is difficult to assess, since a wide fluctuation of cardiac cycle makes the ventricular hemodynamics variable. Although ECG gated blood pool scintigraphy (EGBPS) is useful to evaluate left ventricular (LV) function, a conventional EGBPS might have a problem in applying to Af. Therefore, a new processing algorithm was devised to make multiple gated images discriminated by preceding R-R intervals (PRR), and LV filling and function curves were obtained in 62 patients with Af to evaluate LV function. LV filling curve, obtained by plotting end-diastolic volume (EDV) againt PRR, demonstrated that the blood filling was impaired in mitral stenosis and constrictive pericarditis, but recovered after mitral commissurotomy. LV function curve, by plotting stroke volume (SV) againt EDV, was quantitatively analysed by the indices such as Slope and Position. Both indices reduced significantly in heart failure. When compared among underlying diseases individually, the indices decreased in the following order; lone Af, hyperthyroidism, senile Af, hypertension, mitral valve disease, ischemic heart disease, dilated cardiomyopathy and aortic regurgitation. After the treatment with digitalis and/or diuretics, left and upward shift of function curve was observed. The rise in heart rate by atropine infusion made Slope and Position unchanged, and which implied that function curve was little influenced by heart rate per se. The rise in systolic blood pressure by angiotensin-II infusion caused shifts in function curve to rightward and downward. Downward shift, mostly seen in patients with gentler slope in control state, may imply afterload mismatch due to a decrease in preload reserve. (J.P.N.).

Brain Abscess Associated with Isolated Left Superior Vena Cava Draining into the Left Atrium in the Absence of Coronary Sinus and Atrial Septal Defect

International Nuclear Information System (INIS)

Erol, Ilknur; Cetin, I. Ilker; Alehan, Fuesun; Varan, Birguel; Ozkan, Sueleyman; Agildere, A. Muhtesem; Tokel, Kursad

2006-01-01

A previously healthy 12-year-old girl presented with severe headache for 2 weeks. On physical examination, there was finger clubbing without apparent cyanosis. Neurological examination revealed only papiledema without focal neurologic signs. Cerebral magnetic resonance imaging showed the characteristic features of brain abscess in the left frontal lobe. Cardiologic workup to exclude a right-to-left shunt showed an abnormality of the systemic venous drainage: presence of isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect. This anomaly is rare, because only a few other cases have been reported

Evaluation of Left Atrial Volumes Using Multidetector Computed Tomography: Comparison with Echocardiography

International Nuclear Information System (INIS)

Gweon, Hye Mi; Kim, Sang Jin; Kim, Tae Hoon; Lee, Sang Min; Hong, Yoo Jin; Rim, Se Joong

2010-01-01

To prospectively assess the relationship between the two different measurement methods for the evaluation of left atrial (LA) volume using cardiac multidetector computed tomography (MDCT) and to compare the results between cardiac MDCT and echocardiography. Thirty-five patients (20 men, 15 women; mean age, 60 years) underwent cardiac MDCT angiography for coronary artery disease. The LA volumes were measured using two different methods: the two dimensional (2D) length-based (LB) method measured along the three-orthogonal planes of the LA and the 3D volumetric threshold-based (VTB) method measured according to the threshold 3D segmentation of the LA. The results obtained by cardiac MDCT were compared with those obtained by echocardiography. The LA end-systolic and end-diastolic volumes (LAESV and LAEDV) measured by the 2D-LB method correlated well with those measured by the 3DVTB method using cardiac MDCT (r = 0.763, r = 0.786, p = 0.001). However, there was a significant difference in the LAESVs between the two measurement methods using cardiac MDCT (p < 0.05). The LAESV measured by cardiac MDCT correlated well with measurements by echocardiography (r = 0.864, p = 0.001), however with a significant difference (p < 0.01) in their volumes. The cardiac MDCT overestimated the LAESV by 22% compared to measurements by echocardiography. A significant correlation was found between the two different measurement methods for evaluating LA volumes by cardiac MDCT. Further, cardiac MDCT correlates well with echocardiography in evaluating the LA volume. However, there are significant differences in the LAESV between the two measurement methods using cardiac MDCT and between cardiac MDCT and echocardiography

Evaluation of left ventricular function in patients with atrial fibrillation by ECG gated blood pool scintigraphy. Using frame count normalization method

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Akanabe, Hiroshi; Oshima, Motoo; Sakuma, Sadayuki

1988-07-01

The assumption necessary to perform ECG gated blood pool scintigraphy (EGBPS) are seemingly not valid for patients with atrial fibrillation (af), since they have wide variability in cardiac cycle length. The data were acquired in frame mode within the limits of mean heart rate of fix the first diastolic volume, and were calculated by frame count normalization (FCN) method to correct total counts in each frame. EGBPS were performed twelve patients with af, who were operated against valvular disease. The data acquired within mean heart rate +-10 % in frame mode were divided to 32 frames, and calculated total frame counts. With FCN method total frame counts from at 22nd to 32nd frame were multiplied to be equal to the average of total frame counts. FCN method could correct total frame counts at the latter frames. And there was good correlation between left ventricular ejection fraction calculated from scintigraphy and that from contrast cineangiography. Thus EGBPS with FCN method may be allow estimation of cardiac function even in subjects with af.

Left Ventricular Diastolic Function in Type 2 Diabetes Mellitus and the Association With Coronary Artery Calcium Score: A Cardiac MRI Study

OpenAIRE

Graça, B; Donato, P; Ferreira, MJ; Castelo-Branco, M; Caseiro-Alves, F

2014-01-01

OBJECTIVE: The purpose of this study was to compare cardiac MRI-derived parameters of left ventricular (LV) diastolic function between uncomplicated type 2 diabetes mellitus (DM2) and normoglycemic control subjects and to evaluate whether these parameters of LV diastolic function are related to coronary atherosclerosis. SUBJECTS AND METHODS: We prospectively studied 41 subjects with DM2 and 21 normoglycemic control subjects (30 women and 32 men; mean age, 57.2 ± 7.1 [SD] years) with ...

The incidence and characteristics of supraventricular tachycardia in left atrial isomerism: a high incidence of atrial fibrillation in young patients.

Science.gov (United States)

Miyazaki, Aya; Sakaguchi, Heima; Ohuchi, Hideo; Yamamoto, Tetsuya; Igarashi, Takehiro; Negishi, Jun; Toyota, Naoki; Kagisaki, Koji; Yagihara, Toshikatsu; Yamada, Osamu

2013-06-20

In left atrial isomerism (LAI), both atria show left atrial morphology. Although bradyarrhythmias are frequent and highly complex in LAI patients, previous studies have reported a low incidence of supraventricular tachycardia (SVT). To evaluate the incidence and characteristics of SVT in LAI, we retrospectively evaluated the clinical characteristics of SVTs in 83 patients with LAI (age at last follow-up, 15.3±10.5 years). There were 27 SVTs in 19 patients (23%), including nine episodes of atrial fibrillation (AF) and eight non-reentrant SVTs. Sixteen of the 19 patients with SVT had histories of atriotomy, but the three patients with AF or non-reentrant tachycardia had no history of atriotomy. The rates of freedom from SVT were 66% and 59% at ages of 20 and 30 years, respectively; the corresponding rates for freedom from AF were 89% and 74%. In multivariate analysis, the predictors of SVT were age (OR, 1.14; 95% CI, 1.06-1.26; p=0.003) and sinus node dysfunction (SND) (OR, 3.88; 95% CI, 1.57-13.34; p=0.01). In patients with LAI, SVTs are common, and AF and non-reentrant SVTs are the major type of SVTs. The incidence of AF was high in young patients with LAI. The lack of anatomical barriers in the atria that allow the formation of macro-reentrant circuits may account for the higher incidence of AF and non-reentrant SVT than macro-reentrant tachycardia. Moreover, the increasing prevalence of SND with age should contribute to a higher incidence of SVT. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Catheter Ablation of Ectopic Atrial Tachycardia Originating from the Left Atrial Appendage using CARTOMERGE® System

Directory of Open Access Journals (Sweden)

Masahiko Goya, MD

2008-01-01

Full Text Available A 70-year-old woman was referred because of drug resistant and daily incessant palpitation attack. She had undergone two previous unsuccessful radiofrequency catheter ablations at another hospital. The physical examination, chest X-ray, and echocardiogram were all normal. The 12-lead ECG during tachycardia showed narrow QRS, short PR tachycardia and negative polarity of the P wave in leads I and aVL (Fig. 1A. The ECG monitor showed incessant tachycardia with warming-up phenomenon. Three dimensional electroanatomical map integrated with CT imaging (CARTOMERGE®, Biosense Webster Inc. clearly revealed the radial activation pattern originating from the basalo-postero-inferior aspect of the left atrial appendage. Radiofrequency energy application at this site eliminated tachycardia permanently.

Left ventricular diastolic performance at rest in patients with angina and normal systolic function - assessment by equilibrium radionuclide angiography

International Nuclear Information System (INIS)

Maini, C.L.; Bonetti, M.G.; Valle, G.; Antonelli Incalzi, R.; Montenero, A.S.

1985-01-01

The aim of the study was to correlate diastolic function, as evaluated by peak filling rate (PFR) and relative time (TPFR), with the severity of ischemic heart disease, as evaluated by exercise electrocardiography. Accordingly, 83 ischemic patients with effort angina, but normal ejection function at rest and normal left ventricular size, were studied by equilibrium radionuclide angiocardiography within two weeks from the exercise ECG. Diastolic dysfunction, as determined from PFR and, to a lesser extent, from TPFR, is common in patients with ischemic heart disease and normal systolic function. The prevalence and severity of such dysfunction is related more to the severity of the ischemia, as evaluated by the exercise ECG, than to the presence of an old myocardial infarction. Such findings are consistent with the hypothesis that PFR reflects mainly the early diastolic active uncoupling process. (orig.) [de

Sensitivity and specificity of radionuclide equilibrium angiocardiography for detection of hemodynamically significant secundum atrial septal defect

Energy Technology Data Exchange (ETDEWEB)

Brunotte, F.; Laurens, M.H.; Itty, C.; Robert, J.; Cloez, J.L.; Marcon, F.; Pernot, C.

1986-12-01

To determine the value, of gated equilibrium angiography in secundum atrial septal defect (ASD) in children, the first pass pulmonic/systemic flow ratio (Qp/Qs) was compared with diastolic count ratio (DCR) and stroke count ratio (SCR) of the two ventricles. In 50 children we have found a correlation between Qp/Qs and DCR (r=0.71) and between Qp/Qs and SCR (r=0.66). For detection of significant atrial shunt (Qp/Qs>1.5) the sensitivity of DCR>2 was 0.81 and the specificity 0.75. For SCR>1.5 we sensitivity and specificity values of 0.87 and 0.71 respectively. Left and right ventricular ejection fractions were normal (0.67+-0.08 and 0.50+-0.07).

Diastolic dysfunction and diastolic heart failure: diagnostic, prognostic and therapeutic aspects

Directory of Open Access Journals (Sweden)

Galderisi Maurizio

2005-04-01

Full Text Available Abstract Left ventricular (LV diastolic dysfunction (DD and diastolic heart failure (HF, that is symptomatic DD, are due to alterations of myocardial diastolic properties. These alterations involve relaxation and/or filling and/or distensibility. Arterial hypertension associated to LV concentric remodelling is the main determinant of DD but several other cardiac diseases, including myocardial ischemia, and extra-cardiac pathologies involving the heart are other possible causes. In the majority of the studies, isolated diastolic HF has been made equal to HF with preserved systolic function (= normal ejection fraction but the true definition of this condition needs a quantitative estimation of LV diastolic properties. According to the position of the European Society of Cardiology and subsequent research refinements the use of Doppler echocardiography (transmitral inflow and pulmonary venous flow and the new ultrasound tools has to be encouraged for diagnosis of DD. In relation to uncertain definitions, both prevalence and prognosis of diastolic heart failure are very variable. Despite an apparent lower death rate in comparison with LV systolic HF, long-term follow-up (more than 5 years show similar mortality between the two kinds of HF. Recent studies performed by Doppler diastolic indexes have identified the prognostic power of both transmitral E/A ratio 1.5 (restrictive patterns. The therapy of LV DD and HF is not well established but ACE-inhibitors, angiotensin inhibitors, aldosterone antagonists and β-blockers show potential beneficial effect on diastolic properties. Several trials, completed or ongoing, have been planned to treat DD and diastolic HF.

Computational Fluid Dynamic Analysis of the Left Atrial Appendage to Predict Thrombosis Risk

Directory of Open Access Journals (Sweden)

Giorgia Maria Bosi

2018-04-01

Full Text Available During Atrial Fibrillation (AF more than 90% of the left atrial thrombi responsible for thromboembolic events originate in the left atrial appendage (LAA, a complex small sac protruding from the left atrium (LA. Current available treatments to prevent thromboembolic events are oral anticoagulation, surgical LAA exclusion, or percutaneous LAA occlusion. However, the mechanism behind thrombus formation in the LAA is poorly understood. The aim of this work is to analyse the hemodynamic behaviour in four typical LAA morphologies - “Chicken wing”, “Cactus”, “Windsock” and “Cauliflower” - to identify potential relationships between the different shapes and the risk of thrombotic events. Computerised tomography (CT images from four patients with no LA pathology were segmented to derive the 3D anatomical shape of LAA and LA. Computational Fluid Dynamic (CFD analyses based on the patient-specific anatomies were carried out imposing both healthy and AF flow conditions. Velocity and shear strain rate (SSR were analysed for all cases. Residence time in the different LAA regions was estimated with a virtual contrast agent washing out. CFD results indicate that both velocity and SSR decrease along the LAA, from the ostium to the tip, at each instant in the cardiac cycle, thus making the LAA tip more prone to fluid stagnation, and therefore to thrombus formation. Velocity and SSR also decrease from normal to AF conditions. After four cardiac cycles, the lowest washout of contrast agent was observed for the Cauliflower morphology (3.27% of residual contrast in AF, and the highest for the Windsock (0.56% of residual contrast in AF. This suggests that the former is expected to be associated with a higher risk of thrombosis, in agreement with clinical reports in the literature. The presented computational models highlight the major role played by the LAA morphology on the hemodynamics, both in normal and AF conditions, revealing the potential

Outcomes following the Kawashima procedure for single-ventricle palliation in left atrial isomerism.

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Vollebregt, Anne; Pushparajah, Kuberan; Rizvi, Maleeha; Hoschtitzky, Andreas; Anderson, David; Austin, Conal; Tibby, Shane M; Simpson, John

2012-03-01

Patients with left atrial isomerism and interrupted inferior vena cava palliated with a superior cavopulmonary connection or Kawashima procedure (KP) have a high incidence of developing pulmonary arteriovenous malformations. The necessity for hepatic vein redirection (HVR) and its timing remains a controversy. We aimed to assess the clinical outcome of patients with left atrial isomerism following a KP. The main end points were death, requirement for HVR and the impact of HVR on oxygen saturation. Retrospective review of 21 patients with a diagnosis of left atrial isomerism, interruption of the inferior vena cava and single-ventricle physiology managed with a KP at a single centre between January 1990 and March 2010. Twenty-one patients had a KP, with 12 subsequently undergoing HVR. There was relatively a constant monthly decrement in the proportion of patients who were free from death or HVR up until 60 months following the KP, with a dramatic increase in the hazard after this time. The Cox proportional hazards regression model demonstrated a reduced early risk for HVR or death in patients who underwent pulmonary artery banding versus arterial shunt as the primary procedure (hazard ratio: 0.10; P = 0.01), and an increased risk with bilateral superior vena cavas (SVCs) (hazard ratio: 3.4; P = 0.04) and age at KP (hazard ratio: 1.02 per month increase in age at KP; P = 0.02). HVR mortality was relatively high with 3 of 12 patients dying in the early postoperative period with profound cyanosis. The timing of HVR after the KP did not influence the postoperative rate of increase in oxygen saturation. These findings confirm that the majority of patients who undergo a KP will require HVR. Patients who are older at the time of the KP or having an initial arterial shunt or bilateral SVCs are at higher risk of HVR or death. The relatively high mortality at HVR was characterized by severe postoperative cyanosis.

A Left Atrial Myxoma Case with a History of Stroke on whom a Coronary Bypass Surgery was Performed

Directory of Open Access Journals (Sweden)

Cihangir Kaymaz

2009-12-01

Full Text Available Cardiac myxomas are the most frequently encountered benign cardiac tumors in adult groups. Patients with myxoma may suffer from variety of clinical features. A patient who had suffered from stroke a yearago came to our hospital with a chest pain complaint. In the echocardiography of the patient suffering from acute coronary syndrome, left ventricular disfunction and left atrial mass was determined. In the coronary angiography, LAD and Cx critical stenosis, and an abnormal feeding artery which roots from Cxperformed was observed. LIMA-AD, Ao-RCA bypass and mass exision withleft atriotomy was made. Cardiac tumor embolism which makes up a rare cause of cerebral embolies should be considered especiallyin patients with sinus rhythm. In the coronary angiography the feeding artery of the myxoma was shown. A patient who has underwent coronary bypass operation and left atrial myxoma exision has beenpresented as a case.

Left atrial appendage occlusion with Amplatzer Cardio Plug is an acceptable therapeutic option for prevention of stroke recurrence in patients with non-valvular atrial fibrillation and contraindication or failure of oral anticoagulation with acenocumarol

OpenAIRE

Hawkes, Maximiliano A.; Pertierra, Lucía; Rodriguez-Lucci, Federico; Pujol-Lereis, Virginia A.; Ameriso, Sebastián F.

2016-01-01

ABSTRACT Left atrial appendage occlusion (LAAO) appears as a therapeutic option for some atrial fibrillation patients not suitable for oral anticoagulation because an increased hemorrhagic risk or recurrent ischemic events despite anticoagulant treatment. Methods Report of consecutive atrial fibrillation patients treated with LAAO with Amplatzer Cardio Plug because contraindication or failure of oral anticoagulation with acenocumarol. CHA2DS2VASC, HAS-BLED, NIHSS, mRS, procedural complicati...

Evaluation of left atrial function by multidetector computed tomography before left atrial radiofrequency-catheter ablation: Comparison of a manual and automated 3D volume segmentation method

International Nuclear Information System (INIS)

Wolf, Florian; Ourednicek, Petr; Loewe, Christian; Richter, Bernhard; Goessinger, Heinz David; Gwechenberger, Marianne; Plank, Christina; Schernthaner, Ruediger Egbert; Toepker, Michael; Lammer, Johannes; Feuchtner, Gudrun M.

2010-01-01

Introduction: The purpose of this study was to compare a manual and automated 3D volume segmentation tool for evaluation of left atrial (LA) function by 64-slice multidetector-CT (MDCT). Methods and materials: In 33 patients with paroxysmal atrial fibrillation a MDCT scan was performed before radiofrequency-catheter ablation. Atrial function (minimal volume (LAmin), maximal volume (LAmax), stroke volume (SV), ejection fraction (EF)) was evaluated by two readers using a manual and an automatic tool and measurement time was evaluated. Results: Automated LA volume segmentation failed in one patient due to low LA enhancement (103HU). Mean LAmax, LAmin, SV and EF were 127.7 ml, 93 ml, 34.7 ml, 27.1% by the automated, and 122.7 ml, 89.9 ml, 32.8 ml, 26.3% by the manual method with no significant difference (p > 0.05) and high Pearsons correlation coefficients (r = 0.94, r = 0.94, r = 0.82 and r = 0.85, p < 0.0001), respectively. The automated method was significantly faster (p < 0.001). Interobserver variability was low for both methods with Pearson's correlation coefficients between 0.98 and 0.99 (p < 0.0001). Conclusions: Evaluation of LA volume and function with 64-slice MDCT is feasible with a very low interobserver variability. The automatic method is as accurate as the manual method but significantly less time consuming permitting a routine use in clinical practice before RF-catheter ablation.

Evaluation of left atrial function by multidetector computed tomography before left atrial radiofrequency-catheter ablation: Comparison of a manual and automated 3D volume segmentation method

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Wolf, Florian, E-mail: florian.wolf@meduniwien.ac.a [Department of Radiology, Medical University of Vienna, Vienna (Austria); Ourednicek, Petr [Philips Medical Systems, Prague (Czech Republic); Loewe, Christian [Department of Radiology, Medical University of Vienna, Vienna (Austria); Richter, Bernhard; Goessinger, Heinz David; Gwechenberger, Marianne [Department of Cardiology, Medical University of Vienna, Vienna (Austria); Plank, Christina; Schernthaner, Ruediger Egbert; Toepker, Michael; Lammer, Johannes [Department of Radiology, Medical University of Vienna, Vienna (Austria); Feuchtner, Gudrun M. [Department of Radiology, Innsbruck Medical University, Innsbruck (Austria); Institute of Diagnostic Radiology, University Hospital Zurich (Switzerland)

2010-08-15

Introduction: The purpose of this study was to compare a manual and automated 3D volume segmentation tool for evaluation of left atrial (LA) function by 64-slice multidetector-CT (MDCT). Methods and materials: In 33 patients with paroxysmal atrial fibrillation a MDCT scan was performed before radiofrequency-catheter ablation. Atrial function (minimal volume (LAmin), maximal volume (LAmax), stroke volume (SV), ejection fraction (EF)) was evaluated by two readers using a manual and an automatic tool and measurement time was evaluated. Results: Automated LA volume segmentation failed in one patient due to low LA enhancement (103HU). Mean LAmax, LAmin, SV and EF were 127.7 ml, 93 ml, 34.7 ml, 27.1% by the automated, and 122.7 ml, 89.9 ml, 32.8 ml, 26.3% by the manual method with no significant difference (p > 0.05) and high Pearsons correlation coefficients (r = 0.94, r = 0.94, r = 0.82 and r = 0.85, p < 0.0001), respectively. The automated method was significantly faster (p < 0.001). Interobserver variability was low for both methods with Pearson's correlation coefficients between 0.98 and 0.99 (p < 0.0001). Conclusions: Evaluation of LA volume and function with 64-slice MDCT is feasible with a very low interobserver variability. The automatic method is as accurate as the manual method but significantly less time consuming permitting a routine use in clinical practice before RF-catheter ablation.

Serum levels of advanced glycation end products are associated with left ventricular diastolic function in patients with type 1 diabetes

DEFF Research Database (Denmark)

Berg, T J; Snorgaard, O; Faber, J

1999-01-01

Impairment of left ventricular diastolic function, possibly caused by increased collagen cross-linking of the cardiac muscle, is common in patients with type 1 diabetes even without coronary artery disease. Advanced glycation end products (AGEs) cross-link tissue collagen and are found within...

Echocardiographic indices of left ventricular diastolic dysfunction in 647 individuals with preserved left ventricular systolic function

DEFF Research Database (Denmark)

Pedersen, Frants; Raymond, Ilan; Madsen, Lene H

2004-01-01

Knowledge about the occurrence of isolated diastolic dysfunction (DD) in the general population is limited.......Knowledge about the occurrence of isolated diastolic dysfunction (DD) in the general population is limited....

Alpha1A-adrenergic receptor-directed autoimmunity induces left ventricular damage and diastolic dysfunction in rats.

Directory of Open Access Journals (Sweden)

Katrin Wenzel

Full Text Available BACKGROUND: Agonistic autoantibodies to the alpha(1-adrenergic receptor occur in nearly half of patients with refractory hypertension; however, their relevance is uncertain. METHODS/PRINCIPAL FINDINGS: We immunized Lewis rats with the second extracellular-loop peptides of the human alpha(1A-adrenergic receptor and maintained them for one year. Alpha(1A-adrenergic antibodies (alpha(1A-AR-AB were monitored with a neonatal cardiomyocyte contraction assay by ELISA, and by ERK1/2 phosphorylation in human alpha(1A-adrenergic receptor transfected Chinese hamster ovary cells. The rats were followed with radiotelemetric blood pressure measurements and echocardiography. At 12 months, the left ventricles of immunized rats had greater wall thickness than control rats. The fractional shortening and dp/dt(max demonstrated preserved systolic function. A decreased E/A ratio in immunized rats indicated a diastolic dysfunction. Invasive hemodynamics revealed increased left ventricular end-diastolic pressures and decreased dp/dt(min. Mean diameter of cardiomyocytes showed hypertrophy in immunized rats. Long-term blood pressure values and heart rates were not different. Genes encoding sarcomeric proteins, collagens, extracellular matrix proteins, calcium regulating proteins, and proteins of energy metabolism in immunized rat hearts were upregulated, compared to controls. Furthermore, fibrosis was present in immunized hearts, but not in control hearts. A subset of immunized and control rats was infused with angiotensin (Ang II. The stressor raised blood pressure to a greater degree and led to more cardiac fibrosis in immunized, than in control rats. CONCLUSIONS/SIGNIFICANCE: We show that alpha(1A-AR-AB cause diastolic dysfunction independent of hypertension, and can increase the sensitivity to Ang II. We suggest that alpha(1A-AR-AB could contribute to cardiovascular endorgan damage.

Effects of atorvastatin treatment on left ventricular diastolic function in peritoneal dialysis patients-The ALEVENT clinical trial.

Science.gov (United States)

Wu, Cho-Kai; Yeh, Chih-Fan; Chiang, Jiun-Yang; Lin, Ting-Tse; Wu, Yi-Fan; Chiang, Chih-Kang; Kao, Tze-Wah; Hung, Kuan-Yu; Huang, Jenq-Wen

Left ventricular diastolic dysfunction (LVDD) is common among patients undergoing peritoneal dialysis (PD). Increased levels of inflammatory biomarkers, such as high-sensitivity C-reactive protein, predict the development of LVDD. We hypothesized that PD patients with elevated high-sensitivity C-reactive protein levels might benefit from statin treatment for LVDD and designed a randomized clinical trial to prove the hypothesis. We screened 213 PD patients and randomly assigned 32 men and women with low-density lipoprotein cholesterol levels atorvastatin, 40 mg daily, or without. The primary end points were changes in TDI diastolic parameters or global strain imaging diastolic parameters. Atorvastatin reduced low-density lipoprotein cholesterol levels by 43% and high-sensitivity C-reactive protein levels by 45% (both P atorvastatin and control, respectively, P = .02). There was also a significant improvement in global strain imaging after atorvastatin treatment (global strain rate, -17.12 ± 1.42 vs -14.61 ± 1.78 for atorvastatin and control, respectively, P = .002 and E/SR IVR , 462.35 ± 110.54 vs 634.09 ± 116.81, P = .003). In this trial of PD patients without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels and LVDD, atorvastatin significantly improved cardiac diastolic function (ClinicalTrials.gov number, NCT01503671). Copyright © 2017. Published by Elsevier Inc.

Mitral stenosis in 15 dogs

International Nuclear Information System (INIS)

Lehmkuhl, L.B.; Ware, W.A.; Bonagura, J.D.

1994-01-01

Mitral stenosis was diagnosed in 15 young to middle-aged dogs. There were 5 Newfoundlands and 4 bull terriers affected, suggesting a breed predisposition for this disorder. Clinical signs included cough, dyspnea, exercise intolerance, and syncope. Soft left apical diastolic murmurs were heard only in 4 dogs, whereas 8 dogs had systolic murmurs characteristic of mitral regurgitation. Left atrial enlargement was the most prominent radiographic feature. Left-sided congestive heart failure was detected by radiographs in 11 dogs within 1 year of diagnosis. Electrocardiographic abnormalities varied among dogs and included atrial and ventricular enlargement, as well as atrial and ventricular arrhythmias. Abnormalities on M-mode and two-dimensional echocardiograms included abnormal diastolic motion of the mitral valve characterized by decreased leaflet separation, valve doming, concordant motion of the parietal mitral valve leaflet, and a decreased E-to-F slope. Increased mitral valve inflow velocities and prolonged pressure half-times were detected by Doppler echocardiography. Cardiac catheterization, performed in 8 dogs, documented a diastolic pressure gradient between the left atrial, pulmonary capillary wedge, or pulmonary artery diastolic pressures and the left ventricular diastolic pressure. Necropsy showed mitral stenosis caused by thickened, fused mitral valve leaflets in 5 dogs and a supramitral ring in another dog. The outcome in affected dogs was poor; 9 of 15 dogs were euthanatized or died by 2 1/2 years of age

Effect of hydration status on atrial and ventricular volumes and function in healthy adult volunteers

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Schantz, Daryl I. [The Hospital for Sick Children, The Labatt Family Heart Centre in the Department of Paediatrics, Toronto, ON (Canada); University of Manitoba, Variety Children' s Heart Centre, Winnipeg, MB (Canada); Dragulescu, Andreea [The Hospital for Sick Children, The Labatt Family Heart Centre in the Department of Paediatrics, Toronto, ON (Canada); Memauri, Brett [University of Manitoba, Department of Radiology, St. Boniface General Hospital, Winnipeg, MB (Canada); Grotenhuis, Heynric B. [The Hospital for Sick Children, The Labatt Family Heart Centre in the Department of Paediatrics, Toronto, ON (Canada); Wilhelmina Children' s Hospital, Utrecht (Netherlands); Seed, Mike; Grosse-Wortmann, Lars [The Hospital for Sick Children, The Labatt Family Heart Centre in the Department of Paediatrics, Toronto, ON (Canada); The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

2016-10-15

Assessment of cardiac chamber volumes is a fundamental part of cardiac magnetic resonance (CMR) imaging. While the effects of inter- and intraobserver variability have been studied and have a recognized effect on the comparability of serial cardiac MR imaging studies, the effect of differences in hydration status has not been evaluated. To evaluate the effects of volume administration on cardiac chamber volumes. Thirteen healthy adults underwent a baseline cardiac MR to evaluate cardiac chamber volumes after an overnight fast. They were then given two saline boluses of 10 ml/kg of body weight and the cardiac MR was repeated immediately after each bolus. From the baseline scan to the final scan there was a significant increase in all four cardiac chamber end-diastolic volumes. Right atrial volumes increased 8.0%, from 61.1 to 66.0 ml/m2 (P<0.001), and left atrial volumes increased 10.0%, from 50.0 to 55.0 ml/m2 (P<0.001). Right ventricular volumes increased 6.0%, from 91.1 to 96.5 ml/m2 (P<0.001), and left ventricular volumes increased 3.2%, from 87.0 to 89.8 ml/m2 (P<0.001). Hydration status has a significant effect on the end-diastolic volumes of all cardiac chambers assessed by cardiac MR. Thus, hydration represents a ''variable'' that should be taken into account when assessing cardiac chamber volumes, especially when performing serial imaging studies in a patient. (orig.)

Effect of hydration status on atrial and ventricular volumes and function in healthy adult volunteers

International Nuclear Information System (INIS)

Schantz, Daryl I.; Dragulescu, Andreea; Memauri, Brett; Grotenhuis, Heynric B.; Seed, Mike; Grosse-Wortmann, Lars

2016-01-01

Assessment of cardiac chamber volumes is a fundamental part of cardiac magnetic resonance (CMR) imaging. While the effects of inter- and intraobserver variability have been studied and have a recognized effect on the comparability of serial cardiac MR imaging studies, the effect of differences in hydration status has not been evaluated. To evaluate the effects of volume administration on cardiac chamber volumes. Thirteen healthy adults underwent a baseline cardiac MR to evaluate cardiac chamber volumes after an overnight fast. They were then given two saline boluses of 10 ml/kg of body weight and the cardiac MR was repeated immediately after each bolus. From the baseline scan to the final scan there was a significant increase in all four cardiac chamber end-diastolic volumes. Right atrial volumes increased 8.0%, from 61.1 to 66.0 ml/m2 (P<0.001), and left atrial volumes increased 10.0%, from 50.0 to 55.0 ml/m2 (P<0.001). Right ventricular volumes increased 6.0%, from 91.1 to 96.5 ml/m2 (P<0.001), and left ventricular volumes increased 3.2%, from 87.0 to 89.8 ml/m2 (P<0.001). Hydration status has a significant effect on the end-diastolic volumes of all cardiac chambers assessed by cardiac MR. Thus, hydration represents a ''variable'' that should be taken into account when assessing cardiac chamber volumes, especially when performing serial imaging studies in a patient. (orig.)

Prognostic value of left atrial function in systemic light-chain amyloidosis: a cardiac magnetic resonance study.

Science.gov (United States)

Mohty, Dania; Boulogne, Cyrille; Magne, Julien; Varroud-Vial, Nicolas; Martin, Sylvain; Ettaif, Hind; Fadel, Bahaa M; Bridoux, Frank; Aboyans, Victor; Damy, Thibaud; Jaccard, Arnaud

2016-09-01

Cardiac involvement in systemic light-chain amyloidosis (AL) imparts an adverse impact on outcome. The left atrium (LA), by virtue of its anatomical location and muscular wall, is commonly affected by the amyloid process. Although LA infiltration by amyloid fibrils leads to a reduction in its pump function, the infiltration of the left ventricular (LV) myocardium results in diastolic dysfunction with subsequent increase in filling pressures and LA enlargement. Even though left atrial volume (LAV) is an independent prognostic marker in many cardiomyopathies, its value in amyloid heart disease remains to be determined. In addition, few data are available as to the prognostic value of LA function in systemic AL. Using cardiac magnetic resonance (CMR), the current study aims to assess the prognostic significance of the maximal LAV and total LA emptying fraction (LAEF) in patients with AL. Fifty-four consecutive patients (age 66 ± 10 years, 59% males) with confirmed systemic AL and mean LV ejection fraction of 60 ± 12% underwent CMR. As compared with patients with no or minimal cardiac involvement (Mayo Clinic [MC] stage I), those at moderate and high risk (MC stages II and III) had significantly larger indexed maximal LAV (36 ± 15 vs. 46 ± 13 vs. 52 ± 19 mL/m(2), P = 0.03) and indexed minimal LAV (20 ± 6 vs. 34 ± 11 vs. 44 ± 17 mL/m(2), P 16% (37 ± 11 vs. 94 ± 4%, P = 0.001). In multivariate analysis, lower LAEF remained independently associated with a higher risk of 2-year mortality (HR = 1.08 per 1% decrease, 95% CI: 1.02-1.15, P = 0.003). In patients with systemic AL, LAEF as assessed by CMR is associated with NYHA functional class, MC stage, myocardial LGE and 2-year mortality. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Left atrial appendage: morphology and function in patients with paroxysmal and persistent atrial fibrillation.

Science.gov (United States)

Park, Hwan-Cheol; Shin, Jinho; Ban, Ji-Eun; Choi, Jong-Il; Park, Sang-Weon; Kim, Young-Hoon

2013-04-01

The anatomical and functional characteristics of the left atrial appendage (LAA) and its relationships with anatomical remodeling and ischemic stroke in patients with atrial fibrillation (AF) have not been clearly established. The purpose of this study was to determine whether functional and morphological features of the LAA independently predict clinical outcome and stroke in patients with AF who underwent catheter ablation (CA). Two hundred sixty-four patients with AF, including 176 with paroxysmal AF (PAF, 54.0 ± 11.4 years old, M:F = 138:38) and 88 with persistent AF (PeAF, 56.4 ± 9.6 years old, M:F = 74:14) were studied. Of these patients, 31 (11.7 %) had a history of stroke/TIA (transient ischemic attack). The LA and LAA volumes were 124.0 ± 42.4 and 24.9 ± 4.3 ml in PeAF, these values were greater than those in PAF (81.2 ± 24.8 ml and 21.2 ± 5.1 ml, P stroke, stroke patients had larger LA volume (106.9 ± 23.0 vs. 94.0 ± 38.9 ml, P = 0.004) and had lower LAA EF (50.0 ± 11.0 vs. 65.7 ± 13.4 %, P stroke were age (P = 0.002) and LAA EF (P stroke/TIA and recurrence of AF after CA in paroxysmal AF patients. Further large scaled prospective study is required for validation.

Hemodynamic changes in systolic and diastolic function during isoproterenol challenge predicts symptomatic response to myectomy in hypertrophic cardiomyopathy with labile obstruction.

Science.gov (United States)

Prasad, Megha; Geske, Jeffrey B; Sorajja, Paul; Ommen, Steve R; Schaff, Hartzell V; Gersh, Bernard J; Nishimura, Rick A

2016-11-15

We aimed to assess the utility of changes in systolic and diastolic function by isoproterenol challenge in predicting symptom resolution post-myectomy in selected patients with hypertrophic cardiomyopathy (HCM) and labile obstruction. In a subset of symptomatic HCM patients without resting/provocable obstruction on noninvasive assessment, isoproterenol challenge during hemodynamic catheterization may elicit labile left ventricular outflow tract (LVOT) obstruction, and demonstrate the effect of obstruction on diastolic function. These changes may determine whether patients achieve complete symptom resolution post-myectomy. Between February 2003 and April 2009, 18 symptomatic HCM patients without LVOT obstruction on noninvasive testing underwent isoproterenol provocation and septal myectomy due to presence of provocable gradient and were followed for 4 (IQR 3-7) years. Thirteen (72.2%) had complete symptom resolution, while 5 (27.8%) had improved, but persistent symptoms. Those with provoked gradient >100 mm Hg or increase in left atrial pressure (LAP) with isoproterenol had symptom resolution. Symptomatic HCM patients without LVOT gradient on noninvasive testing may demonstrate labile obstruction with isoproterenol. With isoproterenol, patients with high LVOT gradient or increase in LAP concomitant with an increase in gradient achieved complete symptom resolution post-myectomy. Thus, improved diastolic filling as well as outflow gradient production in patients with HCM may predict symptom response to myectomy. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Left atrial mass 16 years after radiation therapy for mediastinal neuroblastoma

International Nuclear Information System (INIS)

Ensing, G.J.; Driscoll, D.J.; Smithson, W.A.

1987-01-01

Tumors involving the heart during childhood are rare. However, neuroblastoma, a common pediatric malignancy, has been described to involve the cardiovascular system in 3%-12% of patients dying with this tumor. Rarely is such involvement diagnosed ante mortem and never, to our knowledge, has a benign cardiac tumor been reported to present in childhood after successful eradication of neuroblastoma. We describe the identification and surgical resection of a nodular, hypertrophied, calcified, pedunculated left atrial mass in a 16-year-old boy who was complaining of exercise-associated presyncope and headaches 16 years after irradiation and chemotherapy for mediastinal neuroblastoma

Small atrial septal defect associated with heart failure in an infant with a marginal left ventricle

Directory of Open Access Journals (Sweden)

Sandra D.K. Kingma

2012-07-01

Full Text Available Atrial septal defect (ASD is usually asymptomatic in infancy, unless pulmonary hypertension or severe co-morbidity is present. We report a case of a 4-week-old infant with moderate- sized ASD, small patent ductus arteriosus (PDA, and a borderline sized left ventricle that developed heart failure. Despite the relatively small diameter of the ASD, this defect influenced the mechanism of heart failure significantly. After surgical closure of both PDA and ASD, the signs of pulmonary hypertension resolved and the patient developed a normal sized left ventricle. This report illustrates that the presence of a small ASD in combination with a marginal left ventricle may result in inadequate left ventricular filling, pulmonary hypertension and heart failure.

The Effects Of Short Tıme Rıght Ventrıcular Pacıng On Left Atrıal Mechanıcal Functıons

Directory of Open Access Journals (Sweden)

Oyku Gulmez

2009-05-01

Full Text Available Objectives: Left atrium (LA plays an important role in left ventricular filling. It is well known that right ventricular apical pacing has unfavorable effects on ventricular systolic and diastolic performance. The aim of this study is to evaluate the LA mechanical functions with 2D echocardiography in patients with a permanent pacemaker after short time ventricular pacing.Design: Echocardiographic examination was performed in 38 patients (mean age 63.0±10.9, 18 female with dual chamber pacemakers or defibrillators (90% ventricular pacing at 70 beats per minute in DDD mode with an optimal AV interval. Left atrial volumes (LAV including at the time of mitral valve opening (Vmax, at closure (Vmin, and at the onset of atrial systole (Volp were measured. The passive emptying, conduit, active emptying and total emptying volume, stroke volumes were also calculated. Results: No significant differences were noted at baseline and after pacing for absolute Vmax, Volp, passive emptying, conduit, active emptying, total emptying volumes as well as the volumes indexed to body surface area (p >0.05. Conclusion: Short - time RV pacing seems to have no acute effects on left atrial mechanical functions.

The Association between Left Verticle Diastolic Dysfunction and Endothelial Dysfunction and the Result of Stress Myocardial SPECT in Asymptomatic Patients with Type 2 Diabetes

Czech Academy of Sciences Publication Activity Database

Charvát, J.; Michalová, K.; Chlumský, J.; Valenta, Zdeněk; Kvapil, M.

2005-01-01

Roč. 33, - (2005), s. 473-482 ISSN 0300-0605 Institutional research plan: CEZ:AV0Z10300504 Keywords : coronary heart disease * type 2 diabetes mellitus * left ventricular diastolic dysfunction * left ventricular hyperthropy * stress myocardial SPECT Subject RIV: FA - Cardiovascular Disease s incl. Cardiotharic Surgery Impact factor: 0.653, year: 2005

Radionuclide assessment of left ventricular diastolic function in patients with mitral stenosis before and after percutaneous transvenous mitral commissurotomy; Use of list mode method in patients with atrial fibrillation

Energy Technology Data Exchange (ETDEWEB)

Nakamura, Seishi; Iwasaka, Toshiji; Kimura, Yutaka; Ohkubo, Naohiko; Matsuura, Takashi; Inada, Mitsuo; Shiraishi, Tomokuni [Kansai Medical School, Moriguchi, Osaka (Japan)

1991-07-01

To evaluate the effect of percutaneous transvenous mitral commissurotomy (PTMC), equilibrium radionuclide angiocardiography was performed in eight patients with mitral stenosis who had atrial fibrillation. Accurate cardiac function in patients with atrial fibrillation is difficult to assess, since the wide fluctation of cardiac cycle makes the ventricular hemodynamics variable. A new processing algorhythm was devised to make multiple gated images discriminated from a heart rate distribution histogram. We obtained about 1,000 beats data by list mode acquisition, and processed a heart rate distribution histogram. The data in the area {+-}5% of the most frequent heart rate were converted into frame mode and a representative time activity curve was derived. Mitral valve area calculated by echocardiography increased from 1.3{+-}0.5 to 2.0{+-}0.6 (cm{sup 2}) significantly (p<0.01). The mean transmitral pressure gradient measured by catheterization decreased from 12.4{+-}5.9 to 4.9{+-}3.7 (mmHg) significantly (p<0.01) and the clinical symptoms improved in all patients. The change in left ventricular ejection fraction from 43{+-}9 to 48{+-}13 (%) was not statistically significant, but peak filling rate (PFR) derived from the time activity curve increased from 1.5{+-}0.3 to 2.0{+-}0.4 (EDV/sec) significantly (p<0.01). Thus PFR is a noninvasive parameter that can evaluate the effect of PTMC. (author).

Comparison of frequencies of left ventricular systolic and diastolic heart failure in Chinese living in Hong Kong.

Science.gov (United States)

Yip, G W; Ho, P P; Woo, K S; Sanderson, J E

1999-09-01

There is a wide variation (13% to 74%) in the reported prevalence of heart failure associated with normal left ventricular (LV) systolic function (diastolic heart failure). There is no published information on this condition in China. To ascertain the prevalence of diastolic heart failure in this community, 200 consecutive patients with the typical features of congestive heart failure were studied with standard 2-dimensional Doppler echocardiography. A LV ejection fraction (LVEF) >45% was considered normal. The results showed that 12.5% had significant valvular heart disease. Of the remaining 175 patients, 132 had a LVEF >45% (75%). Therefore, 66% of patients with a clinical diagnosis of heart failure had a normal LVEF. Heart failure with normal LV systolic function was more common than systolic heart failure in those >70 years old (65% vs 47%; p = 0.015). Most (57%) had an abnormal relaxation pattern in diastole and 14% had a restrictive filling pattern. In the systolic heart failure group, a restrictive filling pattern was more common (46%). There were no significant differences in the sex distribution, etiology, or prevalence of LV hypertrophy between these 2 heart failure groups. In conclusion, heart failure with a normal LVEF or diastolic heart failure is more common than systolic heart failure in Chinese patients with the symptoms of heart failure. This may be related to older age at presentation and the high prevalence of hypertension in this community.

New pulmonary vein Doppler echocardiographic index predicts significant interatrial shunting in secundum atrial septal defect.

Science.gov (United States)

Lam, Yat-Yin; Fang, Fang; Yip, Gabriel Wai-Kwok; Li, Zhi-An; Yang, Ya; Yu, Cheuk-Man

2012-09-20

The relation between pulmonary venous flow (PVF) pattern and degree of left-to-right interatrial shunting (IAS) in patients with secundum atrial septal defect (ASD) is unknown. Fifty consecutive ASD patients (14 males, 36 ± 17 years) received transthoracic echocardiography (TTE) before and 1 day after transcatheter closure and their results were compared to 40 controls. The ratio of pulmonary-to-systemic flows (Qp/Qs) was assessed by TTE and invasive oximetry. Pre-closure PV systolic (PVs), diastolic (PVd) velocities and velocity-time integral (PV-VTI) increased, time from onset of ECG Q-wave to the peak PV diastolic wave (Q-PVd) shortened and atrial reversal (PVar) velocity significantly decreased as compared to normals. These findings normalized after closure. Patients with large IAS (defined as invasive Qp/Qs ≥ 2) had higher PVs, PVd and PV-VTI, shorter Q-PVd but lower PVar (all pIAS. Invasive Qp/Qs ratios correlated with PVs, PVd, PV-VTI, Q-PVd and TTE-derived Qp/Qs ratios, ASD sizes and RV end-diastolic dimensions (all pIAS after multivariate analysis. The corresponding sensitivity, specificity and AUC were 89%, 82% and 0.90 respectively for a PV-VTI of 30 cm (pIAS have distinguishable PVF features. Doppler evaluation of PV-VTI is a novel additional tool for assessing the magnitude of shunting in these patients non-invasively. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Measurement of Strain in the Left Ventricle during Diastole withcine-MRI and Deformable Image Registration

Energy Technology Data Exchange (ETDEWEB)

Veress, Alexander I.; Gullberg, Grant T.; Weiss, Jeffrey A.

2005-07-20

The assessment of regional heart wall motion (local strain) can localize ischemic myocardial disease, evaluate myocardial viability and identify impaired cardiac function due to hypertrophic or dilated cardiomyopathies. The objectives of this research were to develop and validate a technique known as Hyperelastic Warping for the measurement of local strains in the left ventricle from clinical cine-MRI image datasets. The technique uses differences in image intensities between template (reference) and target (loaded) image datasets to generate a body force that deforms a finite element (FE) representation of the template so that it registers with the target image. To validate the technique, MRI image datasets representing two deformation states of a left ventricle were created such that the deformation map between the states represented in the images was known. A beginning diastoliccine-MRI image dataset from a normal human subject was defined as the template. A second image dataset (target) was created by mapping the template image using the deformation results obtained from a forward FE model of diastolic filling. Fiber stretch and strain predictions from Hyperelastic Warping showed good agreement with those of the forward solution. The technique had low sensitivity to changes in material parameters, with the exception of changes in bulk modulus of the material. The use of an isotropic hyperelastic constitutive model in the Warping analyses degraded the predictions of fiber stretch. Results were unaffected by simulated noise down to an SNR of 4.0. This study demonstrates that Warping in conjunction with cine-MRI imaging can be used to determine local ventricular strains during diastole.

New-Onset Atrial Fibrillation After PCI or CABG for Left Main Disease: The EXCEL Trial.

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Kosmidou, Ioanna; Chen, Shmuel; Kappetein, A Pieter; Serruys, Patrick W; Gersh, Bernard J; Puskas, John D; Kandzari, David E; Taggart, David P; Morice, Marie-Claude; Buszman, Paweł E; Bochenek, Andrzej; Schampaert, Erick; Pagé, Pierre; Sabik, Joseph F; McAndrew, Thomas; Redfors, Björn; Ben-Yehuda, Ori; Stone, Gregg W

2018-02-20

There is limited information on the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD). This study sought to determine the incidence of NOAF following PCI and CABG for LMCAD and its effect on 3-year cardiovascular outcomes. In the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization. Among 1,812 patients without atrial fibrillation on presentation, NOAF developed at a mean of 2.7 ± 2.5 days after revascularization in 162 patients (8.9%), including 161 of 893 (18.0%) CABG-treated patients and 1 of 919 (0.1%) PCI-treated patients (p EXCEL trial, NOAF was common after CABG but extremely rare after PCI. The development of NOAF was strongly associated with subsequent death and stroke in CABG-treated patients. Further studies are warranted to determine whether prophylactic strategies to prevent or treat atrial fibrillation may improve prognosis in patients with LMCAD who are undergoing CABG. (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776). Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Occult left atrial ball-like thrombus in a patient referred for surgical removal of suspected cerebellum tumor

International Nuclear Information System (INIS)

Możeńska, Olga; Kalińska, Irena; Brodowski, Karol; Walecki, Jerzy; Kosior, Dariusz A.

2014-01-01

Atrial fibrillation and related cardio-embolic cerebrovascular accidents are two well-defined major healthcare problems worldwide. It has been approximated that 2.2 million people in America and 4.5 million in European Union have paroxysmal or persistent atrial fibrillation. And atrial fibrillation itself is an independent long-term risk factor of stroke. We present a case of patient referred to our center for surgical removal of suspected cerebellum tumor, a case that had a rather unexpected ending. A 58-year-old male patient with a history of atrial fibrillation, congestive heart failure (NYHA II/III), stable coronary artery disease, diabetes type 2 and hyperlipidemia presented with vertigo, headaches, mainly during physical activity and increased tiredness. Performed computer tomography revealed two lesions in the cerebellum and in the left lateral chamber. The diagnosis of a proliferative disease of the cerebellum was established and patient was referred to the Neurosurgical Department. Fortunately, before the operation the echocardiography was performed, which revealed two lesions in left atrium. The decision of the Heart Team was to refer the patient for an open-heart surgery, in which two thrombi were removed. Neurosurgeons decided to withdraw from further surgery and proceed with head MRI and conservative treatment, deciding that the lesion in the cerebellum was most likely an ischemic area. Looking at the brain lesion should always be done from the whole patient’s perspective. And using mutlimodality imaging may lead to appropriate diagnosis, correct course of therapeutic action and unexpected ending of a rather non-extraordinary case

Diastolic and autonomic dysfunction in early cirrhosis

DEFF Research Database (Denmark)

Dahl, Emilie Kristine; Møller, Søren; Kjær, Andreas

2014-01-01

OBJECTIVE. Presence of cardiac dysfunction in patients with advanced cirrhosis is widely accepted, but data in early stages of cirrhosis are limited. Systolic and diastolic functions, dynamics of QT-interval, and pro-atrial natriuretic peptide (pro-ANP) are investigated in patients with early stage...... cirrhosis during maximal β-adrenergic drive. MATERIAL AND METHODS. Nineteen patients with Child A (n = 12) and Child B cirrhosis (n = 7) and seven matched controls were studied during cardiac stress induced by increasing dosages of dobutamine and atropine. RESULTS. Pharmacological responsiveness was similar...... indicate that patients with early stage cirrhosis exhibit early diastolic and autonomic dysfunction as well as elevated pro-ANP. However, the cardiac chronotropic and inotropic responses to dobutamine stress were normal. The dynamics of ventricular repolarization appears normal in patients with early stage...

Transcatheter treatment of heart failure with preserved or mildly reduced ejection fraction using a novel interatrial implant to lower left atrial pressure

DEFF Research Database (Denmark)

Søndergaard, Lars; Reddy, Vivek; Kaye, David

2014-01-01

BACKGROUND: Heart failure with preserved or mildly reduced ejection fraction (HFpEF) is common and, to date, therapeutic options are limited. Increased left atrial pressure is a key contributor to the symptoms associated with HFpEF, particularly during physical activity. We report the 30-day...... outcome of patients treated with a novel device intended to lower left atrial pressure by creating an 8 mm permanent shunt in the atrial septum. METHODS AND RESULTS: Eleven patients were enrolled in the pilot trial. Key inclusion criteria were: EF >45%; baseline PCWP ≥15 mmHg (rest), or ≥ 25 mm...... patients, one class in five patients, and worsened by one class in one patient. No patient developed pulmonary hypertension. Two serious adverse events occurred; heart failure re-hospitalization, and implant malposition successfully treated with a new device. CONCLUSION: Contemporary management of HFp...

Determinants of global left ventricular peak diastolic filling rate during rest and exercise in normal volunteers

International Nuclear Information System (INIS)

Filiberti, A.W.; Bianco, J.A.; Baker, S.P.; Doherty; Nalivaika, L.A.; King, M.A.; Alpert, J.S.

1984-01-01

Early peak diastolic filling rate (PFR) of the left ventricle (LV) is said to be a sensitive index of LV dysfunction in patients with coronary disease, hypertension and hypertrophic cardiomyopathy. Radionuclide (RN0 multigated PFR was measured in 20 normal volunteers (13 males, 7 females, mean age 31 yrs., range 20-43) at rest and during supine bicycle exercise conducted to a symptomatic end-point. At rest, RN PFR was 3.4 +- SD 0.4 end-diastolic vols./sec (range 3.1 - 3.6). During exercise all normal volunteers had a progressive and numerically and statistically significant increase in PFR. Stepwise multiple linear regression (BMPD2R) was applied to the rest and exercise PFR data to develop a linear model describing the main determinants of the RN PFR. The potential independent variables which were included in the model were heart rate (HR), ejection fraction (EF), systolic arterial pressure, systolic ejection rate and exercise stage. Ranking of variables for prediction of RN PFR, and exclusion of less important variables, was done by F value criteria. The final multivariate equation was: LVPFR = -3.84437 + 0.03834 HR + 0.07537 LVEF. The model fit was highly significant (p<0.001), and accounted for 89 per cent of variability in the PFR. The authors conclude that the left ventricular peak filling rate is critically determined by heart rate and by ejection fraction at rest and during exercise

Thickening of the left atrial wall shortly after radiofrequency ablation predicts early recurrence of atrial fibrillation

International Nuclear Information System (INIS)

Yokokawa, Miki; Koyama, Keiko; Ino, Toshihiko; Naito, Shigeto; Oshima, Shigeru; Taniguchi, Koichi; Tada, Hiroshi

2010-01-01

Inflammatory responses following atrial fibrillation (AF) ablation may aggravate arrhythmogenic activity and cause an early recurrence of AF (ERAF). In 56 patients who underwent circumferential pulmonary vein ablation (CPVA) for paroxysmal AF, cardiovascular magnetic resonance imaging (CMRI) was evaluated in 5 subdivided left atrial (LA) regions before the CPVA and at 1 day and 1 month after. At a mean of 7±10 days after the CPVA, 23 patients (41%) developed 1 or more episodes of AF (ERAF group), while 33 patients (59%) remained free from AF during the first month of follow up (no-ERAF group). LA wall thickness increased 1 day after the CPVA in both groups, as demonstrated by high T2-weighted signal. The LA roof thickness and its increase, however, were greater in the ERAF group than in the no-ERAF group (P<0.05). Regions of delayed enhancement (DE) were also frequently detected in both groups, but the total number of DE regions did not differ between the 2 groups. The thickening of the LA wall associated with a high T2-weighted signal resolved within 1 month. No significant difference between the 2 groups was found in any of the CMRI parameters before or 1 month after CPVA. Thickening of the LA roof shortly after CPVA may predict an ERAF. (author)

Left Ventricular Systolic Function Assessed by Global Longitudinal Strain is Impaired in Atrial Fibrillation Compared to Sinus Rhythm

DEFF Research Database (Denmark)

Agner, Bue Fridolin Ross; Katz, Michael G; Williams, Zachary R

2018-01-01

Background: Atrial fibrillation (AF) is the most common aberrant cardiac arrhythmia. Many AF patients present with symptoms of dyspnea and fatigue, but have normal left ventricular ejection fraction (LVEF). Purpose: To determine the reproducibility of measurements of global longitudinal strain (GLS...

Diagnosing Paroxysmal Atrial Fibrillation in Patients With Ischemic Strokes and Transient Ischemic Attacks Using Echocardiographic Measurements of Left Atrium Function

DEFF Research Database (Denmark)

Skaarup, Kristoffer Grundtvig; Christensen, Hanne Krarup; Høst, Nis

2016-01-01

Twenty-five to 35 percentage of stroke cases are cryptogenic, and it has been demonstrated that paroxysmal atrial fibrillation (AF) is the causal agent in up to 25% of these incidents. The purpose of this study was to investigate if left atrial (LA) parameters have value for diagnosing paroxysmal...... with paroxysmal AF. However, the atrial measurements evaluating LA function (min LA volume and LA emptying fraction) were significantly different (LA emptying fraction: 45% ± 10% vs 50% ± 10%, p = 0.004; minimal LA volume: 30.2 ml ± 17.3 ml vs 24 ml ± 10 ml, p = 0.035 in patients with paroxysmal AF, even after...

Echocardiographic predictors of early in-hospital heart failure during first ST-elevation acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function?

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Machado Cristiano V

2011-06-01

Full Text Available Abstract Background Left ventricular ejection fraction (LVEF has been considered a major determinant of early outcome in acute myocardial infarction (AMI. Myocardial performance index (MPI has been associated to early evolution in AMI in a heterogeneous population, including non ST-elevation or previous AMI. Left atrial volume has been related with late evolution after AMI. We evaluated the independent role of clinical and echocardiographic variables including LVEF, MPI and left atrial volume in predicting early in-hospital congestive heart failure (CHF specifically in patients with a first isolated ST-elevation AMI. Methods Echocardiography was performed within 30 hours of chest pain in 95 patients with a first ST-elevation AMI followed during the first week of hospitalization. Several clinical and echocardiographic variables were analyzed. CHF was defined as Killip class ≥ II. Multivariate regression analysis was used to select independent predictor of in-hospital CHF. Results Early in-hospital CHF occurred in 29 (31% of patients. LVEF ≤ 0.45 was the single independent and highly significant predictor of early CHF among other clinical and echocardiographic variables (odds ratio 17.0; [95% CI 4.1 - 70.8]; p Conclusion For patients with first, isolated ST-elevation AMI, LVEF assessed by echocardiography still constitutes a strong and accurate independent predictor of early in-hospital CHF, superior to isolated MPI and left atrial volume in this particular subset of patients.

Silent Atrial Fibrillation in Elderly Pacemaker Users: A Randomized Trial Using Home Monitoring.

Science.gov (United States)

Lima, Ceb; Martinelli, M; Peixoto, G L; Siqueira, S F; Wajngarten, Maurício; Silva, Rodrigo Tavares; Costa, Roberto; Filho, Roberto; Ramires, José Antônio Franchini

2016-05-01

Pacemaker with remote monitoring (PRM) may be useful for silent atrial fibrillation (AF) detection. The aims of this study were to evaluate the incidence of silent AF, the role of PRM, and to determine predictors of silent AF occurrence. Three hundred elderly patients with permanent pacemaker (PPM) were randomly assigned to the remote group (RG) or control group (CG). All patients received PPM with remote monitoring capabilities. Primary end point was AF occurrence rate and the secondary end points were time to AF detection and number of days with AF. During the average follow-up of 15.7±7.7 months, AF episodes were detected in 21.6% (RG = 24% vs CG = 19.3%, P = 0.36]. There was no difference in the time to detect the first AF episode. However, the median time to detect AF recurrence in the RG was lower than that in the CG (54 days vs 100 days, P = 0.004). The average number of days with AF was 16.0 and 51.2 in the RG and CG, respectively (P = 0.028). Predictors of silent AF were left atrial diameter (odds ratio [OR] 1.2; 95% CI = 1.1-1.3; P pacemaker; left atrial diameter and diastolic dysfunction were predictors of its occurrence. AF monitoring by means of pacemaker is a valuable tool for silent AF detection and continuous remote monitoring allows early AF recurrence detection and reduces the number of days with AF. © 2015 Wiley Periodicals, Inc.

Masked hypertension and cardiac remodeling in middle-aged endurance athletes.

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Trachsel, Lukas D; Carlen, Frederik; Brugger, Nicolas; Seiler, Christian; Wilhelm, Matthias

2015-06-01

Extensive endurance training and arterial hypertension are established risk factors for atrial fibrillation. We aimed to assess the proportion of masked hypertension in endurance athletes and the impact on cardiac remodeling, mechanics, and supraventricular tachycardias (SVT). Male participants of a 10-mile race were recruited and included if office blood pressure was normal (hypertension and normotension group by ambulatory blood pressure. Primary endpoint was diastolic function, expressed as peak early diastolic mitral annulus velocity (E'). Left ventricular global strain, left ventricular mass/volume ratio, left atrial volume index, signal-averaged P-wave duration (SAPWD), and SVT during 24-h Holter monitoring were recorded. From 108 runners recruited, 87 were included in the final analysis. Thirty-three (38%) had masked hypertension. The mean age was 42 ± 8 years. Groups did not differ with respect to age, body composition, cumulative training hours, and 10-mile race time. Athletes with masked hypertension had a lower E' and a higher left ventricular mass/volume ratio. Left ventricular global strain, left atrial volume index, SAPWD, and SVT showed no significant differences between the groups. In multiple linear regression analysis, masked hypertension was independently associated with E' (beta = -0.270, P = 0.004) and left ventricular mass/volume ratio (beta = 0.206, P = 0.049). Cumulative training hours was the only independent predictor for left atrial volume index (beta = 0.474, P hypertension, associated with a lower diastolic function and a higher left ventricular mass/volume ratio, but unrelated to left ventricular systolic function, atrial remodeling, or SVT.

Relationship of radionuclide measurements of left ventricular diastolic filling in patients with type I diabetes mellitus to subsequent clinical cardiac disease

International Nuclear Information System (INIS)

Ohashi, K.; Gerson, M.C.; Khoury, J.C.; Fischer, E.A.; Smith, H.S.

1990-01-01

This paper evaluates left ventricular diastolic filling (LVDF) in patients with type I diabetes mellitus (DM) in order to identify increased risk for subsequent cardiac events. The authors obtained radionuclide ventriculograms in 54 patients with type I DM. Median follow-up for cardiac complications was 63 months. We assessed peak filling rate (PFR; in end diastolic volume [EDV] per second), first 1/2 filling fraction (1/2 FF), and first 1/2 filling fraction/R-R interval (1/2 FF/R-R) by analysis of convariance to account for effects of age and R-R interval. Cardiac complications ere found in 15 of 54 patients

[New technology for prevention of embolic events in atrial fibrillation: a systematic review on percutaneous endovascular left atrial appendage closure].

Science.gov (United States)

Danna, Paolo; Sagone, Antonio; Proietti, Riccardo; Arensi, Andrea; Viecca, Maurizio; Santangeli, Pasquale; Di Biase, Luigi; Natale, Andrea

2012-09-01

Atrial fibrillation (AF) is the most common cardiac arrhythmia. The mortality rate of patients with AF is doubled as compared to non-fibrillating controls. The most relevant complication of AF is a major increase in the risk of stroke. The gold standard in reducing cerebrovascular events in AF is warfarin therapy, which is not free from contraindications and limitations. The left atrial appendage (LAA) is the main source of emboli causing stroke in AF. LAA closure is a seducing approach to stroke risk reduction in AF without anticoagulation. Since 1949, heart surgeons have performed LAA closure or amputation in patients with AF. Percutaneous endovascular LAA closure is a new, less invasive, technique to reach the goal. Several devices have been used to perform this intervention, and the results of published trials are encouraging in terms of effectiveness and relative safety of this attractive technique. In this review we examine the published trials and data on percutaneous LAA closure, with particular attention to the risks and benefits of this procedure.

Organized Atrial Tachycardias after Atrial Fibrillation Ablation

Science.gov (United States)

Castrejón-Castrejón, Sergio; Ortega, Marta; Pérez-Silva, Armando; Doiny, David; Estrada, Alejandro; Filgueiras, David; López-Sendón, José L.; Merino, José L.

2011-01-01

The efficacy of catheter-based ablation techniques to treat atrial fibrillation is limited not only by recurrences of this arrhythmia but also, and not less importantly, by new-onset organized atrial tachycardias. The incidence of such tachycardias depends on the type and duration of the baseline atrial fibrillation and specially on the ablation technique which was used during the index procedure. It has been repeatedly reported that the more extensive the left atrial surface ablated, the higher the incidence of organized atrial tachycardias. The exact origin of the pathologic substrate of these trachycardias is not fully understood and may result from the interaction between preexistent regions with abnormal electrical properties and the new ones resultant from radiofrequency delivery. From a clinical point of view these atrial tachycardias tend to remit after a variable time but in some cases are responsible for significant symptoms. A precise knowledge of the most frequent types of these arrhythmias, of their mechanisms and components is necessary for a thorough electrophysiologic characterization if a new ablation procedure is required. PMID:21941669

Association Between Sedentary Lifestyle and Diastolic Dysfunction Among Outpatients With Normal Left Ventricular Systolic Function Presenting to a Tertiary Referral Center in the Middle East.

Science.gov (United States)

Matta, Stephanie; Chammas, Elie; Alraies, Chadi; Abchee, Antoine; AlJaroudi, Wael

2016-05-01

Sedentary lifestyle has become prevalent in our community. Recent data showed controversy on the effect of regular exercise on left ventricular compliance and myocardial relaxation. We sought to assess whether physical inactivity is an independent predictor of diastolic dysfunction in or community, after adjustment for several covariates. Consecutive outpatients presenting to the echocardiography laboratory between July 2013 and June 2014 were prospectively enrolled. Clinical variables were collected prospectively at enrollment. Patients were considered physically active if they exercised regularly ≥3× a week, ≥30 minutes each time. The primary endpoint was presence of diastolic dysfunction. The final cohort included 1356 patients (mean age [SD] 52.9 [17.4] years, 51.3% female). Compared with physically active patients, the 1009 (74.4%) physically inactive patients were older, more often female, and had more comorbidities and worse diastolic function (51.3% vs 38.3%; P < 0.001). On univariate analysis, physical inactivity was associated with 70% increased odds of having diastolic dysfunction (odds ratio: 1.70, 95% confidence interval: 1.32-2.18, P < 0.001). There was significant interaction between physical activity and left ventricular mass index (LVMI; P = 0.026). On multivariate analysis, patients who were physically inactive and had LVMI ≥ median had significantly higher odds of having diastolic dysfunction (odds ratio: 2.82, 95% confidence interval: 1.58-5.05, P < 0.001). In a large, prospectively enrolled cohort from a single tertiary center in the Middle East, physically inactive patients with increased LVMI had 2- to 3-fold increased odds of having diastolic dysfunction after multivariate adjustment. © 2016 Wiley Periodicals, Inc.

Left Atrial Size and Function in a Canine Model of Chronic Atrial Fibrillation and Heart Failure

Science.gov (United States)

Goldberg, Adam; Kusunose, Kenya; Qamruddin, Salima; Rodriguez, L. Leonardo; Mazgalev, Todor N.; Griffin, Brian P.; Van Wagoner, David R.; Zhang, Youhua; Popović, Zoran B.

2016-01-01

Background Our aim was to assess how atrial fibrillation (AF) induction, chronicity, and RR interval irregularity affect left atrial (LA) function and size in the setting of underlying heart failure (HF), and to determine whether AF effects can be mitigated by vagal nerve stimulation (VNS). Methods HF was induced by 4-weeks of rapid ventricular pacing in 24 dogs. Subsequently, AF was induced and maintained by atrial pacing at 600 bpm. Dogs were randomized into control (n = 9) and VNS (n = 15) groups. In the VNS group, atrioventricular node fat pad stimulation (310 μs, 20 Hz, 3–7 mA) was delivered continuously for 6 months. LA volume and LA strain data were calculated from bi-weekly echocardiograms. Results RR intervals decreased with HF in both groups (p = 0.001), and decreased further during AF in control group (p = 0.014), with a non-significant increase in the VNS group during AF. LA size increased with HF (p<0.0001), with no additional increase during AF. LA strain decreased with HF (p = 0.025) and further decreased after induction of AF (p = 0.0001). LA strain decreased less (p = 0.001) in the VNS than in the control group. Beat-by-beat analysis showed a curvilinear increase of LA strain with longer preceding RR interval, (r = 0.45, p <0.0001) with LA strain 1.1% higher (p = 0.02) in the VNS-treated animals, independent of preceding RR interval duration. The curvilinear relationship between ratio of preceding and pre-preceding RR intervals, and subsequent LA strain was weaker, (r = 0.28, p = 0.001). However, VNS-treated animals again had higher LA strain (by 2.2%, p = 0.002) independently of the ratio of preceding and pre-preceding RR intervals. Conclusions In the underlying presence of pacing-induced HF, AF decreased LA strain, with little impact on LA size. LA strain depends on the preceding RR interval duration. PMID:26771573

Atrial and ventricular function after cardioversion of atrial fibrillation.

Science.gov (United States)

Xiong, C.; Sonnhag, C.; Nylander, E.; Wranne, B.

1995-01-01

OBJECTIVE--Previous studies on atrial recovery after cardioversion of atrial fibrillation have not taken into account new knowledge about the pathophysiology of transmitral and transtricuspid flow velocity patterns. It is possible to shed further light on this problem if atrioventricular inflow velocity, venous filling pattern, and atrioventricular annulus motion are recorded and interpreted together. DESIGN--Prospective examinations of mitral and tricuspid transvalvar flow velocities, superior caval and pulmonary venous filling, and mitral and tricuspid annulus motion were recorded using Doppler echocardiography. Examinations were performed before and 24 hours, 1 month, and 20 months after cardioversion. SETTING--Tertiary referral centre for cardiac disease with facilities for invasive and non-invasive investigation. PATIENTS--16 patients undergoing cardioversion of atrial fibrillation in whom sinus rhythm had persisted for 24 hours or more. RESULTS--Before conversion there was no identifiable A wave in transvalvar flow recordings. The total motion of the tricuspid and mitral annulus was subnormal and there was no identifiable atrial component. Venous flow patterns in general showed a low systolic velocity. After conversion, A waves and atrial components were seen in all patients and increased significantly (P atrial components, an increased systolic component of venous inflow, an increased A wave velocity, and a decreased E/A ratio of the transvalvar velocity curves. The ventricular component of annulus motion was unchanged. Changes in general occurred earlier on the right side than the left. CONCLUSIONS--This study indicates that, in addition to the previously known electromechanical dissociation of atrial recovery that exists after cardioversion of atrial fibrillation, there may also be a transient deterioration of ventricular function modulating the transvalvar inflow velocity recordings. Function on the right side generally becomes normal earlier than on the

Correlation between left ventricular diastolic function before and after valve replacement surgery and myocardial ultrastructural changes in patients with left ventricular volume-overloaded valvular heart diseases; Evaluation with gated blood pool scintigraphy using [sup 99m]Tc

Energy Technology Data Exchange (ETDEWEB)

Okada, Tomiro (Okayama Univ. (Japan). School of Medicine)

1993-06-01

Left ventricular (LV) diastolic functions in 23 patients with aortic regurgitation (AR) and 22 patients with mitral regurgitation (MR) were evaluated by gated blood pool scintigraphy. LV myocardial biopsy was performed during open heart surgery, and LV myocardial ultrastructural changes were evaluated by electron microscope. Correlation between LV diastolic function and myocardial ultrastructural changes was examined. It was suggested that preoperative LV diastolic dysfunction occurred earlier than LV systolic dysfunction in patients with AR and MR. LV early diastolic dysfunction was especially significant in patients with AR. LV systolic function was significantly improved postoperatively compared with LV diastolic function in patients with AR and MR. It was suggested that LV interstitial fibrosis caused LV diastolic dysfunction in patients with AR and MR, and insufficiency of myocardial thickening as compensation in patients with MR. It was presumed that LV diastolic dysfunction was irreversible in patients with AR and MR in the distant postoperative period due to persistence of the preoperative myocardial ultrastructural change, e.g., interstitial fibrosis. These LV diastolic indices measured by gated pool scintigraphy were useful in predicting LV ultrastructural changes and postoperative LV dysfunction in patients with LV volume-overloaded valvular heart disease. (author).

Excessive interatrial adiposity is associated with left atrial remodeling, augmented contractile performance in asymptomatic population

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Yau-Huei Lai

2016-05-01

Full Text Available Purpose: Pericardial adipose tissue had been shown to exert local effects on adjacent cardiac structures. Data regarding the mechanistic link between such measures and left atrial (LA structural/functional remodeling, a clinical hallmark of early stage heart failure (HF and atrial fibrillation (AF incidence, in asymptomatic population remain largely unexplored. Methods: This retrospective analysis includes 356 subjects free from significant valvular disorders, atrial fibrillation, or clinical HF. Regional adipose tissue including pericardial and periaortic fat volumes, interatrial septal (IAS, and left atrioventricular groove (AVG fat thickness were all measured by multidetector computed tomography (MDCT (Aquarius 3D Workstation, TeraRecon, San Mateo, CA, USA. We measured LA volumes, booster performance, reservoir capacity as well as conduit function, and analyzed their association with adiposity measures. Results: All four adiposity measures were positively associated with greater LA volumes (all P < 0.05, while IAS and AVG fat were also related to larger LA kinetic energy and worse reservoir capacity (both P < 0.01. In multivariate models, IAS fat thickness remained independently associated with larger LA volumes, increased LA kinetic energy and ejection force (β-coef: 0.17 & 0.15, both P < 0.05, and impaired LA reservoir and conduit function (β-coef: −0.20 & −0.12, both P < 0.05 after adjusting for clinical variables. Conclusion: Accumulated visceral adiposity, especially interatrial fat depots, was associated with certain LA structural/functional remodeling characterized by impaired LA reservoir and conduit function though augmented kinetic energy and ejection performance. Our data suggested that interatrial fat burden may be associated with certain detrimental LA functions with compensatory LA adaptation in an asymptomatic population.

Estimation of left ventricular operating stiffness from Doppler early filling deceleration time in humans.

Science.gov (United States)

Garcia, M J; Firstenberg, M S; Greenberg, N L; Smedira, N; Rodriguez, L; Prior, D; Thomas, J D

2001-02-01

Shortened early transmitral deceleration times (E(DT)) have been qualitatively associated with increased filling pressure and reduced survival in patients with cardiac disease and increased left ventricular operating stiffness (K(LV)). An equation relating K(LV) quantitatively to E(DT) has previously been described in a canine model but not in humans. During several varying hemodynamic conditions, we studied 18 patients undergoing open-heart surgery. Transesophageal echocardiographic two-dimensional volumes and Doppler flows were combined with high-fidelity left atrial (LA) and left ventricular (LV) pressures to determine K(LV). From digitized Doppler recordings, E(DT) was measured and compared against changes in LV and LA diastolic volumes and pressures. E(DT) (180 +/- 39 ms) was inversely associated with LV end-diastolic pressures (r = -0.56, P = 0.004) and net atrioventricular stiffness (r = -0.55, P = 0.006) but had its strongest association with K(LV) (r = -0.81, P < 0.001). K(LV) was predicted assuming a nonrestrictive orifice (K(nonrest)) from E(DT) as K(nonrest) = (0.07/E(DT))(2) with K(LV) = 1.01 K(nonrest) - 0.02; r = 0.86, P < 0.001, DeltaK (K(nonrest) - K(LV)) = 0.02 +/- 0.06 mm Hg/ml. In adults with cardiac disease, E(DT) provides an accurate estimate of LV operating stiffness and supports its application as a practical noninvasive index in the evaluation of diastolic function.

Diastolic And Systolic Right Ventricular Dysfunction Precedes Left Ventricular Dysfunction In Patients Paced From Right Ventricular Apex

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Dwivedi SK

2006-07-01

Full Text Available Background: Cardiac dysfunction after right ventricular (RV apical pacing is well known but its extent, time frame of appearance and individual effect on left ventricular (LV, RV systolic and diastolic parameters has not evaluated in a systematic fashion. Methods: Patients with symptomatic bradycardia and ACC-AHA Class I indication for permanent pacemaker implantation (PPI were implanted a single chamber (VVI pacemaker. They were followed prospectively by echocardiographic examination which was done at baseline, 1 week, 1 month and 6 months after implantation. Parameters observed were chamber dimensions (M-line, chamber volumes, cardiac output (modified Simpson's method, systolic functions (ejection fraction, pre-ejection period, ejection time and ratio and diastolic functions( isovolumic relaxation time & deceleration time of left and right heart. Results: Forty eight consecutive patients (mean age 65.6±11.8 yrs, 66.7% males, mean EF 61.82±10.36% implanted a VVI pacemaker were enrolled in this study. The first significant change to appear in cardiac function after VVI pacing was in diastolic properties of RV as shown by increase in RV isovolumic relaxation time (IVRT from 65.89±15.93 to 76.58±17.00 ms,(p<0.001 at 1week and RV deceleration time (DT from 133.84±38.13 to 153.09±31.41 ms, (p=0.02 at 1 month. Increase in RV internal dimension (RVID from 1.26±0.41 to 1.44±0.44, (p<0.05 was also noticed at 1 week. The LV diastolic parameters were significantly altered after 1 month with increase in LV-IVRT from 92.36±21.47 to 117.24±27.21ms, (p<0.001 and increase in LV DT from 147.56±31.84 to 189.27±28.49ms,(p<0.01. This was followed by LV systolic abnormality which appeared at 6 months with an increase in LVPEP from 100.33±14.43 to 118.41±21.34ms, (p<0.001 and increase in LVPEP/LVET ratio from 0.34±0.46 to 0.44±0.10, (p<0.001]. The reduction in LV EF was manifested at 6 months falling from 61.82±10.36% to52.52±12.11%, (p<0

Accumulation of epicardial fat rather than visceral fat is an independent risk factor for left ventricular diastolic dysfunction in patients undergoing peritoneal dialysis

OpenAIRE

Lin, Heng-Hsu; Lee, Jen-Kuang; Yang, Chung-Yi; Lien, Yu-Chung; Huang, Jenq-Wen; Wu, Cho-Kai

2013-01-01

Background Symptoms of heart failure with preserved left ventricular systolic function are common among patients undergoing peritoneal dialysis (PD). Epicardial fat (EpF) is an ectopic fat depot with possible paracrine or mechanical effects on myocardial function. The aim of our current study is to assess the association between EpF and Left ventricular diastolic dysfunction (LVDD) in patients undergoing PD and to clarify the relationships among EpF, inflammation, and LVDD in this population....

Hyperglycemia and nocturnal systolic blood pressure are associatedwith left ventricular hypertrophy and diastolic dysfunction in hypertensive diabetic patients

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Felício João S

2006-09-01

Full Text Available Abstract Background The aim of this study was to determine if hypertensive type 2 diabetic patients, when compared to patients with essential hypertension have an increased left ventricular mass index (LVMI and a worse diastolic function, and if this fact would be related to 24-h pressoric levels changes. Methods Ninety-one hypertensive patients with type 2 diabetes mellitus (DM (group-1 [G1], 59 essential hypertensive patients (group-2 [G2] and 26 healthy controls (group-3 [G3] were submitted to 24-h Ambulatory Blood Pressure Monitoring (ABPM and echocardiography (ECHO with Doppler. We calculated an average of fasting blood glucose (AFBG values of G1 from the previous 4.2 years and a glycemic control index (GCI (percentual of FBG above 200 mg/dl. Results G1 and G2 did not differ on average of diurnal systolic and diastolic BP. However, G1 presented worse diastolic function and a higher average of nocturnal systolic BP (NSBP and LVMI (NSBP = 132 ± 18 vs 124 ± 14 mmHg; P 2; P 165 mg/dl showed an additional risk of LVH (P Conclusion This study suggests that hyperglycemia and higher NSBP levels should be responsible for an increased prevalence of LVH in hypertensive patients with Type 2 DM.

Acute and chronic hypothyroidism are associated with similar left ventricular diastolic dysfunction relative to the euthyroid state: results of doppler echocardiographic comparisons.

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Gauna, A; Messuti, H; Papadopulos, G; Benchuga, G; Viale, F; Marlowe, R J; Silva Croome, M C

2011-10-01

How the duration of hypothyroidism affects left ventricular diastolic function is not well-characterized. We sought to compare left ventricular diastolic function in acutely vs chronically hypothyroid patients vs euthyroid controls, and within individuals while on vs off T4. We prospectively performed such comparisons measuring pulsed-wave and color M-mode Doppler echocardiographic variables: early or late mitral peak velocities (E wave or A wave, respectively), E wave/A wave ratio, E wave deceleration time, isovolumic relaxation time (IVRT), mitral flow propagation velocity (Vp), E wave/Vp ratio. Subjects comprised the acute HYPO group, 10 patients undergoing T4 withdrawal ≥ 6 months post-primary treatment for differentiated thyroid cancer (DTC); the chronic HYPO group, 23 treatment-naïve Hashimoto thyroiditis patients; and 21 healthy euthyroid controls. Subjects were adults aged ≤ 60 yr, predominantly female, with sinus rhythm; exclusion criteria were cardiovascular or thyroid disorder besides DTC (Hashimoto thyroiditis) in acute (chronic) HYPO patients or medication (besides thyroid hormone) affecting cardiac or thyroid function. Mean IVRT was significantly delayed and mean Vp, significantly slowed in both HYPO groups vs controls (p<0.0005), but did not differ between HYPO groups. These variables also were significantly impaired (p<0.05) within individuals when off vs on T4 (no.=8 acute, 10 chronic HYPO patients). Both HYPO groups had elevated mean E wave/Vp ratios vs controls, but the elevation reached significance (p<0.05) only in the larger chronic HYPO group. Left ventricular diastolic dysfunction is largely similar in acutely or chronically hypothyroid patients off T4 vs healthy controls or the same patients on T4.

Left atrial appendage morphology in patients with suspected cardiogenic stroke without known atrial fibrillation.

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Miika Korhonen

Full Text Available The left atrial appendage (LAA is the typical origin for intracardiac thrombus formation. Whether LAA morphology is associated with increased stroke/TIA risk is controversial and, if it does, which morphological type most predisposes to thrombus formation. We assessed LAA morphology in stroke patients with cryptogenic or suspected cardiogenic etiology and in age- and gender-matched healthy controls. LAA morphology and volume were analyzed by cardiac computed tomography in 111 patients (74 males; mean age 60 ± 11 years with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology other than known atrial fibrillation (AF. A subgroup of 40 patients was compared to an age- and gender-matched control group of 40 healthy individuals (21 males in each; mean age 54 ± 9 years. LAA was classified into four morphology types (Cactus, ChickenWing, WindSock, CauliFlower modified with a quantitative qualifier. The proportions of LAA morphology types in the main stroke group, matched stroke subgroup, and control group were as follows: Cactus (9.0%, 5.0%, 20.0%, ChickenWing (23.4%, 37.5%, 10.0%, WindSock (47.7%, 35.0%, 67.5%, and CauliFlower (19.8%, 22.5%, 2.5%. The distribution of morphology types differed significantly (P<0.001 between the matched stroke subgroup and control group. The proportion of single-lobed LAA was significantly higher (P<0.001 in the matched stroke subgroup (55% than the control group (6%. LAA volumes were significantly larger (P<0.001 in both stroke study groups compared to controls patients. To conclude, LAA morphology differed significantly between stroke patients and controls, and single-lobed LAAs were overrepresented and LAA volume was larger in patients with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology.

Case Report of a Left Atrial Myxoma Associated with Carney%u2019s Syndrome

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Anil Ozen

2016-05-01

Full Text Available Primary cardiac neoplasms are very rare as compared to metastatic tumors. 70% to 80% of them are benign myxomas. Complications of myxomas include cyst and microabscess formation, embolization, syncope and sudden death. Rarely, cardiac myxomas are associated with primary nodular adrenal cortical disease, mammary fibroadenomas, testicular tumors or pitiutary adenomas with gigantism or acromegaly known as Carney%u2019s syndrome. We present a patient with a left atrial myxoma who underwent reoperation associated with Carney%u2019s syndrome.

Left septal atrial tachycardia after open-heart surgery: relevance to surgical approach, anatomical and electrophysiological characteristics associated with catheter ablation, and procedural outcomes.

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Adachi, Toru; Yoshida, Kentaro; Takeyasu, Noriyuki; Masuda, Keita; Sekiguchi, Yukio; Sato, Akira; Tada, Hiroshi; Nogami, Akihiko; Aonuma, Kazutaka

2015-02-01

Septal atrial tachycardia (AT) can occur in patients without structural heart disease and in patients with previous catheter ablation of atrial fibrillation. We aimed to assess septal AT that occurs after open-heart surgery. This study comprised 20 consecutive patients undergoing catheter ablation of macroreentrant AT after open-heart surgery. Relevance to surgical approach, mechanisms, anatomic and electrophysiological characteristics, and outcomes were assessed. Septal AT was identified in 7 patients who had all undergone mitral valve surgery. All septal ATs were localized in the left atrial septum, whereas 10 of 13 nonseptal ATs originated from the right atrium. Patients with left septal AT had a thicker fossa ovalis (median, 4.0; 25th-75th percentile, 3.6-4.2 versus 2.3; 1.6-2.6 mm; P=0.006) and broader area of low voltage (open-heart surgery was characterized by a thicker septum, more scar burden in the septum, and repeated prolongations of the tachycardia cycle length during ablation. Such an arrhythmogenic substrate may interfere with transmural lesion formation by ablation and may account for higher likelihood of recurrence of left septal AT. © 2014 American Heart Association, Inc.

Left Atrial Appendage Closure Device With Delivery System: A Health Technology Assessment

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Nevis, Immaculate; Falk, Lindsey; Wells, David; Higgins, Caroline

2017-01-01

Background Atrial fibrillation is a common cardiac arrhythmia, and 15% to 20% of those who have experienced stroke have atrial fibrillation. Treatment options to prevent stroke in people with atrial fibrillation include pharmacological agents such as novel oral anticoagulants or nonpharmacological devices such as the left atrial appendage closure device with delivery system (LAAC device). The objectives of this health technology assessment were to assess the clinical effectiveness and cost-effectiveness of the LAAC device versus novel oral anticoagulants in patients without contraindications to oral anticoagulants and versus antiplatelet agents in patients with contraindications to oral anticoagulants. Methods We performed a systematic review and network meta-analysis. We also conducted an economic literature review, economic evaluation, and budget impact analysis to assess the cost-effectiveness and budget impact of the LAAC device compared with novel oral anticoagulants and oral antiplatelet agents (e.g., aspirin). We also spoke with patients to better understand their preferences, perspectives, and values. Results Seven randomized controlled studies met the inclusion criteria for indirect comparison. Five studies assessed the effectiveness of novel oral anticoagulants versus warfarin, and two studies compared the LAAC device with warfarin. No studies were identified that compared the LAAC device with aspirin in patients in whom oral anticoagulants were contraindicated. Using the random effects model, we found that the LAAC device was comparable to novel oral anticoagulants in reducing stroke (odds ratio [OR] 0.85; credible interval [Cr.I] 0.63–1.05). Similarly, the reduction in the risk of all-cause mortality was comparable between the LAAC device and novel oral anticoagulants (OR 0.71; Cr.I 0.49–1.22). The LAAC device was found to be superior to novel oral anticoagulants in preventing hemorrhagic stroke (OR 0.45; Cr.I 0.29–0.79), whereas novel oral

Role of diastolic function indices in the risk stratification of patients with mixed aortic valve disease.

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Egbe, Alexander C; Khan, Arooj R; Boler, Amber; Said, Sameh M; Geske, Jeffrey B; Miranda, William R; Akintoye, Emmanuel; Connolly, Heidi M; Warnes, Carole A; Oh, Jae K

2018-06-01

Determine the role of diastolic function indices in pre-operative and post-operative risk stratification in patients with moderate mixed aortic valve disease (MAVD). A retrospective study was conducted of asymptomatic patients with moderate MAVD (a combination of moderate aortic stenosis and moderate aortic regurgitation) and an ejection fraction of 50% or more who were followed up at Mayo Clinic from 1 January 2004, to 31 December 2013. A pre-requisite for inclusion in the study was assessment of diastolic function involving at least three of the following indices: tissue Doppler early diastolic velocity (e'), mitral inflow early velocity (E), tricuspid regurgitation velocity, and left atrial volume index. Primary endpoints were aortic valve replacement (AVR) or cardiac death while secondary endpoints were cardiovascular adverse events (CAEs) after AVR. We defined CAEs as stroke, heart failure hospitalization, severe left ventricular dysfunction, and cardiac death. There were 214 patients (age 61 ± 8 years, men 146 [68%]) followed for 6.1 ± 2.3 years during which 162 (76%) AVRs and 11 (5%) cardiac deaths occurred. The multivariable risk factors for cardiac death or AVR were relative wall thickness (RWT) > 0.42 [hazard ratio (HR), 1.88 [95% CI, 1.28-2.59]; P = 0.001] and average E/e' >14 (HR, 1.94 [95% CI, 1.29-3.01]; P = 0.02). Freedom from CAE after AVR was significantly lower in the patients with baseline RWT >0.42 or mean E/e' >14 than the other patients: 79% (95% CI 74-83%) vs. 94% (95% CI 89-98%) at 3 years (P = 0.03). The presence of RWT >0.42 or E/e' >14 identifies a high-risk patient subset whose risk for cardiovascular morbidities persists even after AVR.

Ventricular distension and diastolic coronary blood flow in the anaesthetized dog.

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Gattullo, D; Linden, R J; Losano, G; Pagliaro, P; Westerhof, N

1993-01-01

There appears to be no agreement as to whether or not an increase in diastolic left ventricular pressure and/or volume can cause a decrease in diastolic coronary blood flow. We investigated the problem in the anaesthetized dog using a flaccid freely distensible latex balloon inserted into the left ventricle with the animal on extracorporeal circulation and the coronary perfusion pressure constant at about 45 mm Hg. Maximal vasodilatation and suppression of autoregulation in coronary vasculature was obtained by the intracoronary infusion of dipyridamole (10-40 mg/h). Ventricular volume was changed in steps of 10 ml from 10 to 70 ml and back to 10 ml, whilst recording coronary blood flow and left ventricular pressure in the left circumflex coronary artery. Over a range of ventricular volumes from 20 to 50 ml and a concomitant rise in diastolic ventricular pressure to about 20 mm Hg there was no change in the diastolic coronary flow. Only when the ventricular volume was more than two times the control value (i.e. exceeded 50 ml) and left ventricular pressure was more than 20 mm Hg, was there a decrease in coronary flow. During the return of the volume to the control level there was a fall in diastolic flow and ventricular contractility with respect to the values obtained when the volume was increased; these two effects were transient lasting less than 10 min. It was not considered that any of the three models of the coronary circulation, waterfall, intramyocardial pump or varying elastance model could explain our results.(ABSTRACT TRUNCATED AT 250 WORDS)

Three-dimensional atrial wall thickness maps to inform catheter ablation procedures for atrial fibrillation.

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Bishop, Martin; Rajani, Ronak; Plank, Gernot; Gaddum, Nicholas; Carr-White, Gerry; Wright, Matt; O'Neill, Mark; Niederer, Steven

2016-03-01

Transmural lesion formation is critical to success in atrial fibrillation ablation and is dependent on left atrial wall thickness (LAWT). Pre- and peri-procedural planning may benefit from LAWT measurements. To calculate the LAWT, the Laplace equation was solved over a finite element mesh of the left atrium derived from the segmented computed tomographic angiography (CTA) dataset. Local LAWT was then calculated from the length of field lines derived from the Laplace solution that spanned the wall from the endocardium or epicardium. The method was validated on an atrium phantom and retrospectively applied to 10 patients who underwent routine coronary CTA for standard clinical indications at our institute. The Laplace wall thickness algorithm was validated on the left atrium phantom. Wall thickness measurements had errors of atrial wall thickness measurements were performed on 10 patients. Successful comprehensive LAWT maps were generated in all patients from the coronary CTA images. Mean LAWT measurements ranged from 0.6 to 1.0 mm and showed significant inter and intra patient variability. Left atrial wall thickness can be measured robustly and efficiently across the whole left atrium using a solution of the Laplace equation over a finite element mesh of the left atrium. Further studies are indicated to determine whether the integration of LAWT maps into pre-existing 3D anatomical mapping systems may provide important anatomical information for guiding radiofrequency ablation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

The immediate future for the medical treatment of atrial fibrillation

DEFF Research Database (Denmark)

Pedersen, Ole Dyg; Brendorp, Bente; Køber, Lars

2002-01-01

) the rhythm causes loss of atrioventricular synchrony, which reduces diastolic filling and may lead to heart failure; and iii) atrial contraction is lost leading to stagnant blood that again may lead to atrial thrombi and peripheral embolism. Thus, the treatment of atrial fibrillation is focused...... on the maintenance of sinus rhythm, rate control and prevention of embolism. For the maintenance of sinus rhythm, all drugs under current development are potassium channel blockers; the so-called class III anti-arrhythmic drugs. Those which have been further investigated appear to be valuable for maintenance...

Increased left ventricular mass and diastolic dysfunction are associated with endothelial dysfunction in normotensive offspring of subjects with essential hypertension.

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Zizek, Bogomir; Poredos, Pavel

2007-01-01

We aimed to investigate left ventricular (LV) morphology and function in normotensive offspring of subjects with essential hypertension (familial trait - FT), and to determine the association between LV mass and determinants of LV diastolic function and endothelium-dependent (NO-mediated) dilation of the brachial artery (BA). The study encompassed 76 volunteers of whom 44 were normotonics with FT aged 28-39 (mean 33) years and 32 age-matched controls without FT. LV mass and LV diastolic function was measured using conventional echocardiography and tissue Doppler imaging (TDI). LV diastolic filling properties were assessed and reported as the peak E/A wave ratio, and peak septal annular velocities (E(m) and E(m)/A(m) ratio) on TDI. Using high-resolution ultrasound, BA diameters at rest and during reactive hyperaemia (flow-mediated dilation--FMD) were measured. In subjects with FT, the LV mass index was higher than in controls (92.14+/-24.02 vs 70.08+/-20.58); p<0.001). Offspring of hypertensive families had worse LV diastolic function than control subjects (lower E/A ratio, lower E(m) and E(m)/A(m) ratio; p<0.001). In subjects with FT, FMD was decreased compared with the controls (6.11+/-3.28% vs 10.20+/-2.07%; p<0.001). LV mass index and E(m)/A(m) ratio were associated with FMD (p<0.001). In normotensive individuals with FT, LV morphological and functional changes were found. We demonstrated that an increase in LV mass and alterations in LV diastolic function are related to endothelial dysfunction.

Effect of the Size of the Left Atrium on Sustained Sinus Rhythm in Patients Undergoing Mitral Valve Surgery and Concomitant Bipolar Radiofrequency Ablation for Atrial Fibrillation.

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Avdagić, Harun; Sijerčić Avdagić, Selma; Pirić Avdagić, Melika; Antonič, Miha

2017-12-01

Atrial fibrillation is associated with systemic embolization and complications due to anticoagulant therapy. Radiofrequency ablation has been established as an effective and safe method for the treatment of atrial fibrillation. The aim of this study was to evaluate the effect of the size of the left atrium on the outcome of surgical radiofrequency ablation. Forty patients scheduled for elective mitral valve surgery and radiofrequency ablation were enrolled in the study. Group 1 consisted of patients with a left atrium diameter ≤5 cm and group 2 of patients with left atrium diameter >5 cm. The primary endpoint of the study was stable sinus rhythm 6 months postoperatively. At 6 months postoperatively, sinus rhythm was present in significantly more group 1 patients as compared with group 2 patients, i.e. 15 (75%) vs. 8 (40%), p=0.025. Multivariate analysis proved the size of the left atrium to be an independent predictor of the radiofrequency ablation outcome. Accordingly, the size of the left atrium was demonstrated to be an important predictor of the outcome of radiofrequency ablation for atrial fibrillation. A lower cut-off value of surgical reduction of the atria than previously reported should be considered in order to improve the radiofrequency ablation outcome.

Sildenafil and diastolic dysfunction after acute myocardial infarction in patients with preserved ejection fraction

DEFF Research Database (Denmark)

Andersen, Mads J; Ersbøll, Mads; Axelsson, Anna

2013-01-01

with diastolic dysfunction after myocardial infarction. METHODS AND RESULTS: Seventy patients with diastolic dysfunction and near normal left ventricular ejection fraction on echocardiography were randomly assigned sildenafil 40 mg thrice daily or matching placebo for 9 weeks. Before randomization and after 9......, and systemic vascular resistance index (resting, P=0.0002; peak exercise, P=0.007) and diastolic blood pressure (resting, P=0.005; peak exercise, P=0.02) were lower in the sildenafil group. Resting left ventricular end-diastolic volume index increased (P=0.001) within the sildenafil group but was unchanged...

Prospective randomized evaluation of the watchman left atrial appendage closure device in patients with atrial fibrillation versus long-term warfarin therapy: The PREVAIL trial.

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Belgaid, Djouhar Roufeida; Khan, Zara; Zaidi, Mariam; Hobbs, Adrian

2016-09-15

Assessing the safety and effectiveness of left atrial appendage (LAA) (pouch found in the upper chambers of the heart) occlusion, using the Watchman device compared to long term warfarin therapy (drug that reduces clot formation), in preventing the risk of stroke in patients with atrial fibrillation (most common type of irregular heart beat). 90% of strokes in atrial fibrillation arise from clots forming in this pouch. By mechanically blocking it using the device less clots are suggested to be formed. This is an alternative to taking warfarin especially in patients who cannot take it. 50 sites in the United States enrolled 407 participants. After being randomly allocated, the device group had 269 participants and warfarin group (comparator)had 138 participants. Patients with atrial fibrillation and at high risk of stroke were randomly allocated a group after they were deemed eligible. Patients in the device group had to take warfarin and aspirin for 45days till the complete closure of the LAA. The oral anticoagulant was followed by dual antiplatelet therapy until 6months and then ASA. Patients in the warfarin group have to take it for life and were continually monitored. The study ran for 26months. The trial assessed the rate of adverse events using three endpoints: The PREVAIL trial was not designed to show superiority, but non-inferiority. It met the safety endpoint and one efficacy endpoint for the watchman device compared to long term warfarin for overall efficacy of the device. The results established that LAA occlusion is not worse than warfarin intake for the prevention of stroke more than 1week after randomization. Compared to previous trials, the safety of the device has also improved. LAA occlusion is a reasonable alternative to chronic warfarin therapy in stroke prevention for patients with atrial fibrillation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

An effect of left ventricular hypertrophy on mild-to-moderate left ventricular diastolic dysfunction

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Sharma Kattel, MD

2016-03-01

Conclusions: In mild-to-moderate LVDD patients, both FP and the Tei index were significantly higher when LVH was present. This may suggest LVH as a possible predictor for the future development of severe LVDD and diastolic heart failure.

Percutaneous left atrial appendage occlusion in atrial fibrillation patients with a contraindication to oral anticoagulation: a focused review.

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Nishimura, Marin; Sab, Shiv; Reeves, Ryan R; Hsu, Jonathan C

2017-12-08

Stroke is the most feared complication of atrial fibrillation (AF). Although oral anticoagulation with non-vitamin K antagonist and non-vitamin K antagonist oral anticoagulants (NOACs) have been established to significantly reduce risk of stroke, real-world use of these agents are often suboptimal due to concerns for adverse events including bleeding from both patients and clinicians. Particularly in patients with previous serious bleeding, oral anticoagulation may be contraindicated. Left atrial appendage occlusion (LAAO), mechanically targeting the source of most of the thrombi in AF, holds an immense potential as an alternative to OAC in management of stroke prophylaxis. In this focused review, we describe the available evidence of various LAAO devices, detailing data regarding their use in patients with a contraindication for oral anticoagulation. Although some questions of safety and appropriate use of these new devices in patients who cannot tolerate anticoagulation remain, LAAO devices offer a significant step forward in the management of patients with AF, including those patients who may not be able to be prescribed OAC at all. Future studies involving patients fully contraindicated to OAC are warranted in the era of LAAO devices for stroke risk reduction. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

Layer-specific systolic and diastolic strain in  hypertensive patients with and without mild diastolic dysfunction

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Hisham Sharif PhD

2018-03-01

Full Text Available This study sought to examine layer-specific longitudinal and circumferential systolic and diastolic strain, strain rate (SR and diastolic time intervals in hypertensive patients with and without diastolic dysfunction. Fifty-eight treated hypertensive patients were assigned to normal diastolic function (NDF, N = 39 or mild diastolic dysfunction (DD, N = 19 group. Layer-specific systolic and diastolic longitudinal and circumferential strains and SR were assessed. Results showed no between-group difference in left ventricular mass index (DD: 92.1 ± 18.1 vs NDF: 88.4 ± 16.3; P = 0.44. Patients with DD had a proportional reduction in longitudinal strain across the myocardium (endocardial for DD −13 ± 4%; vs NDF −17 ± 3, P < 0.01; epicardial for DD −10 ± 3% vs NDF −13 ± 3%, P < 0.01; global for DD: −12 ± 3% vs NDF: −15 ± 3, P = 0.01, and longitudinal mechanical diastolic impairments as evidenced by reduced longitudinal strain rate of early diastole (DD 0.7 ± 0.2 L/s vs NDF 1.0 ± 0.3 L/s, P < 0.01 and absence of a transmural gradient in the duration of diastolic strain (DD endocardial: 547 ± 105 ms vs epicardial: 542 ± 113 ms, P = 0.24; NDF endocardial: 566 ± 86 ms vs epicardial: 553 ± 77 ms, P = 0.03. Patients with DD also demonstrate a longer duration of early circumferential diastolic strain (231 ± 71 ms vs 189 ± 58 ms, P = 0.02. In conclusion, hypertensive patients with mild DD demonstrate a proportional reduction in longitudinal strain across the myocardium, as well as longitudinal mechanical diastolic impairment, and prolonging duration of circumferential mechanical relaxation.

Classification of Atrial Septal Defect and Ventricular Septal Defect with Documented Hemodynamic Parameters via Cardiac Catheterization by Genetic Algorithms and Multi-Layered Artificial Neural Network

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Mustafa Yıldız

2012-08-01

Full Text Available Introduction: We aimed to develop a classification method to discriminate ventricular septal defect and atrial septal defect by using severalhemodynamic parameters.Patients and Methods: Forty three patients (30 atrial septal defect, 13 ventricular septal defect; 26 female, 17 male with documentedhemodynamic parameters via cardiac catheterization are included to study. Such parameters as blood pressure values of different areas,gender, age and Qp/Qs ratios are used for classification. Parameters, we used in classification are determined by divergence analysismethod. Those parameters are; i pulmonary artery diastolic pressure, ii Qp/Qs ratio, iii right atrium pressure, iv age, v pulmonary arterysystolic pressure, vi left ventricular sistolic pressure, vii aorta mean pressure, viii left ventricular diastolic pressure, ix aorta diastolicpressure, x aorta systolic pressure. Those parameters detected from our study population, are uploaded to multi-layered artificial neuralnetwork and the network was trained by genetic algorithm.Results: Trained cluster consists of 14 factors (7 atrial septal defect and 7 ventricular septal defect. Overall success ratio is 79.2%, andwith a proper instruction of artificial neural network this ratio increases up to 89%.Conclusion: Parameters, belonging to artificial neural network, which are needed to be detected by the investigator in classical methods,can easily be detected with the help of genetic algorithms. During the instruction of artificial neural network by genetic algorithms, boththe topology of network and factors of network can be determined. During the test stage, elements, not included in instruction cluster, areassumed as in test cluster, and as a result of this study, we observed that multi-layered artificial neural network can be instructed properly,and neural network is a successful method for aimed classification.

The impact of age on the postoperative response of the diastolic function and left ventricular mass regression after surgical or transcatheter aortic valve replacement for severe aortic stenosis.

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Nakamura, Teruya; Toda, Koichi; Kuratani, Toru; Miyagawa, Shigeru; Yoshikawa, Yasushi; Fukushima, Satsuki; Saito, Shunsuke; Sawa, Yoshiki

2017-06-01

We examined the impact of advanced age on left ventricular mass regression and the change in the diastolic function after aortic valve replacement in patients with aortic stenosis. The present study included 129 patients who underwent either surgical or transcatheter aortic valve replacement and 1-year postoperative echocardiography. The patient characteristics and echocardiographic findings were compared between patients who were regression was significantly greater (p = 0.02) and diastolic dysfunction was less prevalent in group Y (p = 0.02) in comparison to group O. The change in E/e' was significantly correlated with the left ventricular mass regression in group Y (p = 0.02), but not in Group O (p = 0.21). The patients in group O were less susceptible to improvements in myocardial remodeling and the diastolic function in comparison to those in group Y. The altered physiological response to aortic valve replacement might help to determine the appropriate timing of surgery in elderly patients.