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- Henein, Mark, et al.
(author)
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Atrial interaction in the form of 'cross talk' in patients with ventricular outflow tract obstruction.
- 2011
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 17:147(3), s. 388-392
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Journal article (peer-reviewed)abstract
- BACKGROUND: The Bernheim 'a' wave in the jugular venous pulse of patients with left ventricular hypertrophy has been shown to reflect accentuated right atrial activity. OBJECTIVE: To study possible atrial interaction in patients with right and left ventricular outflow tract obstruction due to significant pulmonary (PS) and aortic valvular stenosis (AS) respectively. METHODS: We studied 41 PS patients (age 36+/-10 year) and 41 AS patients (age 35+/-12 year) and their results were compared with those of 27 controls (age 30+/-7 year). RV and LV filling were recorded by conventional PW Doppler. Biventricular segmental function was studied using the PW tissue Doppler imaging (TDI) and M-mode techniques. RESULTS: The 2 patient groups had similar degree of ventricular outflow tract obstruction. Long axis function was impaired while global systolic function was preserved in the pressure-overloaded ventricle. Patients had higher peak late filling (A wave) and TDI late diastolic (Aa) velocities recorded in the disease-free ventricles despite having similar peak early filling velocities (E wave), E wave deceleration time and E/Ea ratios were not different from controls (p>0.05 for all). Such accentuation of atrial activity (A wave) was moderately correlated with the degree of contralateral ventricular outflow tract obstruction (p<0.001 for both). CONCLUSIONS: Long axis function is more sensitive than global function in revealing myocardial dysfunction in the pressure-overloaded ventricles. The increased contralateral atrial systolic activity suggests an evidence for atrial interaction in the form of 'cross talk'.
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| 3. |
- Henein, Mark, et al.
(author)
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Disturbed left atrial mechanical function in paroxysmal atrial fibrillation : a speckle tracking study
- 2012
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 155:3, s. 437-441
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Journal article (peer-reviewed)abstract
- OBJECTIVE: We aimed to assess left atrial (LA) intrinsic myocardial function and its relationship to left ventricular (LV) filling pattern in a group of paroxysmal atrial fibrillation (PAF) patients. METHODS: Twenty-three PAF patients (age 68±7year, 10 males) were studied using speckle tracking echocardiography and compared with 18 age and sex matched controls. LA segmental longitudinal strain (S), strain rate (SR) and myocardial velocities during atrial systole were measured as were LA diameters. E/A and E/Em were also measured. RESULTS: LA longitudinal diameter was larger in patients (5.5±0.6 vs. 4.8±0.6cm, p<0.01) and global LA S (-9.2±4.3 vs. -12.9±4.6%, p=0.01) and SR (-1.1±0.5 vs. -1.6±0.7 1/s, p<0.01) were reduced and correlated with E/A (r=0.52, p=0.01 and r=0.43, p<0.05, respectively). LA lateral S and SR were uniformly reduced compared with controls (p<0.05 for all). Both septal and lateral wall SR correlated with E/A (p<0.05 for all), only septal S correlated with E/A (p<0.05). LA myocardial velocities were highest at the annular level and lowest at the rear in both patients and controls (p<0.01 for all). CONCLUSION: In PAF patients, LA systolic function is suppressed and is directly related to the pattern of LV filling which itself may suggest raised pressures. While intrinsic global and segmental function can reproducibly be studied by S and SR, myocardial velocities reflect only regional motion, thus less sensitive in demonstrating localize dysfunction.
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| 6. |
- Henein, Mark, et al.
(author)
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Suppressed left atrial function in PAF
- 2012
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 157:2, s. 272-272
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Journal article (peer-reviewed)
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| 7. |
- Bajraktari, G. Gani, et al.
(author)
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LA diameter more than 40 mm predicts recurrence of atrial fibrillation after trans-catheter ablation : a systematic review and meta-analysis
- 2017
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In: European Journal of Heart Failure. - : European Society of Cardiology. - 1388-9842 .- 1879-0844. ; 19:S1, s. 431-432
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Journal article (peer-reviewed)abstract
- Background and Aim: Left atrial (LA) enlargement is associated with atrial fibrillation (AF) incidence and outcome. Trans-catheter ablation of AF has now become a conventional treatment of AF but its recurrence remains of clinical significance. The predictive role of the LA size in AF treatment is still controversial, hence the aim of this meta-analysis was to analyze the potential association between LA diameter and AF recurrence after ablation.Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to December 2016 in order to select clinical trial and observational studies, which assessed the predictive role of LA diameter in AF recurrence after catheter-ablation. 13.573 patients from 61 studies with paroxysmal AF (PAF), persistent (PeAF) or longstanding persistent AF (L-PeAF) were included.Results: The pooled analysis showed that after a follow-up period of 19± 7.74 months, patients with AF recurrence had larger LA size compared with those without AF recurrence, with a weighted mean difference (WMD) 0.49 ([95% CI 0.39 to 0.59], P < 0.001), irrespective of the type of AF. A subgroup analysis showed LA diameter to be different; WMD was 2.29 ([95% CI 1.31 to 3.26], P < 0.001) in PAF and 1.51 ([95% CI 1.10 to 1.93], P < 0.001) in PeAF/L-PeAF, the difference between these two subgroups was not significant (Chi2=2.04, I2=51.1%, p=0.15). LA diameter ≥40 mm predicted AF recurrence HR:1.08 [95% CI 1.03 to 1.14], P=0.006), but the best cut-off value, in all included patients, was ≥50mm HR:2.73 [95% CI 1.64 to 4.55], P<0.001).Conclusions: Increased LA diameter significantly predicts recurrence of AF after ablation procedure. While a diameter of 40 mm predicts recurrence, a diameter more than 50 mm is the most accurate predictor.
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| 8. |
- Bajraktari, G. Gani, et al.
(author)
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Reduced LA strain predicts atrial fibrillation recurrence after catheter ablation : a systematic review and meta-analysis
- 2017
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In: European Journal of Heart Failure. - : European Society of Cardiology. - 1388-9842 .- 1879-0844. ; 19:S1, s. 430-431
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Journal article (peer-reviewed)abstract
- Background and Aim: Despite the improved outcome of patients with atrial fibrillation (AF) who undergo catheter ablation, recurrence of the arrhythmia remains a concern. The aim of this meta-analysis was to assess the potential association between left atrial (LA) strain and AF recurrence after ablation.Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to December 2016 in order to identify clinical trial and observational studies, which assessed the predictive role of LA strain in AF recurrence after catheter-ablation. The search identified 898 patients form 10 studies, with paroxysmal AF (PAF) and persistent AF (PeAF).Results: The pooled analysis showed that after a follow-up period of 11.8± 8.1 months, patients with AF recurrence had reduced LA strain compared with those without AF, with a weighted mean difference (WMD) -7.04% ([95% CI -9.62 to -4.45], P < 0.0001). A subgroup analysis showed that LA strain was reduced regardless of AF type; WMD was -5.47% ([95% CI -9.82% to -1.13%], P=0.003) in PAF and -7.88% ([95% CI -11.19% to -4.56%], P < 0.001) in PAF/PeAF, the difference between these two subgroups was not significant (Chi2=0.75, I2=0.0%, p=0.39). A cut off value of 21% [6% to 30%], was 79% [65-86%] sensitive and 77% [66% to 91%] specific for predicting AF recurrence.Conclusions: Reduced LA strain significantly predicts recurrence of AF after ablation procedure, irrespective of AF type. This emphasizes the impact of LA wall remodeling on successful ablation.
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| 9. |
- Batalli, A., et al.
(author)
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Different predictors of exercise capacity in HFpEF compared to HFrEF
- 2017
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In: European Journal of Heart Failure. - : European Society of Cardiology. - 1388-9842 .- 1879-0844. ; 19:1, s. 314-314
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Journal article (peer-reviewed)abstract
- Background and Aim: Quality of life is as important as survival in heart failure (HF) patients. Controversies exist with regards to echocardiographic predictors of exercise capacity in HF, particularly in patients with preserved ejection fraction (HFpEF). The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional exercise capacity assessed by 6 min walk test (6-MWT) in patients with HFpEF.Methods: In 111 HF patients (mean age 63± 10 years, 47% female), an echo-Doppler study and a 6-MWT were performed in the same day. Patients were divided into two groups based on the 6-MWT distance (Group I: ≤ 300 m and Group II: >300 m).Results: Group I were older (p=0.008), had higher prevalence of diabetes (p=0.027), higher baseline heart rate (p=0.004), larger left atrium - LA (p=0.001), longer LV filling time - FT (p=0.019), shorter isovolumic relaxation time (p=0.037), shorter pulmonary acceleration time - PAAT (p=0.006), lower left atrial lateral wall myocardial velocity (a’) (p=0.018) and lower septal systolic myocardial velocity (s’) (p=0.023), compared with Group II. Patients with HF and reduced EF (HFrEF) had lower hemoglobin (p=0.007), higher baseline heart rate (p=0.005), higher NT-ProBNP (p=0.001), larger LA (p=0.004), lower septal s’, e’, a’ waves, and septal MAPSE, shorter PAAT (p < 0.001 for all), lower lateral MAPSE, higher E/A & E/e’, and shorter LVFT (p=0.001 for all), lower lateral e’ (p=0.009), s’ (p=0.006), RV e’ and LA emptying fraction (p=0.012 for both), compared with HFpEF patients. In multivariate analysis, only LA diameter [2.676 (1.242-5.766), p=0.012], and diabetes [0.274 (0.084 - 0.898), p=0.033] independently predicted poor 6-MWT performance in the group as a whole. In HFrEF, age [1.073 (1.012 - 1.137), p=0.018] and LA diameter [3.685 (1.348 - 10.071), p=0.011], but in HFpEF, lateral s’ [0.295 (0.099 - 0.882), p=0.029], and hemoglobin level [0.497 (0.248-0.998), p=0.049] independently predicted poor 6-MWT performance.Conclusion: In HF patients predictors of exercise capacity differ according to severity of overall LV systolic function, with left atrial enlargement in HFrEF and longitudinal systolic shortening in HFpEF as the the main predictors.
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