Left atrial strain as a predictor of atrial fibrillation in patients with asymptomatic severe aortic stenosis and preserved left ventricular systolic function

Aim. To study the structural and functional left heart parameters in patients with severe aortic stenosis (AS) and preserved ejection fraction (EF) in order to determine the risk of atrial fibrillation (AF).Material and methods. The study included 84 patients (men, 37; mean age, 68±8 years) with severe AS and EF >55%. All patients had sinus rhythm and were asymptomatic. Echocardiography was performed to assess longitudinal strain of the left ventricle (LVLS), right ventricle, left atrium (LALS) and the left atrial stiffness (LAS) using the speckle tracking method. Left ventricular mass index (LVMI) and maximum left atrium volume index (LAVI) were also determined. Patients were followed up for 1 year.Results. AF was reported in 27 (32%) patients, of which 9 (33%) had asymptomatic AF episodes detected by 48-hour electrocardiography. Eighteen (67%) patients with AF felt palpitations. Patients with and without episodes of atrial fibrillation had non-significant differences in LVMI, LAVI, and LVLS. Patients with atrial fibrillation had a lower LALS and a higher LAS compared with patients without atrial fibrillation. Regression analysis revealed that LALS and LAS were independent predictors of AF.Conclusion. AF develops in about one third of asymptomatic patients with severe AS and normal EF. The development of AF predisposes to the onset of AS symptoms in most patients. LALS and LAS were predictors of AF in these patients. Identification of patients at risk of AF will allow for earlier aortic valve replacement

INFLUENCE OF AEROBIC AND RESISTANT LOAD ON THE RISK OF ATRIAL FIBRILLATION IN ARTERIAL HYPERTENSION AND PAROXYSMAL ATRIAL FIBRILLATION

Aim. To study the influence of the two basic load types, aerobic exercise (AE) and resistant with weights (RW), on the course of atrial fibrillation, on echocardiographic, structural and functional parameters of the left ventricle and left atrium and on the frequency of atrial fibrillation (AF) onsets. Material and methods. We performed controlled study in 102 patients (45 women) with AH at the age 56±9 years with sinus rhythm and at least one known episode of AF. The patients were randomized to three groups for AE on thread-mill (n=34), for RW (n=34), and controls without any load (n=34).Results. As the study has shown, both types of load significantly improved structural and functional parameters of the left ventricle and atrium, and reduced the frequency of onset of AF comparing to controls. However, in 6 months of regular exercise the RW group had better diastolic function parameters of the left ventricle and the left atrium, and did not have any episodes of AF comparing to AE and controls. Systemic pressure and systolic parameters of the left ventricle did not differ in groups.Conclusion. Adherence in RW was better than AE group. Aftereffect in patients who stopped training was more significant than in stopped AE patients, which presented with higher peak of oxygen consumption in 9-minute thread-mill test in these patients with RW

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

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. </p

ECHOCARDIOGRAPHIC PARAMETERS OF THE LEFT ATRIUM IN DIASTOLIC DYSFUNCTION OF THE LEFT VENTRICLE AND EPISODES OF ATRIAL FIBRILLATION

Aim. To study the parameters of left atrium (LA) deformation for evaluation of left atrium deformation in diastolic dysfunction of the left ventricular (LV) and at least one known episode of paroxysmal AF or persisting AF with normal volumes of atriums.Material and methods. The controlled study is performed in 45 patients with diastolic dysfunction of the LV and at least one known episode of paroxysmal (PXAF) of persisting (PSAF) atrial fibrillation with normal chambers volumes, by studying of EchoCG parameters of maximum deformation and other parameters of the LA for definition of atrial functioning in the conditions of LV dysfunction.Results. By the data obtained in the study, in sinus rhythm patients and episodes of PXAF and PSAF, volumes of the LA and parameters of maximum deformity do differ from those in healthy individuals. Within these conditions LA works with more overload. Patients with PXAF and PSAF have, by 96 h EXG monitoring, more supraventricular extrasystoles.Conclusion. In AF patients the parameters of LA differ among the groups of patients with PSAF and PXAF and are more benign in PXAF

Prevalence and echocardiographic predictors of atrial fibrillation in patients with heart failure with preserved ejection fraction

Aim. To study the occurrence of atrial fibrillation (AF) in patients withnormal ejection fraction heart failure (NEJHF) without AF in anamnesis,and to perform comparative analysis of echocardiographic parameterswith the parameters of patients with NEJHF and known AF, as to studyindependent predictors of AF occurrence in NEJHF.Material and methods. Totally, 182 patients included (105 women)with metabolic syndrome and NEJHF (II-III functional classes by NYHA)at the age 63±12 y. o., with sinus rhythm and no anamnesis of AF(n=118), and with paroxysmal AF (PxAF) in anamnesis (n=28) orpersistent (PeAF) in anamnesis (n=36).Results. Among 118 patients with AF in anamnesis, in 49 (41,5%)during 3 years of follow-up, there were cases of PeAF and PxAF.Patients without AF in anamnesis had better relations for left and rightventricles filling comparison (E/e`) under load, index of maximum leftatrium volume (LA) (IVLAmax), systolic pressure in pulmonary artery(SPPA) during rest and after exertion, than patients with knownepisodes of PeAF and PxAF. Patients with PeAF had significantly highervalues of the index of post systolic shortening of the left ventricle,rigidity index of LA, IVLAmax, E/e` of RV, interatrial mechanicalasynchrony and low values of longitudinal deformation of the LA (LDLA)and velocity parameters of LDLA (VPLDLA). Female sex, systolicarterial pressure, SPPA, IVLAmax, E/e` in load, E/e` of RV, LDLA,longitudinal deformation of the left ventricle and VPLDLA wereindependent predictors of AF.Conclusion. Increased rigidity, parameters of longitudinal deformationand the volume of LA, as interatrial mechanical asynchrony are strongindependent predictors of AF in NEJHF

Mechanisms and predictors of ischemic mitral regurgitation at rest and on exertion in patients at early stage of myocardial infarction

Aim. Determination of the mechanisms and predictors of ischemic mitral regurgitation (IMR) at rest and on exertion in patients at early stage of myocardial infarction (MI).Material and methods. Seventy-seven patients with inferoposterior MI and 79 patients with anteroseptal apical MI were examined on the 7th day at rest and after exertion. We determined the degree of IMR (according to the PISA method), posteromedial and anterolateral papillary muscle (PM) displacement, closure height of the mitral valve (MV), systolic and diastolic mitral valve orifice area, volume of the left ventricle (LV), LV contractility index, deformation of the infarction regions, general LV deformation, deformation and systolic dyssinchrony of the PM.Results. IMR was more common in inferior MI (42% vs 28%). LV volumes in cases with anteroseptal apical MI and IMR were greater and LV deformation was less than in patients without IMR. In inferoposterior MI and IMR, differences were observed in the index of local contractility and function of the posteromedial PM. The differences in MI of both localizations and IMR compared with MI without IMR were the areas of the mitral orifice and dyssinchrony of the PM. The degree of IMR after exertion did not depend on the degree of IMR at rest. Predictors of IMR at rest in MI of both localizations were the apical displacement of MV closure and the area of the mitral orifice. In inferoposterior, posteromedial PM displacement, deformation of the infarcted areas, PM dyssinchrony were also predictors. In anteroseptal apical MI, the area of the mitral orifice was the predictor of IMR. Predictors of anteroseptal apical MI after physical exertion after inferior MI were mitral orifice areas, contractility index, displacement and deformation of the posteromedial PM. In anteroseptal apical MI, the IMR predictors were MV closure height and systolic area of mitral orifice.Conclusion. The study confirms the significance of changing the spatial orientation of the MV structures in MI of both localizations, impaired regional contractility in inferoposterior MI and LV volume in anteroseptal apical MI at early stage of the disease

Heart failure in Europe: Guideline-directed medical therapy use and decision making in chronic and acute, pre-existing and de novo, heart failure with reduced, mildly reduced, and preserved ejection fraction – the ESC EORP Heart Failure III Registry

Aims We analysed baseline characteristics and guideline-directed medical therapy (GDMT) use and decisions in theEuropean Society of Cardiology (ESC) Heart Failure (HF) III Registry. Methods and results Between1November 2018and31December 2020,10162 patients with acute HF (AHF, 39%, age 70 [62-79],36% women) or outpatient visit for HF (61%, age 66 [58-75], 33% women), with HF with reduced (HFrEF, 57%),mildly reduced (HFmrEF,17%) or preserved (HFpEF, 26%) ejection fraction were enrolled from 220 centres in 41European or ESC-affiliated countries. With AHF, 97% were hospitalized, 2.2% received intravenous treatment in theemergency department, and 0.9% received intravenous treatment in an outpatient clinic. AHF was seen by most bya general cardiologist (51%) and outpatient HF most by a HF specialist (48%). A majority had been hospitalized forHF before, but 26% of AHF and 6.1% of outpatient HF had de novo HF. Baseline use, initiation and discontinuation ofGDMT varied according to AHF versus outpatient HF, de novo versus pre-existing HF, and by ejection fraction. Afterthe AHF event or outpatient HF visit, use of any renin-angiotensin system inhibitor, angiotensin receptor-neprilysininhibitor, beta-blocker, mineralocorticoid receptor antagonist and loop diuretics was 89%, 29%, 92%, 78%, and 85%in HFrEF; 89%, 9.7%, 90%, 64%, and 81% in HFmrEF; and 77%, 3.1%, 80%, 48%, and 80% in HFpEF. ConclusionUse and initiation of GDMT was high in cardiology centres in Europe, compared to previous reports from cohortsand registries including more primary care and general medicine and regions more local or outside of Europe andESC-affiliated countries....................................