Relation between Left Atrial Remodeling in Young Patients with Cryptogenic Stroke and Normal Inter-atrial Anatomy / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: To investigate an association between left atrial (LA) structural and P wave dispersion (PWD) during sinus rhythm, and electrical remodeling in cryptogenic stroke (CS) patients. METHODS: Forty CS patients and 40 age- and sex-matched healthy controls were enrolled. P wave calculations were based on 12-lead electrocardiography (ECG) at a 50-mm/s-paper speed with an amplitude of 10 mm/mV. Difference between the maximum and minimum P wave duration was the P wave dispersion (PWD=Pmax-Pmin). LA deformation was evaluated by speckle tracking echocardiography within 3 days of the acute event. RESULTS: PWD was 30.1+/-7.0 ms and 27.4+/-3.5 ms in CS and control group (P=0.02), whereas LA maximum volume index [LAVImax] was 20.4+/-4.5 mL/m2 and 19.9+/-2.4 mL/m2 in CS and control group, respectively (P = 0.04). While global peak LA strain was [pLA-S] (LA reservoir function) 41.4 +/- 6.3% and 44.5 +/- 7.1% in CS and control group, (P = 0.04), global peak late diastolic strain rate values [pLA-SRa] (LA pump function) were 2.5 +/- 0.4% and 2.9 +/- 0.5% in CS and control group, respectively (P = 0.001). A mild and a strong negative correlation between global pLA-S and LAVImax (r=-0.49; P<0.01), and between PWD and global pLA-S (r = -0.52; P < 0.01), respectively, was observed in CS. CONCLUSIONS: Increased PWD is associated with impaired LA mechanical functions and enlargement, and involved in the pathophysiology of AF or an AF-like physiology in CS.

Infliximab; an Anti-TNF-Alpha Agent; Improves Left Atrial Abnormalities in Patients with Rheumatoid Arthritis: Preliminary Results : Cardiovascular Topic

Background : Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality. In the current prospective study; we addressed the impact of RA on left atrial (LA) function and electrical remodelling. Further; we tried to demonstrate the effects of infliximab; an anti-TNF-alpha agent; on echocardiographical LA abnormality in RA patients with preserved left ventricular (LV) ejection fraction. Methods: We compared 38 female RA patients without clinical evidence of heart disease and 30 female controls without RA and clinical evidence of heart disease. Further; we compared RA patients receiving infliximab and increasing doses of prednisolone over a three-month period. At baseline and post treatment; this study assessed (1) LA and LV parameters using conventional and speckle tracking echocardiography (STE); and (2) electrocardiographic P-wave changes. Results: The values of C-reactive protein (CRP); isovolumic relaxation time (IVRT); A wave; and deceleration time (DT) were significantly higher in RA patients compared to the control group (p 0.05); whereas E/E' and E/A values were found to be lower (p 0.05) in RA patients. E/E' values were lower in prednisolone- compared to infliximab-treated patients (p 0.05). After three months of infliximab and prednisolone treatment; CRP and disease activity score (DAS 28) values decreased in both groups (p 0.05); and Duke activity status index (DASI) increased (p 0.05). Maximal left atrial volume index (LAVImax); pre-contraction left atrial volume index (LAVIpreA) and maximum P wave (Pmax) of the RA patients were higher compared to the control group (p 0.05); whereas LA global strain was found to be lower (p 0.05). There was no difference in Pmax values between groups before and after the treatment period. E/E'; LAVImax and LAVIpreA values of infliximab-treated patients decreased and LA global strain increased after three months of therapy compared to baseline (p 0.05). At baseline in both treatment groups; E/E' and LA global late diastolic strain rate were lower in prednisolone- compared to infliximab-treated patients (p 0.05). Conclusion: There was echocardiographic LA abnormality in these RA patients. In this patient group there was also a meaningful increase in maximum P wave assessed by