Prevalence of Mitral Valve Regurge with or without Prolapse and Left Atrial Volume among Patients with Secundum Type Atrial Septal Defect

Background: An atrial septal defect (ASD) is a persistent interatrial communication. It is distinct from a patent foramen ovale wherein there is a flap with intermittent communication. The aim of this work was to assess prevalence of mitral valve regurge or prolapse and left atrial volume in patients with secundum type ASD. Methods: This prospective study was carried out at the cardiovascular department, Tanta University Hospitals on 140 patients either adult or children who were diagnosed as atrial septal defect by 2-D echocardiography. They were subjected to detailed history, detailed clinical examination, chest x-ray and echocardiography (2-D echo & Doppler). Results: 95% of patients were trivial or mild mitral regurgitation, 3.6% were moderate and 1.4% were severe. Cause of mitral valve regurgitation was 2.86% prolapse, 1.43% rheumatic and 0.71 dysplastic. Left atrial enlargement was found in 2.1% of patients. Mean LA diameter was 34.68 ± 3.9 mm, mean LA volume was 45.75 ± 3.44 ml and mean LA volume index was 24.14 ± 2.97 ml/m2. 1.43% of patients have history of rheumatic fever. 51.4% of patients presented with fatigue, 45.7% presented with palpitation, 41.4% of the patients presented with exertional dyspnea and 22.8% presented with tachypnea. Conclusions: The prevalence of mitral regurgitation is low in secundum ASD. Mitral regurgitation associated with secundum atrial septal defect could exist as a coexistent lesion, its recognition is important and most of them could be repaired with satisfactory results. Also, the left atrial volume was not affected except in sever mitral regurgitation.

Parâmetros Ecocardiográficos Simples são Fortes Preditores de Risco Cardiovascular em Indivíduos Assintomáticos: Coorte Elsa-Brasil / Simple Echocardiographic Parameters are Strong Predictors of the Cardiovascular Risk in Asymptomatic Individuals: Elsa-Brasil Cohort

Resumo Fundamento vários estudos avaliam alterações ecocardiográficas como preditores de risco cardiovascular; entretanto, nenhum associa risco cardiovascular global com alterações ecocardiográficas em brasileiros. Objetivo Este estudo avalia a associação entre risco cardiovascular global (ASCVD) e achados ecocardiográficos como hipertrofia ventricular esquerda (HVE), disfunção diastólica (DDVE) e aumento do volume do átrio esquerdo (AE). Métodos A população foi composta por participantes do ELSA-Brasil que realizaram ecocardiografia entre 2008 e 2010 (n = 2.973). Eram assintomáticos e não tinham história de doença cardiovascular (DCV). O escore ASCVD foi calculado em dois períodos: 2008-2010 e 2012-2014. Razões de prevalência (RP) foram estimadas com intervalos de confiança (IC) de 95%. Resultados Evidenciou-se associação entre alterações ecocardiográficas e alto risco cardiovascular global (escore ASCVD ≥ 7,5) nos dois períodos do estudo, separadamente. O risco global combinado (baixo risco no primeiro período e alto risco no segundo período) teve associação significativa apenas com DDVE (RP = 3,68; IC 95%: 2,63-5,15) e HVE (RP = 2,20; IC 95%: 1,62-3,00). Conclusão Alterações ecocardiográficas (DDVE, HVE e aumento do volume do AE) são preditores independentes de risco cardiovascular em adultos brasileiros sem DCV prévias.

Abstract Background Several studies have evaluated echocardiographic abnormalities as predictors of cardiovascular risk; however, none have associated the global cardiovascular risk with echocardiographic abnormalities in the Brazilian population. Objective This study evaluates the association between the global cardiovascular risk (ASCVD score) and three echocardiographic abnormalities: left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), and increased left atrium (LA) volume. Methods The study population was composed of participants from ELSA-Brasil who underwent echocardiography between 2008 and 2010 (n = 2973). They were asymptomatic and had no history of cardiovascular disease. The ASCVD score was calculated in two periods: 2008-2010 and 2012-2014. Prevalence ratios (PR) were estimated with 95% confidence intervals (CI). Results There is an association between echocardiographic abnormalities and high global cardiovascular risk (ASCVD score ≥ 7.5) in both study periods, separately. The combined global risk (low risk in the first period and high risk in the second period) was significantly associated only with LVDD (PR = 3.68, CI 95% 2.63-5.15) and LVH (PR = 2.20, 95% CI 1.62-3.00). Conclusion Echocardiographic abnormalities (LVDD, LVH, and increased LA volume) are independent predictors of cardiovascular risk in Brazilian adults.

Is Indexed Left Atrial Volume (LAVi) in Indian Patients with Acute Coronary Syndrome (ACS) Undergoing Revascularization a Predictor of Cardiovascular Outcomes?

Background: Left atrial volume indexed to body surface area (LAVi) is the recommended method for LA size quantification. Assessing LAVi in Indian patients undergoing coronary interventions for acute coronary syndrome (STEMI, NSTEMI, and UA) is clinically relevant. Methods and Results: Amongst 190 patients (66.4 yrs, 68.4% males), 29.5%, 40.5%, and 30% respectively had STEMI, NSTEMI and UA. Mean LAVi was 32.29 ± 12.06 ml/m2 and 111 (58.4%) had LAVi ?32 while 79 (41.6%) had LAVi <32. Patients were divided into 2 groups (group 1 LAVi >32 and group 2 LAVi <32). Group 1 patients had higher prevalence of TVD [n = 49 vs n = 5, p = <0.001] and higher mean Syntax score (24.47 vs 14.64, p = <0.001). Despite similar LVEF, those with higher LAVi had had higher incidence of mild MR (50.4 vs 27.8, P = 0.0002) and moderate/severe MR was present only in Group 1 patients (27.9% and 5.4%). Grade I, II, and III diastolic dysfunction was present in 71.2, 17.1, and 9.9% patients in Group 1 vs 45.6%, 0%, and 0% in group 2. Diastolic parameters like septal E/e’ and lateral E/e’ratio were also higher in Group 1. Major adverse cardiovascular events? (MACE) at 30 days was significantly higher in group 1 (20.7 vs 6.3%, P = 0.006). On multivariate analysis, triple vessel disease and LAVi were the only predictors of MACE while LVEF was not. ROC curve analysis for LAVi demonstrated that a cut?off 33.35 ml/m2, predicted 30 day MACE with Area under curve (AUC) 0.775 (95% CI 0.700?0.850); sensitivity and specificity of 86.7% and 61.4%. Inter?quartile analysis of LAVi (<26.3, 26.3?33.35, 33.36?36.3, and >36.3 ml/m2) demonstrated that 30 day MACE increased across quartiles (4.16%, 4.25%, 22.44%, and 28.26%, respectively, P < 0.001). Conclusion: Amongst patients with ACS undergoing revascularization, those with higher LAVi had more severe CAD, diastolic dysfunction and higher 30 day MACE. LAVi provides superior prognostic information as compared to conventional LV systolic and diastolic parameters in patients with ACS and should be incorporated in routine echocardiographic analysis. More studies with larger numbers and longer follow up are required to further elucidate on this.

Evaluation of changes in left atrial volume and function in patients with early diabetic nephropathy by four-dimensional auto left atrial quantification / 中华超声影像学杂志

Objective:To explore the changes of left atrial volume and function in patients with early diabetic nephropathy by four-dimensional auto left atrial quantification (4D Auto LAQ).Methods:Forty patients with early diabetic nephropathy (early diabetic nephropathy group), 40 patients with type 2 diabetes (diabetes group) in Henan Provincial People′s Hospital from March 2020 to April 2021 were selected, and 36 healthy volunteers (control group) were collected during the same period. The parameters of conventional echocardiography were measured, and the four-dimensional volume probe was used to obtain the complete left atrial volume image in 5 cardiac cycles. The 4D Auto LAQ software on the EchoPAC workstation was used for analysis to obtain the left atrial volume and strain indicators: left atrial (LA) maximum volume (LAVmax), left atrial minimum volume (LAVmin), pre-systolic volume (LAVpreA), left atrial volume index (LAVImax), left atrial emptying volume (LAEV), left atrial emptying fraction (LAEF), and long axis and circumferential strains in left atrial reserve phase, pipeline phase and systolic phase (LASr, LASr-c; LAScd, LAScd-c; LASct, LASct-c). The differences of these parameters among 3 groups were analyzed.Results:There were no significant differences in interventricular septum end-diastolic thickness(IVSd), left ventricular posterior wall end-diastolic thickness(LVPWd), left ventricular end-diastolic dimension(LVIDd), left ventricular ejection fraction(LVEF), and E/A (ration of early to late diastolic peak flow velocity of mitral orifice) among 3 groups (all P>0.05), and left atrial diameter(LAD), relative wall thickness(RWT), and E/e′ (ration of early diastolic peak flow velocity of mitral orifice to early diastolic velocity of lateral mitral annulus) among 3 groups were significantly different (all P<0.05). Further pairwise comparison results showed that LAD was only significantly different between the early diabetic nephropathy group and control group ( P=0.001 2), and the differences in RWT and E/e′ were statistically significant among 3 groups (all P<0.05). There were no significant differences in LAEV, LAScd-c, and LASct-c among 3 groups (all P>0.05), and LAVmin, LAVmax, LAVpreA, LAVImax, LAEF, LASr, LAScd, LASct, and LASr-c among the 3 groups were significantly different (all P<0.05). The pairwise comparison showed that, compared with the control group and the diabetes group, LAVmin, AVpreA, and LAVImax in the early diabetic nephropathy group were increased, and LAEF, LAScd, LASct, and LASr-c were decreased (all P<0.05). Compared with the control group, LAVmax, LAVImax and LASct in the diabetes group were increased, and LAEF, LAScd, and LASr-c were decreased (all P<0.05). Conclusions:4D Auto LAQ technology can quantitatively evaluate the changes in left atrium volume and function in patients with early diabetic nephropathy. Patients with early diabetic nephropathy have an increase in left atrium volume and a decrease in strain value.

Evaluation of left atrial function in asymptomatic dogs with chronic myxomatous mitral valve disease: two-dimensional feature-tracking echocardiography and Simpsons monoplanar methods / Avaliação da função atrial esquerda em cães assintomáticos com degeneração mixomatosa crônica de valva mitral: métodos ecocardiográficos bidimensional feature tracking e monoplanar de Simpson

The present study evaluated the volume and function of the left atrium by two-dimensional echocardiographic feature-tracking imaging (2D-FTI) and Simpson's monoplanar modeling in dogs with asymptomatic degenerative mitral valve disease (DMVD). The study consisted of 80 dogs that were divided into the following three groups: Group 1, 21 dogs (A); Group 2, 30 dogs (B1) and Group 3, 29 dogs (B2). The variable strain (contraction phase) was significantly lower in Group 3 than in Group 1 (12.92±4.54 x 16.69±5.74, p=0.014), and significant differences in the contraction strain index (CSI) were observed between all of the groups that were evaluated (1 = 46.82±8.10, 2 = 39.88±8.03, 3 = 35.25±5.64, p<0.0001). The atrial diastolic volume index (AdVi) that was measured by 2D-FTI was significantly higher in Group 3 than in Group 1 (1.31±0.95 x 0.96±0.31, p=0.038), and the atrial cardiac index (ACI) was also higher in Group 3 than in Group 1 (102.38±80.18 x 78.19±33.38, p=0.030). Atrial function was assessed by Simpson's monoplanar method, which demonstrated an increase in the left atrial systolic volume, while the contractile function decreased with an increasing disease severity (Group 1 0.21±0.06; Group 2 0.25±0.06; Group 3 0.32±0.08, p<0.0001). The intraobserver and interobserver assessments showed low to moderate variability; most of the values for the coefficient of variation for the variables that were analysed with each method were below 25%. Thus, DMVD was determined to cause an alteration in atrial function, especially in the contraction phase, and even in asymptomatic animals, and the methods of 2D-FTI echocardiography and Simpson's monoplanar evaluation are sensitive and early methods for the detection of left atrial dysfunction.(AU)

O presente estudo avaliou o volume e a função atrial esquerda obtidos por meio da ecocardiografia bidimensional feature tracking (2D-FTI) e pelo método monoplanar de Simpson em cães saudáveis e cães com DMVD assintomáticos. Foram avaliados 80 cães distribuídos em três grupos: Grupo 1, 21 cães (classe A); Grupo 2, 30 cães (classe B1) e Grupo 3, 29 cães (classe B2). A variável strain (fase de contração) foi significativamente menor no Grupo 3 que no Grupo 1 (12,92±4,54 x 16,69±5,74, p=0,014) e para a variável índice de strain de contração (CSI), houve diferença estatística entre todos os grupos avaliados (1 = 46,82±8,10; 2 = 39,88±8,03; 3 = 35,25±5,64, p<0,0001). O índice de volume diastólico atrial (iVdA) mensurado por meio do 2D-FTI foi significativamente maior no Grupo 3 que no Grupo 1 (1,31±0,95 x 0,96±0,31, p=0,038), assim como para o índice cardíaco atrial (iCA) também foi maior no Grupo 3 (102,38±80,18 x 78,19±33,38, p=0,030). A função atrial avaliada pelo método monoplanar de Simpson demonstrou um aumento do volume atrial esquerdo e do volume sistólico do átrio esquerdo, enquanto que a função contrátil diminuiu com o aumento da gravidade da doença (Grupo 1 0,21±0,06; Grupo 2 0,25±0,06; Grupo 3 0,32±0,08; p<0,0001). A avaliação intraobservador e interobservador, demonstrou variabilidade baixa a moderada, uma vez que a maioria dos valores de coeficiente de variação se concentraram abaixo de 25% para as variáveis analisadas em ambos os métodos. Dessa forma, conclui-se que a DMVD causa alteração na função atrial, principalmente na fase de contração, mesmo em animais assintomáticos e que a ecocardiografia 2D-FTI e o método monoplanar de Simpson são métodos sensíveis e precoces na detecção da disfunção atrial esquerda.(AU)

Left atrial function and volume by magnetic resonance in patients with hereditary amyloidosis

ABSTRACT Background Left atrial (LA) enlargement is a reliable predictor of adverse cardiovascular events, and reduced atrial function is an independent risk factor for mortality in patients with amyloidosis. The objective of this study was to characterize the LA function in Mexican patients with a confirmed diagnosis of hereditary transthyretin amyloidosis (amyloid transthyretin [ATTR]) Methods All consecutive patients with diagnosis of hereditary ATTR who underwent a cardiac magnetic resonance study in the period from March 2016 to June 2017 were included in the study; the volumes and function of the left atrium were evaluated Results Patients were divided into two groups, one with and one without cardiac amyloidosis. Statistically significant differences were observed between both groups in terms of indexed maximal LA volume, 26 mL versus 35.9mL, p = 0.03; indexed minimal LA volume, 10.7 mL versus 13.6mL, p = 0.03; and indexed LA pre-contraction volume, 17 mL versus 22.4mL, p = 0.03. No statistically significant differences were observed between both groups when comparing neither different ejection volumes nor the different ejection fractions Conclusions Patients with hereditary ATTR with cardiac involvement have remodeling of the left atrium, with increased atrial volumes, without diminishing its function.

Prognostic Significance of Left Atrial Volume Index in Acute Myocardial Infarction and its Angiographic Correlation

Evaluating left atrium volume is a good way to estimate prognosis in acute myocardial infarction patients because it indicates to time and severity of diastolic dysfunction and longer-term results of acute myocardial infarction. Left atrial (LA) volume is a prognostic predictor across a wide spectrum of cardiac and non-cardiac diseases. Aim: To assess the left atrial volume index in Myocardial Infarction & Angiographic correlation and to assess any correlation between with left atrial volume index and outcomes of MI such as heart failure, short term mortality, arrhythmias, and ejection fraction. Methods: 100 patients with ST elevation in ECG, with history, examination, ECG changes and elevated CK-MB, Anterior, Inferior, Right ventricle & Posterior wall Myocardial infarction were included. The patients were studied considering demographic factors, risk factors, echocardiography indexes such as systolic and diastolic functions and left atrium volume and angiography. Results: Among LAVI >34, 22 had (70-90%) of RCA, 7 had (70-90%) of LCX, 29 had (70-90%) of LAD. Among LAVI>34, 14 patients had TVD, 5 had DVD, 29 had SVD, 9 normal coronaries, which are not statistically significant. Among LAVI >34, 22 patients undergone PCI, 7 patients underwent CABG, 1 patient had CHB, 3 patient had VT and 9 patients had AF, which is statistically significant. Among LAVI>34, 24 patients had HF at 30 days follow-up. Among LAVI>34, in 30 days follow up 1 patient expired. When compared with LAVI <34 it was not statistically significant. Conclusion: LA Volume index provides prognostic information incremental to clinical data and standard Echocardiographic predictors of outcome, including LV systolic function and Doppler assessment of Diastolic Function.

Methodological comparison of left atrium classification according to the latest echocardiographic data from Chinese adults / 中华超声影像学杂志

Objective To analyze and compare the classification of left atrial size by different echocardiographic measurements based on the latest large sample of normal Chinese adults'echocardiographic data . Methods The echocardiography data of 1067 unselected adult outpatients were retrospectively analyzed . The outpatients were divided into normal or enlarged groups according to the left atrialantero-posteriordiameter(LAD)andleftatrialvolume(LAV),respectively.Results ①LADand LAV enlargement were found in 299 (28 .0％ ) patients and 449 (42 .1％ ) patients of the total population , respectively . ②There was a good positive linear correlation between LAD and LAV ( r = 0 .642 , P =0 .000) ,but the agreement for the classification of left atrial size by LAD and LAV was not ideal ( Kappa =0 .392 , P = 0 .000) . The majority of the patients ( 74 .6％ ) with abnormal LAD had abnormal LAV . Conversely ,among the patients with abnormal LAV ( 50 .3％ ) had normal LAD . ③ The sensitivity and specificity of judging left atrial enlargement were 76 .8％ and 66 .8％ for LAD>3 .7 cm in male ,and 74 .9％and 70 .6％ for LAD>3 .4 cm in female ,respectively . The sensitivity and specificity of judging severely left atrial enlargement were 75 .5％ and 78 .7％ for LAD>4 .0 cm in male ,and 84 .2％ and 75 .8％ for LAD>3 .7 cm in female ,respectively . Conclusions The agreement of the classification of left atrial size by LAD and LAV is limited . LAD-based assessment may result in an underestimation of left atrial size . When LAD is larger than 4 .0 cm for male or 3 .7 cm for female ,the accuracy of LAD in the diagnosis of left atrial enlargement is better .

Real-time three-dimensional echocardiographic left heart parameters in healthy indian adults

Objective Cardiac chamber dimensions are race and anthropometry dependent. We determined the age and gender specific 3-Dimensional echocardiographic (3DE) reference values for dimensions and function of left ventricle (LV) and left atrium (LA) in normal Indian adults. Methods This single center prospective study enrolled 133 adult Indians free of heart disease and/or hypertensions, subjecting them to 3DE measurements of left atrial (LA) & left ventricular (LV) volumes, function and left ventricular mass (LVM). The higher limits of normal cut-offs were determined for these parameters and their dependency on age, gender and anthropometry were analyzed. Results The body surface area (BSA) corrected higher limit cut-offs were: 59.37 ml/m2 for LV end diastolic volume (59.19 ml/m2 and 59.61 ml/m2 for men and women, respectively; P = NS); 23.48 ml/m2 for LV end systolic volume (23.27 ml/m2 and 23.11 ml/m2 for men and women, P = NS). Mean LVEF was 64.79% ± 7.26 (62.99% ± 6.51 and 67.05% ± 7.58 in men and women, P = NS). Men had higher LVM than women (119.79 g±23.95 vs. 103.26 g±23.76, P < 0.001), this difference disappeared after BSA indexing. The higher limit cut-offs for normal LA volumes were 20.49 ml for minimum volume (21.18 ml and 19.46 ml for men and women, P = NS) and 39.76 ml for maximum volume (39.60 ml and 40.03 ml in men and women, P = NS). The parameters were smaller compared to western populations but the differences attenuated after BSA indexing. Conclusions The study reports normal 3DE parameters of size and function of left heart chambers in Indians.

The relationship between left atrial appendage volume and recurrence of atrial fibrillation after radiofre- quency catheter ablation / 实用医学杂志

Objective To investigate the relationship between the volume of left atrial appendage and recurrence of atrial fibrillation(AF)after radiofrequency ablation. Methods In this retrospective cohort study, 66 cases of first atrial fibrillation radiofrequency catheter ablation in the Department of cardiovascular medicine of the First Affiliated Hospital of Zhengzhou University were enrolled from June 2014 to June 2016 and divided into the recurrence group(n=18)and the non recurrent group(n=48)based on the 1 year follow-up results ,Collecting the patient's clinical data and following up.64 layers of spiral CT scans were performed for all patients before operation,and the volume of left atrium( LAV)and left atrial appendage volume(LAAV)were measured. The general data ,laboratory examinationresults ,echocardiographic parameters and left atrial CT parameters of two groups were compared. The relationship between patient parameters and recurrence of atrial fibrillation after radio-frequency ablation were analyzed by multivariate logistic regression analysis. Results There was no significant difference in blood lipid and left ventricular ejection fraction(LVEF%)between the two groups in terms of sex, age ,hypertension ,coronary heart disease and other common diseases (P > 0.05).The volume of left atrial appendage and left atrial volume in the recurrent group were larger than those in the non recurrence group (P <0.05). The left atrial appendage volume(OR=1.518,95%CI:1.151-2.000,P = 0.003)can be used as an independent risk factor for postoperative recurrence of atrial fibrillation. The area under the ROC curve of left atrial appendage volume in predicting the recurrence of atrial fibrillation after radiofrequency ablation is 0.806(95%CI:0.689-0.922 ,P < 0.001). Conclusion Greater left ventricular volume is an independent risk factor for recurrence of atrial fibrillation after radiofrequency catheter ablation ,whether in paroxysmal atrial fibrillation or persistent atrial fibrillation.

Z-scores for fetal atrial volume using real-time three-dimensional echocardiographic Xplane imaging in normal fetuses / 中华超声影像学杂志

Objective To establish Z-scores reference ranges for fetal atrial volume in normal fetuses for accurate assessment of fetal cardiac structure and function . Methods Two hundred ninty-three normal fetuses with gestational ages between 18 to 38 weeks were investigated .Biparietal diameter (BPD) , femur length (FL) and gestational age (GA) were measured .Left atrial volume (LAV) and right atrial volume ( RAV ) were obtained using echocardiographic Xplane imaging . Subsequently , the optimal regression equation was established with BPD ,FL and GA as the independent variable and LAV and RAV as the dependent variable ,and then Z-scores of LAV and RAV were calculated . Results The linear regression equation of LAV and FL was Y＝0 .056×FL －1 .791 ( r ＝0 .952) ;the linear regression equation of RAV and FL was Y＝0 .057×FL －1 .833 ( r ＝0 .942) ;the linear regression equation of LAV and BPD was Y＝0 .046×BPD－2 .289 ( r ＝0 .910) ;the linear regression equation of RAV and BPD was Y＝0 .047×BPD－2 .348 ( r ＝0 .903) ;the linear regression equation of LAV and GA was Y ＝ 0 .122 × GA －2 .403 ( r ＝0 .952) ;the linear regression equation of RAV and GA was Y ＝0 .125×GA －2 .456 ( r ＝0 .942) . There was significant heteroscedasticity of standard deviation ( SD ) with increasing independent variables ,then weighted regression of absolute residuals was used in order to minimize the effect of heteroscedasticity ,and the linear regression equation was established . The linear regression equation of LAV-SD and FL was Y＝0 .005×FL －0 .119 ( r ＝0 .272) ;the linear regression equation of RAV-SD and FL was Y＝0 .005×FL －0 .104 ( r ＝0 .240) ;the linear regression equation of LAV-SD and BPD was Y＝ 0 .00375×BPD －0 .125 ( r＝0 .210) ;the linear regression equation of RAV-SD and BPD was Y＝0 .00375×BPD －0 .10875 ( r ＝0 .192) ;the linear regression equation of LAV-SD and GA is Y＝0 .0125×GA －0 .21125 ( r ＝0 .346) ;the linear regression equation of RAV-SD and GA was Y＝0 .0125×GA －0 .20875 ( r ＝0 .308) . According to these equations ,the Z-score calculation formula for LAV was ( measured LAV-predicted LAV from BPD , FL and GA)/SD of predicted LAV ; Z-score calculation formula for RAV was ( measured RAV －predicted RAV from BPD ,FL and GA)/SD of predicted RAV . Conclusions Fetal Z-scores references for the LAV and RAV can be established using common fetal biometrical parameters ( including FL ,BPD and GA utilizing statistical methods based on a large sample size) . This enhances accurate assessment of growth and development of fetal cardiac structures ,and provides novel insights for the determination of fetal atrial volume in fetuses with congenital heart disease .

Mitral Regurgitation Severity with Left Atrial Volume Index as a Guide to the Early Myocardial Infarction Prognostic Outcome.

Background: Mitral regurgitation and the increase in left atrial volume are seen frequently in severe acute myocardial infarction. They are associated with left ventricular dysfunction and may predict the prognosis and the outcome for long term follow up myocardial infarction. It is important to understand the effect of both in early admission to intensive care unit especially on the development of shock, heart failure, dysrhythmia and the mortality. Methods: This is a prospective study carried out at Al Sader Teaching Hospital in Najaf City and in Cardiac Care Unit (CCU) from March 2014 to November 2014. 150 Patients with acute myocardial infarction were followed during their admission in CCU. Recording was done to the variables like age, sex, STEMI (ST Elevation Myocardial Infarction) or NSTEMI (Non ST Elevation Myocardial Infarction) types, the site of infarction, presence or absence of shock, pulmonary edema and dysrhythmia. All patients were studied by Echo-Doppler and mitral regurgitation severity was recorded as well as measurement of the left atrial volume index and both were correlated with the variables. Results: Mean age 66±15, 52.52% females, NSTEMI 65%, 30% atrial arrhythmia, 32% ventricular arrhythmia, left atrial volume index increased in 59%, mitral regurgitation in 56%. Severity grading of mitral regurgitation and the increase in left atrial volume index were significantly associated with shock p value 0.001, pulmonary edema p value 0.001 and arrhythmia P value 0.001. The mortality in acute myocardial infarction patients found to be significantly associated with the increase in Left Atrial Volume Index p value 0.0001 and with the severity of Mitral Regurgitation p value 0.013. Mortality of acute myocardial infarction was also significantly associated with pulmonary edema 0.001, shock p value 0.03 and site of infarction p value 0.017as well as the type of the infarction p value 0.007. Conclusion: Both mitral regurgitation severity and left atrial volume can predict the early outcome of Myocardial Infarction in early Cardiac Care Unit admission.

To investigate atrial septum and right atrial appendage pacing for prevention of new-on atrial fibrillation / 安徽医科大学学报

66 patients with sick sinus syndrome were enrolled in this study. All patients meeting the indications for dual chamber pacing were randomly divided into two groups: right atrial appendage(RAA) pacing group was made up of 36 patients and low atrial septal(LAS) pacing group was made up of 30 patients. Follow-up was 12 months. The incidence of atrial fibrillation(AF) was lower in LAS group(3. 3% ) compared with the RAA group(19. 4% );P wave dispersion in RAA group was significantly higher than that in the LAS group (P < 0. 01). After 3 months of the operation, left atrial volume index(LAVI) in RAA group was significantly larger than that in the LAS group. In LAS group compared with the RAA group P wave dispersion and LAVI were significantly lower after operation in sick sinus syndrome. LAS pacing was superior to RAA pacing in preventing new atrial fibrillation.

Changes of echocardiographic indices in patients receiving catheter ablation for atrial fibrillation with ;different outcomes / 实用医学杂志

Objective To explore the changes of different echocardiographic indices in patients receiving catheter ablation for atrial fibrillation with different outcomes. Methods 75 patients received catheter ablation for atrial fibrillation during the period of January 2012 to February 2014. Before and 6 monthes after ablation , all the patients were examined left atrial volume index (LAVi), left atrium pressure (LAP), and left atrial ejection force (LAF) with echocardiography. Then after 6 months, according to the outcomes of the procedure, we divided the patients into two groups and compared the changes of these three parameters. Results In sinus group, LAVi decreased while LAF increased after treatment [LAVi: (29.3 ± 1.9) vs. (41.2 ± 9.3), LAF:(1.31 ± 0.61) (kg·cm)/s2 vs. (0.83 ± 0.22) (kg·cm)/s2, P 0.05]; while in recurrent group, there were no changes in LAVi, LAP, and LAF after treatment (P > 0.05). Conclusions Radiofrequency catheter ablation is safe and effective in treatment of atrial fibrillation, resulting in significant improvements in left atrial volume and cardiac function.

Relationship between cardiac resynchronization therapy and change of left atrial volume index / 重庆医学

Objective To prospectively assess the association between cardiac resynchronization therapy (CRT )and left atrial volume .Methods Fourteen patients with chronic heart failure ,sinus rhythm and left bundle branch block were enrolled in this study and prepared for CRT implantation .Clinical and echocardiographic evaluations were performed before CRT implantation and 6 months later .Followings were parameters of the left atrial and left ventricular volume:left ventricular end-systolic volume index (LVESVi)and end-diastolic volume index(LVEDVi) ,maximal LAV index(iLAVmax) ,etc ,LAV index before atrial systole(iL-AVpre)and minimal LAV(iLAVmin) .CRT responders were defined as those whose reduction rates were more than 10% in iL-VESV in 6-month follow-up .Results Responders(71 .4% )and non-responders(28 .6% )had similar baseline ,clinical characteristics and pre-implantation LV volumes .However ,iLAVmax in the responders was remarkably lower than that in non-responders .CRT therapy significantly reduced LVESVi(P<0 .01) ,LVEDVi(P<0 .001) ,iLAVmax(P=0 .004) ,iLAVpre(P=0 .003)and iLAVpost (P<0 .01) ,but when compared with the non-responders ,iLAVmax was much lower in responders .Correlation analysis showed that there was a significant correlation of LVEDVi with iLAVmax ,iLAVpost(P<0 .05) .Conclusion CRT therapy can significant-ly improve iLAVpre and iLAVmax may be a predictor of LV reverse remodeling .

Relationship of left atrial volume index and vasovagal syncope / 中华实用儿科临床杂志

Objective To explore the relationship between the volume and function of the heart and the pathogenesis of vasovagol syncope (VVS) through the detection of the left atrial volume index(LAVI).Methods The 68 cases in the observation group were diagnosed as VVS and hospitalized in the First Hospital of Jilin University from Jan.1 to Dec.31 in 2012.The 60 cases in the control group were children and adolescents receiving healthy physical examinations during the same period.All the patients were given the examination of heart color Doppler ultrasound,head up tilt test(HUT),body height,body mass,chest X-ray and accounted the LAVI and cardiothoracic ratio was accounted.Results The average age in the observation group and the control group was(12.19 ± 2.01) and(12.15 ± 2.00) years old,respectively.And there was no statistically significant difference in age between these two groups (t =0.10,P ＞0.05).There were 23 boys and 45 girls in the observation group,and 31 boys and 29 girls in the control group.There was statistically significant difference in the ratio of gender composition between these two groups (x2 =4.16,P ＜ 0.05).The LAVI values in these two groups were (21.23 ± 2.04) mL/m2 and (23.45 ± 3.01) mL/m2,respectively.There was statistically significant difference between two groups(t =4.29,P ＜ 0.05).The LAVI values in VVS mixed inhibition (VVS-MI),VVS vascular inhibition (VVS-VI) and VVS cardiac inhibition (VVS-CI) were (21.41 ± 2.98) mL/m2,(21.06 ± 2.59) mL/m2 and(21.23 ± 3.22) mL/m2,respectively.There were statistically significant differences between VVS-MI or VVS-VI and the control groups(t =3.27,3.36,all P ＜ 0.05),but there was no statistically significant difference between VVS-CI and control groups(t =1.61,P ＞ 0.05).The cardiothoracic ratio were 0.43 ± 0.07 and 0.46 ± 0.06 in the observation group and the control group,respectively,and there was statistically significant difference between these two groups(t =3.05,P ＜0.05).Conclusions The pathogenesis of VVS is related to the size and function of left heart.The children and adolescents with smaller LAVI and cardiothoracic ratio are more susceptible to VVS.

The diagnostic value of left atrial volume index for heart failure with preserved ejection fraction / 实用医学杂志

Objective To explore the value of left atrium volume index (LAVI) in the diagnosis of heart failure with preserved ejection fraction (HFPEF). Methods Seventy-seven patients with HFPEF and 33 patients without HFPEF who had been treated from May 2012 to September 2013 in Guangdong General Hospital were en-rolled. The clinical data and a series of ultrasound parameters were collected and analysed. The relationship between LAVI, LAV, and other indexes of diastolic function was determined by Pearson correlation analysis. The value of LAVI and LAV for diagnosing HFPEF was compared by the ROC curve. Results LAVI and LAV of were signifi-cantly greater in HFPEF group than in non-HFPEF group. LAV and LAVI were significantly associated wtih HEPEF. The area under the ROC curve (AUC) of LAVI increased significantly as compared with the AUC of LAV (0.832 vs. 0.799, P<0.05). With a cut-off value of 30 mL/m2, the specificity and sensitivity for diagnosing HEPEF were 64.9%and 84.8%, respectively. Conclusions LAVI may be valuable in the diagnosis of HFPEF.

Evaluation of right atrial function in patients with pulmonary hypertension by left atrial volume tracking technique / 中国医师进修杂志

Objective To probe into the application of left atrial volume tracking technique(LAVT)on the evaluation of right atrial function in patients with pulmonary hypertension.Methods Forty-one patients with pulmonary hypertension (pulmonary hypertension group) and 37 control subjects (control group) were involved.Right atrial maximal volume (RAVmax),right atrial presystolic volume(RAVpre),right atrial minimal volume (RAVmax),systolic right atrial filling rate (dv/dtS),early diastolic right atrial emptying rate(dv/dtE) and late diastolic right atrial emptying rate(dv/dtA) was derived by LAVT.Right atrial passive emptying volume (RAVp),right atrial passive emptying fraction (RAVpEF),right atrial active emptying volume (RAVa),right atrial active emptying fraction (RAVaEF),right atrial total emptying volume (RAVt)and right atrial total emptying fraction (RAVtEF) was calculated.All the right atrial volume parameter was corrected by body surface area to obtain right atrial volume index (RAVI).Results RAVImax,RAVImin,RAVIpre,RAVIt,RAVIa,dv/dtS and dv/dtA in pulmonary hypertension group was higher than that in control group [(78.39 ± 49.35) ml/m2 vs.(24.80 ± 11.91) ml/m2,(62.59 ± 46.56) ml/m2vs.(17.46 ± 8.40)ml/m2,(70.12 ± 48.03) ml/m2 vs.(20.02 ± 9.46) ml/m2,(18.77 ± 11.47) ml/m2 vs.(9.35 ± 6.74) ml/m2,(8.53 ± 9.81) ml/m2 vs.(3.25 ± 3.00) ml/m2,(145.85 ± 80.56) ml/s vs.(86.44 ± 48.46) ml/s,(155.63 ±126.47) ml/s vs.(67.74 ± 33.27) ml/s],and RAVIp in pulmonary hypertension group was lower than that in control group [(6.09 ± 5.16) ml/m2 vs.(10.23 ± 11.12) ml/m2],and there were significant differences (P ＜0.05).But there were no significant differences in RAVItEF,RAVIpEF,RAVIaEF and dv/dtE between two groups (P＞0.05).Conclusions In patients with pulmonary hypertension,right atrial booster pump function and reservoir function increases,while right atrial conduit function decreases.LAVT has a potential ability to evaluate right atrial function.

Alterações precoces da função diastólica do ventrículo esquerdo e da função do átrio esquerdo na doença de chagas detectadas ao doppler tecidual e por novos índices ecocardiográficos: Ecocardiografia tridimensional e deformação miocárdica / Early changes in diastolic function of the left ventricle and left atrium function in Chagas disease detected by tissue Doppler echocardiographic indices and new: Three-dimensional echocardiography and myocardial deformation

Fundamento: A doença de Chagas ainda é importante problema de saúde pública na América Latina onde 12 a 15 milhões de pessoas são infectadas pelo Trypanosoma cruzi. A forma crônica cardíaca apresenta alta morbimortalidade. A disfunção diastólica do ventrículo esquerdo (VE) está presente em diferentes estágios da doença de Chagas e o seu diagnóstico pode ser uma estratégia para o reconhecimento precoce do acometimento cardíaco na doença de Chagas. Objetivos: Analisar a função diastólica do VE e a função do AE em pacientes na fase crônica da doença de Chagas sem acometimento global ou segmentar da função sistólica do VE. Métodos: Pacientes com doença de Chagas entre 18 e 60 anos de idade foram consecutivamente analisados no período de março de 2010 a agosto de 2011. Ecocardiogramas de 52 pacientes sem lesão cardíaca aparente, 29 no estágio A da fase cardíaca (alterações apenas no eletrocardiograma) e 25 controles foram analisados. A função diastólica do VE foi analisada pelo fluxo mitral, fluxo de veia pulmonar, velocidade de propagação ao modo M colorido, untwist do VE e Doppler tecidual do anel mitral. A função do AE foi avaliada pela ecocardiografia tridimensional e pela análise de deformação bidimensional...

Resultados: Todos os grupos tinham idade e massa corpórea similar. Todos os grupos tinham diâmetros cavitários, massa do VE e função sistólica do VE similares. A disfunção diastólica foi mais prevalente em pacientes no estágio A que em pacientes sem envolvimento cardíaco aparente. Os parâmetros derivados do Doppler tecidual foram os melhores para discriminar o grau de disfunção diastólica entre os grupos. A razão EE foi progressivamente maior e a razão EA foi progressivamente menor de controles, para indeterminados e pacientes no estágio A. Os volumes do AE foram maiores em pacientes no estágio A, porém as frações de esvaziamento do AE foram similares entre os grupos. O pico positivo do do AE foi menor no estágio A enquanto que os outros parâmetros do do AE não diferiram entre os grupos. Conclusões: Pacientes com doença de Chagas e função sistólica do VE preservada apresentam disfunção diastólica, a qual é mais prevalente em pacientes no estágio A. O Doppler tecidual é o melhor índice para identificar a diferença na função diastólica entre os grupos estudados. Apenas a função condutiva do AE estava deprimida em pacientes no estágio A da fase cardíaca da doença de Chagas. Novos estudos são necessários para definir o valor prognóstico dos achados dessa Tese...

Left Atrial Volume Index as Indicator of Left Ventricular Diastolic Dysfunction: Comparation between Left Atrial Volume Index and Tissue Myocardial Performance Index

BACKGROUND: To point out a possible correlation between left atrial volume index (LAVI) and left ventricular (LV) diastolic time interval to better define LV diastolic dysfunction, this study was performed. METHODS: In 62 hypertensive-hypertrophic patients without LV systolic dysfunction, LV volumes, myocardial mass index, ejection fraction% (EF%) and LAVI were measured by two-dimensional echocardiography. Instead, tissue Doppler echocardiography (TDE) was used to measure myocardial performance index (MPI) and its systo-diastolic time intervals, such as: iso-volumetric contraction time (IVCT); iso-volumetric relaxation time (IVRT); ejection time. LAVI, TDE-MPI and time intervals where also measured in 15 healthy controls, to obtain the reference values. RESULTS: Results shown a significant increase of LV volumes in hypertensives in comparison to the control group (p < 0.05). LV mass index also augmented (p < 0.001). Instead, EF% not significantly changed in hypertrophic patients in comparison with healthy controls. LAVI raised in hypertensives wih left ventricular hypertrophy, whereas IVCT resulted within the normal limits. On the contrary, IVRT significantly raised. Accordingly, MPI resulted higher in controls. CONCLUSION: LAVI, MPI and its time intervals appear as reliable tools to non-invasively individualize LV diastolic dysfunction in systemic hypertension, in absence of mitral valve disease.