The study of clinical and echocardiographic assessment of patients with atrial fibrillation

Background: Atrial Fibrillation is the most common arrhythmia encountered in our clinical practice accounting for 1/3rd of the total hospital admissions for cardiac rhythm disturbances. Recent worldwide epidemiological data have reaffirmed that AF is a global epidemic and has adverse effects on long term morbidity and mortality. This study is aimed to assess the clinical profile and etiology along with Echocardiographic evaluation of patients presenting with Atrial Fibrillation.Methods: Total of 100 patients of Atrial Fibrillation were enrolled for the study, who got admitted in hospital from March 2017 to June 2018. These patients were evaluated clinically, and detailed Cardiovascular, Neurological examination was done to evaluate etiology and for any evidence of thromboembolism. Echocardiography was also done.Results: Mean Age of the patients enrolled was 67.02±12.50 yrs. There was male predominance. The presenting complaints were dyspnea, palpitations, chest pain & pedal edema. On Echocardiography, Hypertensive Heart Disease was found to be the most common etiology. Mean LA size was 46.18±9.49 mm. LA clot was present in 4% patients. Most common complication was congestive cardiac failure followed by stroke. CHA2DS2- VASc score was ?2 in 86% patients.Conclusions: Increasing age and hypertension are associated with occurrence of AF. Hypertensive heart disease was the most common etiology in elderly age group. Presence of LVH or left atrial enlargement in patients with hypertensive heart disease requires early management to improve the outcomes.

Left atrial size and contractile function in healthy dogs and dogs with chronic mitral valve disease / Tamanho e função sistólica atrial esquerda em cães sadios e com doença valvar crônica de mitral

In humans, left atrial enlargement and reduced contractile functions are associated with adverse cardiovascular events and a poor prognosis in many dilatation of the left atrium occurs with the gradual evolution of chronic mitral valve disease and is well diseases. The left atrium is the most compromised cardiac chamber in dogs with chronic mitral valve disease (CMVD). Therefore, this study aimed to compare the main parameters of left atrial enlargement (left atrium/aorta ratio, left atrial diameter and volume indices) and contractile function (transmitral flow peak velocity A wave and time velocity integral, atrial fraction, and atrial ejection force) at different stages of valve disease, and correlate the left atrial diameter, volume, and contractile function indices with echocardiographic variables predictive of heart failure in dogs (transmitral flow peak velocity E wave, E wave/IVRT ratio, E wave/E´wave ratio, and E wave/A wave ratio). The results showed that progressive characterized by the left atrium/aorta ratio and left atrium volume index. The left atrial diameter and volume indices and left atrium/aorta ratio correlated positively with the transmitral flow peak velocity E wave and E wave/IVRT ratio, which are important indices of diastolic function. The left atrial contractile function indices increased as CMVD evolved. Except for the atrial fraction, the left atrial contractile function indices correlated with the left ventricular filling pressure indices.(AU)

O tamanho e a função atrial esquerda estão relacionados em humanos com eventos cardiovasculares adversos e prognóstico nas principais cardiopatias. Na doença valvar crônica de mitral (DVCM) em cães, o átrio esquerdo é a câmara cardíaca mais comprometida. Portanto, os objetivos deste estudo foram comparar os principais parâmetros de aumento atrial esquerdo (relação átrio esquerdo/aorta, índice do diâmetro atrial esquerdo e índice do volume atrial esquerdo) e função contrátil de átrio esquerdo (velocidade máxima e integral de velocidade da onda A do fluxo transvalvar mitral, fração atrial e força de ejeção atrial) nos diferentes estágios da doença valvar; correlacionar diâmetro e volume atrial esquerdo e os índices de função contrátil atrial esquerda com as variáveis ecocardiográficas preditivas de insuficiência cardíaca em cães (velocidade máxima da onda E do fluxo transvalvar mitral, relação E/TRIV, relação E/E'par e relação E/A). Os resultados mostraram que com a evolução progressiva da doença valvar crônica de mitral, ocorre dilatação progressiva do átrio esquerdo, bem caracterizada pela relação átrio esquerdo/aorta e pelo índice de volume atrial esquerdo. O índice do diâmetro atrial esquerdo, o índice de volume atrial esquerdo e a relação átrio esquerdo/aorta correlacionam-se, positivamente, com a velocidade da onda E e com a relação E/TRIV, que são importantes índices de função diastólica. Os índices de função contrátil do átrio esquerdo aumentam à medida que a DVCM evolui. Os índices de função contrátil do átrio esquerdo apresentam correlação positiva com os índices de pressão de enchimento ventricular esquerdo, exceção feita à fração atrial.(AU)

P wave dispersion in obese dogs with and without mitral valve disease / Dispersão da onda P em cães obesos apresentando ou não doença valvar mitral

ABSTRACT: Pwave dispersion (Pd) is an electrocardiographic index defined as the difference between the minimum and maximum Pwave duration in multiple leads. The augmentation of Pd reflects the discontinuous and inhomogeneous atrial depolarization resulting from cardiac and non-cardiac conditions. In humans, an increased Pd is associated with the development of cardiac arrhythmias, particularly atrial fibrillation. To investigate Pd in obese dogs, we enrolled 76 dogs, which were classified in four distinct categories according to body condition and the existance of valve insufficiency: obese dogs (O), dogs with both obesity and cardiac disease (O+CD), lean dogs with cardiac disease (CD) and healthy controls (H). To be included in the study, all dogs underwent an electrocardiographic and echocardiographic assessment. We reported significantly higher Pd in the animals included in categories O, O+CD and CD (18.0±7.6ms, 16.1±4.4ms, 12.1±4.3ms, respectively) as compared to the healthy subjects (7.3±2.2ms). Also, significant correlations between Pd and both the body mass index and body fat percentage were documented for the obese dogs. However, no association between Pd and LA/Ao could be identified in patients belonging to the O, O+CD and H categories. Thus, we have demonstrated that obese dogs, regardless of their valvular competency status, present high Pd values, suggesting an impaired propagation of atrial electrical impulse.

RESUMO: A dispersão da onda P (Pd) é um índice eletrocardiográfico definido como a diferença entre as durações máxima e mínima da onda P em múltiplas derivações. O aumento da Pd reflete a despolarização discontínua e não homogênea resultante de condições cardíacas e não cardíacas. Em seres humanos, uma Pdaumentada está associada com o desenvolvimento de arritmias cardíacas, particularmente fibrilação atrial. Com o intuito de investigar a Pd em cães obesos, foram selecionados 76 cães, os quais foram classificados em quatro categorias distintas, de acordo com sua condição corporal e a existência de insuficiência valvar: cães obesos (O), cães com obesidade e doença cardíaca (O+CD), cães magros com doença cardíaca (CD) e cães saudáveis usados como controle (H). Uma vez selecionados para o estudo, todos os cães foram submetidos às avaliações eletrocardiográfica e ecocardiográfica. Os resultados mostraram maior Pd nos animais pertencentes aos grupos O, O+CD e CD (18.0±7.6ms, 16,1±4,4ms, 12,1±4,3ms, respectivamente) quando comparados aos cães saudáveis (7.3±2.2ms). Além disso, foram verificadas correlações significativas entre Pde tanto o índice de massa corporal quanto o percentual de gordura corporal nos cães obesos. Entretanto, não se identificou associação entre Pd e a relação AE/Ao nos pacientes das categorias O, O+CD e H. Dessa forma, foi possível demonstrar que cães obesos, independentemente do estado de competência valvar, apresentam Pd elevada, fato que sugere comprometimento da propagação do impulso elétrico atrial.

Left Atrial Size in Hypertensive Patients with Atrial Fibrillation

BACKGROUND: As atrial fibrillation occurs in the patients with hypertensive heart disease, the functional abnormalities of heart become more severe and the risk of systemic and cerebral embolization increases. In this study we checked left atrial dimension and other parameters with echocardiography in hypertensive patients with atrial fibrillation. METHODS: In an attempt to define the difference in left atrial dimension and the relation between left atrial size and various echocardiographic parameters, M-mode echocardiography was used to study 63 hypertensive patients, 33 patients with atrial fibrillation, and 30 patients with sinus rhythm. RESULTS: The mean left atrial dimension was 51.7±8.7mm in hypertensive patients with atrial fibrillation versus 39.3±8.4mm in hypertensive patients with sinus rhythm(p < 0.001). In hypertensive patients with atrial fibrillation left atrial dimension was over 50mm in 82%(27 of 33). Left atrial size had positive correlations with end-systolic and -diastolic internal dimension of left ventricle(LV), LV mass and E-point septal separation, and negative correlations with fractional shortening and ejection fraction of LV. CONCLUSION: The echocardiographic measurement of left atrial dimension in patients with hypertension was useful in evaluating the hypertensive heart disease.