Association between CHARGE-AF risk score and LA mechanics: LA reservoir strain can be a single parameter for predicting AF risk.

AIMS: Atrial fibrillation (AF) is a prevalent arrhythmia and the leading preventable cause of cardioembolic stroke. Scoring systems for predicting AF risk do not use imaging modalities. We sought to determine whether LA longitudinal strain could be used as a single parameter for predicting the risk of AF. METHODS AND RESULTS: Consecutive patients diagnosed with diastolic dysfunction between December 2019 and March 2020 were included. Two-dimensional, colour flow, continuous pulse-wave, and tissue Doppler transthoracic echocardiography (TTE) were performed using a Vivid E9 imaging system (GE Medical Systems, Chicago, USA). Measurements were obtained in the standard manner recommended by the American Society of Echocardiography. Moreover, LA longitudinal strain was measured using 2D speckle tracking echocardiography in the four-chamber view to evaluate left atrial function. The CHARGE-AF scoring system was used to predict AF risk.A total of 148 patients (mean age: 57.6 ± 11.9; male: 53%) with feasible views for LA strain measurement were divided into two groups based on a 10% CHARGE-AF cut-off score. The >10% group (48 patients; 32%) was defined as having a predicted 5-year AF risk >10%, and the ≤10% group (100 patients; 68%) was defined as having a predicted risk <10%. In the multivariate analysis, LA reservoir strain (LASr) was independently associated with CHARGE-AF score. Furthermore, using the Pearson correlation method, LASr was found to be highly correlated with CHARGE-AF score (r = -0.74, p < 0.0001). CONCLUSIONS: LASr was highly correlated with CHARGE-AF risk score and may be used as a parameter to predict atrial myopathy and hence AF risk.

An Unconventional Approach to Overcome the Extreme Angulation of LAD: A Challenging Percutaneous Coronary Intervention.

We herein describe a challenging acute anterior ST-elevation myocardial infarction (STEMI) case. The patient was hemodynamically unstable during the procedure and the extremely angulated culprit vessel hindered our repeated attempts of wiring. Procedural complexity and risks were increased not only due to angulation but also the bifurcational nature of the culprit lesion. We report an innovative solution that enabled the successful revascularisation of such a complex situation, after the failure of multiple attempts of conventional methods for wiring. We also briefly review the literature about recommended methods for such severely angulated vessels. Key Words: Angulation, infarction, Vessel, Angiography.