Explore the vast range of titles available.

Atrial fibrillation (AF) and diabetes mellitus (DM) are common pathogenic diseases. Diabetes is an independent risk factor for AF, and coexisting AF is a risk factor for the diabetic pa-tient's progression. The purpose of this study was to see if two-dimensional-speckle tracking echocardiography (2D-STE) might provide valuable criteria for determining the risk of AF in diabetic patients. This retrospective study compared 30 adult diabetic patients with documented paroxysmal atrial fibrillation (PAF) with 30 age- and sex-matched diabetic patients without PAF. Inclusion criteria were: age ≥18 years, sinus rhythm, diabetes mellitus type 2, and the ability to sign the informed consent. Exclusion criteria included: moderate or severe valvular disease, previous myocardial infarction, left ventricular ejection fraction (LVEF) <50%, congenital heart disease, a history of cardiac surgery, paced atrial or ventricular rhythm, inadequate echocardiography imaging. The medical history, clinical, biochemical data and the results of the transthoracic cardiac ultrasound examination were registered during their evaluation at the outpatients cardiology clinics. The mean age of the patients was 62.5±1.7 years, 60% were men. Diabetic patients who experienced PAF episodes demonstrated significantly impaired left atrial (LA) deformation patterns, with decreased LA strains and increased LA stiffness (p < 0.05). The present study demonstrates that LA strains and LA stiffness are significantly associated with the occurrence of PAF in diabetic patients. As 2D-STE of the LA is more sensitive than routine echocardiographic examination, it should be performed in patients suspected of being suffering from PAF.

The aim of this study was to determine the role of left-sided mechanical parameters in postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG). Ninety patients with coronary artery disease and normal left ventricular (LV) function in sinus rhythm were enrolled in the study. Preoperative LV and left atrial (LA) mechanics were evaluated by two-dimensional (2D) speckle-tracking echocardiography (STE), including strain and rotation parameters, and volume indices. Patients were monitored in order to detect POAF during the postoperative period. Twenty-three of 90 patients (25.6%) developed POAF. Age (p<0.001) and preoperative beta blocker usage (p=0.001) were the clinical parameters associated with POAF. Left atrial maximum volume index (LAV[max]i) increased, and peak left atrial longitudinal strain (PALS) was impaired in POAF patients (p=0.001, p<0.001, respectively). Left ventricular twist (LVtw) and left ventricular peak untwisting velocity (UntwV) were augmented in POAF patients (p=0.013, p=0.009, respectively). Receiver operating characteristic analysis showed N-terminal pro-brain natriuretic peptide (NT-proBNP) levels above 70 pg/ml and predicted POAF with a sensitivity of 74% and specificity of 78% (area under curve: 0.758, 95% confidence interval [CI] 0.631-0.894, p<0.001). Logistic regression analysis demonstrated that age (odds ratio [OR] 1.1, CI 1.01-1.20, p=0.034), preoperative beta blocker usage (OR 8.84, CI 1.36-57.28, p=0.022), NT-proBNP (values >70 pg/ml, OR 22.377, CI 3.286-152.381, p<0.001), PALS (OR 0.86, CI 0.75-0.98, p=0.023), and UntwV (OR 1.02, CI 1.00-1.04, p=0.029) were the independent predictors of POAF. The combination of 2D STE, clinical, and biochemical parameters may help predict POAF.

In metabolic syndrome, cardiomyocyte changes induced by metabolic and proinflammatory factors impair repolarization and exacerbate the heterogeneity of the transmural dispersion of repolarization, and this is proarrhythmogenic. Limited data in the literature on the capabilities of speckle tracking echocardiography for assessing proarrhythmogenicity in metabolic syndrome exists. 71 patients with newly diagnosed metabolic syndrome, aged 35–55 years, were studied. Ischemic heart disease was excluded in all patients with stress test cycle ergometry, CT-angiography or selective coronary angiography. All patients underwent a 48-h Holter ECG recording. Based on the latter, they were divided into two groups: 38 patients (53.5%) with a high arrhythmogenic load (supraventricular or ventricular tachycardia, atrial fibrillation/flutter, ventricular extrasystoles over 10%, frequent supraventricular extrasystoles > 500/24 h are included); and 33 patients (46.5%) with low arrhythmogenic load (no significant rhythm disturbances are included). Echocardiography was performed with a GE Vivid T9 emphasizing global longitudinal strain, mechanical dispersion index and left atrium strains. Statistically significant differences in the global longitudinal strain, mechanical dispersion index, and left atrium strain were found between the group with low arrhythmogenicity and the group with high arrhythmogenicity (p < 0.0001). The index of mechanical dispersion has the most optimal sensitivity and specificity of all investigated echocardiographic markers. These results support the mechanical dispersion index as an additional tool for assessing proarrhythmogenicity in metabolic syndrome.

Background and Objectives: Left atrial function is commonly assessed using speckle-tracking echocardiography, focusing on global strain averaged from the 4-chamber and 2-chamber views. However, regional variations in atrial strain remain underexplored. This study aimed to evaluate regional left atrial deformation in healthy subjects. Materials and Methods: A total of 22 healthy subjects underwent echocardiographic examinations during routine check-ups in 2023–2024. Images were retrieved and analyzed offline. Left atrial reservoir strain was calculated from four-chamber, two-chamber, and three-chamber views. A comprehensive map of 3-plane strain was generated for each patient, with detailed analysis of regional strain differences. Regional and average longitudinal displacement were also assessed. Results: There was no significant difference between triplane and biplane left atrial reservoir strain (34.4 ± 7.7% vs. 34.7 ± 6.8%, p = 0.9). Strain in the segments near the mitral annulus was significantly higher than in the mid-atrial segments. Mid-atrial strain was, in turn, higher than in the superior segments. Regional longitudinal displacement showed a gradient from the mitral annulus toward the superior part of the atrium, correlating well with the strain results. Additionally, strain in the inferior and septal walls was higher than in the lateral wall. Conclusions: Left atrial strain varies significantly across different regions. Strain is highest near the mitral annulus and lowest in the superior wall. Longitudinal displacement may serve as an additional tool for assessing left atrial function, showing a strong correlation with strain measurements. Biplane and triplane strain assessment yielded comparable results.

Background The contribution of atrial and ventricular function in neurocardiogenic syncope (NCS) pathophysiology is elusive. Hypothesis We assessed the influence of echocardiographic properties to the age of presentation and NCS recurrences. Methods We assigned 124 patients with symptoms suggesting NCS, to those with syncope initiation at age <35 (group A, n = 56) and >35 years (group B, n = 68). Echocardiographic indices were measured before head‐up tilt test (HUTT). Results A total of 55 had positive HUTT (44%) with a trend favoring group A (p = .08). Group A exhibited lower left atrial (LA) volume index (17 ± 6 vs. 22 ± 11 ml/m2, p = .015), higher LA ejection fraction (69 ± 10 vs. 63 ± 11%, p = .008), LA peak strain (reservoir phase 41 ± 13 vs. 31 ± 14%, p = .001, contraction phase 27 ± 11 vs. 15 ± 10%, p < .001) and LA peak strain rate (reservoir phase 1.83 ± 1.04 vs. 1.36 ± 0.96 1/s, p = .012, conduit phase 2.36 ± 1.25 vs. 1.36 ± 0.78 1/s, p = .001). Group A showed smaller minimum right atrial (RA) volume, better RA systolic function, superior left ventricular diastolic indices, and lower filling pressures. Group A patients were more likely to have >3 recurrences (82.0% vs. 50.1%, p < .05). Conclusions Patients with younger age of NCS onset and more syncopal recurrences manifest smaller LA and RA dimensions with distinct patterns of systolic and diastolic function and better LA reservoir and contraction properties. These findings may indicate an increased susceptibility to preload reduction, thereby triggering the NCS mechanism.

Aims: The present study aims to evaluate magnetic-resonance-imaging (MRI)-assessed left atrial strain (LAS) and left atrial strain rate (LASR) as potential parameters for the diagnosis of cardiac amyloidosis (CA), the distinction of clinical subtypes and differentiation from other cardiomyopathies. Methods and results: LAS and LASR were assessed by MRI feature tracking in patients with biopsy-proven CA. LAS and LASR of patients with CA were compared to healthy subjects and patients with hypertrophic cardiomyopathy. LAS and LASR were also analyzed concerning differences between patients with transthyretin (ATTR) and light chain amyloidosis (AL). A total of 44 patients with biopsy-proven CA, 19 patients with hypertrophic cardiomyopathy and 24 healthy subjects were included. In 22 CA patients (50%), histological examination identified ATTR as CA subtype and AL in the remaining patients. No significant difference was observed for reservoir, conduit or booster LAS in patients with AL or ATTR. Reservoir LAS, conduit LAS and booster LAS were significantly reduced in patients with CA and HCM as compared to healthy subjects (p < 0.001). Reservoir LAS and booster LAS were significantly reduced in CA as compared to HCM patients (p < 0.001). A linear correlation was observed between LA global reservoir strain and LA-EF (p < 0.001, r = 0.5), conduit strain and global longitudinal LV strain (p < 0.001, r = 0.5), global booster strain rate and LA-EF (p < 0.001, r = 0.6) and between global booster strain rate and LA area at LVED (p < 0.0001, 0.5). Conclusions: LAS and LASR are severely impaired in patients with CA. The MRI-based assessment of LAS and LASR might allow non-invasive diagnosis and categorization of CA and its distinct differentiation from other hypertrophic phenotypes.

Background Despite its proven prognostic value in different contexts, the precise implications of left atrial strain (LAS) assessment throughout different phases of the atrial cycle remain uncertain. A direct correlation between left atrial reservoir strain (LARS) and left ventricular global longitudinal strain (GLS) has been consistently demonstrated in several studies involving patients with various heart diseases. The objective of our study is to identify factors directly associated with LARS, left atrial conduction strain (LACS) and left atrial booster strain (LABS) in patients without cardiovascular (CV) disease. Methods Transthoracic echocardiographic examinations in patients without CV disease were prospectively selected in two tertiary hospitals echocardiography labs for clinical purposes. LAS, maximal and minimal left atrial (LA) volumes and left atrial ejection fraction (LAEF) were measured using the two-dimensional strain analysis package provided by the EchoPAC Plugging workstation (AFI LA). Results A total of 196 cases were included, median age of 54 (45–62) with 85 (43%) being men. The mean left ventricular ejection fraction (LVEF) was 61% ± 5, and the median GLS was − 18% (-17 to -20). Median indexed maximum volume of left atrium (LAVI) was 27 ml/m 2 (22–31), and LAEF was 64% (58–70). The mean LARS biplane was 35,1% ± 8. Notably, LARS was greater in the 2-chamber view (36,1% ± 10) compared to the 4-chamber view (34,1% ± 8 p  < 0,05). The multivariate analysis of LARS revealed that sex, GLS, LAEF and e’ mean are independently correlated with LARS. Multivariate analysis of LACS showed independent correlations between LACS and age, GLS, LAEF, E/A ratio and e’ mean . Conversely, the multivariate analysis of LABS demonstrated significant correlations among A wave, e’ mean , and left atrial stiffness index (LASI). Conclusions In patients without CV disease, GLS emerges as a crucial determinant of LARS and LACS. LAEF and e’ mean are directly and independently related to both LARS and LACS. LARS (univariate) and LACS (multivariate) exhibited a decline with older age in individuals without CV disease.

Little is known about the prognostic value of left atrial strain by four-dimensional speckle-tracking echocardiography in end-stage renal disease patients with preserved left ventricular ejection fraction. This prospective study collected clinical and echocardiographic data from 80 stable dialysis patients (mean age 57 ± 10 years; 62.5% men). All patients underwent the dedicated four-dimensional speckle-tracking echocardiography to measure LASr (peak longitudinal strain of reservoir function), LAScd (peak longitudinal strain of conduit function), LASct (peak longitudinal strain of contractile function), LASr_c (peak circumferential strain of reservoir function), LAScd_c (peak circumferential strain of conduit function) and LASct_c (peak circumferential strain of contractile function). These patients were enrolled from August 2021 to August 2023 and followed-up for 19 months (interquartile-range 15 to 20 months). The primary outcome was a composite of all-cause mortality or major adverse cardiovascular events (MACEs). The study patients were classified into event (developed mortality or MACEs) and event-free group according to the primary outcome. Multivariate Cox regression analysis was used to investigate risk factors for all-cause mortality or MACEs. The event group had lower LASr (16.4% vs. 21.2%, P  = 0.0003), LASct (8.2% vs. 11.2%, P  = 0.01), LASr_c (25.2% vs. 35.0%, P  = 0.0004) and LASct_c (14.9% vs. 20.9%, P  = 0.001) than the event-free group. Using optimal cut-off value determined by ROC curve, the less LASr (LASr < 18.5%), LASct (LASct < 8.5%), LASr_c (LASr_c < 28.5%), and LASct_c (LASct_c < 17.5%) group had a higher mortality or MACEs rate. Multivariate cox regression analyses revealed that LASr (HR = 0.81, 95% CI [0.17; 0.91], P  = 0.0005, per 1% increase) and LASr_c (HR = 0.93, 95% CI [0.87; 0.98], P  = 0.01, per 1% increase) were independent predictors of all-cause mortality or MACEs. Less peak longitudinal and circumferential strains of reservoir function are predictive of poor prognosis among end-stage renal disease patients with preserved left ventricular ejection fraction.

IntroductionGrowing evidence implicates atrial cardiopathy (AC) as a causative factor for embolic strokes of undetermined source (ESUS), a distinct subtype of cryptogenic stroke (CS). AC however is poorly defined, with several surrogate measures used in its characterisation. The aim of this systematic review and meta-analysis was to assess structural, and echocardiographic indices associated with adverse left atrial (LA) remodelling following CS or ESUS. Identification of such cardiac biomarkers may allow for prediction of incident AF following CS or ESUS.MethodologyFollowing PRISMA guidelines, a rigorous search of medical databases was conducted to identify literature investigating AF incidence after CS (PROSPERO registration CRD42023426712) (figure 1). Relevant studies analysing electrocardiographic and echocardiographic features of AC in this setting were included. Meta-analysis was performed on measures present in at least three studies meeting inclusion criteria. Effect sizes were displayed using standardised mean difference (SMD) or odds ratio (OR), employing a random effects model. 95% confidence intervals were generated and a p-value of <0.05 was considered significant.ResultsData from 49 included studies involving 8027 patients demonstrated that parameters of impaired LA function demonstrated the greatest strength of association with post-stroke AF. LA contractile (SMD: -1.279, 95% CI: -1.481 to -1.077, p<0.001) and LA reservoir strain (SMD: -0.913, 95% CI: -1.363 to -0.463, p<0.001) were the best echocardiographic predictors of incident AF following CS and ESUS. On electrocardiographic assessment, abnormal p-wave axis (OR 2.73; 95% CI: 1.43 to 5.22, p=0.002) and partial inter-atrial block (OR 2.10; 95% CI: 1.18 to 3.72, p=0.011) was also associated. Interestingly, abnormal electrocardiographic P-wave terminal force in lead V1 (PTFV1) was not associated with incident AF. See table 1.ConclusionsMarkers of atrial cardiopathy are predictive of AF occurrence following CS or ESUS strokes, with LA strain measurements displaying greatest association. Use of such markers may assist in identification of patients most benefitting from post-stroke prolonged ambulatory monitoring.Abstract 191 Table 1Markers of adverse LA remodelling and their association with incident AF post-CS or ESUS Outcomes Results 95% CI P-value LA Volume Index 0.709† 0.593 to 0.825 <0.001 LA Reservoir Strain -0.913† -1.363 to -0.463 <0.001 LA Contractile Strain -1.279† -1.481 to -1.077 <0.001 Abnormal PWA 2.727* 1.425 to 5.218 0.002 A-IAB 8.112* 1.120 to 58.761 0.038 P-IAB 2.102* 1.186 to 3.723 0.011 PR- Interval 0.345† 0.187 to 0.503 <0.001 P Wave Duration PTFV1 0.583† 0.372† 0.269 to 0.898-0.181 to 0.925 <0.001 0.187 NB: *Odds Ratio; †Standardized Mean DifferenceAbstract 191 Figure 1PRISMA flow diagramConflict of InterestN/A

[Display omitted] •Lower left atrial (LA) strain and LA strain rate were independently associated with new-onset atrial fibrillation (AF).•Lower LA strain and LA strain rate predicted AF even in participants with normal LA volume.•Reduced reservoir function predicted AF in participants with smaller LA volume.•Reduced pump function predicted AF in participants with larger LA volume. Atrial fibrillation (AF) is frequent in older adults and associated with left atrial (LA) dysfunction. LA strain (LAε) and LA strain rate (LASR) may detect subclinical LA disease. We investigated whether reduced LAε and LASR predict new-onset AF in older adults without history of AF or stroke. LAε and LASR were assessed by speckle-tracking echocardiography in 824 participants from the community-based Cardiovascular Abnormalities and Brain Lesions study. Positive longitudinal LAε and LASR during ventricular systole, LASR during early ventricular diastole, and LASR during LA contraction were measured. Cause-specific hazards regression model evaluated the association of LAε and LASR with incident AF, adjusting for pertinent covariates. The mean age was 71.1 ± 9.2 years (313 men, 511 women). During a mean follow-up of 10.9 years, new-onset AF occurred in 105 participants (12.7%). Lower LAε and LASR at baseline were observed in patients with new-onset AF (all p <0.01). In multivariable analysis, positive longitudinal LAε (adjusted hazard ratio [HR] per SD decrease 2.05, confidence interval [CI] 1.24 to 3.36) and LASR during LA contraction (HR per SD increase 2.24, CI 1.37 to 3.65) remained associated with new-onset AF, independently of LA volumes and left ventricular function. Along with positive longitudinal LAε, reduced LASR during ventricular systole predicted AF in participants with LA volume below the median value (HR 2.54, CI 1.10 to 6.09), whereas reduced LASR during LA contraction predicted AF in participants with larger LA (HR 2.35, CI 1.31 to 4.23). In conclusion, reduced positive longitudinal LAε and LASR predict new-onset AF in older adults regardless of LA size and may improve AF risk stratification.