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Background: The left atrial appendage (LAA) is the primary site of embolism in individuals with atrial fibrillation (AF). We aimed to evaluate the morphological features of the LAA orifice in patients with sinus rhythm, paroxysmal AF, and persistent AF using three-dimensional (3D) transesophageal echocardiography (TOE). We also intended to identify morphometric parameters of the LAA orifice that may be potentially associated with an increased risk of ischemic stroke., Methods: We prospectively enrolled 106 patients undergoing TOE. Patients were divided into three groups: group 1 (sinus rhythm), group 2 (persistent AF), and group 3 (paroxysmal AF). All patients underwent a comprehensive evaluation through transthoracic echocardiography (TTE) and TOE. Off-line analyses were performed of the recorded images., Results: The LAA minor orifice area and minimal orifice diameter were greater in patients with persistent AF compared with individuals in sinus rhythm. Patients with persistent AF also had deeper LAAs compared with those in sinus rhythm. None of the LAA orifice morphometric measures were related to ischemic stroke risk. The only independent predictors of ischemic stroke were heart rhythm and the CHA 2 DS 2 VASc score., Conclusion: Persistent AF is associated with LAA dilation, increased depth, and larger orifice size. To our knowledge, this is the first study to demonstrate LAA orifice structural remodeling in patients with AF using 3D TOE., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: Malnutrition is common among heart failure (HF) patients. The prognostic nutritional index (PNI) and controlling nutritional status (CONUT) are widely used for evaluation of nutritional status in HF patients. Right ventricular dysfunction, functional tricuspid regurgitation, and elevated right atrial pressure might exacerbate malnutrition by promoting bowel congestion and malabsorption in HF patients. We aimed to investigate the relationship between echocardiographic measures of right heart function and nutritional status in patients hospitalised for acutely decompensated HF, and to define a simple nutritional heart failure index based on non-invasively measured right heart functions to predict nutritional status., Methods: 133 consecutive patients who were admitted to inpatient cardiology clinics for acutely decompensated HF were included in the study. All patients underwent a comprehensive echocardiographic examination on admission day. PNI and CONUT scores were calculated in order to assess the nutritional status., Results: We defined a novel nutritional heart failure index (HFI-N) based on the echocardiographic measurements of inferior vena cava diameter (IVC), IVC collapsibility and right atrial pressure to predict the nutritional status of the patients. The HFI-N index was a significant predictor for both PNI and CONUT scores. In addition, both PNI and CONUT scores were significantly correlated to length of hospital stay., Conclusion: Malnutrition was associated with a prolonged hospital stay in HF patients. The newly defined HFI-N index is a good predictor of the nutritional status in patients with heart failure.