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Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia following coronary artery bypass grafting (CABG). We hypothesized that measures of left atrial (LA) function would be useful in predicting AF in patients undergoing CABG. Methods and results: In the study, 611 patients were included after CABG. All patients had echocardiograms performed preoperatively and LA functional measurements were assessed. These measurements were LA maximum volume index (LAVmax), LA minimum volume index (LAVmin) and LA emptying fraction (LAEF). The endpoint was AF occurring >14 days after surgery. During the follow‐up period of a median of 3.7 years, 52 (9%) developed AF. The mean age was 67 years, 84% were male and the average left ventricle ejection fraction was 50%. Patients who developed AF had a lower CCS class and lower LAEF (40 vs. 45%), otherwise no clinical differences were observed between outcome groups. No functional LA measurements were significant predictors of AF in the whole CABG population. However, in patients with normal‐sized LA (n = 532, events: 49), both LAEF and LAVmin were univariable predictors of AF. When the functional measurements were adjusted for the CHADS2 score, both LAVmin (HR = 1.07 [1.01‐1.13], p =.014) and LAEF (HR: 1.02 [1.00‐1.03], p =.023), remained significant predictors. Conclusion: No echocardiographic measurements were significant predictors of AF after CABG. In patients with a normal LA size, LAVmin as well as LAEF were significant predictors of AF. [ABSTRACT FROM AUTHOR]

Aims: Layer‐specific global longitudinal strain (GLS) has been demonstrated to predict outcome in various patient cohorts. However, little is known regarding the prognostic value of layer‐specific GLS in the general population and whether different layers entail differential prognostic information. The aim of the present study was to investigate the prognostic value of whole wall (GLSWW), endomyocardial (GLSEndo), and epimyocardial (GLSEpi) GLS in the general population. Methods and results: A total of 4013 citizens were included in the present study. All 4013 had two‐dimensional speckle tracking echocardiography performed and analysed. Outcome was a composite endpoint of incident heart failure and/or cardiovascular death. Mean age was 56 years and 57% were female. During a median follow‐up time of 3.5 years, 133 participants (3.3%) reached the composite outcome. Sex modified the relationship between all GLS parameters and outcome. In sex‐stratified analysis, no GLS parameter remained significant predictors of outcome in females. In contrast, GLSWW [hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.02–1.31, per 1% decrease] and GLSEpi (HR 1.19, 95% CI 1.04–1.38, per 1% decrease) remained as significant predictors of outcome in males after multivariable adjustment (including demographic, clinical, biochemistry, and echocardiographic parameters). Lastly, only in males did GLS parameters provide incremental prognostic information to general population risk models. Conclusions: In the general population, sex modifies the prognostic value of GLS resulting in GLSEpi being the only layer‐specific prognosticator in males, while no GLS parameter provides independent prognostic information in females. [ABSTRACT FROM AUTHOR]

Background: Previous studies have identified several echocardiographic markers of cardiac dysfunction in participants with diabetes mellitus, including E/e'. However, previous studies have been limited by short follow‐up duration or low statistical power, and none have assessed whether echocardiographic predictors of adverse cardiovascular outcome differ between individuals with DM and individuals without DM. Methods: A total of 1997 individuals from the general population without heart disease had an echocardiogram performed in 2001 to 2003. Diabetes was defined as HbA1c ≥6.5% (≥48 mmol/mol), non‐fasted blood glucose ≥11.1 mmol/L or the use of glucose lowering medication. The end‐point was a composite of heart failure (HF), ischemic heart disease (IHD) and cardiovascular death (CVD). Results: At baseline, a total of 292 participants (15%) had diabetes. Median follow‐up time was 12.4 years (interquartile‐range: 9.8–12.8 years) and follow‐up was 100%. During follow‐up, 101 participants (35%) with diabetes and 281 participants without diabetes (16%) reached the composite end‐point. The prognostic value of E/e' was significantly modified by diabetes (p for interaction: 0.003). In participants with diabetes, only E/e' remained an independent predictor of outcome in a final multivariable model adjusted for clinical and echocardiographic parameters (HR 1.08, 95% CI 1.00–1.17, p = 0.0041, per 1 increase). In participants without diabetes, left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF) and a' remained independent predictors of outcome when adjusted for clinical and echocardiographic parameters. In individuals with diabetes, only E/e' added incremental prognostic value to risk factors from the SCORE risk chart and the ACC/AHA Pooled Cohort Equation. Conclusion: In individuals with diabetes from the general population, E/e' is a stronger predictor of cardiovascular mortality and morbidity than in individuals without diabetes and contributes with incremental prognostic value in addition to established cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Background: The ratio of transmitral early filling velocity to early diastolic strain rate (E/e'sr) may be a more accurate measure of LV filling pressure then ratio of early filling pressure to early tissue velocity. The aim of the study was to investigate the impact of age, sex, obesity, smoking, hypertension, hypercholesterolemia, diabetes, physical activity level, socioeconomic, and psychosocial status on E/e'sr over a decade. Additionally, the predictive value of ΔE/e'sr on future major adverse cardiovascular events (MACE) has never been explored. Method: The study included 623 participants from the general population, who participated in the 4th and 5th Copenhagen City Heart Study (CCHS4 and CCHS5). Examinations were median 10 years apart. MACE was the composite endpoint of heart failure, myocardial infarction, and all‐cause death. Results: Follow‐up time was median 5.7 years, and 43 (7%) experienced MACE. Mean age was 51 ± 14 years, and 43% were male. Mean ΔE/e'sr was 2.1 ± 23.0 cm. After multivariable adjustment for demographic, clinical, and biochemistry variables, high age (stand. β‐coef. =.24, P <.001) and mean arterial blood pressure (MAP) (stand. β‐coef. =.17, P <.001) were significantly associated with an accelerated increase in E/e'sr In multivariable Cox regression, E/e'sr at CCHS5 and ΔE/e'sr were independent predictors of MACE (HR = 1.20, 95% CI [1.01; 1.42] per 10 cm increase for both). ΔE/e'sr did only provide incremental prognostic value to change in left atrial volume index of the conventional diastolic measurements. Conclusion: In the general population, age and MAP were predictors of an accelerated increase in E/e'sr over a decade. E/e'sr at CCHS5 and ΔE/e'sr were independent predictors of future MACE. [ABSTRACT FROM AUTHOR]

Purpose: We tested the hypothesis that participation in small‐sided team handball training could provide beneficial effects on cardiovascular and metabolic parameters in overweight premenopausal women with special focus on the importance of prior team handball experience. Methods: A 16‐week RCT training intervention was conducted in overweight premenopausal women randomized into three groups: a team handball training group without prior experience (UN; n = 13), a team handball group with prior experience (EXP; n = 10), and an inactive control group (CON; n = 9). Both UN and EXP completed 1.6 ± 0.3 training sessions per week with average heart rates of 84 ± 5 and 85 ± 9% of maximal heart rate, respectively. Cardiovascular and metabolic parameters were assessed before and after the intervention. Results: Compared to CON, UN had significant increases in VO2max (7 ± 4%) and intermittent endurance performance (26 ± 14%) as well as reduced total fat mass (4 ± 6%), total fat percentage (4 ± 5%), and android fat mass (7 ± 12%), respectively (all P <.05). Compared to UN and CON, EXP displayed increased left ventricular mass and left ventricular mass index (both P <.05) after the training period. There were no significant changes between any of the groups in muscle mass, blood lipids, resting heart rate, and blood pressure (all P >.05). Conclusion: Small‐sided team handball training in overweight premenopausal women resulted in improvement of VO2max and body composition for participants with minimal team handball experience, indicating that prior team handball experience is not a prerequisite for improving physiological parameters of importance for health. Furthermore, EXP displayed cardiac adaptations, including increased left ventricular mass and left ventricular mass index. [ABSTRACT FROM AUTHOR]

Background: Global longitudinal strain (GLS) is a predictor of outcome after cardiac surgery. If integrated into clinical decision‐making and timing of surgery, it is important to evaluate the feasibility, reproducibility, and variation of GLS in this selection of patients, where poor image quality and nontraceable segments are frequent. Methods and results: Two‐dimensional strain analysis was performed on 250 patients planned to undergo open‐heart surgery. Intra‐ and inter‐examiner retest variability was assessed in 50 consecutive patients. All myocardial segments were traceable in 119 patients, and GLS of those served as a reference in comparison with alternative strain models with nontraceable segments. Global longitudinal strain estimation by the recommended method of a maximum of one nontraceable segment per view was only feasible in 64% of cases (mean GLS −16%). Reproducibility was moderate (intra‐observer coefficient of variation [CV] 8%; inter‐observer CV 10%) and variation of GLS showed bias ± 95% limits of agreement (LOA) of 0.6 ± 1.1 (P <.05). Accepting three nontraceable segments in total increased feasibility to 77% with similar reproducibility (intra‐observer CV 8%; inter‐observer CV 11%) and variation (bias ± LOA: 0.6 ± 1.3, P <.05). A model with a maximum of one apical, one mid, and one basal nontraceable segment increased feasibility to 72% with similar reproducibility (intra‐observer CV 8%; inter‐observer CV 10%) and variation (bias ± LOA: 0.4 ± 1.2, P <.05). Conclusion: Global longitudinal strain estimation in patients prior to cardiac surgery is challenged by moderate feasibility, retest variation as well as variation in cases of nontraceable segments. We suggest alternative strain models with improved feasibility without compromising reproducibility and variation. [ABSTRACT FROM AUTHOR]