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Aim: The aim of the present study was to estimate left atrial volume index in patients with ischemic stroke using 2D Echocardiography. METHODS: The Patients of ischemic stroke who were admitted to emergency or ward SGRD Hospital, Amritsar were enrolled in the study. Patients of acute ischemic stroke from 01st January 2023 to 31st March 2024 getting enrolled in emergency/ward of SGRDIMSAR Amritsar were selected. Informed consent was taken from patients for participation in the study. Results: Majority of the patients (40%) were more than 65 years old followed by 55-65 years (27.7%), 45-55 years (23.1%), 35-45 years (6.2%), and 25-35 years (3.1%). Mean age of the patients was 62.20±13.16 years. 53.8% were males and 46.2% were females. 66.2% patients had BSA <1.7 m2, 27.7% had 1.7-2 m2, and 6.2% had >2 m2. Mean BSA was 1.5874±0.23250 m2. According to TOAST Criteria, 63.1% belonged to class I, 16.9% belonged to class II, 16.9% belonged to class III and 3.1% belonged to class V. Mean total cholesterol levels were 184.5385+62.05393, mean triglyceride levels were 169.1231+80.39522, mean HDL cholesterol levels were 45.0769+23.93305, and mean LDL cholesterol levels were 98.6923+33.14029. Mean LAVI of patients with TOAST classification 1 was 34.1933+2.20066, class 2 was 34.0500+2.13605, class 3 was 36.4600+1.97687 and class 5 was 31.4333+2.20530. We found a statistically significant difference in mean values of LAVI in Class 3 and Class 5 patients. Conclusion: In conclusion, LAVI was significantly associated with class III (cardio embolic) and class V (stroke of undetermined etiology) strokes according to TOAST criteria. We also found significantly increased LAVI with larger left atria. We suggest that further prospective observational studies studying the relationship between atrial parameters and stroke subtypes should be performed as they provide useful insight into unraveling mechanisms of strokes in individual patients especially those with perhaps multiple overlapping proximate causes of stroke, with increasing atrial dilation. [ABSTRACT FROM AUTHOR]

Abstract Background Cryptogenic cerebrovascular stroke can be defined as an ischemic stroke that lacks a clear cause, even after a thorough evaluation. It should be distinguished from the embolic stroke of undetermined source (ESUS), a subgroup that includes cardio-embolic sources. This study aims to assess left atrial function through two-dimensional speckle tracking echocardiography (2D-STE) to determine its potential association with cryptogenic stroke and its predictive value for subclinical atrial fibrillation (AF). Our prospective cohort study involved 62 patients with unexplained cerebrovascular stroke or TIA, regardless of gender. Following TEE assessments, 22 patients were excluded due to identified sources of cardio-embolism. The remaining 40 participants were clustered into Group I. Group II, consisted of 40 healthy individuals without significant medical history, served as a control group. Both groups underwent two-dimensional trans-thoracic echocardiography and speckle tracking echocardiography. Results LA dysfunction parameters exhibited significant differences between Group I and Group II. LV diastolic dysfunction, LAVI, LAEF, and LASr were notably affected in Group I. At the same time, LA diameter in the parasternal long-axis view (PLAX) displayed a significant difference with a p value of 0.001. Within Group I, 14 patients experienced AF episodes (Group Ia, 35%); while, the remaining 26 were categorized as Group Ib (65%). LV diastolic dysfunction displayed a p value

Background: Cryptogenic cerebrovascular stroke can be defined as an ischemic stroke that lacks a clear cause, even after a thorough evaluation. It should be distinguished from the embolic stroke of undetermined source (ESUS), a subgroup that includes cardio-embolic sources. This study aims to assess left atrial function through two-dimensional speckle tracking echocardiography (2D-STE) to determine its potential association with cryptogenic stroke and its predictive value for subclinical atrial fibrillation (AF). Our prospective cohort study involved 62 patients with unexplained cerebrovascular stroke or TIA, regardless of gender. Following TEE assessments, 22 patients were excluded due to identified sources of cardio-embolism. The remaining 40 participants were clustered into Group I. Group II, consisted of 40 healthy individuals without significant medical history, served as a control group. Both groups underwent two-dimensional trans-thoracic echocardiography and speckle tracking echocardiography. Results: LA dysfunction parameters exhibited significant differences between Group I and Group II. LV diastolic dysfunction, LAVI, LAEF, and LASr were notably affected in Group I. At the same time, LA diameter in the parasternal long-axis view (PLAX) displayed a significant difference with a p value of 0.001. Within Group I, 14 patients experienced AF episodes (Group Ia, 35%); while, the remaining 26 were categorized as Group Ib (65%). LV diastolic dysfunction displayed a p value < 0.011; while, LAVI, LAEF, and LASr exhibited considerable differences with p values < 0.0001. However, the LA diameter showed no significant variation between the two groups. LASr emerged as the most sensitive and specific parameter for predicting AF, with a cutoff point of ≤ 24.5% and a p value < 0.0001. LAEF showed a cutoff point of ≤ 40.5% and a p value of 0.011. Meanwhile, LAVI demonstrated the lowest sensitivity and specificity, with a mean cutoff point of ≥ 38.5 ml/m2 and a p value of 0.003. Conclusions: 2D-STE is crucial for assessing LA dysfunction as a potential cryptogenic stroke cause after TEE and ruling out cardio-embolism sources. LASr serves as a key LA cardiopathy indicator, even preceding AF. LASr independently poses an AF risk. While LAEF and LAVI are significant LA dysfunction parameters and AF predictors, they exhibit lower sensitivity and specificity than LASr. [ABSTRACT FROM AUTHOR]

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Background: Patients with acute coronary syndrome (ACS) and increased left atrial volume index (LAVI) have worse long-term prognosis. The present study was designed to evaluate the association between LAVI and the clinical characteristics of the patients with ACS at admission and at follow-up. Materials and Methods: A prospective cohort study was conducted at a tertiary care center in India between April 2018 and December 2019. A total of 80 patients (aged >18 years) having chest pain or its equivalent with a diagnosis of ACS were enrolled as the case group and 30 healthy controls (aged >18 years) were enrolled as the control group. The case group was further classified into two groups based on LAVI values (i.e., LAVI

Abstract Background Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. However, the predictive value of single indictor still remains controversial. This study aimed to assess the predictive value of combining preoperative left atrial volume index (LAVI) and postoperative interleukin-6 (IL-6) for POAF in the patients receiving cardiac surgery. Methods Patients who admitted to Nanjing First Hospital during the study period between December 2022 and June 2023, and underwent open-heart surgery without a history of atrial fibrillation (AF) were enrolled. The relationships between predictors and POAF were investigated using logistic regression analysis. We determined the combined predictive value of LAVI and IL-6 for POAF by measuring the changes in the area under the receiver operating characteristic curve (AUC) and calculating the net reclassification improvements (NRIs) and integrated discrimination improvement (IDIs). Results 102 patients were enrolled in this study, and 50 participants developed POAF (49.0%). Patients who experienced POAF had higher levels of preoperative LAVI and postoperative IL-6 than those who did not. Regression analysis revealed that larger LAVI and higher level of IL-6 were independently associated with increased risk of POAF. The combined addition of LAVI and IL-6 to the predictive model resulted in an evident increase in the AUC. Incorporating both LAVI and IL-6 increased IDIs in all models. Conclusion Our results demonstrated that combined LAVI and IL-6 achieved a higher prediction performance for POAF.

Background: It has been shown that obesity and a higher body mass index (BMI) are associated with a higher recurrence rate of atrial fibrillation (AF) after successful catheter ablation (CA). The same has been proven for the left atrial volume index (LAVI). It has also been shown that there is a correlation between LAVI and BMI. However, whether the LAVI's prognostic impact on AF recurrence is BMI-independent remains unclear. Methods: We prospectively included 62 patients with paroxysmal AF who were referred to our institution for CA. All patients underwent radiofrequency CA with standard pulmonary veins isolation. Transthoracic 2-D echocardiography was performed one day after CA to obtain standard measures of cardiac function and morphology. Recurrence was defined as documented AF within 6 months of the follow-up period. Patients were also instructed to visit our outpatient clinic earlier in case of symptoms suggesting AF recurrence. Results: We observed AF recurrence in 27% of patients after 6 months. The mean BMI in our cohort was 29.65 ± 5.08 kg/cm2 and the mean LAVI was 38.04 ± 11.38 mL/m2. We further divided patients into two groups according to BMI. Even though the LAVI was similar in both groups, we found it to be a significant predictor of AF recurrence only in obese patients (BMI ≥ 30) and not in the non-obese group (BMI < 30). There was also no significant difference in AF recurrence between both cohorts. The significance of the LAVI as an AF recurrence predictor in the obesity group was also confirmed in a multivariate model. Conclusions: According to our results, the LAVI tends to be a significant predictor of AF recurrence after successful catheter ablation in obese patients, but not in normal-weight or overweight patients. This would suggest different mechanisms of AF in non-obese patients in comparison to obese patients. Further studies are needed in this regard. [ABSTRACT FROM AUTHOR]

Background: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. However, the predictive value of single indictor still remains controversial. This study aimed to assess the predictive value of combining preoperative left atrial volume index (LAVI) and postoperative interleukin-6 (IL-6) for POAF in the patients receiving cardiac surgery. Methods: Patients who admitted to Nanjing First Hospital during the study period between December 2022 and June 2023, and underwent open-heart surgery without a history of atrial fibrillation (AF) were enrolled. The relationships between predictors and POAF were investigated using logistic regression analysis. We determined the combined predictive value of LAVI and IL-6 for POAF by measuring the changes in the area under the receiver operating characteristic curve (AUC) and calculating the net reclassification improvements (NRIs) and integrated discrimination improvement (IDIs). Results: 102 patients were enrolled in this study, and 50 participants developed POAF (49.0%). Patients who experienced POAF had higher levels of preoperative LAVI and postoperative IL-6 than those who did not. Regression analysis revealed that larger LAVI and higher level of IL-6 were independently associated with increased risk of POAF. The combined addition of LAVI and IL-6 to the predictive model resulted in an evident increase in the AUC. Incorporating both LAVI and IL-6 increased IDIs in all models. Conclusion: Our results demonstrated that combined LAVI and IL-6 achieved a higher prediction performance for POAF. [ABSTRACT FROM AUTHOR]

Background: Patients with acute coronary syndrome (ACS) and increased left atrial volume index (LAVI) have worse long-term prognosis. The present study was designed to evaluate the association between LAVI and the clinical characteristics of the patients with ACS at admission and at follow-up. Materials and Methods: A prospective cohort study was conducted at a tertiary care center in India between April 2018 and December 2019. A total of 80 patients (aged >18 years) having chest pain or its equivalent with a diagnosis of ACS were enrolled as the case group and 30 healthy controls (aged >18 years) were enrolled as the control group. The case group was further classified into two groups based on LAVI values (i.e., LAVI <31 mL/m2 and LAVI ≥31 mL/m2). Baseline demographics, clinical characteristics, and echocardiographic characteristics were recorded of all the patients at admission. The patients were followed up at 1 month and 6 months. Results: The mean age of the case group was 54.7 ± 11.6 years and males were predominant (78.8%). Mean LAVI was 31.1 ± 9.0 mL/m2 in the case group and 24.2 ± 3.1 mL/m2 in the control group. Grade II (30%) and Grade III diastolic dysfunction (30%) were predominant in patients with LAVI ≥31 mL/m2. At 1-month follow-up, mortality was reported in 2 (5%) patients with LAVI <31 mL/m2 and in 5 (12.5%) patients with LAVI ≥31 mL/m2, whereas there was no mortality at 6-months follow-up. A positive correlation was observed between LAVI and E/e' (P = 0.001), left ventricular end-diastolic diameter (P = 0.001), and left ventricular end-systolic diameter (P = 0.001). The area under the curve for detection of mortality based on LAVI values was 0.776 (95% confidence interval of 0.692–0.860; P = 0.001). Conclusion: The present study demonstrated that LAVI acts as a prognostic marker of adverse events and mortality in patients with ACS. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the relationship between uveitis and left atrial volume index (LAVI) in patients with ankylosing spondylitis (AS). Materials and Methods: Demographic, clinical, echocardiographic and brachial artery flow-mediated dilation measurement data of patients diagnosed with AS were recorded prospectively between January 2019 and June 2023. The patients were categorized into two groups: increased (Group 2) and normal (Group 1) based on a cut-off value of 34 ml/m2 for increased LAVI and the data were compared. Results: Of the 89 patients with AS, 54 were male and 35 were female, with a mean age of 42.8±11.8 years. There were N=67 patients in the group with normal LAVI levels, and N=22 patients in the group with high LAVI levels. Mean age, uveitis and comorbid conditions were higher in Group 2. Among the basic echocardiographic parameters that may affect LAVI, only the left ventricular mass index was different in Group 2. In Group 2, flow-dependent dilatation in the vessel decreased. When we evaluated all parameters by multivariate logistic regression analysis, we found that age (odds ratio:1.097; 95% confidence interval:1.017-1.183; P=0.016) and the presence of uveitis (odds ratio:21.3; 95% confidence interval:2.476-182.1; P=0.005) independently predicted Group 2. Conclusion: Evaluation of LAVI in AS patients with uveitis may be a guide in predicting the risk of cardiovascular events and early treatment. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease leads to cardiac remodelling of multifactorial origin known as "uraemic cardiomyopathy", the reversibility of which after kidney transplantation (KT) remains controversial. Our objectives were to assess, in the modern era, changes in echocardiographic parameters following KT and identify predictive clinical and biological factors associated with echocardiographic changes. Methods: One hundred six patients (mean age 48 ± 16, 73% male) who underwent KT at the University Hospital of Nancy between 2007 and 2018 were retrospectively investigated. Pre- and post-KT echocardiography findings (8.6 months before and 22 months after KT on average, respectively) were centralised, blind-reviewed and compared. Results: A majority of patients (60%) had either a left ventricular (LV) ejection fraction < 50%, at least moderately abnormal LV mass index or left atrial (LA) dilatation at pretransplanted echocardiography. After KT, LV remodelling and diastolic doppler indices did not significantly change whereas LA volume index (LAVI) increased (35.9 mL/m2 post-KT vs. 30.9 mL/m2 pre-KT, p = 0.006). Advancing age, cardiac valvular disease, delayed graft function, lower post-KT haemoglobin, and more severe post-KT hypertension were associated with higher LAVI after KT. Higher post-KT serum creatinine, more severe post-KT hypertension and lower pre-KT blood calcium levels were associated with a deterioration in LAVI after KT. Discussion/Conclusion: Adverse remodelling of the left atrial volume occurred after KT, predominantly in patients with lower pre-KT blood calcium, poorer graft function and post-KT hypertension. These results suggest that a better management of modifiable factors such as pre-KT hyperparathyroidism or post-KT hypertension could limit post-KT cardiac remodelling. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to identify which resting echocardiographic parameters can detect asymptomatic or mildly symptomatic patients with primary mitral regurgitation (MR) who require exercise stress echocardiography (ESE) to determine their suitability for surgery. Methods: We examined 56 consecutive patients with primary moderate/severe MR who underwent ergometer-based ESE. Patients who met the surgical indications at rest were excluded. Eligible patients were divided into Group I (pulmonary artery systolic pressure [PASP] during exercise >60 mmHg; n=11) and Group II (PASP during exercise ≤60 mmHg; n=30). Results: Forty-one patients were included. Group I was significantly older (65±12 vs. 54±14 years, P=0.042) and had significantly higher serum N-terminal pro-B-type natriuretic peptide concentrations than Group II (351±278 vs. 125±163 pg/mL, P=0.002). The univariate analysis demonstrated that peak E wave velocity (Group I vs. Group II: 125±45 vs. 101±24 cm/sec, P=0.050), left ventricular (LV) end-diastolic diameter index (32±4 vs. 30±3 mm/m2, P=0.035), and left atrial volume index (LAVI; 45±14 vs. 30±11 mL/m2, P=0.008) were predictors of increased PASP during exercise. In the multivariate analysis, resting LAVI best predicted exercise-induced pulmonary hypertension (hazard ratio 1.081 [95% confidence interval 1.009–1.158], P=0.028), with a cutoff value of 37 mL/m2. Conclusions: In asymptomatic or mildly symptomatic patients with primary moderate/severe MR, increased resting LAVI indicates the requirement for ESE, even without LV dilatation.

Background: Both atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) commonly coexist with overlapping symptoms, risk factors, and shared pathophysiology. Both conditions independently impact left atrial volume index (LAVI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, making it difficult to diagnose HFpEF in AF. Aim: The aim is to study the association of AF with NT-proBNP levels, LAVI, and left atrial (LA) size in HFpEF. Materials and Methods: An observational study of 40 patients was conducted at a Tertiary Care Center in Western India. Patients above 18 years of age with classical heart failure presentation were included and their clinical history and general and systemic examination were done along with NT-proBNP measurement and two-dimensional echocardiography for assessing heart structure and function. Results: Twenty-one patients had sinus rhythm; 19 had AF. AF patients had higher NT-proBNP levels (2599 pg/mL) compared to patients with sinus rhythm (785 pg/mL). AF patients had a greater degree of left ventricular (LV) dysfunction (higher LV end-diastolic dimensions, LV posterior wall thickness, LV mass index, LA diameter, LA volume and LAVI), more prevalence of pulmonary artery hypertension (n = 19 vs. n = 17), higher degrees of diastolic dysfunction (e.g. higher e’ septum, e’ lateral and E/e’), and higher right ventricle systolic pressure as compared to patients with sinus rhythm. Conclusions: The present study shows that AF occurs in around half of HFpEF patients, with a higher incidence in women and younger people. Patients with AF have higher rates of right heart failure, severe atrial and ventricular remodeling, and higher levels of NT-proBNP, which indicate an advanced form of the disease.

Background: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and a major predictor of morbidity and mortality. In recent years, genome-wide association studies (GWAS) have identified common genetic variants associated with a higher risk of AF. The aim of our research was to study the possible association of the 4q25/PITX2 SNP rs6817105 with the risk of developing AF in patients with arterial hypertension (AH) in the Uzbek population. Methods and Results: The study included 142 AH (Grades 1-3; ESC/ESH, 2018) patients of Uzbek nationality who were initially diagnosed with paroxysmal form (15[10.6%]), persistent form (43[30.3%]), and permanent form of AF (84[59.1%]). The mean age of these patients was 64.8±10.9 years. AF was verified using ECG Holter monitoring. The control group (n=88) consisted of AH patients without AF with a mean age of 56.5±12.3 years. Echocardiography was carried out according to the recommendations of the American Society of Echocardiography in M- and B-modes. We genotyped SNP rs6817105 (T>C) and examined the relationships among rs6817105 genotype, clinical characteristics, and echocardiographic parameters in AH patients with AF and non-AF AH patients (controls). The rs6817105 minor C allele frequency was significantly higher in AH patients with AF than in non-AF AH patients (71.8% vs. 59.7%, P=0.007). Analysis of the multiplicative model for the rs6817105 SNP showed a significant risk of AF in the carriage of the C allele (OR=1.72, 95% CI: 1.16-2.56, P=0.007). The dominant and additive models for the rs6817105 SNP showed a significant risk of AF with the carriage of the CC+CT genotypes (OR=3.16, 95% CI: 1.37-7.27, P=0.005) and the homozygous CC genotype (OR=1.63, 95% CI: 0.95-2.81, P=0.008), respectively. The allelic distribution showed that the carriage of the C allele was dominant in permanent and persistent AF (110/68.75% vs. 50/31.25% for the T allele [(χ2=22.50, P=0.000], and 64/74.42% vs. 22/25.58% for the T allele [χ2=20.512, P=0.000], respectively). Among AH patients with paroxysmal AF, the C allele prevailed to the greatest extent: 20(90.9%) vs. 2(9.1%) for the T allele (χ2=14.727, P=0.000), indicating a significant accumulation of the C allele and CC genotype among patients with paroxysmal AF. In general, in AH patients with AF, carriers of the CC genotype, the left atrial volume index (LAVI) was significantly higher than the carriers of the CT and TT genotypes: 46.8±13.9 ml/m2 vs. 40.4±13.0 ml/m2 and 36.1±11.0 ml/m2, respectively (P=0.0083). Conclusion: Our results indicate the rs6817105 minor C allele and CC genotype are associated with the risk of developing AF in AH patients of Uzbek nationality. The highest accumulation of the rs6817105 minor C allele and CC genotype is found in paroxysmal AF. In carriers of the rs6817105 CC genotype, the LAVI was significantly larger than in carriers of the CT and TT genotypes.

Introduction: Detection of atrial fibrillation (AF) is crucial for preventing recurrence in patients with ischemic stroke. We aimed to examine whether the left atrial volume index (LAVI) and global longitudinal peak strain (GLPS) are associated with AF in patients with ischemic stroke. Methods: We prospectively analyzed 678 consecutive patients with ischemic stroke. LAVI and GLPS were assessed using three-dimensional transthoracic echocardiography with speckle-tracking imaging. Multiple logistic regression was used to evaluate the association of AF with LAVI and GLPS. To evaluate the predictive value of LAVI and GLPS for the presence of AF, we used optimism- corrected c-statistics calculated by 100 bootstrap repetitions and the net reclassification improvement (NRI). Results: The mean patient age was 68 ± 13 years (men, 60%). Patients with AF (18%) were a higher LAVI (41.7 ml/m² vs. 74.9 ml/m², P < 0.001) and a higher GLPS than those without AF (-14.0 vs. -17.3, P < 0.001). Among the 89 patients classified with embolic stroke of unknown source, the probable cardioembolic group had higher GLPS (n = 17, -14.6 vs. -18.6, respectively; P = 0.014) than the other groups (n = 72). Adding GLPS to age, hypertension, and the LAVI significantly improved the NRI, with an overall NRI improvement of 6.1% (P = 0.03). Discussion: The LAVI andGLPS with speckle-tracking imaging echocardiography may help identify patients with AF. [ABSTRACT FROM AUTHOR]

Background and Objective: Recently, the antidiabetic drug sodium-glucose cotransporter type 2 inhibitor (SGLT2i) has been approved among the drugs that reduce mortality in patients with Heart failure with reduced ejection fraction (HFrEF). The impact of SGLT2i inhibitors on the left ventricle longitudinal myocardial function in heart failure (HF) patients remained vague. The effect of SGLT2i on left ventricular remodeling and function in patients with HFrEF was studied using speckle tracking (STE) and traditional echocardiography. Objectives: Studying the effects of SGLT2i on left ventricular remodeling and function in HFrEF patients using STE and traditional echocardiography. Methods:. 300 patients with HFrEF were included. Study design: This prospective observational study involves 300 patients with HFrEFadministered SGLT2i (Empagliflozin and Dapagliflozin) and the classical treatment of heart failure. Then the patients were examined 2, 4, and 6 months after treatment with laboratory investigations of baseline glycosylated hemoglobin (HbA1C), glomerular filtration rate (eGFR), 2D echo, and STE studies. Results: The mean age was 50±9.2 for males and females. The mean weight, height, and body mass index (BMI) were 85.6±8.8 kg, 178.6±7.2 cm, and 26.6±2.9, respectively. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 115.3±5.1 and 75.4±4.5, respectively. The mean heart rate was 79.9±10.2. The mean respiratory rate was15±2.2. Regarding functional NYHA class, 0.2 %, 12%, 87.1%, and 0.7% of the patients were in class I, II, III, and IV, respectively. The lab investigations before the treatment: mean HbA1C was 4.2±0.6, and eGFR was 66.4±9.3. Using Empagliflozin, left ventricular ejection fraction (LVEF) showed a significant improvement from 34.73±2.9 at baseline to 34.91±1.2, 35.42±3.5, and 36.54±3.6 at 2, 4, and 6 months (p=0.001), respectively. In addition, Global longitudinal strain GLS showed a remarkable enhancement from -15.67±2.74 to -16.5±3.19, - 17.32±3.21, -18.03±3.05 at 2, 4, and 6 months (p=0.001), respectively as indicated by GLS A2. While GLS A4 indicated that GLS was changed from -15.66±2.65 to -16.50±3.31, - 17.41±3.23, and -17.93±3.32 (p=0.001). By Employing Dapagliflozin, LVEF showed significant improvement from 34.87±2.86 at baseline to 34.87±2.86, 35.05±3.01, and 37.53±4.1 at 2, 4, and 6 months (p=0.001), respectively. GLS showed a remarkable improvement similar to the improvement observed with Empagliflozin. E/e' significantly reduced from 11.2±2.7 to 9.1±2.3 cm/s after administration of Empagliflozin and Dapagliflozin within 6 months (p=0.01). Left atrial volume index (LAVI) improved from 45.6 ± 15.3 to 37.5 ±6.5 (ml/m2) (p=0.001) after 6 months. The results revealed a significant increase of ejection fraction at 4 and 6 months of follow-up and a significant improvement of global longitudinal strain at 2, 4, and 6 months with patients given SGLT2i. Conclusion: SGLT2i was associated with improving left ventricular (LV) longitudinal myocardial function, further enhancing LV diastolic function. SGLT2i is associated with increased ejection fraction (EF) and LV longitudinal myocardial function improvement, subsequently ameliorating LV diastolic function. The Dapa group had a more significant improvement in LVEF at four months and six months compared to the Empa group. The Empa group showed a significant improvement in HbA1C at six months compared to the Dapa group. [ABSTRACT FROM AUTHOR]

Introduction: Coronary computed tomography angiography (CCTA) is known to have a high negative predictive value (NPV) in identifying coronary artery disease (CAD). This study aimed to examine whether resting echocardiographic parameters could exclude significant CAD on CCTA. Methods: We recruited 142 patients who had undergone both CCTA and echocardiography within a 3‐month window. Based on the CCTA findings, patients were divided into two groups: Group A (non‐significant CAD, defined as all coronary segments having <50% stenosis) and Group B (significant CAD). Resting echocardiographic parameters were compared between the two groups to identify predictors of non‐significant CAD on CCTA. Results: A total 92 patients (mean age, 68 ± 13 years; males, 62%) were eligible for this study; 50 in Group A and 42 in Group B. Among the various echo parameters, left atrial volume index (LAVI) and left ventricular (LV) global longitudinal strain (GLS) were significantly lower in Group A (23.5 ± 7.6 vs. 33.6 ± 7.4 mL/m2, p <.001; −20.2 ± 1.8% vs. −16.8 ± 2.0%, p <.001, respectively). Analysis of the receiver operating characteristic curve revealed that the cutoff value to exclude significant CAD on CCTA was 29.0 mL/m2 for LAVI (NPV 80.8%) and −18.1% for GLS (NPV 80.7%). The NPV increased to 95.0% when these parameters were combined (LAVI < 29.0 mL/m2 and GLS < −18.1%). Conclusion: The combination of resting LAVI and GLS was clinically useful in excluding significant CAD via CCTA. [ABSTRACT FROM AUTHOR]

Introduction: Increased left atrial (LA) size is a risk factor for cardiovascular events and all-cause mortality. It is closely related to left ventricular hypertrophy and chronic volume overload, both of which are common in hemodialysis. Calcimimetic treatment with etelcalcetide (ETL) previously showed an inhibitory effect on left ventricular mass index (LVMI) progression in this population. Methods: This is a post hoc analysis of the EtECAR-HD trial, where 62 patients were randomized to ETL or alfacalcidol (ALFA) for 1 year. LA volume index (LAVI) was measured using cardiac magnetic resonance imaging. The aim of the study was to investigate whether ETL was associated with a change of LAVI. Results: Median baseline levels of LAVI were 40 mL/m2 (31, 54 IQR) in the ETL group and 36 mL/m2 (26, 46 IQR) in the ALFA group. In the ITT population, the change of LAVI was 5.0 mL/m2 [95% CI: −0.04, 10] lower under ETL, compared to ALFA (p = 0.052, R2adj = 0.259). In the PP population, the difference in LAVI changes widened to 5.8 [95% CI: 0.36, 11], p = 0.037, R2adj = 0.302). Secondary analysis showed that the study delta of LVMI was correlated with the LAVI delta (r = 0.387) and that an inclusion of LVMI delta in the ANCOVA model mediated the effect on LAVI delta to β = 3.3 [95% CI: −0.04, 10] (p = 0.2, R2adj = 0.323). The same could not be observed for parameters assessing the volume status. Conclusions: The analysis indicates that ETL could inhibit LAVI progression compared with ALFA. This effect was mediated by the change of LVMI. [ABSTRACT FROM AUTHOR]

Background: Identification of predictors for atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) can lead to better long-term results. Our aim was to investigate the association between novel CT imaging markers reflecting the severity of coronary atherosclerosis and the risk of recurrence following PVI. Methods: This study included 80 patients with paroxysmal/persistent AF who underwent PVI. The patients were divided into two groups: Group 1–23 patients with recurrence and Group 2–57 patients without recurrence. Results: Patients with recurrence presented with a more enlarged left atrial diameter and reduced left ventricle EF, as assessed by echocardiography. Elevated calcium scores and right coronary artery (RCA) stenosis were correlated with a higher risk of AF recurrence (25.38 ± 4.1% vs. 9.76 ± 2.32%, p = 0.001). Patients with AF recurrence presented a higher left atrial volume index (LAVI) (61.38 ± 11.12 mm3/m2 vs. 46.34 ± 12.27 mm3/m2, p < 0.0001). The bi-atrial volume index (BAVI) was similarly higher in the AF recurrence group (98.23 ± 14.44 mm3/m2 vs. 76.48 ± 17.61 mm3/m2, p < 0.0001). Increased EAT volumes located around the LA (EAT-LA) were correlated with recurrence (25.55 ± 6.37 vs. 15.54 ± 8.44, p < 0.0001). Conclusions: RCA stenosis, together with atrial volumes and EAT-AS evaluated by CCTA, is associated with the risk of AF recurrence following PVI. [ABSTRACT FROM AUTHOR]

BackgroundCardiac sympathetic denervation (CSD) is a promising treatment for patients with structural heart disease (SHD) and refractory ventricular tachyarrhythmias (VTs). The effect of CSD on atrial rhythm as well as the prognostic impact of atrial arrhythmias (AAs) or left atrial volume index (LAVI) on CSD outcome are unknown.ObjectivesThe goals of this study were to evaluate the impact of AAs and LAVI on CSD outcome and to assess changes in AAs burden and in atrial pacing after CSD.MethodsPatients with SHD undergoing CSD for VTs were analyzed. Hazards models were built to assess predictors of sustained VT/implantable cardioverter-defibrillator (ICD) shock recurrences and death/orthotopic heart transplant (OHT). Changes before vs after CSD were assessed using ICD, clinical, and echocardiographic data. A drug index was devised to correct for medication use.ResultsBetween 2009 and 2018, 91 patients (mean age 56 ± 13 years; mean left ventricular ejection fraction 34% ± 14%; 47% with a history of AAs) underwent left CSD (16%) or bilateral CSD (BCSD). The median follow-up was 14 months (interquartile range 4-37 months). Using multivariable analysis, neither LAVI nor AAs were associated with recurrences; LAVI was an independent predictor of death/OHT. AAs burden did not change after BCSD, but atrial pacing increased from a median of 28% to 72% (P < .01). Left ventricular end-diastolic diameter slightly increased; however, sustained VT/ICD shocks were reduced.ConclusionIn patients with SHD undergoing CSD, LAVI predicts death/OHT. AAs burden, already low at baseline, was unchanged after BCSD, while the need for atrial pacing increased, suggesting an impact of BCSD on sinus node chronotropism.

Objective: We aimed to assess feasibility and functional correlates of left atrial volume index (LAVI) changes during exercise stress echocardiography (ESE). Methods: ESE on a bike or treadmill was performed in 363 patients with heart failure with preserved ejection fraction (HFpEF, n = 173), reduced ejection fraction (HFrEF, n = 59), or hypertrophic cardiomyopathy (HCM, n = 131). The LAVI stress-rest increase ≥6.8 ml/m2 was defined as dilation. Results: LAVI measurements were feasible in 100%. LAVI did not change in HFrEF being at rest 32 (25-45) vs at stress 36 (24-54) ml/m2, P = NS and in HCM at rest 35 (26-48) vs at stress 38 (28-48) ml/m2, P = NS, whereas it decreased in HFpEF from 30 (24-40) to 29 (21-37) ml/m2 at stress, P = 0.007. LA dilation occurred in 107 (30%) patients (27% with treadmill vs 33% with bike ESE, P = NS): 26 with HFpEF (15%), 26 with HFrEF (44%), and 55 with HCM (42%) with P 14 at rest with odds ratio (OR) 4.4, LVEF

Aims Indications for surgery in patients with degenerative mitral regurgitation (DMR) are increasingly liberal in all clinical guidelines but the role of secondary outcome determinants (left atrial volume index ≥60 mL/m2, atrial fibrillation, pulmonary artery systolic pressure ≥50 mmHg and moderate to severe tricuspid regurgitation) and their impact on post-operative outcome remain disputed. Whether these secondary outcome markers are just reflective of the DMR severity or intrinsically affect survival after DMR surgery is uncertain and may have critical importance in the management of patients with DMR. To address these gaps of knowledge the present study gathered a large cohort of patients with quantified DMR, accounted for the number of secondary outcome markers and examined their independent impact on survival after surgical correction of the DMR. Methods and results The Mitral Regurgitation International DAtabase-Quantitative registry includes patients with isolated DMR from centres across North America, Europe, and the Middle East. Patient enrolment extended from January 2003 to January 2020. All patients undergoing mitral valve surgery within 1 year of registry enrolment were selected. A total of 2276 patients [65 (55–73) years, 32% male] across five centres met study eligibility criteria. Over a median follow-up of 5.6 (3.6 to 8.7) years, 278 patients (12.2%) died. In a comprehensive multivariable Cox regression model adjusted for age, EuroSCORE II, symptoms, left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LV ESD) and DMR severity, the number of secondary outcome determinants was independently associated with post-operative all-cause mortality, with adjusted hazard ratios of 1.56 [95% confidence interval (CI): 1.11–2.20, P = 0.011], 1.78 (95% CI: 1.23–2.58, P = 0.002) and 2.58 (95% CI: 1.73–3.83, P < 0.0001) for patients with one, two, and three or four secondary outcome determinants, respectively. A model incorporating the number of secondary outcome determinants demonstrated a higher C-index and was significantly more concordant with post-operative mortality than models incorporating traditional Class I indications alone [the presence of symptoms (P = 0.0003), or LVEF ≤60% (P = 0.006), or LV ESD ≥40 mm (P = 0.014)], while there was no significant difference in concordance observed compared with a model that incorporated the number of Class I indications for surgery combined (P = 0.71). Conclusion In this large cohort of patients treated surgically for DMR, the presence and number of secondary outcome determinants was independently associated with post-surgical survival and demonstrated better outcome discrimination than traditional Class I indications for surgery. Randomised controlled trials are needed to determine if patients with severe DMR who demonstrate a cardiac phenotype with an increasing number of secondary outcome determinants would benefit from earlier surgery. [ABSTRACT FROM AUTHOR]

Objective: To study the frequency of left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus presenting to a tertiary care hospital. Study Design: Cross sectional study. Place and Duration of Study: Medicine Dept, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Mar to Aug 2022. Methodology: Fifty-one patients between the ages of 30 to 65 years were enrolled, belonging to either gender, presenting to outdoor department, with diagnosed type 2 diabetes mellitus for at least 1 year, on oral hypoglycemic drugs or insulin, and no underlying hypertensive cardiac pathology or diastolic dysfunction. These patients were further analyzed using statistical software based on their 2D echocardiogram findings. Results: Out of 51 type 2 diabetes mellitus patients, there were more males 32(62.7%) as compared to females 19(37.3%), with mean age of 52.25±8.09 years. We observed that 21(41.2%) patients did not have left ventricular diastolic dysfunction at the time of our study, but among these patients, 13(61.9%) had type 2 diabetes mellitus for 1-3 years while remaining 30(58.8%) patients had both type 2 diabetes mellitus and left ventricular diastolic dysfunction, with 13(25.5%) having grade-I, 10(19.6%) having grade-II and 7(13.7%) having grade-III categorization. Conclusion: There was an increased risk of left ventricular diastolic dysfunction in type 2 diabetes mellitus with longer duration of disease and higher HbA1c. Patients with type 2 diabetes mellitus to be followed up for diabetic control and monitored for the presence of asymptomatic left ventricular diastolic dysfunction with measures to be taken to prevent it. [ABSTRACT FROM AUTHOR]

Abstract Background Nerve injury-induced protein 1 (Ninj1) is elevated in various inflammatory diseases. The soluble form of Ninj1 yield by matrix metalloproteinase cleavage is a secreted protein and inhibits cell adhesion and inflammation. However, the role of plasma Ninj1 in atrial fibrillation (AF) has not been reported. The present study aimed to investigate the correlation between plasma Ninj1 levels and AF. Methods A total of 96 AF patients [age 66.00 (60.00, 72.00) years, male 56 (58.33%)] and 51 controls without AF [age 65.00 (55.00, 68.00) years, male 21 (41.18%)] were enrolled in this study. Plasma Ninj1 concentrations were detected using enzyme-linked immunosorbent assay. Also, the clinical characteristics, left atrial volume index (LAVI), CHA2DS2-VASc score, and HAS-BLED score were evaluated. Results Plasma Ninj1 levels were significantly higher in patients with AF than in controls (P

OBJECTIVE: To study the associations of comprehensive measures of cardiac structure and function with multidimensional neurocognitive measures. PATIENTS AND METHODS: The Echocardiographic Study of Latinos is a population-based cohort of Hispanic/Latino adults older than 45 years enrolled from October 1, 2011, through June 30, 2014. Neurocognitive measures included Word Fluency (WF), Brief-Spanish English Verbal Learning Test (B-SEVLT), and Digit Symbol Substitution Test. The B-SEVLT included B-SEVLT-recall and B-SEVLT-sum. Echocardiographic measures included cardiac structure, systolic and diastolic function, and myocardial strain. Multivariable regression models were fit using survey statistics and sampling probabilities. RESULTS: A total of 1794 participants (mean age, 56±0.5 years; 56% women) were included in the analysis. In the adjusted model, higher left ventricular mass index was associated with lower B-SEVLT-sum and Digit Symbol Substitution Test scores. Left ventricular systolic dysfunction was associated with lower WF scores. Abnormal left ventricular geometry was associated with lower B-SEVLT-sum scores. Higher relative wall thickness was associated with B-SEVLT-recall and B-SEVLT-sum scores. Mitral annular relaxation velocities were associated with lower B-SEVLT-recall, B-SEVLT-sum, and WF scores. Higher mitral inflow to annular early diastolic velocity ratio was associated with lower B-SEVLT-recall and B-SEVLT-sum scores. Diastolic dysfunction was associated with lower B-SEVLT-sum scores. Finally, lower global longitudinal strain was associated with lower WF scores. CONCLUSION: Alterations in cardiac structure, systolic and diastolic function, and myocardial strain were associated with worse neurocognitive function. Further study is needed to determine the mechanisms (ie, impairment of cerebral flow and silent brain infarctions) mediating these heart-brain associations.

Objective: To investigate the predictive efficacy of serum B-type brain natriuretic peptide (BNP), galectin-3 (Gal-3) combined with left atrial volume index (LAⅥ) in patients with postoperative new-onset atrial fibrillation after off-pump coronary artery bypass grafting (OPCAB). Methods: 196 patients who were admitted to the Department of Cardiovascular Surgery of our hospital from January 2020 to January 2022 were selected, and they were divided into new-onset atrial fibrillation group (36 cases) and non-new-onset atrial fibrillation group (160 cases) according to whether they had new atrial fibrillation during the postoperative hospital stay. The serum BNP, Gal-3 levels and LAⅥ in the two groups were detected, and the clinical data of all patients were collected. Multivariate Logistic regression was used to analyze the influencing factors of postoperative new-onset atrial fibrillation in patients with OPCAB. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of BNP, Gal-3 and LAⅥ in predicting postoperative new-onset atrial fibrillation in patients with OPCAB. Results: The serum BNP, Gal-3 levels and LAⅥ in the new-onset atrial fibrillation group were higher than those in the non-new-onset atrial fibrillation group (P＜0.05). Postoperative IABP assistance, older age, high level of BNP, high level of Gal-3, and high LAⅥ were risk factors for postoperative new-onset atrial fibrillation in patients with OPCAB (P＜0.05). The area under curve of BNP, Gal-3 and LAⅥ in predicting postoperative new-onset atrial fibrillation in patients with OPCAB was0.872, which was higher than 0.773, 0.711 and 0.766 for BNP, Gal-3 and LAⅥ alone. Conclusions: The serum BNP, Gal-3 levels and LAⅥ in patients with new-onset atrial fibrillation after OPCAB are increased, All the above indicators can assist in predicting the risk of new-onset atrial fibrillation in patients with OPCAB after OPCAB, and the combined detection has higher predictive efficiency. [ABSTRACT FROM AUTHOR]

Aims: Left atrial volume index (LAVI) is an adequate analysis to predicate the left ventricle (LV) filling pressures, providing a powerful predictive marker of LV diastolic dysfunction. LAVI is a dynamic morphophysiological marker, and whether LAVI changes can predicate clinical outcomes in HF with preserved ejection fraction (HFpEF) is unknown. Methods: HFpEF patients were retrospectively studied from the First Affiliated Hospital of Dalian Medical University. Patients were classified into deteriorated, stable and improved groups according to the change in LAVI. Rehospitalization was defined as the main endpoint, the composite outcome of rehospitalization or all‐cause death was defined as the secondary endpoint. Results: A total of 409 patients were included. In this cohort, the percentage of deteriorated, stable, and improved LAVI were 99 (24.2%), 235 (57.4%), and 75 (18.4%), respectively. During the 22 months follow‐up period, 168 patients (41.1%) were rehospitalized, 31 patients (7.5%) died and 182 patients (44.5%) experienced a composite outcome. Multivariate Cox regression showed that compared to improved LAVI, those with deteriorated and stable LAVI experienced higher risk of rehospitalization. Logistic regression showed atrial fibrillation (AF) and higher creatinine were independent predictors of deteriorated LAVI, whereas the use of loop diuretics, calcium channel blockers (CCB), and high level of high‐density lipoprotein cholesterol (HDL‐C) were significantly associated with improved LAVI. Conclusions: Change in LAVI provides a powerful and dynamic morphophysiological marker of LV filling status and can be used to evaluate the rehospitalization in HFpEF patients. [ABSTRACT FROM AUTHOR]

Purpose: Degenerative mitral stenosis (DMS) is associated with a poor prognosis. Although mean transmitral gradient (TMG) has shown a good correlation with outcome, little is known about the association between other echocardiographic parameters and prognosis in patients with DMS. The current study aimed to evaluate the prognostic value of left atrial volume index (LAVI) in patients with DMS.Methods: A total of 155 patients with DMS (72[63-80] years, 67% female) were included. The population was divided according to LAVI: normal-sized LAVI (LAVI ≤ 34 ml/m2); and enlarged LAVI (> 34 ml/m2).Results: Patients with enlarged LAVI had a higher left ventricular mass index (120[96-146] vs. 91[70-112] g/m2 p < 0.001), as well as a higher prevalence of significant mitral regurgitation and severe aortic stenosis (23% vs. 10% p = 0.046 and 38% vs. 15% p=0.001, respectively) compared to patients with normal-sized LAVI. During a median follow-up of 25 months, 56 (36%) patients died. Patients with enlarged LAVI had worse prognosis compared to patients with normal-sized LAVI (p = 0.026). In multivariable Cox regression model, an enlarged LAVI was independently associated with all-cause mortality (HR 2.009, 95% CI 1.040 to 3.880, P = 0.038).Conclusion: An enlarged LAVI (> 34 ml/m2) is significantly associated with excess mortality in patients with DMS. After adjusting for potential confounders, an enlarged LAVI was the only parameter that remained independently associated with prognosis. [ABSTRACT FROM AUTHOR]

Nonischemic dilated cardiomyopathy (NIDCM) is associated with an increased risk of atrial fibrillation (AF) and stroke, especially in patients with high CHA 2 DS 2 -VASc. We aimed to identify variables associated with incident AF or stroke using left atrial deformation analysis and its prognostic value added to CHA 2 DS 2 -VASc score. Patients with NIDCM and left ventricular ejection fraction <50% in sinus rhythm were included between January 2015 and December 2019. Left atrial volume index (LAVI) and atrial strain were used in combination with the CHA 2 DS 2 -VAS score to predict ischemic stroke or incident AF. Proportional hazards Cox regression was used to provide hazard ratios (HRs). There were 338 patients included. After a median follow-up of 3.6 years, the end point occurred in 41 patients (12.1%). LAVI outperformed other echocardiographic parameters, with a significant improvement in risk reclassification compared with CHA 2 DS 2 -VASc alone (net reclassification index 0.6, increase in Harrell's C from 0.63 to 0.73, p = 0.003), and remained significant after multivariate adjustment. LAVI was associated with both components of the end point separately. The best cutoff for LAVI was 44 ml/m 2 . LAVI ≥44 ml/m 2 increased the risk of the end point among those with CHA 2 DS 2 -VASc ≥3 (HR 6.0, 95% confidence interval 2.6 to 13.5) but not in those with CHA 2 DS 2 -VASc <3 (HR 1.2, 95% confidence interval 0.3 to 4.5). Competing risk analysis did not alter the results. In conclusion, LAVI might be used to assess the risk of incident AF or stroke in NIDCM. Patients with LAVI ≥44 ml/m 2 and CHA 2 DS 2 -VASc ≥3 could be at high risk of AF and stroke and may benefit from more intensive surveillance., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The European Society of Cardiology has recently defined heart failure (HF) patient group with a left ventricular ejection fraction (LVEF) of 41–49% as a different category with the term heart failure with mildly reduced ejection fraction (HFmrEF). In this study, we aimed to conduct a research about the correlation between left atrial volume index (LAVI) and atrial fibrillation in patients HFmrEF. A total of 282 patients HFmrEF who were admitted to the cardiology department from three different centres were included in the study. The study was planned as multicenter, cross-sectional study. The patients were divided into two groups as sinus rhythm and atrial fibrillation based on their electrocardiographic findings. It was found out that Nt-ProBNP, LA area, LAVI, pulmonary artery pressure, and severe mitral regurgitation rates were significantly higher in the AF group (p < 0.001). ROC analysis resulting in LAVI > 30.5 had 64% sensitivity and 66% specificity in the predicting presence of AF (ROC area under the curve: 0.660, 95% CI: 0.587–0.733, p < 0.001). We also observed that the LA area being >16.55 predicting presence of AF with 60% sensitivity and 58% specificity (ROC area under the curve: 0.624, 95% CI: 0.549–0.699, p = 0.002). In the study conducted, we found a correlation between AF and LAVI values in patients in the HFmrEF group. If the LAVI value increases in the follow-up of this group of patients with echocardiography, close follow-up in terms of AF may allow the early control and treatment of AF-related incidents. [ABSTRACT FROM AUTHOR]

BackgroundPostoperative atrial fibrillation (POAF) is related to mortality after non-cardiac surgery. Left atrial volume index (LAVI) is known to be associated with prognosis and development of atrial fibrillation, but it has not been fully investigated in patients undergoing non-cardiac surgery.Materials and methodsA total of 203,787 consecutive adult patients underwent non-cardiac surgery at our institution between January 2011 and June 2019. After identifying those with available LAVI estimated during preoperative echocardiography, we divided them into those with LAVI higher and lower than 34 mL/m2. The primary outcome was incidence of POAF.ResultsA total of 83,097 patients were enrolled in this study. The study patients were divided into the low (57,838 [69.6%]) and high (25,259 [30.4%]) LAVI groups. After an adjustment, higher LAVI was associated with increased incidence of POAF (5.1% vs. 8.1%; odds ratio [OR], 1.33; 95% confidence interval [CI], 1.25–1.41; p < 0.001). In 24,549 pairs of propensity-score-matched population, the result was similar (6.2% vs. 7.9%; OR, 1.30; 95% CI, 1.21–1.39; p < 0.001). The estimated threshold of LAVI associated with POAF was 36.4 mL/m2 with an area under the curve of 0.571. Subgroup analysis in non-thoracic and thoracic surgery showed that the association between preoperative LAVI and POAF significantly interacted with diastolic dysfunction (p for interaction < 0.001), and the observed association was valid in patients without diastolic dysfunction.ConclusionPreoperative LAVI was shown to be associated with POAF in non-cardiac surgery. Our result needs verification in further studies.

Atrial fibrillation (AF) increases stroke and mortality in patients with hypertrophic cardiomyopathy (HCM). Cardiac MRI (CMR) is increasingly used to detect late gadolinium enhancement (LGE) as a reliable indicator of left ventricular fibrosis, a potential predisposing factor of AF. Our research explored the correlation between left ventricular LGE and AF prevalence in HCM. This retrospective study involved 351 HCM patients who underwent CMR. LGE percentages (0%, 1–5%, 6–14%, ≥15%) on CMR were compared with AF prevalence in HCM patients. Demographic, comorbidity, and imaging data were analyzed using appropriate univariate and multivariate analyses assessing for significant differences in AF prevalence. The predetermined significance level was p < 0.05. CMR demonstrated increased LGE in those with AF (p = 0.004). Increased LGE correlated with increased AF rates: 27.6% (0% LGE), 38.5% (1–5% LGE), 44.4% (6–14% LGE), and 54.7% (≥15% LGE) (p = 0.101, p = 0.043, p = 0.002, respectively, vs. 0% LGE). Adjusted for age, differences persisted and were most evident for LGE >15% (p = 0.001). Multivariate analysis, factoring age, gender, BMI, RVSP, and LVEF, supported LGE (odds ratio of 1.20, p = 0.036) and LAVI (odds ratio 1.05, 1.02–1.07, p < 0.001) as predictive markers for AF prevalence. Our study suggests a correlation between ventricular LGE and AF in patients with HCM. LGE exceeding 15% was associated with a significant increase in AF prevalence. These patients may require more frequent AF monitoring. • Increasing ventricular LGE on CMR correlate with higher AF prevalence in HCM patients. • Non-invasive LAVI measurement via TTE correlates with AF in HCM. • When LAVI is normal, increased ventricular LGE on CMR correlates with increased AF in HCM. [ABSTRACT FROM AUTHOR]

Aims: To investigate the role of left atrial volume index (LAVi) in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge‐to‐edge mitral valve repair (TEER). Methods and results: Outcomes were evaluated in SMR patients of a European multicentre registry according to baseline LAVi. Main analysis was performed for all‐cause mortality; residual mitral regurgitation (MR) and New York Heart Association (NYHA) class improvement were analysed for patients available. A total of 1074 patients were included with a median LAVi (interquartile range) of 58 ml/m2 (46–73). Postprocedural reduction of MR grade to ≤2+ was similar across LAVi quintiles, ranging 91%–96% (p = 0.26). Symptomatic benefit (≥1 NYHA class improvement) also did not differ by LAVi quintiles (61%–68% of patients) (p = 0.66). The risk of mortality increased by 23%–42% in the four upper quintiles compared to the bottom quintile (LAVi <42 ml/m2). The hazard ratio (HR) of mortality was 1.35 (95% confidence interval [CI] 1.02–1.78, p = 0.035) associated with a LAVi >42 ml/m2, which was attenuated after multivariable adjustment (HR 1.18, 95% CI 0.83–1.67, p = 0.36). A significant interaction was found for MR severity and pulmonary hypertension, with an increased risk of death associated with enlarged LAVi in patients with inframedian effective regurgitant orifice area (HR 1.99, 95% CI 1.06–3.74, p = 0.032) and in patients with systolic pulmonary pressure ≤50 mmHg (HR 1.67, 95% CI 1.02–2.75, p = 0.042) in multivariable analysis. Conclusion: Procedural success and symptomatic benefit were high throughout the whole range of LAVi. The prognostic impact of left atrial enlargement was relevant in patients with less severe SMR and without pulmonary hypertension, reinforcing the need to identify patients in the early course of backward congestion to achieve good long‐term outcome after TEER. [ABSTRACT FROM AUTHOR]

Background and Aim: Pulmonary pulse transit time (pPTT) is a new marker of pulmonary hypertension (PH), which shows the time needed for the pulse wave to propagate from the right ventricular outflow tract to the left atrium (LA), but the relationship between pPTT and diastolic-LA function is almost unknown. In this study, we investigated the relationship between pPTT and LA-diastolic functions without PH. Materials and Methods: One hundred and fifty-six patients were included in this prospectively designed study. Comprehensive echocardiographic evaluation was performed and pPTT was recorded as the time from the beginning of the R-wave on the electrocardiogram to the peak of the S-wave in the pulmonary veins. Results: We found a statistically significant correlation between LA total stroke volume, passive stroke volume, LA max area, LA volume (LAV) max and LA volume index (LAVi) max, and pPTT (r = 0.263** P = 0.003, r = 0.240** P = 0.007, (r = 0.339** P < 0.001, r = 0.307** P < 0.001 r = 0.199*, P = 0.024, LA total stroke volume, passive stroke volume, LA max area, LAV max, LAVi max respectively). Heart rate (HRt) and LAVi were detected as independent predictors of pPTT (hazard ratio: −2.290 P < 0.001, 95% confidence interval (CI): −3.274–1.306, HR: 0.461, P = 0.028, 95% CI: 0.050–0.873, HRt and LAVi, respectively). Conclusion: LAVi and HRt also affected pPTT. The dominant effect of HRt on pPTT should be considered in future studies. Larger studies are needed to determine the change and clinical significance of pPTT in left heart disease. [ABSTRACT FROM AUTHOR]

Background: Heart failure with preserved ejection fraction (HFpEF) has been assessed extensively, but few studies analysed the predictive value of the NT-proBNP in patients with de novo and acute HFpEF. We sought to identify NT-proBNP at admission as a predictor for all-cause mortality and rehospitalisation at 12 months in patients with new-onset HFpEF. Methods: We analysed 91 patients (73 ± 11 years, 68% females) admitted for de novo and acute HFpEF, using the Cox proportional hazard risk model. Results: An admission NT-proBNP level above the threshold of 2910 pg/mL identified increased all-cause mortality at 12 months (AUC = 0.72, sensitivity = 92%, specificity = 53%, p < 0.001). All-cause mortality adjusted for age, gender, medical history, and medication in the augmented NT-proBNP group was 16-fold higher (p = 0.018), but with no difference in rehospitalisation rates (p = 0.391). The predictors of increased NT-proBNP ≥ 2910 pg/mL were: age (p = 0.016), estimated glomerular filtration rate (p = 0.006), left atrial volume index (p = 0.001), history of atrial fibrillation (p = 0.006), and TAPSE (p = 0.009). Conclusions: NT-proBNP above 2910 pg/mL at admission for de novo and acute HFpEF predicted a 16-fold increased mortality at 12 months, whereas values less than 2910 pg/mL forecast a high likelihood of survival (99.3%) in the next 12 months, and should be considered as a useful prognostic tool, in addition to its utility in diagnosing heart failure. [ABSTRACT FROM AUTHOR]

Background & Objectives: Previous studies showed left atrial volume index (LAVi) is a precise surrogate of atrial cardiopathy and associated with new-onset atrial fibrillation and embolic stroke undetermined source (ESUS). Recent data suggest that the left atrial functional index (LAFi) is associated with the risk of developing AF recurrence. However, there was no study to show LAFi in ESUS. We aim to compare the performance of different surrogates of atrial cardiopathy (LAVi and LAFi) in a cohort of ESUS patients and healthy adults. Methods: Between Dec 2018 to Feb 2020, consecutive patients diagnosed with ESUS and normal healthy controls (>18 years) were included. Left atrial diameter (LAD), left atrial diameter index (LADi), LAVi and LAFi were measured by transthoracic echocardiogram under American Society of Echocardiography guidelines. Results: A total of 125 patients (43 controls and 82 ESUS patients) were compared. Significant differences of LADi, LAVi, and LAFi were detected between ESUS and control (p=0.04, p=0.002, and p=0.001, respectively). On adjustment for age, sex, hypertension, and diabetes mellitus, LADi and LAVi the association with ESUS and LAFi (aOR decrease, 0.928; 95% CI 0.882--0.976; p = 0.004) remained significant and LAD, LADi, and LAVi were not associated with ESUS in this analysis. Conclusions: LAFi may be a more comprehensive predictor of atrial cardiopathy as compared to LADi and LAVi in risk stratification of ESUS or cryptogenic stroke. [ABSTRACT FROM AUTHOR]

Zhidan Li,1 Xiaojuan Bai,2 Lulu Han,2 Wen Han,2 Weina Hu3 1Department of Ultrasound, The Fourth Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China; 2Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China; 3Department of Cardiology, The Fourth Affiliated Hospital of China Medical University, Shenyang, People’s Republic of ChinaCorrespondence: Weina HuDepartment of Cardiology, The Fourth Affiliated Hospital of China Medical University, Shenyang, 110032, People’s Republic of ChinaEmail weina_hu2021@126.comXiaojuan BaiDepartment of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of ChinaEmail xiaojuan_Bai@126.comBackground: Electromechanical coupling may play a significant role in the association between abnormal myocardial mechanics and heterogeneity of repolarization. This study sought to assess the potential relationship between the left atrial volume index (LAVI), which is an important marker of cardiac diastolic function, and ventricular repolarization variables, such as the QT interval, Tpeak-to-Tend (Tpe) interval and Tpe/QT ratio, in an apparently healthy Chinese population.Methods: This was a community-based cross-sectional study conducted in Shenyang, China. A total of 414 healthy subjects aged 35– 91 years, including 186 men (44.9%), were enrolled. In addition to performing clinical and laboratory measurements, all subjects underwent comprehensive echocardiography and standard 12-lead electrocardiography. Echocardiographic and electrocardiographic results were analysed separately and in a blinded fashion. Correlation and regression analyses were applied to determine associations.Results: Subjects were divided into four groups according to quartile of LAVI levels (< 16.0, 16.0– 18.9, 19.0– 22.5 and > 22.5 mL/m2). Ventricular repolarization variables, such as QT interval and QTc interval, gradually increased with the progression from low to high LAVI levels (P< 0.05). LAVI was positively and significantly correlated with the QT interval, the QTc interval, and the Tpe interval (P< 0.01). After adjusting for age and other possible confounders, LAVI showed significant and independent associations with the QT interval and the QTc interval (P< 0.001; P=0.003).Conclusion: Echocardiographic LAVI is linearly associated with ventricular repolarization variables even in healthy people.Keywords: left atrial volume index, QT interval, Tpe interval, diastolic dysfunction, ventricular repolarization

Introduction: Peripartum cardiomyopathy (PPCM) is an important cause of maternal mortality and morbidity. But, there is a paucity of prospective data on outcomes and prognostic markers in patients receiving contemporary evidence-based therapy, particularly in developing countries. Methods: This was a single centre, prospective, cohort study on 43 PPCM patients who were followed for 6 months. The primary endpoint was a composite incidence of decompensation related re-hospitalization, all-cause death, and poor recovery (defined as left ventricular ejection fraction, LVEF: 29.6 ml/m2 with 72% accuracy) at presentation but not LVEF, predicts poor outcomes. Presence of both these risk factors at index hospitalization was associated with a significantly lower event free survival compared to patients without these predictors.

Objectives: The use of sodium-glucose cotransporter-2 inhibitors (SGLT2-Is) has resulted in significant benefits in patients with heart failure irrespective of left ventricular ejection fraction (LVEF) and the presence of diabetes mellitus. The aim of this systematic review and meta-analysis was to assess the impact of SGLT2-Is on cardiac function indices. Methods: We conducted a systematic literature search for studies assessing the changes in LVEF, global longitudinal strain (GLS), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular mass index (LVMi), left atrial volume index (LAVi), and E/e′ following the initiation of an SGLT2-I. Results: A total of 32 studies with 2351 patients were included. SGLT2 inhibition resulted in a significant improvement of LVEF [MD 1.97 (95%CI 0.92, 3.02), p

Context: Left ventricular ejection fraction (LVEF) recovery is an important treatment goal for patients with heart failure (HF) and reduced EF (HFrEF); however, the applicability of the left atrial volume index (LAVI) in predicting long-term LVEF recovery in HFrEF remains unknown. Aim: We aimed to assess the predictive value of the LAVI in predicting long-term LVEF recovery in patients hospitalized with HFrEF. Settings and Design: This was a retrospective cohort study. Materials and Methods: We analyzed 70 decompensated patients with HF, hospitalized between 2013 and 2014, with an LVEF 3 years postdischarge. Predictive LAVI values used to predict long-term LVEF improvement were determined. Statistical Analysis: The survival rate was determined using Kaplan–Meier analysis. In receiver operating characteristic curve (ROC) analysis, the area under the curve (AUC) and optimal cutoff values were obtained from several echocardiographic parameters. Univariate and multivariate logistic regression analyses identified predictors of LVEF improvement. Results: Twenty-seven (39%) patients had recovered LVEFs. During a median follow-up period of 76 (60–80) months, the survival rate was significantly higher in the recovered group (log-rank test, P = 0.001). ROC analysis showed that LAVI's predictive performance in long-term LVEF improvement (AUC 0.78, 95% confidence interval [CI] 0.66–0.87) was optimal at a cutoff of 35 g/m2. LAVI

Background: Nerve injury-induced protein 1 (Ninj1) is elevated in various inflammatory diseases. The soluble form of Ninj1 yield by matrix metalloproteinase cleavage is a secreted protein and inhibits cell adhesion and inflammation. However, the role of plasma Ninj1 in atrial fibrillation (AF) has not been reported. The present study aimed to investigate the correlation between plasma Ninj1 levels and AF.Methods: A total of 96 AF patients [age 66.00 (60.00, 72.00) years, male 56 (58.33%)] and 51 controls without AF [age 65.00 (55.00, 68.00) years, male 21 (41.18%)] were enrolled in this study. Plasma Ninj1 concentrations were detected using enzyme-linked immunosorbent assay. Also, the clinical characteristics, left atrial volume index (LAVI), CHA2DS2-VASc score, and HAS-BLED score were evaluated.Results: Plasma Ninj1 levels were significantly higher in patients with AF than in controls (P < 0.001). Plasma Ninj1 levels were positively correlated with LAVI (P = 0.019) and CHA2DS2-VASc score (P = 0.024). Logistic regression analysis confirmed that the Ninj1 plasma levels were associated with AF (P = 0.009). The receiver operating characteristic analysis showed that plasma Ninj1 had a predictive value for AF (P < 0.001).Conclusions: Plasma Ninj1 levels were elevated in patients with AF, associated with left atrial enlargement and thromboembolic risk in AF. [ABSTRACT FROM AUTHOR]

Background: Arterial stiffness (AS) has emerged as a strong predictor of cardiovascular (CV) diseases. Although increased AS has been described as a predictor of atrial fibrillation (AF), its role as a risk marker for AF recurrence has not yet been elucidated. Methods: Patients with AF who underwent pulmonary vein isolation (PVI) were included in this study. Presence of AS was evaluated by measuring aortic distensibility (AD) of the descending aorta by transoesophageal echocardiography. Results: In total, 151 patients (mean ± standard deviation (SD) age 71.9 ± 9.8 years) were enrolled and followed for a median duration of 21 months (interquartile range 15.0–31.0). During follow-up, AF recurred in 94 (62.3%) patients. AF recurrence was seen more frequently in patients with permanent AF (27% vs 46%, p = 0.03) and in those who had undergone prior PVI (9% vs 23%, p = 0.02). AD was significantly reduced in patients with AF recurrence (mean ± SD 2.6 ± 2.3 vs 1.5 ± 0.7 × 10−3 mm Hg−1, p < 0.0001), as well as left atrial volume index (LAVI) (mean ± SD 29 ± 12 vs 44 ± 15 ml/m2, p < 0.0001). Multivariable analysis revealed LAVI (odds ratio (OR) 2.9, 95% confidence interval (CI) 1.2–3.4) and AS (OR 3.6, 95% CI 2.8–4.1) as independent risk factors of AF recurrence. Conclusion: Increased AS and left atrial size were independent predictors of AF recurrence after PVI. AD as surrogate marker of AS seemed to reflect the overall CV risk. In addition, AD was significantly correlated with left atrial size, which suggests that increased AS leads to atrial remodelling and thus to AF recurrence. Trial registration: German registry for clinical studies (DRKS), DRKS00019007. [ABSTRACT FROM AUTHOR]

The left atrial volume index (LAVI) is considered to be the most accurate index to estimate the size of the left atrium (LA). In this study, we investigated the relationship between LA size measured by LAVI and the occurrence of large-vessel occlusion (LVO) in patients with cardiogenic cerebral infarction (CCI). This retrospective single-center cohort study involved 118 patients with CCI within the internal carotid artery (ICA) or middle cerebral artery regions seen between January 2015 and July 2020. In all patients, the type of CCI was determined according to the Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomography Scores (TOAST) subtype diagnosis criteria. LVO was defined as positive when magnetic resonance imaging and computed tomography angiography showed ICA, M1, or M2 occlusion, with all others defined as non-LVO. Clinical characteristics, including LAVI, were evaluated in the records of several patients to investigate if they were risk factors for developing LVO. Seventy patients (59%) were diagnosed as having LVO infarction (ICA occlusion, n = 19 [16%]; M1 occlusion, n = 26 [22%]; and M2 occlusion, n = 25 [21%]). Echocardiography showed no difference between LVO and non-LVO in terms of the ejection fraction (P = 0.64), LA dimension (P = 0.93), and LA volume (P = 0.06). However, LAVI significantly differed between the LVO and non-LVO groups (P = 0.02). Multivariate logistic regression analysis showed larger LAVI as a significant risk factor for LVO (P = 0.01). Our findings suggest that a larger LAVI is a predictor of developing LVO in patients with CCI. [ABSTRACT FROM AUTHOR]

Background: The relationship between changes in the left atrial volume index (LAVI) post-catheter ablation (CA) and long-term prognostic events in patients with persistent atrial fibrillation (AF) remains unclear. We evaluated the incidence of major adverse clinical events (MACE), including all-cause death, unplanned heart failure hospitalization, and unplanned cardiovascular hospitalization using pre- and post-CA LAVI., Methods and Results: We collected data retrospectively from 150 patients with persistent AF who underwent their first CA. LAVI was calculated during preprocedural echocardiography under AF rhythm (pre-CA LAVI) and 3 months post-CA under sinus rhythm (post-CA LAVI). The cumulative incidence of MACE was compared among 3 subgroups based on the cutoff values of pre-CA (45.5 mL/m 2 ) and post-CA (46.5 mL/m 2 ; both determined using the c-statistic) LAVI. The subgroup of a pre-CA LAVI >45.5 mL/m 2 with a post-CA LAVI >46.5 mL/m 2 (n=45) had a significantly higher MACE incidence compared with other subgroups (P=0.002). Multivariate analysis identified this subgroup as independently at higher risk for MACE. The subgroup of a pre-CA LAVI >45.5 mL/m 2 with a post-CA LAVI ≤46.5 mL/m 2 (n=49) had an incidence comparable with those with pre-CA LAVI ≤45.5 mL/m 2 (n=56) and exhibited a significantly greater reduction in LAVI than other subgroups did (P<0.001)., Conclusions: Combining pre-CA and post-CA LAVIs is valuable in stratifying long-term MACE development risk following CA., Competing Interests: The authors declare that there are no conflicts of interest. This research received no grants from any funding agency in the public, commercial, or not-for-profit sectors. M.S. is a member of the Editorial Board of Circulation Journal/ Circulation Reports., (Copyright © 2024, THE JAPANESE CIRCULATION SOCIETY.)

Aim: To investigate the association between the left atrial volume index (LAVI) and the incidence of cardiovascular events in patients with acute coronary syndrome (ACS) who did not have atrial fibrillation (AF). Methods: In this sub‐analysis of the HIJ‐PROPER study, 226 ACS patients who did not have a history of AF were enrolled. Participants were divided into two groups according to the LAVI cut‐off level calculated by receiver operating characteristic (ROC) curve analysis to predict the primary endpoint, and cardiovascular events were compared between groups. The primary endpoint was the first occurrence of all‐cause death, non‐fatal myocardial infarction, non‐fatal stroke, and hospitalization for heart failure. Results: ROC curve analysis for the occurrence of composite of cardiovascular events indicated a LAVI cut‐off point of 34 mL/m2. Based on this, 131 patients (58.0%) were in the LAVI < 34 mL/m2 group and 95 (42.0%) were in the LAVI ≥ 34 mL/m2 group. Over a median follow‐up period of 4.0 years [interquartile range: 3.2, 5.1], cardiovascular events were noted in 7 and 15 patients in the LAVI < 34 mL/m2 and LAVI ≥ 34 mL/m2 groups, corresponding to an incidence rate of 5.3% and 15.8%, respectively. Patients with a LAVI value ≥ 34 mL/m2 had a significantly higher risk of cardiovascular events than those with a LAVI value < 34 mL/m2 (hazard ratio: 2.93; 95% confidence interval: 1.19–7.22; P =.014). The tendency was similar after adjusting for several confounders (P =.025). Conclusion: In ACS patients without AF, elevated LAVI was associated with increased cardiovascular events. Clinical trial registration: International standard randomized controlled trial (URL: https://www.umin.ac.jp; UMIN000002742). [ABSTRACT FROM AUTHOR]