The usefulness of global left atrial strain for predicting atrial fibrillation recurrence after catheter ablation in patients with persistent and paroxysmal atrial fibrillation.

BACKGROUND: Given the potential complications of atrial fibrillation (AF) recurrence after ablation, better predictors of the effectiveness of the procedure are necessary to guide patient selection. AIM: This prospective study was conducted to evaluate the clinical relevance of global left atrial longitudinal strain (GLAS) and AF recurrence after catheter ablation. METHODS: In 115 consecutive patients with AF (persistent, n=62; paroxysmal, n=53), transthoracic echocardiography was performed before catheter ablation to assess baseline left atrial mechanical function using speckle tracking echocardiography (STE). RESULTS: After 12 months of follow-up, 22 (35.5%) patients in the persistent AF group and 15 (28.3%) in the paroxysmal AF group exhibited AF recurrence. In both the paroxysmal and persistent AF populations, patients with recurrence presented with significantly impaired GLAS compared with patients without recurrence. Patients with recurrence also had a significantly higher pro-B-type natriuretic peptide concentration. A receiver operator curve analysis yielded area under the curve values of 0.94 and 0.86 for paroxysmal and persistent AF, respectively. In a multivariable Cox proportional-hazards analysis, GLAS was an independent predictor of AF recurrence after catheter ablation in both the paroxysmal AF group (hazard ratio: 0.79, 95% confidence interval: 0.67-0.96; P=0.01) and the persistent AF group (hazard ratio: 0.81, 95% confidence interval: 0.71-0.93; P=0.004). CONCLUSIONS: In both paroxysmal and persistent AF, decreased baseline left atrial deformation capabilities assessed by two-dimensional STE can help to identify patients at high risk of AF recurrence after catheter ablation. This variable may help to guide candidate selection and improve therapeutic strategies.

Association between left atrial appendage emptying velocity, N-terminal plasma brain natriuretic peptide levels, and recurrence of atrial fibrillation after catheter ablation.

PURPOSE: Multiple studies have shown the efficacy and potentially curative effect of catheter ablation (CA). However, CA is always accompanied by a considerable recurrence rate for atrial fibrillation (AF). We hypothesized that pre-procedure assessments of baseline left atrial appendage emptying flow velocity (LAAFV) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels would help identify abnormal atrial substrate and offer preliminary evidence regarding susceptibility to AF recurrence in patients with paroxysmal or persistent AF, respectively. METHODS: In 120 patients with AF (paroxysmal, 55; persistent, 65), transesophageal echocardiography was performed with assessment of LAAFV and NT-proBNP was measured before the first AF ablation. RESULTS: After 12 months of follow-up, 16 patients (29.1%) in the paroxysmal AF and 23 patients (35.4%) in the persistent AF experienced recurrence of AF. In ROC analysis, a NT-proBNP value of ≥291 pg/ml in the paroxysmal AF and ≥368 pg/ml in the persistent AF discriminated AFR and non-AFR with the greatest sensitivity and specificity. In multivariate regression analysis, LAAFV (OR 0.88, 95% CI 0.79-0.98, p = 0.023) was identified as an independent predictor of AFR in the paroxysmal AF population post-CA after adjustment for other risk factors; however, in the persistent AF population, LAAFV (OR 0.81, 95% CI 0.68-0.94, p = 0.007) and a NT-proBNP value ≥368 pg/ml (OR 18.29, 95% CI 1.32-252.84, p = 0.030) were identified as independent predictors for rhythm outcome compared to other parameters. CONCLUSIONS: In patients with persistent AF, elevated plasma NT-proBNP concentrations combined with low LAAFV were associated with rhythm outcome after AF ablation; however, LAAFV was the only independent predictor of CA efficacy in patients with paroxysmal AF.

The value of live three-dimensional echocardiography in an adult patient with aortico-left ventricular tunnel.

Aortico-left ventricular tunnel (ALVT) is a rare cardiac abnormality. This article presents an adult case of ALVT with aortic ostium lying above the left-noncommissure which was diagnosed with live three-dimensional echocardiography (3DE). Live 3DE has shown its value in providing more detailed information.

Echocardiographic findings on congenital left ventricular diverticulum and aneurysm: two rare cases and literature review.

Congenital diverticulum and aneurysm are rare cardiac abnormalities. Given their very low incidence especially in adult patients and the few cases reported, the diagnosis might be ignored when the cardiac malformation is seen for the first time. This article presents two adult cases of congenital diverticulum and aneurysm, which were first detected by echocardiography. The relevant literature is reviewed.

Coronary flow velocity pattern and recovery of regional left ventricular function: the relationship observed in patients with reperfused acute myocardial infarction.

Coronary flow velocity pattern (CFVP) recorded within 3 days of percutaneous coronary intervention (PCI) has been reported to be useful in predicting left ventricular (LV) function. The aim of this prospective study was to investigate, via transthoracic Doppler echocardiography, whether the relationship between CFVP and recovery of LV function persists. Our study group comprised 37 patients with 1st anterior-wall acute myocardial infarction who underwent successful PCI for lesions in the left anterior descending coronary artery (LAD). The CFVP in the LAD was recorded at 24-48 hours, 7 days, and 4 weeks after PCI. Myocardial contrast echocardiography was performed at 24-48 hours after PCI. The diastolic deceleration time (DDT) at each stage correlated significantly with the regional LV wall-motion score index at 6-month follow-up (r=-0.58 at 24-48 hr, -0.57 at day 7, and -0.50 at week 4; P <0.01 for all). The mean DDT increased over time. Optimal cutoff values for DDT to predict regional LV wall-motion score indices of <2.0 were 327 ms at 24-48 hours (sensitivity, 0.78; specificity, 0.64), 495 ms at day 7 (sensitivity, 0.75; specificity, 0.69), and 525 ms at week 4 (sensitivity, 0.83; specificity, 0.69). The DDT at 24-48 hours significantly correlated, better than the peak creatine kinase value, with reperfusion (r=0.68, P <0.01) as defined by myocardial contrast echocardiography. In conclusion, CFVP in the LAD can be used, within 4 weeks after PCI, to predict the recovery of regional LV function in patients with reperfused anterior-wall acute myocardial infarction.

Ile90Met, a novel mutation in the cardiac troponin T gene for familial hypertrophic cardiomyopathy in a Chinese pedigree.

To identify the disease-causing gene for a large multi-generational Chinese family affected by familial hypertrophic cardiomyopathy (FHCM), genome-wide screening was carried out in a Chinese family with FHCM using micro-satellite markers, and linkage analysis was performed using the MLINK program. The disease locus was mapped to 1q32 in this family. Screening for a mutation in the cardiac troponin T (cTnT) gene was performed by a PCR and sequencing was done with an ABI Prism 3700 sequencer. A novel C-->G transition located in the ninth exon of the cTnT gene, leading to a predicted amino acid residue change from Ile to Met at codon 90, was identified in all individuals with hypertrophic cardiomyopathy (HCM). The results presented here strongly suggest that Ile90Met, a novel mutation in the cTnT gene, is causative agent of HCM in this family.