Left Atrial Function Determined by Cardiac Computed Tomography Predicts Device-Detected Atrial High-Rate Episodes in Patients Treated With Cardiac Resynchronization Therapy.

OBJECTIVE: The objective of this study was to examine whether left atrial (LA) volumes and function were associated with atrial high-rate episodes (AHREs) in patients with cardiac resynchronization therapy (CRT). METHODS: Ninety-two consecutive patients without prior atrial fibrillation underwent clinical evaluation, echocardiograms, and cardiac computed tomography (CT) before CRT implantation and after 6 months. Left atrial volumes and LA emptying fraction (LAEF) were derived by CT images reconstructed at 5% phase increments of the cardiac cycle. Cox regression was used to assess associations between AHRE and LA anatomical and functional variables. RESULTS: Twenty-two patients (24%) developed AHRE during 1.9 years (SD, 1 year) At baseline, higher LAEF was associated with a lower risk of AHRE (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.91-0.98; P = 0.003), and large LA minimal (LAmin) volume was related to higher risk of AHRE (HR, 1.03; 95% CI, 1.00-1.06; P = 0.04). When combining LAEF and LAmin volume, only LAEF remained associated with occurrence of AHRE. Higher passive LAEF was associated with lower risk of AHRE (HR, 0.95; 95% CI, 0.91-0.98; P = 0.003). CONCLUSIONS: In patients with CRT, low preimplant LAEF measured by cardiac CT was independently associated with device-detected AHRE.

Left atrial size and function as assessed by computed tomography in cardiac resynchronization therapy: Association to echocardiographic and clinical outcome.

To evaluate whether baseline left atrial (LA) volume and function were associated with clinical or echocardiographic response to cardiac resynchronization therapy (CRT), and to determine LA reverse remodeling as assessed by computed tomography (CT). We prospectively included patients receiving a CRT system who underwent dynamic cardiac CT with measurement of LA size and function before and 6 months after implantation. Patients alive not hospitalized for heart failure, and improving ≥1 NYHA class or ≥10% in 6-min walk test after 6 months follow-up were classified as clinical responders. Echocardiographic response was defined as ≥15% reduction in left ventricular (LV) end-systolic volume. We included 138 patients, of whom 95 (69%) were clinical responders and 114 (83%) were echocardiographic responders. We found no association between baseline measures of LA volume or function and clinical or echocardiographic response. Mean reduction in LA maximum and minimum volumes at 6 months were 3.3 ± 12.7 ml/m2 (p = 0.004) and 2.6 ± 11.4 ml/m2 (p = 0.01) corresponding to a relative reduction of 4.1 and 5.0%, respectively. LV end-systolic relative volume reduction was 35.2 ± 22.4% (p < 0.001). No measures of LA function changed significantly. Cardiac CT measures of baseline LA volume and function are not associated with clinical or echocardiographic response to CRT. Change in LA volume and function is marginal after 6 months despite pronounced LV reverse remodeling.

[Mitral valve endocarditis diagnosed after panophthalmitis with Enterococcus faecalis].

An 86-year-old man underwent cataract surgery on the left eye, but suddenly he lost his vision three days after surgery. Topical treatments for panophthalmitis were started according to international guidelines. Later, a broad-range polymerase chain reaction showed Enterococcus faecalis in corpus vitreum, and IV antiobiotic treatment was initiated. To exclude endocarditis an echocardiography was performed, and this showed mitral regurgitation with a small mobile vegetation. Uncertainty concerning a possible causality between panophthalmitis and mitral valve endocarditis remains.