Risk Factors of Early Atrial Fibrillation Recurrence Following Electrical Cardioversion When Left Ventricular Ejection Fraction Is Preserved.

Background and objectives: To identify clinical, echocardiographic, and laboratory parameters that affect the early recurrence of atrial fibrillation (AF) after restoring sinus rhythm (SR) by electrical cardioversion (ECV), and to determine whether left atrial (LA) strain, as a noninvasive indicator reflecting fibrosis, is associated with laboratory indicators affecting the development of fibrosis, interleukin 6 (IL-6) or tumor necrosis factor α (TNF-α). Materials and Methods: The study included 92 persistent AF patients who underwent elective ECV. The effective maintenance of SR was evaluated after 40 ± 10 days of ECV. Echocardiography, inflammatory markers (high-sensitivity c-reactive protein (hs-CRP), IL-6, and TNF-α), and natriuretic peptides (N-terminal pro b-type natriuretic peptide (NT-proBNP) and N-terminal pro a-type natriuretic peptide (NT-proANP)) were assessed. Results: After a 40 ± 10 days observation period, 51 patients (55.4%) were in SR. Patients with AF recurrence had a significantly longer duration of AF (p = 0.008) and of arterial hypertension (p = 0.035), lower LA ejection fraction (p = 0.009), lower LA strain (p < 0.0001), higher left ventricular global longitudinal strain (p = 0.001), and a higher E/e' ratio (p < 0.0001). LA strain was an independent predictor of early AF recurrence (OR: 0.65; 95% Cl 0.5−0.9, p = 0.004). LA strain < 11.85% predicted AF recurrence with 70% sensitivity and 88% specificity (AUC 0.855, 95% CI 0.77−0.94, p < 0.0001). LA strain demonstrated the association with NT-proBNP (r = −0.489, p < 0.0001) and NT-proANP (r = −0.378, p = 0.002), as well as with hs-CRP (r = −0.243, p = 0.04). Conclusions: LA strain appeared to be the most accurate predictor of early AF recurrence after ECV in patients with persistent AF. LA strain inversely correlated with NT-proBNP and NT-proANP, but no significant association with any of the inflammatory markers was identified.

The short-term associations of weather and air pollution with emergency ambulance calls for paroxysmal atrial fibrillation.

A circadian variation in the cardiovascular parameters has been detected. It is plausible that the influence of the environment varies during different periods of the day. We investigated the association between daily emergency ambulance calls (EC) for paroxysmal atrial fibrillation (AF) that occurred during the time intervals of 8:00-13:59, 14:00-21:59, and 22:00-7:59, and weather conditions and exposure to CO and PM10. We used Poisson regression to explore the association between the risk of EC for AF and environmental variables, adjusting for seasonal variation. Before noon, the risk was associated with an IQR (0.333 mg/m3) increase in CO at lag 2-6 days above the median (RR = 1.15, P = 0.002); a protective impact of CO on previous day was observed (RR = 0.91, P = 0.018). During 14:00-21:59, a negative effect of air temperature below 1.9 °C (lag 2-3 days) was detected (per 10 °C decrease: RR = 1.17, P = 0.044). At night, the elevated risk was associated with wind speed above the median (lag 2-4 days) (per 1-kt increase: RR = 1.07, P = 0.001) and with PM10 at lag 2-5 days below the median (per IQR (7.31 µg/m3) increase: RR = 1.21, P = 0.002). Individuals over 65 years of age were more sensitive to air pollution, especially at night (CO lag 2-3 days < median, per IQR (0.12 mg/m3) increase: RR = 1.14, P = 0.045; PM10 lag 2-5 days < median, per IQR increase: RR = 1.32, P = 0.001). The associations of air pollution and other environmental variables with acute events may be analyzed depending on the time of the event.

The value of 99mTc-MIBI myocardial perfusion imaging in differentiation of heart failure conditioned by global left ventricular systolic impairment.

OBJECTIVE: The global left ventricular systolic impairment with left ventricular dilatation can manifest due to idiopathic dilated cardiomyopathy or ischemic heart disease and can present a similar clinical picture of severe heart failure. The aim of our investigation was to assess a differential diagnostic value of resting (99m)Tc-MIBI myocardial perfusion defects in evaluation of the etiology of heart failure. MATERIAL AND METHODS: The data of 2D echocardiography, coronary angiography, and myocardial gated single photon emission computed tomography with (99m)Tc-MIBI investigation were evaluated in 43 patients with global left ventricular systolic impairment, characterized by left ventricular end-diastolic diameter of > or =65 mm and ejection fraction of < or =40%. The idiopathic dilative cardiomyopathy was diagnosed in 26 patients (Group 1) and ischemic heart failure in 17 patients (Group 2). The area and the degree (severity) of myocardial perfusion defects (AMPD and DMPD) at rest in regions supplied by three coronary arteries were evaluated in all the patients. RESULTS: The area of perfusion defects in the left anterior descending (LAD) and right coronary artery (RCA) regions in dilative cardiomyopathy patients was smaller than in ischemic heart failure patients (1.43+/-0.9 vs 2.53+/-0.53, P=0.001, and 2.19+/-0.6 vs 2.82+/-0.56, P=0.02). The degree of perfusion defects was also less severe in the same circulation regions (1.39+/-0.93 vs 2.59+/-0.6, P=0.01, and 1.6+/-0.46 vs 2.71+/-0.15, P=0.001). We have designed a logistic regression model expressed by formula x=2.52AMPD(rca)+2.47AMPD(lad)+2.21DMPD(rca). Idiopathic dilative cardiomyopathy was predicted when x was < or =16 and ischemic heart failure when x was >16. The sensitivity in predicting idiopathic dilative cardiomyopathy was 94.44%, and the specificity was 88.24%. CONCLUSION: The difference in the area and degree of (99m)Tc-MIBI myocardial perfusion defects at rest in patients with heart failure caused by idiopathic dilative cardiomyopathy or ischemic heart failure is measurable and has a predictive value for differentiation of the etiology of global left ventricular systolic impairment.

[The diagnostic value of non-invasive tests for determining idiopathic dilated, ischemic and hypertensive cardiomyopathies]. / Neinvaziniu tyrimu svarba atskiriant idiopatine dilatacine, isemine ir hipertenzine kardiomiopatijas.

UNLABELLED: The objectives of this study were to detect regional myocardial perfusion defects performing 99mTc-MIBI myocardial perfusion imaging and to compare the results with echocardiography for differential diagnostics of the idiopathic dilated, ischemic and hypertensive cardiomyopathies until coronary angiography will be performed. MATERIAL AND METHODS: In total 90 patients with cardiomegaly have been evaluated: 30 patients with idiopathic dilated cardiomyopathy (group I), 30 with ischemic cardiomyopathy (group II) and 30 with hypertensive cardiomyopathy (group III). All patients underwent 2D echocardiography examination and 99mTc-MIBI myocardial perfusion imaging before coronary angiography was done. RESULTS: Informative complex findings (age, thickness of the interventricular septum, thickness of the left ventricle posterior wall, the wall motion score index in the region of the right coronary artery and the left anterior descending branch and the degree of distress of myocardial perfusion in the area of right coronary artery circulation) selected by variable logic model enabled to differentiate patients with idiopathic dilated, ischemic and hypertensive cardiomyopathies with an accuracy of 92.0%, 86.2% and 79.2%, respectively. CONCLUSION: Informative echocardiographic indices (thickness of the interventricular septum and left ventricle posterior wall, the mass of the myocardium, the wall motion score index in the region of the right coronary artery and left anterior descending branch, ejection fraction) selected by discriminative analysis enabled to differentiate patients with idiopathic dilated, ischemic and hypertensive cardiomyopathies with an accuracy of 62.1%, 75.2% and 80.0%, respectively.

[The diagnostic value of myocardial perfusion in diagnosis of ischemic cardiomyopathy and hypertensive heart disease]. / Miokardo perfuzijos tyrimo svarba diagnozuojant isemine ir hipertenzine kardiomiopatijas.

UNLABELLED: Objective of this study was to detect regional myocardial perfusion defects performing (99m)Tc-MIBI myocardial perfusion imaging and to compare the results with echocardiography for differential diagnostics of the ischemic and hypertensive cardiomyopathy until coronary angiography will be performed. MATERIAL AND METHODS: In total 50 patients with cardiomegaly have been evaluated: 18 patients with hypertensive cardiomyopathy (I(st) group), 15 - with ischemic and hypertensive cardiomyopathy (II(nd) group) and 17 patients with ischemic cardiomyopathy (III(rd) group). All patients underwent 2D echocardiography examination and (99m)Tc-MIBI myocardial perfusion imaging before coronary angiography was done. RESULTS: Thickness of interventricular septum, myocardial mass and relative wall thickness were statistically significantly smaller in the III(rd) group of patients in comparison with the I(st) and the II(nd) group of patients. CONCLUSIONS: Logistic regression model including selected data from myocardial perfusion imaging with (99m)Tc-MIBI in combination with selected echocardiography data enables prognosis of coronary arteries stenosis with 91.2% sensitivity and 93.8% specificity.