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Definitions and Clinical Diagnosis of Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Katerina K. Naka, Aris Bechlioulis
The presence of AF is another important problem complicating the diagnostic process in HF and especially HFpEF. AF is the most common arrhythmia in persons over age 60 and is common in patients with HF, whereas AF frequently precedes HFpEF.31 Cardiac structural alterations, such as increased left atrial volume index (LAVI), are common in AF, irrespective of HF, although parameters of LV diastolic dysfunction are more difficult to assess in the presence of AF.2 Moreover, AF is associated with higher natriuretic peptide values and lower exercise tolerance compared to non-AF patients, irrespective of HF diagnosis.32 It is unclear whether standard or higher cut-off values of natriuretic peptides should be used for the diagnosis of HF in the presence of AF.31 Although the use of higher levels is recommended, guidelines have not provided a clear alternative cut-off value for patients with AF.2 In patients with dyspnea and concurrent AF, HF is present in at least 65% of cases and, thus, these patients should be considered to have HF until proven otherwise.17
Minimally Invasive Atrial Ablation Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Pison et al. reported their experience in 26 patients undergoing hybrid thoracoscopic and transvenous ablation for AF in patients who had either failed prior catheter ablation, had an enlarged left atrial volume (≥29 ml/m2) or had persistent or long-standing persistent AF [25]. Similar to Mahapatra and La Meir, the pulmonary veins were isolated at the antra using a bipolar RF clamp and confirmed endocardially. In those with persistent AF, a roof line and posterior LA line (box lesion), SVC isolation and intercaval lines were created. Epicardial and endocardial mitral lines were created. A cavotricuspid isthmus line was made in those with a prior history of atrial flutter or flutter during the procedure. Finally, the LAA was excluded in a subset.
Arrhythmias in Hypertrophic Cardiomyopathy and Their Management
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Tom Kai Ming Wang, Milind Y. Desai
Multi-modality cardiac imaging, especially echocardiography and magnetic resonance imaging (MRI), plays a central role in the diagnosis of HCM, but also in reporting imaging factors associated with developing AF (Table 11.2) [1, 2]. One of the most important risk factors for developing AF in the general population, and also in HCM, is left atrial dimensions. One meta-analysis of 7,381 patients found a higher left atrial diameter in HCM patients with AF compared to sinus rhythm [5]. Left atrial volume index is a better marker of its size and remodeling than the current standard [24], and also predicts AF with increasing dilation [22, 25]. Left atrial measurements and emptying fraction (threshold < 38% in one study, which is a marker of left atrial dysfunction) are traditionally measured by echocardiography [24], but can also be assessed on MRI, and be prognostic of AF [20]. Significant mitral regurgitation, diastolic dysfunction parameters, and reduced left ventricular ejection fraction are also all associated with AF in HCM, but not in LVOT obstruction [22]. Furthermore, the degree of septal hypertrophy and presence of late gadolinium enhancement on MRI also appear to predict AF [14].
A retrospective study of baseline peritoneal transport character and left ventricular hypertrophy in incident peritoneal dialysis patients: interrelationship and prognostic impacts
Published in Renal Failure, 2022
Yi Wang, Guansen Huang, Xiaoyan Ma, Xiujuan Zang, Shoujun Bai, Yakun Wang, Lin Du, Zexin Lv, Jinqing Li, Hui Chen, Yan Hu, Yingfeng Shi, Xun Zhou, Min Tao, Shougang Zhuang, Na Liu
LAE is closely related to LVH and diastolic dysfunction [24]. Several studies have demonstrated that left atrial volume index (LAVI) is an independent predictor of mortality in dialysis populations [25–28]. A prospective cohort study proved that changes in left atrial volume (LAV) had an independent association with cardiovascular outcomes (HR [1-mL/m2.7 per yr increase in LAV] 1.12; 95% CI, 1.05–1.20; p < 0.001), and the predictive ability was independent of left ventricular mass [29]. LA size as a predictor of adverse cardiovascular events may be associated with atrial fibrillation, acute myocardial infarction, heart failure, and cerebrovascular events [11]. In our study, LAE did not show a significant relationship with patients’ survival in the multivariate analysis, it still needed to be explored in larger samples.
Mexiletine for ventricular arrhythmias in patients with chronic coronary syndrome: a cohort study
Published in Acta Cardiologica, 2022
Giacomo Mugnai, Carla Paolini, Stefano Cavedon, Alessandro Mecenero, Cosimo Perrone, Claudio Bilato
At baseline, mean tele-diastolic and tele-systolic volumes of the left ventricle (LV) were 86.7 ± 32.9 ml/m2 and 56.1 ± 27.3 ml/m2, respectively. Mean left ventricular ejection fraction (LVEF) before mexiletine treatment was 33.7 ± 11.7% (median 31.5%; IR: 25–43%). In particular, a mild to moderate LV dysfunction ranging from 35 to 50% was found in 8 patients (23.5%), while a severe LVEF reduction was observed in 22 subjects (64.7%). A myocardial scar involving 3 or more LV segments was observed in 26 patients (76.5%). Mean left atrial volume resulted 35.2 ± 17.8 ml/m2. Thirty patients (88.2%) showed mitral regurgitation (18 mild, 60%; 8 moderate, 27%; and 4 severe, 13%); 2 of them were previously treated with MitraClipTM (Abbott Vascular, Santa Clara, CA, USA) and one with mitral anuloplasty. Of note, the mean LVEF assessed at the last follow-up resulted unchanged (32.9 ± 11.4%; p = 0.7).
Correlation of left ventricular longitudinal strain and E/e’ ratio in primary hypertension patients
Published in Clinical and Experimental Hypertension, 2021
Dan Zhou, Yingling Zhou, Songtao Tang, Yingqing Feng
Left ventricular end-diastolic dimensions (LVEDD), left ventricular end-systolic dimensions (LVESD), wall thickness inter-ventricular septal wall thickness (IVS) in diastole and left ventricular posterior wall thickness (PWT) in diastole, were made in the parasternal long axis with the M-mode cursor positioned just beyond the mitral leaflet tips, perpendicular to the long axis of the ventricle. Maximal left atrial internal diameter (LAD) was also made in the parasternal long axis. The left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV), LVEF, fractional shortening (FS) and stroke volume (SV) were measured with left ventricular inner diameter by automatic machine calculation. Maximal left atrial volume (LAV) was measured from the apical four-chamber view. LVM was calculated according to the formula (9).