Jul 20, 2018 - P2078 | BEDSIDE. Left atrial function predicts new-onset atrial fibrillation after aortic valve replacement independently from atrial enlargement.
Diastolic function and left atrial function / Mechanical circulatory support and heart transplantation Methods: Stage 3 CKD patients (eGFR 30–59 ml/min/1.73m2 ) without previous cardiac disease were recruited. Participants underwent a comprehensive transthoracic echocardiogram with detailed assessment of left ventricular (LV) and left atrial (LA) size/function including 2D strain analysis. Participants were followed up yearly for 5 years. The primary end point was a composite of death and/or major adverse cardiovascular events (MACE). Results: 95 patients (male 68%; mean age 65±9.6 years) were followed for a median of 42 months; 19 patients (Grp 1) met the primary end point while 76 (Grp2) did not. Grp1 patients were older, with reduced LA global longitudinal strain (GLS) and similar incidence of diabetes, LV function (LVEF and strain), LV mass, diastolic grade and indexed LA volume. On Cox regression analysis, both LA global longitudinal strain (p=0.017) and age (p=0.019) were independent predictors of MACE and death. On Kaplan-Meier analyses, LA GLS was significant for death and MACE events (Figure 1). Conclusions: LA GLS is impaired in individuals with CKD and is a predictor of cardiovascular events. Acknowledgement/Funding: Nil
P2078 | BEDSIDE Left atrial function predicts new-onset atrial fibrillation after aortic valve replacement independently from atrial enlargement G. Pessoa Amorim 1 , J. Mancio 1 , M. Barros 1 , L. Vouga 2 , J. Ribeiro 1 , V. Gama Ribeiro 1 , N. Bettencourt 3 , R. Fontes Carvalho 1 . 1 Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology, Vila Nova de Gaia, Portugal; 2 Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiothoracic Surgery, Vila Nova de Gaia, Portugal; 3 Faculty of Medicine University of Porto, Porto, Portugal Background: Left atrium (LA) function impairment in aortic stenosis (AS), assessed by speckle-tracking echocardiography (STE), may precede atrial enlargement and predict the occurrence of atrial fibrillation (AF) after aortic valve replacement (AVR). Purpose: To determine the impact of LA function on the incidence of AF after AVR Methods: 149 severe AS patients (74±8.6 years, 51% men) with no prior permanent AF were assessed using STE to determine peak atrial longitudinal (PALS) and contraction (PACS) strain, as well as LA maximum, minimum and pre-A wave volumes; the occurrence of AF was monitored in 114 patients from AVR until discharge. Results: Mean PALS and PACS were 25.5±10.9% and 12.5±7.1%, respectively. In multivariate linear regression, PALS and PACS were inversely correlated with LA dilation, left ventricular hypertrophy and diastolic dysfunction. AF occurred in 36 patients after AVR. Using multivariate Cox regression analysis, PALS and PACS were associated with the incidence of AF (Hazard Ratio [HR] with PALS: 0.946, 95% confidence interval [CI]: 0.910 to 0.983, p=0.005; HR with PCAS: Table 1. Uni- and Multivariate Cox regression
Univariate Model 1 Model 2: LA diameter Model 3: LA indexed volume Model 4: LA maximum volume Model 5: LA minimum volume Model 6: LA pre-A wave volume
PALS HR (95% CI)
P-value
PACS HR (95% CI)
P-value
0.968 (0.938–0.998) 0.946 (0.91–0.983) 0.955 (0.917–0.994) 0.947 (0.906–0.989) 0.952 (0.915–0.992) 0.957 (0.917–1) 0.953 (0.912–0.993)
0.042 0.005 0.025 0.015 0.018 0.05 0.024
0.962 (0.919–1.007) 0.932 (0.883–0.984) 0.942 (0.894–1.001) 0.936 (0.8–0.994) 0.941 (0.89–0.996) 0.949 (0.841–1.007) 0.94 (0.889–0.995)
0.098 0.011 0.058 0.033 0.038 0.085 0.034
CI = Confidence interval, HR = Hazard ratio, LA = Left atrium, PACS = Peak atrial contraction strain, PALS = Peak atrial longitudinal strain. Model 1 includes pre-operative medication with beta-blockers or statins, type of procedure, number of coronary bypasses and prosthetic material. Models 2, 3, 4, 5 and 6 include the variables used in the initial multivariate Cox regression + LA diameter, or LA indexed volume, or Maximum atrial volume, or Minimum atrial volume or pre-A wave atrial volume, respectively.
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0.932, 95% CI: 0.883 to 0.984, p=0.011) (Figure 1), independently from LA size (Table 1). Conclusions: Impaired LA function predicted the incidence of AF after AVR, independently from LA dimensions. This finding suggests that LA function analysis before AVR may identify patients at higher risk for post-operative AF, even before the LA starts to dilate. Acknowledgement/Funding: Fundação Portuguesa para a Ciência e Tecnologia (SFRH/BD/104369/2014) and Sociedade Portuguesa de Cardiologia (“Bolsa de investigação João Porto”)
P2079 | BEDSIDE Left atrial function and mortality in the elderly J. Koslowsky 1 , D. Gilon 2 , J. Stessman 3 , J. Jacobs 3 , D. Leibowitz 2 . 1 Shaare Zedek Medical Center, Dept. of Cardiology, Jerusalem, Israel; 2 Hadassah University Medical Center, Heart Institute, Jerusalem, Israel; 3 Hadassah University Medical Center, Dept. of Geriatrics and Rehabilitation, Jerusalem, Israel Background: People over the age of 85 are the world’s most rapidly growing age group and provide an increasing challenge given their relatively high frequency of cardiac death. Previous studies have demonstrated that LA diameter and volume, which increase with age, are associated with mortality. Indices of LA function may provide incremental prognostic information beyond that obtained by LA size, however data regarding prognostic value of LA function in elderly population is limited. Methods: Subjects were recruited from a local longitudinal cohort that has followed subjects who were born between 1920 and 1921. Echocardiography was performed in randomly selected subjects. We determined maximum volume, minimal volume and volume prior to atrial contraction. From measurements of these phasic volumes, we calculated phasic functions of the LA: LA expansion index (reflecting reservoir function); LA passive emptying fraction (reflecting conduit function); and LA active emptying fraction (reflecting booster function). Survival status at 5 year follow-up was assessed, and we compared between the quartile with most impaired atrial function and the upper 3 quartiles. Results: A total of 274 subjects were included in the study of whom 87 (31.8%) had died at the time of the 5 year follow-up. There were no major differences between the groups examined in clinical data or LA volume. Survival of subjects in the lowest quartile of LA expansion was significantly lower compared to survival in the upper 3 quartiles (56.7% vs. 71.5%, P=0.016). We found similar significant results for LA active emptying as well (52.9% vs. 73.3%, p=0.001). When measurements of LA volume were added to the model, the relationship remained significant. Discussion: Utilizing home-based echocardiography, this study demonstrated that elderly subjects with significantly impaired LA function had increased 5 year mortality, independent of indices of LA volume. The findings in the study may have clinically importance in the elderly population. For example, left atrial dysfunction may contribute to the pathophysiology of heart failure with preserved ejection fraction, a common clinical problem in the elderly. Our findings also suggest that preserving LA pump function, for example by trying to maintain sinus rhythm in patients with atrial arrhythmias, may be important in this subset of patients. To our knowledge, this is the first study to use home echocardiography to address the effects of LA function on elderly prognosis.
MECHANICAL CIRCULATORY SUPPORT AND HEART TRANSPLANTATION P2080 | BEDSIDE Cardiopulmonary, vascular and biomarker responses to acute hypoxic stress following cardiac transplantation M. Sanz 1 , N. Iannino 2 , V. Finnerty 2 , F. Harel 2 , A. Mansour 3 , M. Gayda 4 , D. Chaar 2 , M. Sirois 5 , N. Racine 2 , M. White 2 . 1 Barcelona Hospital Clinic, Barcelona, Spain; 2 Montreal Heart Institute, Cardiology, Montreal, Canada; 3 Montreal Heart Institute, Health Innovation Coordinating Centre, Montreal, Canada; 4 Montreal Heart Institute, Cardiovascular Prevention and Rehabilitation Centre, Montreal, Canada; 5 Montreal Heart Institute, Farmacology, Montreal, Canada
Kaplan-Meier curves for AF incidence
Background: A few case studies have shown good adaptation of cardiac transplant (CTx) recipients to exposure to a high altitude environment. No studies have investigated the cardiovascular, pulmonary, and biomarker responses to acute hypoxic challenges both at rest and in response to sub-maximal exercise in longterm cardiac transplant recipients. Methods: Thirty-six CTx recipients 8.8±7.6 years after transplantation and seventeen age-matched healthy controls (HC) were recruited. Seventeen CTx patients (42%) presented cardiac allograft vasculopathy (CAV), thirteen of grade 1 (87%) and two of grade 2 (13%). Ventilatory and cardiovascular responses to maximal and submaximal exercise in normoxic conditions, following to 20-min normobaric hypoxia and after 10 minutes hypoxic challenge using 30% submaximal load at 11.5% oxygen (02) were performed. Endothelial peripheral function was assessed at 21% 02 using near-infrared spectroscopy. Biomarkers including vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and suppression of tumorigenicty 2 (ST2) were measured at baseline and at peak stress.
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