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Henein, Mark
Publications (10 of 15) Show all publications
Batalli, A., Ibrahimi, P., Bytyci, I., Ahmeti, A., Haliti, E., Elezi, S., . . . Bajraktari, G. G. (2017). Different predictors of exercise capacity in HFpEF compared to HFrEF. European Journal of Heart Failure, 19(1), 314-314, Article ID P1244.
Open this publication in new window or tab >>Different predictors of exercise capacity in HFpEF compared to HFrEF
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2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no 1, p. 314-314, article id P1244Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background and Aim: Quality of life is as important as survival in heart failure (HF) patients. Controversies exist with regards to echocardiographic predictors of exercise capacity in HF, particularly in patients with preserved ejection fraction (HFpEF). The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional exercise capacity assessed by 6 min walk test (6-MWT) in patients with HFpEF.

Methods: In 111 HF patients (mean age 63± 10 years, 47% female), an echo-Doppler study and a 6-MWT were performed in the same day. Patients were divided into two groups based on the 6-MWT distance (Group I: ≤ 300 m and Group II: >300 m).

Results: Group I were older (p=0.008), had higher prevalence of diabetes (p=0.027), higher baseline heart rate (p=0.004), larger left atrium - LA (p=0.001), longer LV filling time - FT (p=0.019), shorter isovolumic relaxation time (p=0.037), shorter pulmonary acceleration time - PAAT (p=0.006), lower left atrial lateral wall myocardial velocity (a’) (p=0.018) and lower septal systolic myocardial velocity (s’) (p=0.023), compared with Group II. Patients with HF and reduced EF (HFrEF) had lower hemoglobin (p=0.007), higher baseline heart rate (p=0.005), higher NT-ProBNP (p=0.001), larger LA (p=0.004), lower septal s’, e’, a’ waves, and septal MAPSE, shorter PAAT (p < 0.001 for all), lower lateral MAPSE, higher E/A & E/e’, and shorter LVFT (p=0.001 for all), lower lateral e’ (p=0.009), s’ (p=0.006), RV e’ and LA emptying fraction (p=0.012 for both), compared with HFpEF patients. In multivariate analysis, only LA diameter [2.676 (1.242-5.766), p=0.012], and diabetes [0.274 (0.084 - 0.898), p=0.033] independently predicted poor 6-MWT performance in the group as a whole. In HFrEF, age [1.073 (1.012 - 1.137), p=0.018] and LA diameter [3.685 (1.348 - 10.071), p=0.011], but in HFpEF, lateral s’ [0.295 (0.099 - 0.882), p=0.029], and hemoglobin level [0.497 (0.248-0.998), p=0.049] independently predicted poor 6-MWT performance.

Conclusion: In HF patients predictors of exercise capacity differ according to severity of overall LV systolic function, with left atrial enlargement in HFrEF and longitudinal systolic shortening in HFpEF as the the main predictors.

Place, publisher, year, edition, pages
European Society of Cardiology, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-136997 (URN)10.1002/ejhf.833 (DOI)000401005301045 ()
Note

Abstracts of the Heart Failure 2017 and the 4th World Congress on Acute Heart Failure, Paris, France, 29 April – 2 May 2017

Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2020-03-12Bibliographically approved
Ibrahimi, P., Batalli, A., Ahmeti, A., Elezi, S. H., Henein, M. & Bajraktari, G. (2017). Enlarged left atrium and increased basal heart rate predict exercise capacity in heart failure patients. European Journal of Heart Failure, 19(S1), 582-583, Article ID P2260.
Open this publication in new window or tab >>Enlarged left atrium and increased basal heart rate predict exercise capacity in heart failure patients
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2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no S1, p. 582-583, article id P2260Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background and aim: Heart failure (HF) is a major and growing health problem characterized by high mortality, frequent hospitalization, reduced quality of life and a complex therapeutic regimen. Six minute walking test (6-MWT) may serve as a reproducible test for assessing exercise capacity in HF patients and can be clinically predicted. The aim of this study was to assess clinical, biochemical and echocardiographical predictors of limited exercise capacity in HF patients.

Methods: The study subjects were 135 consecutive clinically stable HF patients (64±11 years, 66 [47%] female, classified as NYHA I-III). Echocardiography, including tissue Doppler measurements, was performed in all patients. A six minute walk test (6-MWT) distance was performed in all patients, who were divided into two groups based on the 6-MWT distance (Group I: ≤ 300 m and Group II: >300 m).

Results: Patients with limited exercise performance (≤ 300 m) were older (p<001), more frequent female (p=0.007) and diabetics (p=0.003), had lower level of hemoglobin (p=0.02), larger left atrium (LA, p=0.003), higher basal heart rate (p=0.009), higher E/e’ ratio (p=0.01) and lower septal systolic myocardial velocity (p=0.03) compared with good performance patients. Enlarged LA [2.856 (1.439-5.666), p=0.003], older age [1.110 (1.036-1.188), p=0.003], increased basal heart rate [1.055 (1.012-1.099), p=0.012] and the presence of diabetes [3.321 (1.022-10.796), p=0.046] independently predicted poor 6-MWT performance.

Conclusions: In patients with HF, the limited exercise capacity assessed by 6-MWT, is related mostly to the enlarged left atrium as e reflection of longstanding increased left ventricular filling pressure, increased basal heart rate, in addition to the older age and the presence of diabetes. These findings highlights the need of the optimal medical treatment of HF patients towards the decreasing LV filling pressure and heart rate.

Place, publisher, year, edition, pages
European Society of Cardiology, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-136989 (URN)10.1002/ejhf.833 (DOI)000401005301841 ()
Note

Abstracts of the Heart Failure 2017 and the 4th World Congress on Acute Heart Failure, Paris, France, 29 April – 2 May 2017

Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2020-03-12Bibliographically approved
Bytyci, I. I., Bajraktari, G. & Henein, M. (2017). Increased left atrial volume predicts atrial fibrillation recurrence after transcatheter ablation: a systematic review and meta-analysis. European Journal of Heart Failure, 19(Suppl: 1), 252-252
Open this publication in new window or tab >>Increased left atrial volume predicts atrial fibrillation recurrence after transcatheter ablation: a systematic review and meta-analysis
2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no Suppl: 1, p. 252-252Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
WILEY, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-136998 (URN)000401005300717 ()
Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2018-06-09Bibliographically approved
Bajraktari, G. G., Bytyci, I. & Henein, M. (2017). LA diameter more than 40 mm predicts recurrence of atrial fibrillation after trans-catheter ablation: a systematic review and meta-analysis. European Journal of Heart Failure, 19(S1), 431-432, Article ID P1758.
Open this publication in new window or tab >>LA diameter more than 40 mm predicts recurrence of atrial fibrillation after trans-catheter ablation: a systematic review and meta-analysis
2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no S1, p. 431-432, article id P1758Article in journal (Refereed) Published
Abstract [en]

Background and Aim: Left atrial (LA) enlargement is associated with atrial fibrillation (AF) incidence and outcome. Trans-catheter ablation of AF has now become a conventional treatment of AF but its recurrence remains of clinical significance. The predictive role of the LA size in AF treatment is still controversial, hence the aim of this meta-analysis was to analyze the potential association between LA diameter and AF recurrence after ablation.

Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to December 2016 in order to select clinical trial and observational studies, which assessed the predictive role of LA diameter in AF recurrence after catheter-ablation. 13.573 patients from 61 studies with paroxysmal AF (PAF), persistent (PeAF) or longstanding persistent AF (L-PeAF) were included.

Results: The pooled analysis showed that after a follow-up period of 19± 7.74 months, patients with AF recurrence had larger LA size compared with those without AF recurrence, with a weighted mean difference (WMD) 0.49 ([95% CI 0.39 to 0.59], P < 0.001), irrespective of the type of AF. A subgroup analysis showed LA diameter to be different; WMD was 2.29 ([95% CI 1.31 to 3.26], P < 0.001) in PAF and 1.51 ([95% CI 1.10 to 1.93], P < 0.001) in PeAF/L-PeAF, the difference between these two subgroups was not significant (Chi2=2.04, I2=51.1%, p=0.15). LA diameter ≥40 mm predicted AF recurrence HR:1.08 [95% CI 1.03 to 1.14], P=0.006), but the best cut-off value, in all included patients, was ≥50mm HR:2.73 [95% CI 1.64 to 4.55], P<0.001).

Conclusions: Increased LA diameter significantly predicts recurrence of AF after ablation procedure. While a diameter of 40 mm predicts recurrence, a diameter more than 50 mm is the most accurate predictor.

Place, publisher, year, edition, pages
European Society of Cardiology, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-136990 (URN)10.1002/ejhf.833 (DOI)000401005301377 ()
Note

Abstracts of the Heart Failure 2017 and the 4th World Congress on Acute Heart Failure, Paris, France, 29 April – 2 May 2017

Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2020-03-12Bibliographically approved
Bytyci, I. I., Bajraktari, G. & Henein, M. (2017). Left atrial size as predictor of recurrences after catheter ablation in paroxysmal atrial fibrillation: a systematic review and meta-analysis. European Journal of Heart Failure, 19(S1), 80-80, Article ID P360.
Open this publication in new window or tab >>Left atrial size as predictor of recurrences after catheter ablation in paroxysmal atrial fibrillation: a systematic review and meta-analysis
2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no S1, p. 80-80, article id P360Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background and Aim: Left atrial (LA) enlargement is associated with paroxysmal atrial fibrillation (PAF) incidence and outcome. The predictive role of the LA size in AF treatment with catheter ablation is still controversial. The aim of this meta-analysis was to analyze the potential association between LA diameter in patients with PAF undergoing ablation and AF recurrence after ablation.

Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to December 2016 in order to select clinical trial and observational studies, which assessed the predictive role of LA diameter in AF recurrence after catheter-ablation. 2962 patients from 16 studies with paroxysmal AF (PAF) were included.

Results: The pooled analysis showed that after a follow-up period of 19. 66± 8.31 months, patients with AF recurrence had larger LA size compared with those without AF recurrence, with a weighted mean difference (WMD) 2.31 ([95% CI 1.27 to 3.34], P < 0.0001). LA diameter ≥40 mm predicted AF recurrence HR:1.04 [95% CI 1.00 to 1.08], P=0.04), but the best cut-off value, in all included patients, was ≥50mm HR:3.08 [95% CI 1.47 to 6.49], P=0.003).

Conclusions: Enlarged left atrium in patients with PAF undergoing catheter ablation predicts recurrences. The diameter more than 50 mm is the best cut-off of the recurrences of AF, but diameter of 40 mm also can predict recurrences in these patients.

Place, publisher, year, edition, pages
European Society of Cardiology, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-137000 (URN)10.1002/ejhf.833 (DOI)000401005300203 ()
Note

Abstracts of the Heart Failure 2017 and the 4th World Congress on Acute Heart Failure, Paris, France, 29 April – 2 May 2017

Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2020-03-12Bibliographically approved
Bajraktari, G. G., Bytyci, I. & Henein, M. (2017). Reduced LA strain predicts atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis. European Journal of Heart Failure, 19(S1), 430-431, Article ID P1755.
Open this publication in new window or tab >>Reduced LA strain predicts atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis
2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no S1, p. 430-431, article id P1755Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background and Aim: Despite the improved outcome of patients with atrial fibrillation (AF) who undergo catheter ablation, recurrence of the arrhythmia remains a concern. The aim of this meta-analysis was to assess the potential association between left atrial (LA) strain and AF recurrence after ablation.

Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to December 2016 in order to identify clinical trial and observational studies, which assessed the predictive role of LA strain in AF recurrence after catheter-ablation. The search identified 898 patients form 10 studies, with paroxysmal AF (PAF) and persistent AF (PeAF).

Results: The pooled analysis showed that after a follow-up period of 11.8± 8.1 months, patients with AF recurrence had reduced LA strain compared with those without AF, with a weighted mean difference (WMD) -7.04% ([95% CI -9.62 to -4.45], P < 0.0001). A subgroup analysis showed that LA strain was reduced regardless of AF type; WMD was -5.47% ([95% CI -9.82% to -1.13%], P=0.003) in PAF and -7.88% ([95% CI -11.19% to -4.56%], P < 0.001) in PAF/PeAF, the difference between these two subgroups was not significant (Chi2=0.75, I2=0.0%, p=0.39). A cut off value of 21% [6% to 30%], was 79% [65-86%] sensitive and 77% [66% to 91%] specific for predicting AF recurrence.

Conclusions: Reduced LA strain significantly predicts recurrence of AF after ablation procedure, irrespective of AF type. This emphasizes the impact of LA wall remodeling on successful ablation.

Place, publisher, year, edition, pages
European Society of Cardiology, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-136991 (URN)10.1002/ejhf.833 (DOI)000401005301374 ()
Note

Abstracts of the Heart Failure 2017 and the 4th World Congress on Acute Heart Failure, Paris, France, 29 April – 2 May 2017

Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2020-03-12Bibliographically approved
Cameli, M., Righini, F. M., Lisi, M., Di Tommaso, C., Curci, V., Navarri, R., . . . Mondillo, S. (2014). Left atrial strain for prognisis prediction of patients with moderate mitral valve regurgitation. Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 30-SEP 03, 2014, Barcelona, SPAIN. European Heart Journal, 35(Supplement 1, Meeting abstract P1380), 243-243
Open this publication in new window or tab >>Left atrial strain for prognisis prediction of patients with moderate mitral valve regurgitation
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2014 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P1380, p. 243-243Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2014
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-97248 (URN)000343001301260 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 30-SEP 03, 2014, Barcelona, SPAIN
Available from: 2014-12-15 Created: 2014-12-12 Last updated: 2018-06-07Bibliographically approved
Henein, M., Tossavainen, E., Söderberg, S., Grönlund, C., Gonzalez, M. & Lindqvist, P. (2013). Left atrial strain rate estimates PCWP. International cardiovascular forum (1), 25-30
Open this publication in new window or tab >>Left atrial strain rate estimates PCWP
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2013 (English)In: International cardiovascular forum, ISSN 2409-3424, no 1, p. 25-30Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Raised left atrial (LA) pressure is a common pathway for many pathologies and is known for its complications. It has a direct effect on LA cavity size and potentially also its function. We hypothesized that raised LA pressure, as shown by pulmonary capillary wedge pressure (PCWP), correlates with severity of global LA deformation abnormalities during atrial systole (LASRa). DESIGN AND PATIENTS: We prospectively studied 46 consecutive patients, mean age 61 ±13 years, 17 males, of various etiologies who underwent right heart catheterization and simultaneous Doppler echocardiography using spectral, tissue Doppler and speckle tracking echocardiography techniques for assessing LA structure and function. RESULTS: PCWP correlated with direct measurements of LA structure and function: LA volume (r= 0.43, p<0.01) and LASRa (r=0.79, p<0.001). PCWP correlated also with other indirect measures of LA pressure such as E/A (r=0.65, p<0.001), E wave deceleration time (r=0.54, p<0.001), E/e’ (r=0.49, p<0.001) and LA systolic filling fraction (r=0.52, p<0.001). However, LASRa together with LA systolic filling fraction, had the highest areas under the curve (0.83 and 0.87, respectively) for identifying patients with PCWP > 15 mmHg. CONCLUSION: PCWP correlates with LA deformation rate during atrial systole and to a higher extent than conventional Doppler measures of raised LA pressures. These findings should have significant clinical implications in correctly identifying breathless patients due to raised LA pressure.

Keywords
echocardiography, E/e’, variability, amyloid, color Doppler, atrial fibrillation, coronary artery stent, anticoagulation, dual antiplatelet therapy, triple therapy
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine, cardiovascular disease
Identifiers
urn:nbn:se:umu:diva-94197 (URN)
Available from: 2014-10-06 Created: 2014-10-06 Last updated: 2018-06-07Bibliographically approved
Henein, M., Zhao, Y., Henein, M. Y. & Lindqvist, P. (2012). Disturbed left atrial mechanical function in paroxysmal atrial fibrillation: a speckle tracking study. International Journal of Cardiology, 155(3), 437-441
Open this publication in new window or tab >>Disturbed left atrial mechanical function in paroxysmal atrial fibrillation: a speckle tracking study
2012 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 155, no 3, p. 437-441Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: We aimed to assess left atrial (LA) intrinsic myocardial function and its relationship to left ventricular (LV) filling pattern in a group of paroxysmal atrial fibrillation (PAF) patients.

METHODS: Twenty-three PAF patients (age 68±7year, 10 males) were studied using speckle tracking echocardiography and compared with 18 age and sex matched controls. LA segmental longitudinal strain (S), strain rate (SR) and myocardial velocities during atrial systole were measured as were LA diameters. E/A and E/Em were also measured.

RESULTS: LA longitudinal diameter was larger in patients (5.5±0.6 vs. 4.8±0.6cm, p<0.01) and global LA S (-9.2±4.3 vs. -12.9±4.6%, p=0.01) and SR (-1.1±0.5 vs. -1.6±0.7 1/s, p<0.01) were reduced and correlated with E/A (r=0.52, p=0.01 and r=0.43, p<0.05, respectively). LA lateral S and SR were uniformly reduced compared with controls (p<0.05 for all). Both septal and lateral wall SR correlated with E/A (p<0.05 for all), only septal S correlated with E/A (p<0.05). LA myocardial velocities were highest at the annular level and lowest at the rear in both patients and controls (p<0.01 for all).

CONCLUSION: In PAF patients, LA systolic function is suppressed and is directly related to the pattern of LV filling which itself may suggest raised pressures. While intrinsic global and segmental function can reproducibly be studied by S and SR, myocardial velocities reflect only regional motion, thus less sensitive in demonstrating localize dysfunction.

Keywords
left atrial, speckle tracking echocardiography, strain, strain rate
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-51368 (URN)10.1016/j.ijcard.2011.10.007 (DOI)22088228 (PubMedID)
Available from: 2012-01-18 Created: 2012-01-18 Last updated: 2018-06-08Bibliographically approved
Henein, M. (2012). Left atrial function in health and disease. (Doctoral dissertation). Umeå: Umeå university
Open this publication in new window or tab >>Left atrial function in health and disease
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The Objectives of this thesis are:

1) To study possible atrial interaction in patients with right and left ventricular outflow tract obstruction due to significant pulmonary (PS) and aortic valve stenosis (AS), respectively.

2) To assess left atrial (LA) intrinsic myocardial function and its relationship to indirect measures of left ventricular (LV) filling pressures in patients with paroxysmal atrial fibrillation (PAF).

3) To test the hypothesis that the LA function is affected in patients with pulmonary arterial hypertension (PAH).

4) To test the hypothesis that raised LA pressure as shown by pulmonary capillary wedge pressure (PCWP) correlates with severity of LA intrinsic systolic function.

We conducted 4 studies to achieve the objective sabove.

Study I

Methods:

We studied 41 PS patients (age 36±10 year) and 41 AS patients (age 35 ± 12 year) and compared them with 27 controls (age 30 ± 7 year). RV and LV filling were recorded by conventional PW Doppler. Biventricular segmental function was studied using the PW tissue Doppler imaging (TDI) and M mode techniques.

Results:

The 2 patient groups had similar degree of ventricular outflow tract obstruction. In the pressureoverloaded ventricle, global systolic function was preserved but long axis function was impaired.Patients had higher peak late filling (Awave)and TDI late diastolic (a’) velocities recorded in the disease free ventricles despite having similar peak early filling velocities (E wave), E wave deceleration time and E/e’ ratios were not different from controls (p>0.05 for all). The accentuation of atrial activity (A wave) was moderately correlated with the degree of contra lateral ventricular outflow tract obstruction (p<0.001 for both).

Conclusion:

In the pressure overloaded ventricle long axis function is more sensitive than global function in revealing myocardial dysfunction. The increased contra lateral atrial systolic activity suggests an evidence for atrial interaction in the form of ‘Cross Talk’.

Study II

Methods:

Twentyfive PAF patients (age 68±7 year, 10 males) with Doppler signs of raised filling pressures were studied using speckle tracking echocardiography and compared with 21 controls. LA segmental longitudinal strain (S), strain rate (SR) and myocardial velocities during atrial systole were measured as were LA longitudinal and transverse diameters. Markers of LV filling pressures were E/A andE/e’.

Results:

LA longitudinal diameter was larger in patients (5.5±0.6 vs. 4.8±0.6cm,p<0.01) and global LAS and SR were reduced (p<0.05 for both) and correlated with E/A (r=0.52 and r=0.43, p<0.05 for both). LA segmental S and SR were uniformly reduced compared with controls (p<0.05 for all) and also correlated with E/A (p<0.05 for all). LA myocardial velocities (TDI) were highest at the annular level and lowest at the rear in both patients and controls (p<0.01 for all), with the absolute values at each level not different between groups. Myocardial velocities negatively correlated with E/A at the annular level only in patients (septal: r=0.52; lateral: r=0.62, p<0.01 for both).

Conclusion:

In PAF patients, LA systolic function is suppressed and is directly related to the raised filling pressures. While intrinsic global and segmental function can reproducibly be studied by S and SR, myocardial velocities reflect only regional motion. These findings provide a sound explanation to the known beneficial effect of vasodilators in PAF patients.

Study III

Methods:

We studied LA size and reservoir function in 35 patients (age 63 ± 15 years, 16 male) with idiopathic PAH using speckle tracking echocardiography who also underwent right heart catheterization simultaneously to assess pulmonary artery systolic pressure, and compared them with 27 age and gender normal controls.

Results:

In PAH patients, LA longitudinal diameter was not different from controls but transverse diameter was reduced (3.0 ± 0.6 vs. 3.7 ± 0.5cm, p<0.001). LA lateral wall strain rate (SR) during LV systole (atrial reservoir function was reduced at annular (p<0.001) and mid cavity (p<0.01) levels as were septal segments (p<0.03, for both) compared to controls. Opposite to controls, the two LA walls responded differently to right heart pressures. Lateral SR inversely correlated with pulmonary artery systolic pressure (PASP) (annular: r=0.45, p<0.005 and midcavity: r=0.43, p<0.01), but not with right atrial pressure (RAP). In contrast, septal SR inversely correlated with RAP (annular: r=0.39, p=0.02 and midcavity: r=0.38, p=0.03) but not with PASP.

Conclusion:

In patients with PAH, LA reservoir function is significantly impaired showing reduced myocardial strain rate properties. In addition,segmental function differs in their response to raised right heart pressures with the septal wall related to right atrial pressure and lateral wall related to the PASP. These findings suggest an evidence for atrial interaction in PAH, which is likely to have significant impact on LV performance.

Study IV

Methods:

We studied 46 patients, mean age 61 ± 13 years, 17 males, of various etiologies with exertional breathlessness who underwent right heart catheterization and simultaneous transthoracic Doppler echocardiography using spectral, tissue Doppler and speckle tracking echocardiography techniques for assessing LA structure and function.

Results:

PCWP correlated with direct measurements of LA structure and function: LA volume (r= 0.43, p<0.01), LA global systolic strain rate (r=0.79, p<0.001) and to a lesser extent with LA systolic filling fraction (r=0.52, p<0.001). PCWP also correlated with indirect measures of LA pressure: LV E/A (r=0.66, p<0.001), E wave deceleration time (r=0.54, p<0.001), lateral E/e’ (r=0.49, p<0.001) and LV isovolumic relaxation time (r=0.36, p<0.01). LA strain rate was 78% sensitive and 84% specific in identifying patients with PCWP>15 mmHg, having accurately predicted PCWP in 63% of the cases.

Conclusion:

PCWP correlates with LA intrinsic systolic function and to a much lesser degree with indirect Doppler measures of raised LV filling pressures. These findings should have significant clinical implications in identifying breathless patients with raised LA pressure.

Place, publisher, year, edition, pages
Umeå: Umeå university, 2012. p. 103
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1523
Keywords
Left atrium, Doppler echocardiography, atrial interaction, atrial pressure
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-60223 (URN)978-91-7459-482-9 (ISBN)
Public defence
2012-10-26, Sal D, 9 trappor, by 1D, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2012-10-05 Created: 2012-10-05 Last updated: 2018-06-08Bibliographically approved
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