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Examples of strain wave of curves of different colors representing the strain of different segments of atrial walls. Imagine A (from 4-chamber view) and B (from 2-chamber view) show the strain wave from a paroxysmal AF subjects. doi: 10.1371/journal.pone.0077653.g001
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The CHADS2/CHA2DS2-VASc scores are used to predict thrombo-embolic/stroke in patients with nonvalvular atrial fibrillation (AF). Nevertheless, limited data are available regarding the association between these risk stratification for stroke and left atrial (LA) remodeling status of AF patients. The purpose of this study was to explore the associati...
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Context 1
... tracing was performed several times to achieve the most accurate endocardial border. Thus, strain versus time curves were generated from these regions of interest (Figure 1). Strain measurements performed in the myocardium of the 8 LA segments (each basal, mid segments of LA septal, lateral, inferior, anterior wall) were calculated by averaging values for LA mean strain. ...
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The prediction of coronary artery disease (CAD) by conventional echocardiographic measurements is principally based on the estimation of ejection fraction and regional wall motion abnormality (RWMA). This study aimed to determine whether strain echocardiography of left ventricle measured by velocity vector imaging (VVI) method could detect patients...
Citations
... 14 The LA mean strain was reduced even if CHADS2 was 0 as confirmed by Yihui Li et al . 15 LA strain in AF patients is reduced, with large score-related changes in another study. 16 The current study has its limitations as the sample size was not calculated, which could have had an adverse effect on the power of the study. ...
Objectives:
To compare the left atrial function utilising speckle tracking echocardiography in patients with low-risk and high-risk non-valvular atrial fibrillation.
Method:
The descriptive, cross-sectional study was conducted at the cardiology department of Kafrelsheikh University Hospital, Egypt, from January 2021 to January 2022, and comprised low-risk atrial fibrillatin participants in group I, high-risk atrial fibrillatin patients in group II, and healthy controls in group III. After detailed medical history, the subjects underwent 12-lead electrocardigram, and echocardiographic assessment, including two dimensional, M-mode, tissue doppler, and speckle tracking of the left atrium. The association of left atrial strain with Congestive heart failure, hypertension, age ≥75 (doubled), diabetes,stroke (doubled), vascular disease sex category (female)score was explored. Data was analysed using SPSS 28.
Results:
Of the 90 subjects, there were 30(33.3%) in each of the 3 groups. The mean age among the groups was significantly different among the groups (p=0.014). Left atrial ejection fraction and left atrial strain had an overall significant difference among the groups(p<0.001). Congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease sex category (female)score was negatively correlated with Left atrial ejection fraction and (p<0.001) and left atrial strain (p<0.001).
Conclusions:
In individuals with atrial fibrillatin, there was a significant decrease in left atrial strain and left atrial function. The use of speckle tracking echocardiography allowed for a more detailed analysis of left atrial mechanics. The correlation of left atrialstrain and left atrial ejection fraction with Congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease sex category (female) score was significantly negative.
... LA strain rate changes re ect the ability of the LA deformability, it changed early than LA remodeling [26][27][28] , and was more accurate than LA strain, so it was more suitable for screening of patients at an early stage. Because of the noninvasive and easy operation, the speckle tracking technique is becoming more and more mature, we hoped that it would be proved to be a reliable parameter in subsequent studies. ...
Left atrial (LA) remodeling is closely related to cerebral stroke, but the relationship between impaired deformability of LA in early stages and stroke/TIA is not clear. The aim of this study was to evaluate the changes of LA deformability and its relationship with stroke/TIA events by using Speckle Tracking echocardiography. In 365 patients with paroxysmal atrial fibrillation (AF) (318, Non stroke/TIA; 47, stroke/TIA), comprehensive echocardiography was performed by using speckle tracking imaging to calculate mean LA longitudinal strain and strain rate values from apical four chamber view, apical two chamber view and apical three cavity view. The patients in stroke/TIA group had greater ages, a greater proportion of men and lower LA strain rate during left ventricular (LV) early diastole (SRE), and the difference was statistically significant(p<0.05). In the univariate linear regression analysis, the following clinical and conventional echocardiographic parameters each had a significant linear correlation with SRE(p<0.001), they were E/A ratio, LA volume index, body mass index, mean E/e′, LV ejection fraction, age, proportion of hypertension. Through a multiple linear regression analysis, the results show that there is a linear dependence between SRE and E/A ratio, LA volume index and Body mass index.
The regression equation is y=-1.430-0.394X1+0.012X2+0.019X3(p<0.001) (y,SRE; X1,E/A ratio; X2,LA volume index; X3,Body mass index).In the multivariate logistic regression analyses, SRE and Sex ratio were independently risk factors stroke/TIA. (SRE, OR 2.945, 95% CI 1.092-7.943, p= 0.033; Sex, OR 0.462, 95% CI 0.230-0.930, p = 0.031)
In patients with paroxysmal AF, SRE could reflect the impaired deformability of LA in early stages, and it was associated with the risk of stroke/TIA.
... Use of the CHADS 2 and CHA 2 DS 2 -VASc scores has extended beyond assessment of thromboembolism risk to predict new-onset AF, left atrial remodelling, and AF recurrence after catheter ablation. [21][22][23] We found no significant difference in the performance of the two scores to predict AHRE. In fact, unlike clinically manifest AF, these risk scores did not perform well in predicting device-detected AHRE of any duration. ...
Aims
Atrial high rate episodes (AHREs) are associated with increased risks of thromboembolism and cardiovascular mortality. However, the clinical characteristics of patients developing AHRE of various durations are not well studied.
Methods and results
This was an ancillary analysis of the multicentre, randomized IMPACT trial. In the present analysis, we classified patients according to the duration of AHRE ≤6 min, >6 min to ≤6 h, >6 to ≤24 h and >24 h, and investigated the association between clinical factors and the development of each duration of AHRE. Of 2718 patients included in the trial, 945 (34.8%) developed AHRE. The incidence rates of each AHRE duration category were 5.4/100, 12.0/100, 6.8/100, and 3.3/100 patient-years, respectively. The incidence rates of AHRE >6 h were significantly higher in patients at high risk of thromboembolism (CHADS2 score ≥3) compared to those at low risk (CHADS2 score 1 or 2). Using Cox regression analysis, age ≥65 years and history of atrial fibrillation (AF) and/or atrial flutter (AFL) were risk factors for AHRE >6 min. In addition, hypertension was associated with AHRE >24 h (hazard ratio 2.13, 95% confidence interval 1.24–3.65, P = 0.006).
Conclusion
Atrial high rate episode >6 min to ≤6 h were most prevalent among all AHRE duration categories. Longer AHREs were more common in patients at risk of thromboembolism. Age and history of AF/AFL were risk factors for AHRE >6 min. Furthermore, hypertension showed a strong impact on the development of AHRE >24 h rather than age.
... Two-dimensional speckle-tracking echocardiography (2DSTE) can assess deformations in LA myocardium and is deemed an accepted imaging modality for the evaluation of LA function [20]. Previous research has revealed that LA strain measured by 2DSTE is reduced in patients with AF rhythm or paroxysmal AF and high CHA 2 DS 2 -VASc or CHADS 2 scores compared with those with low CHA 2 DS 2 -VASc or CHADS 2 scores [21][22][23]. Nonetheless, whether or not the CHA 2 DS 2 -VASc scoring system is capable of identifying LA dysfunction in patients with sinus rhythm has yet to be determined. We sought to assess the ability of the CHA 2 DS 2 -VASc scoring system to grade LA function in a group of candidates for CABG who were in sinus rhythm. ...
... To the best of our knowledge, we are the first to assess the efficacy of the CHA 2 DS 2 -VASc scoring system in categorizing all 3 LA functions as evaluated by longitudinal strain and strain rate markers in patients with sinus rhythm. Previous investigations have evaluated the ability of the CHADS 2 and CHA 2 DS 2 -VASc scoring systems to categorize LA function in patients with AF by focusing solely on LASr [21][22][23]. We categorized our study population via the CHA 2 DS 2 -VASc scoring system in compliance with the latest recommendations of the American College of Cardiology/American Heart Association, which consider the factor of sex to be an effect modifier [24]. ...
... Saha and colleagues, however, failed to perform pairwise comparisons between their 3 groups and regarded CHADS 2 scores of 2, 2 and 3, and greater than 3 as mild-, moderate-, and high-risk scores, respectively, which is in stark contrast to what we did in our study. In their investigation on patients with AF, Li et al. reported diminished LASr in their moderate-and high-risk score groups compared with their mild-risk score group [22]. Moreover, they found no significant difference between the moderate-and high-risk score groups concerning LASr. ...
Abstract Background The CHA2DS2-VASc scoring system is correlated with left atrial (LA) reservoir function in patients with atrial fibrillation (AF) rhythm or paroxysmal AF. We assessed the ability of CHA2DS2-VASc to grade LA function in patients with sinus rhythm who were candidates for coronary artery bypass grafting (CABG). Methods This cross-sectional study recruited 340 consecutive candidates for CABG and categorized them according to their CHA2DS2-VASc scores as mild-, moderate-, and high-risk score groups with 34 (10%), 83 (24%), and 223 (66%) patients, respectively. LA function was evaluated via 2D speckle-tracking echocardiography in terms of global longitudinal strain and strain rate during the reservoir, conduit, and contraction phases. In-hospital mortality, postoperative AF, prolonged intensive care unit (ICU) stay, and prolonged mechanical ventilation were assessed. Results LA strain and strain rate during the reservoir phase was statistically significantly lower in the high-risk score group than the low- and moderate-risk score groups (27.8 ± 6.9% vs 31.0 ± 5.0% vs 29.8 ± 6.1%, respectively; P = 0.004 and 2.6 ± 0.7 s−1 vs 2.9 ± 0.6 s−1 vs 2.9 ± 0.6 s−1, correspondingly; P = 0.009) and regarding LA strain and strain rate during the conduit phase (9.7 [7.1–12.5]% vs 12.9 [9.4–15.1]% vs 11.5 [9.1–13.8]%, correspondingly; P
... p = 0.67) Table (4). There was significant decrease in LA strain with in patients with CHA2DS2-VASc score > 2 compared to patients with CHA2DS2-VASc score < 2 (16 (14-20) vs 30 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), p <.001) Table (5). The receiver-operator characteristic (ROC) curve was used to test diagnostic value of various echocardiographic parameters models in the correlation between left atrial function by speckle tracking and stroke risk in patients with persistent atrial fibrillation The value of LA strain < 22.5 was shown to have the best diagnostic accuracy with (sensitivity = 82%; specificity = 60%) in predicting the stroke risk in atrial fibrillation patient with AUC.871 Table (6). ...
... In the current investigation, there was noteworthy diminishing in LA strain with in patients with CHA2DS2-VASc score > 2 contrasted with patients with CHA2DS2-VASc score < 2 (16 (14-20) versus 30 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), p <.001) Table (3). Islas et al. [26] and Kurosawa et al. [27] expressed that LA strain was connected fundamentally and autonomously with CHA2DS2-VASc score and these discoveries are with our outcomes. ...
... In our investigation, there was huge lessening in LA strain in patients with CHA2DS2-VASc score > 2 contrasted with patients with CHA2DS2-VASc score < 2 (16 (14-20) versus 30 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), p <.001) Table (5). Not at all like the examination by Ahmed et al. (24) who found no huge connection between's left atrial strain and CHA2DS2 VAS c score in persistent with score not exactly or equivalent to 2 or those with score more than 2. ...
... To further explore the relationship of disordered GM in psAF of short or long duration mediated by metabolites, we carried out a Spearman correlation analysis between the top 10 common gut microbes, top 10 common fecal metabolites, distinctive gut microbes, and distinctive fecal metabolites. The clinical AF scores of nine genera and 10 species were significantly correlated with six fecal metabolites, and these metabolites were further correlated with the AF duration and CHA2DS2-VASc score (congestive heart failure, HTN, age Ն75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65 to 74 years, sex category of female), which represents the severity of atrial remodeling in psAF patients (34)(35)(36)(37). Some commonly ...
Atrial fibrillation was associated with a disordered gut microbiota in previous research. However, the gut microbiota signature of patients at different stages of atrial fibrillation remains largely unknown. We sought to determine whether the shift in the gut microbiota and metabolic profiles occurs early and remains stable or develops gradually during atrial fibrillation. We found that patients with persistent atrial fibrillation of <12 months and persistent atrial fibrillation of >12 months shared most of the common features of gut microbiota dysbiosis. However, some distinctive and progressive alterations in the gut microbiota and metabolic structure, which may contribute to the progression of atrial fibrillation, were identified. The present study provides a comprehensive description of the dysbiotic gut microbiota and metabolic profiles in patients of short and long persistent atrial fibrillation, and our findings may help identify therapeutic strategies targeting the gut microbiota to treat atrial fibrillation at an early stage.
... We can argue reasonably that those with "rare" PAF had more left heart pathology than those with AFL, which was manifested in the way the LAA behaved during AFL in the current study. More detailed LA functional assessment, e.g., with strain measurements 22 , and LA fibrosis evaluation using cardiac magnetic resonance imaging may be needed in future studies. Nevertheless, the study findings support the concept that when PAF is present, though uncommonly, the thrombogenic risk in patients with isthmus-dependent AFL is higher than that in patients with isolated AFL alone based on the LAA functional characteristics. ...
Impaired left atrial appendage ejection fraction (LAA-EF) and peak LAA flow velocity (LAA-FV) are associated with high thromboembolic risks in patients with atrial fibrillation (AF). Herein, we examined LAA function among patients with atrial flutter (AFL) stratified by the CHA2DS2-VASc score using transesophageal echocardiography (TEE). Of 231 consecutive patients with typical AFL, 84 who fulfilled the inclusion criteria were enrolled. Among them, 57 had ongoing AFL and were divided into the isolated AFL (n = 38) and AFL with paroxysmal AF (PAF) (n = 19) groups, depending on whether they had sporadic AF before TEE. The remaining 27 patients with spontaneous sinus rhythm during TEE were designated as controls. Both the LAA-FV (31.9 cm/s vs. 51.5 cm/s, P = 0.004) and LAA-EF (28.4% vs. 36.5%, P = 0.024) measured during AFL were significantly lower in the AFL + PAF group than in the isolated AFL group. Significant inverse correlations between the CHA2DS2-VASc score and LAA-EF were identified in the AFL (P = 0.008) and AFL + PAF (P = 0.032) groups. We observed progressive LAA dysfunction in patients with AFL + PAF compared with that in patients with isolated AFL, and the LAA-EF was inversely correlated with the CHA2DS2-VASc score in these patients. Our findings may have implications on the application of thromboprophylactic therapy in patients with AFL.
... The cluster of 4 risk factors largely overlaps with components of the CHADS 2 and CHA 2 DS 2-VASc scores. In recent years, use of the CHADS 2 and CHA 2 DS 2-VASc scores has extended beyond the prediction of thromboembolism to the prediction of left atrial remodeling, AF recurrence after catheter ablation, and development of new-onset AF [34][35][36]. These might be explained by the multiple risk factors included in the CHADS 2 and CHA 2 DS 2-VASc scores that are associated with AFrelated pathophysiology. ...
Background:
Stress affects us in every environment and it is also present in the educational sphere. Previous studies have reported a high prevalence of stress in university students. The Student Stress Inventory-Stress Manifestations (SSI-SM), identify stressors and evaluate stress manifestations in adolescents but its validity in university students remains uncertain.
Objectives:
We aimed to determine the internal consistency and validity of an adapted version of the Student Stress Inventory-Stress Manifestations (SSI-SM) for university students and to investigate if high stress levels are associated with personal and academic factors.
Design and methods:
In this quantitative, descriptive, cross-sectional study, we included 115 university students of the Nursing Degree during the second semester of the 2014/2015 academic year. Information about personal issues, lifestyle and academic performance was recorded and the stress was evaluated with the SSI-SM questionnaire. The internal consistency and homogeneity of the SSI-SM questionnaire was tested and a factorial analysis was performed.
Results:
After the homogeneity analysis, the final version of the SSI-SM questionnaire included 19 items, with a Cronbach's alpha of 0.924. In the factorial analysis, 4 factors were found ('Self-concept', 'Sociability', 'Uncertainty' and 'Somatization'; all Cronbach's alpha >0.700). Students with higher values on the SSI-SM were, in overall, women (41.0 ± 12.7 vs. 33.2 ± 9.5; p = 0.001) and had significantly more family conflicts (47.6 ± 13.8 vs. 35.2 ± 9.6; p < 0.001), consumed less alcohol (R = -0.184, p = 0.048), slept less hours (R = -0.193, p = 0.038) and had worse academic performance in Clinical Nursing (36.3 ± 10.4 vs. 41.2 ± 13.3, p = 0.039).
Conclusions:
After exclude three items of the original SSI-SM, higher scores in the SSI-SM are correlated with stress level in a cohort of university students of the Nursing Degree. Family conflicts, female gender, absence of alcohol consumption, few sleep hours and poor academic performance are associated with higher stress levels.
... Similarly, Azemi et al. [23] retrospectively studied patients with AF, stroke or transient ischemic attack, and CHADS 2 scores of ≤ 1 before their events from a large single-center stroke registry and compared it with age-and gender-matched controls regarding echocardiographic parameters including chamber volumes, the LV mass, the LA peak negative and positive strain, and the strain rate, and they reported that the peak positive LA strain (14 ± 11 vs. 25 ± 12%, P < 0.001) was significantly reduced in patients compared with controls. Even if the CHADS 2 score was 0, the LA mean strain was reduced as demonstrated by Li et al. [24], who found that the LA mean strain was 18.33 ± 8.57 in the patient group of CHADS 2 score 0. ...
Objectives: To assess the relation between left atrial systolic strain and CHA2DS2 -VASc score in patients with non valvular atrial fibrillation and to assess whether it can be used in guiding the decision for oral anticoagulation. Methods: The study included 100 patients with non- valvular persistent AF (group I) compared to 100 individuals with sinus rhythm of matching age and gender (group II). Standard two-dimensional echocardiography, PW Doppler and TDI derived velocity and strains were used to assess LA function then its correlation with CHA2DS2-VASc score in group I was evaluated. Results: The prevalence of DM (P<0.001), HTN (P=0.001), prior stroke (P<0.001), heart failure (P < 0.001) and peripheral vascular disease (P < 0.001) was increased in patients in group I. Group I showed significant increase in LA diameters (anterio-posterior, transverse and longitudinal) P ˂ 0.001, LA volumes (maximal and minimal P < 0.001 and mitral E/e" ratio P ˂ 0.05. The correlation between LA emptying fraction and CHA2DS2 - VASc score was negative and significant (P < 0.05). Systolic LA strain was significantly reduced in patients with AF (P < 0.001) and it was negatively correlated to CHA2DS2 - VASc score but without statistical significance. There was no significant difference of LA systolic strain between the CHA2DS2 - VASc score of < 2 points and ≥ 2 points (P = 0.52). Systolic LA strain ≤ 17.44 was shown to have the best diagnostic accuracy (sensitivity = 42.11 %; specificity = 62.07%) in predicting CHA2DS2 - VASc ≥ 2. Conclusion: LA systolic strain is significantly reduced in AF patients and negatively correlated to CHA2DS2- VASc score and no significant difference between LA systolic strain in patients with CHA2DS2 - VASc score of < 2 points and ≥ 2 points so LA strain may be a tool that helps in guiding the decision for oral anticoagulation.
... In clinical practice, accurate assessment of LA function or concomitant events requires several, rather than single quantitative echocardiographic analysis [34]. So we intended to define basic and single echocardiographic parameter to predict the CHA2DS2-VASc score of !2. ...
CHA2DS2-VASc score is the most widely preferred method for prediction of stroke risk in patients with atrial fibrillation. We hypothesized that CHA2DS2-VASc score may represent atrial remodeling status, and therefore echocardiographic evaluation of left atrial electromechanical remodeling can be used to identify patients with high risk.
A total of 65 patients who had documented diagnosis of paroxysmal atrial fibrillation (PAF) were divided into three risk groups according to the CHA2DS2-VASc score: patients with low risk (score=0, group 1), with moderate risk (score=1, group 2), and with high risk score (score ≥2, group 3). We compared groups according to atrial electromechanical intervals and left atrium mechanical functions.
Atrial electromechanical intervals including inter-atrial and intra-atrial electromechanical delay were not different between groups. However, parameters reflecting atrial mechanical functions including LA phasic volumes (Vmax, Vmin and Vp) were significantly higher in groups 2 and 3 compared with group 1. Likewise, LA passive emptying volume (LATEV) in the groups 2 and 3 was significantly higher than low-risk group (14.12±8.13ml/m(2), 22.36±8.78ml/m(2), 22.89±7.23ml/m(2), p: 0.031). Univariate analysis demonstrated that Vmax, Vmin and Vp were significantly correlated with CHA2DS2-VASc score (r=0.428, r=0.456, r=0.451 and p<0.001). Also, LATEV (r=0.397, p=0.016) and LA active emptying volume (LAAEV) (r=0.281, p=0.023) were positively correlated with CHA2DS2-VASc score. In the ROC analysis, Vmin≥11ml/m(2) has the highest predictive value for CHA2DS2-VASc score ≥2 (88% sensitivity and 89% specificity; ROC area 0.88, p<0.001, CI [0.76-0.99]).
Echocardiographic evaluation of left atrial electromechanical function might represent a useful method to identify patients with high risk.
Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
