Plasma natriuretic peptides (NPs) are increased in patients with atrial fibrillation (AF) compared with the patients with sinus rhythm. This study investigated whether this phenomenon is intrinsic to heart rhythm irregularity and independent of the heart rate and left atrial pressure (LAP) overload. We investigated 46 patients (age: 59 ± 10 years, male gender: 77%) with non-valvular paroxysmal AF who were scheduled for catheter ablation and had documented stable sinus rhythm for at least 18 hours before the procedure. All patients underwent direct measurement of right atrial pressure and LAP, simultaneously with assessment of plasma B-type NP, N-terminal pro-brain NP, and mid-regional pro-atrial NP. The baseline measurement was followed by induction of AF by rapid atrial pacing in the first 24 patients and by regular pacing from the coronary sinus at 100/min (corresponding to the mean heart rate during induced AF) in the latter 22 patients. Hemodynamic assessment and blood sampling were repeated after 20 min of the ongoing AF or fast regular paging. The baseline characteristics and hemodynamic measurements were comparable between study groups; however, patients in the regular atrial pacing group had a higher body mass index and a larger left atrial diameter compared with the induced AF group. Plasma levels of all 3 NPs increased significantly during induced AF but not during fast regular pacing, and the increase of NPs was independent of right atrial pressure and LAP. Baseline concentrations of NPs and heart rhythm irregularity were the only independent predictors of increased NPs.

• MeSH
• fibrilace síní * MeSH
• katetrizační ablace * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• natriuretické peptidy MeSH
• senioři MeSH
• síňový tlak fyziologie   MeSH
• srdeční frekvence MeSH
• srdeční síně MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

AIMS: Impaired left ventricular diastolic function leading to elevated left atrial pressures, particularly during exertion, is a key driver of symptoms and outcomes in heart failure with preserved ejection fraction (HFpEF). Insertion of an interatrial shunt device (IASD) to reduce left atrial pressure in HFpEF has been shown to be associated with short-term haemodynamic and symptomatic benefit. We aimed to investigate the potential effects of IASD placement on HFpEF survival and heart failure hospitalization (HFH). METHODS AND RESULTS: Heart failure with preserved ejection fraction patients participating in the Reduce Elevated Left Atrial Pressure in Patients with Heart Failure study (Corvia Medical) of an IASD were followed for a median duration of 739 days. The theoretical impact of IASD implantation on HFpEF mortality was investigated by comparing the observed survival of the study cohort with the survival predicted from baseline data using the Meta-analysis Global Group in Chronic Heart Failure heart failure risk survival score. Baseline and post-IASD implant parameters associated with HFH were also investigated. Based upon the individual baseline demographic and cardiovascular profile of the study cohort, the Meta-analysis Global Group in Chronic Heart Failure score-predicted mortality was 10.2/100 pt years. The observed mortality rate of the IASD-treated cohort was 3.4/100 pt years, representing a 33% lower rate (P = 0.02). By Kaplan-Meier analysis, the observed survival in IASD patients was greater than predicted (P = 0.014). Baseline parameters were not predictive of future HFH events; however, poorer exercise tolerance and a higher workload-corrected exercise pulmonary capillary wedge pressure at the 6 months post-IASD study were associated with HFH. CONCLUSIONS: The current study suggests IASD implantation may be associated with a reduction in mortality in HFpEF. Large-scale ongoing randomized studies are required to confirm the potential benefit of this therapy.

• MeSH
• časové faktory MeSH
• funkce levé komory srdeční fyziologie   MeSH
• hospitalizace trendy   MeSH
• lidé MeSH
• míra přežití trendy   MeSH
• následné studie MeSH
• prospektivní studie MeSH
• protézy a implantáty * MeSH
• senioři MeSH
• síňový tlak fyziologie   MeSH
• srdeční katetrizace metody   MeSH
• srdeční selhání mortalita   patofyziologie   chirurgie   MeSH
• srdeční síně patofyziologie   chirurgie   MeSH
• tepový objem fyziologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Austrálie MeSH
• Evropa MeSH
• Nový Zéland MeSH

BACKGROUND: We investigated whether the increase of plasma natriuretic peptides (NPs) in atrial fibrillation (AF) is independent of the effect of AF on the left atrial (LA) hemodynamics. METHODS: Hemodynamically stable patients scheduled for AF ablation underwent assessment of B-type natriuretic peptide (BNP) and mid-regional pro-atrial natriuretic peptide (MR-proANP), echocardiography, and direct measurement of left atrial (LA) pressure. Concentrations of the NPs were compared between patients in AF (n = 31) and controls in sinus rhythm (SR; n = 31) who were matched for age, gender, heart rate, left ventricular ejection fraction, LA volume index, and directly measured mean LA pressure. Eighteen patients underwent serial measurement of NPs and LA pressure during native SR and after 20 min of pacing-induced AF. RESULTS: Compared to the patients in SR, the patients in AF had 2.6 times higher unadjusted BNP [median (inter-quartile range), 101 (63, 129) vs. 38 (26, 79) ng/L] and two times higher unadjusted MR-proANP [183 (140, 230) vs. 91 (67, 135) pmol/L; both p < 0.001]. Concentrations of both NPs correlated with mean LA pressure in the patients in SR (r = 0.75 for BNP and 0.62 for MR-proANP, both p < 0.001) but not in the patients in AF (r = 0.18 and 0.04, respectively, both p > 0.3). Both NPs increased significantly during induced AF [adjusted median (IQR) relative change, BNP: 27 (22; 40)%, MR-proANP: 75 (64; 99)%, both p < 0.001] without a significant change in the LA pressure. CONCLUSIONS: The increase of NPs in AF was independent of its effect on the LA hemodynamics.

• MeSH
• atriální natriuretický faktor krev   MeSH
• biologické markery krev   MeSH
• echokardiografie MeSH
• fibrilace síní krev   diagnóza   chirurgie   MeSH
• funkce levé komory srdeční fyziologie   MeSH
• katetrizační ablace metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• natriuretický peptid typu B krev   MeSH
• prognóza MeSH
• progrese nemoci MeSH
• prospektivní studie MeSH
• síňové ouško diagnostické zobrazování   MeSH
• síňový tlak fyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: The aim of this paper was to investigate the prevalence of resting and exercise-induced left atrial hypertension (LAH) in patients with nonvalvular atrial fibrillation (AF), association of the LAH with other cardiac abnormalities, and its implications for AF catheter ablation. BACKGROUND: The clinical role of LAH in patients with established AF is largely unknown. METHODS: Patients scheduled for catheter ablation of AF (n = 240; age 60 ± 10 years; 67% men, 62% paroxysmal AF) underwent detailed echocardiography, assessment of quality of life (QoL), left atrial (LA) voltage mapping, and measurement of the LA pressure at rest and during isometric handgrip exercise. After ablation they were followed for AF recurrence for 16 ± 6 months. RESULTS: Resting and exercise-induced LAH (mean LA pressure >15 mm Hg) occurred in 15% and 34% of the patients, respectively. Both the patients with resting and exercise-induced LAH had typical features of latent heart failure with preserved ejection fraction associated with advanced LA structural and functional remodeling. AF recurred after ablation in 45% of the patients. LAH was an independent risk factor for arrhythmia recurrence (hazard ratio: 1.7, 95% confidence interval: 1.2 to 2.2). The patients with LAH had worse baseline QoL, but they benefited significantly more from a successful ablation than the patients without LAH. CONCLUSIONS: Presence of either resting or exercise-induced LAH identified AF patients with a distinct clinical profile, extensive LA substrate, and different clinical response to catheter ablation. Stratification of AF patients based on the LA exercise hemodynamics could help in the future to tailor the ablation strategy.

• MeSH
• cvičení fyziologie   MeSH
• fibrilace síní etiologie   chirurgie   MeSH
• hypertenze etiologie   MeSH
• katetrizační ablace * MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• recidiva MeSH
• remodelace síní fyziologie   MeSH
• rizikové faktory MeSH
• senioři MeSH
• síla ruky fyziologie   MeSH
• síňový tlak fyziologie   MeSH
• srdce - funkce levé síně fyziologie   MeSH
• srdeční síně MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Heart failure with preserved ejection fraction has a complex pathophysiology and remains a therapeutic challenge. Elevated left atrial pressure, particularly during exercise, is a key contributor to morbidity and mortality. Preliminary analyses have demonstrated that a novel interatrial septal shunt device that allows shunting to reduce the left atrial pressure provides clinical and hemodynamic benefit at 6 months. Given the chronicity of heart failure with preserved ejection fraction, evidence of longer-term benefit is required. METHODS AND RESULTS: Patients (n=64) with left ventricular ejection fraction ≥40%, New York Heart Association class II-IV, elevated pulmonary capillary wedge pressure (≥15 mm Hg at rest or ≥25 mm Hg during supine bicycle exercise) participated in the open-label study of the interatrial septal shunt device. One year after interatrial septal shunt device implantation, there were sustained improvements in New York Heart Association class (P<0.001), quality of life (Minnesota Living with Heart Failure score, P<0.001), and 6-minute walk distance (P<0.01). Echocardiography showed a small, stable reduction in left ventricular end-diastolic volume index (P<0.001), with a concomitant small stable increase in the right ventricular end-diastolic volume index (P<0.001). Invasive hemodynamic studies performed in a subset of patients demonstrated a sustained reduction in the workload corrected exercise pulmonary capillary wedge pressure (P<0.01). Survival at 1 year was 95%, and there was no evidence of device-related complications. CONCLUSIONS: These results provide evidence of safety and sustained clinical benefit in heart failure with preserved ejection fraction patients 1 year after interatrial septal shunt device implantation. Randomized, blinded studies are underway to confirm these observations. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01913613.

• MeSH
• časové faktory MeSH
• design vybavení MeSH
• dospělí MeSH
• funkce levé komory srdeční MeSH
• implantace protézy * MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• senioři MeSH
• síňový tlak fyziologie   MeSH
• srdeční katetrizace * MeSH
• srdeční selhání patofyziologie   terapie   MeSH
• srdeční síně MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Chronické srdeční selhání se zachovalou ejekční frakcí levé komory (HFpEF) je časté a terapeutické možnosti jsou v současné době omezeny. Za rozvoj příznaků je u pa­cientů s HFpEF odpovědný vzestup tlaku v levé síni. Bylo vyvinuto zařízení, které se zavádí katetrizační metodou s cílem snížit tlak v levé síni vytvořením trvalé mezisíňové komunikace. Použití tohoto zařízení by mohlo vést ke snížení rizika hospitalizací, zlepšit symp­tomy a kvalitu života u pa­cientů s HFpEF a pokročilou symp­tomatologií.

Chronic heart failure with preserved ejection fraction (HFpEF) is common and yet therapeutic options available to date are limited. Increased left atrial pressure is a key contributor to the symptoms in HFpEF. A novel catheter-based device has been developed, which is designed to lower left atrial pressure by creating a permanent shunt in the atrial septum. Use of this device could reduce the risk of hospitalisation for heart failure and improve the symptomatic status and quality of life in HFpEF patients with advanced symptoms.

• Klíčová slova
• levá síň, mezisíňová kominukace, IASD, srdeční implantáty,
• MeSH
• implantace protézy * metody   MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• pilotní projekty MeSH
• plicní tlak v zaklínění fyziologie   MeSH
• protézy a implantáty MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• síňová přepážka MeSH
• síňový tlak fyziologie   MeSH
• srdce - funkce levé síně fyziologie   MeSH
• srdeční katetrizace metody   MeSH
• srdeční selhání * patofyziologie   terapie   MeSH
• srdeční síně * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• multicentrická studie MeSH
• práce podpořená grantem MeSH

OBJECTIVES: We set to measure the interatrial pressure gradient during simulated obstructive sleep apnea (OSA). BACKGROUND: OSA occurs when a sleeping patient attempts to inhale against an obstructed airway. How this event affects the interatrial pressure gradient has not been defined. We hypothesized that simulated OSA in a conscious subject (Mueller maneuver [MM], inspiration against obstruction) would promote increased right-to-left pressure gradient, and then the substrate for right-to-left atrial shunting. METHODS: Selected patients underwent simultaneous measurement of airway and atrial pressures (both left and right atrium [LA, RA]) using high-fidelity micromanometry at rest, during MM, and during VM, during right heart catheterization. RESULTS: Ten patients (age 55 ± 11 years, two women) were successfully studied. During the onset of MM, RA pressure transiently but consistently exceeded LA pressure in response to the steep decline in intrathoracic pressure (maximum RA-LA pressure gradient increased from 0.1 ± 1.4 mm Hg at baseline to 7.0 ± 4.3 mm Hg during MM, P < 0.001). The maximum right-to-left atrial pressure gradient during Mueller maneuver was higher than that achieved during the Valsalva maneuver release (P < 0.007). CONCLUSIONS: The onset of MM increased right-to-left pressure gradient across the atrial septum, likely as a result of greater blood return to the RA from extrathoracic veins. The RA-LA pressure gradient achieved during MM was greater than that observed during VM. These findings delineate the hemodynamic substrate for right to left shunting during OSA.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• manometrie metody   MeSH
• následné studie MeSH
• obstrukční spánková apnoe patofyziologie   MeSH
• osoby simulující pacienta ve výuce * MeSH
• prospektivní studie MeSH
• síňový tlak fyziologie   MeSH
• srdce - funkce pravé síně fyziologie   MeSH
• srdeční katetrizace metody   MeSH
• srdeční síně patofyziologie   MeSH
• Valsalvův manévr MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH