BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and can lead in the long-term to atrial remodelling. Three-dimensional speckle-tracking echocardiography allows evaluation of left atrial function and the magnitude of remodelling processes. METHODS: Echocardiography loops were collected between December 2021 and December 2022. Only valid atrial loops with sinus rhythm during examination were included. The Spearman test was used to establish correlation matrices of left atrial parameters, with uni-, multivariate and binary logistic regression to predict the presence or absence of AF. RESULTS: A total of 116 patients (50% females) aged 76.9 ± 11.2 years were included in the analysis. Males and females differed in anthropometric and other clinical parameters. Intra- and interobserver variability was 1.12% and 1.85%, respectively. 2D and 3D left atrial volumes correlated significantly (r = .8, P<.0001). Almost all left atrium strain measurements uni- and multivariately predicted the presence of AF, binary logistic regression model identified 2 independent parameters, left atrial longitudinal strain reservoir (LASr, P = .042) and LAS conduit phase (P = .044). LASr was significantly greater in patients without a history of AF than in patient with a history of AF (16 ± 16 and 10.5 ± 7.1, respectively; P = .012). LASr was able to discriminate between a history of paroxysmal AF and its absence with 72% specificity and 68% sensitivity with a cut-off value of 14% (AUC 0.72, 95% CI 0.62-0.82, P < .0001). CONCLUSIONS: Three-dimensional left atrial reservoir function can differentiate patients with paroxysmal AF from patients without a history of this arrhythmia.

• Klíčová slova
• atrial fibrillation, left atrial reservoir function, three-dimensional atrial strain,
• Publikační typ
• časopisecké články MeSH

To assess the feasibility of left atrial flow propagation velocity (LAFPV) measurement and to evaluate the influence of preload alterations on this new parameter of left atrial (LA) reservoir function as compared to conventional echocardiographic indices. 30 healthy volunteers (26 ± 5 years, 20 males) underwent echocardiographic examination at rest, during passive leg lifting and after sublingual administration of nitroglycerine with subsequent Valsalva maneuver. LA reservoir function was assessed by conventional indices including LA expansion index, peak velocity and velocity-time integral of pulmonary venous systolic flow. As well, LAFPV was measured by color M-mode in an apical 4-chamber view as the slope of the transatrial flow wave during LA reservoir phase. LAFPV measurement was feasible in 25 subjects (83%). All conventional parameters of LA reservoir function were significantly altered from resting values by both load-modifying conditions. However, LAPFV was not significantly altered by such maneuvers (228 ± 28 cm s⁻¹ at rest vs. 238 ± 3 cm s⁻¹ during leg lifting, P = NS, vs. 218 ± 38 cm s(-1) after nitroglycerin with Valsalva maneuver, P = NS vs. rest, P < 0.01 vs. leg lifting). LAFPV can be measured in a majority of subjects and represents a new, less load-dependent index of LA reservoir function that may more appropriately reflect LA compliance.

• MeSH
• analýza rozptylu MeSH
• barevná dopplerovská echokardiografie * MeSH
• dospělí MeSH
• hemodynamika * MeSH
• lidé MeSH
• mladý dospělý MeSH
• nitroglycerin aplikace a dávkování   MeSH
• odchylka pozorovatele MeSH
• poddajnost MeSH
• prediktivní hodnota testů MeSH
• pulzní dopplerovská echokardiografie * MeSH
• reprodukovatelnost výsledků MeSH
• rychlost toku krve MeSH
• srdce - funkce levé síně * MeSH
• srdeční síně diagnostické zobrazování   patofyziologie   MeSH
• studie proveditelnosti MeSH
• svalová kontrakce MeSH
• Valsalvův manévr MeSH
• vazodilatancia aplikace a dávkování   MeSH
• venae pulmonales diagnostické zobrazování   patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• práce podpořená grantem MeSH
• Názvy látek
• nitroglycerin MeSH
• vazodilatancia MeSH

Atrial fibrillation (AF) is an abnormal and irregular heartbeat caused by uncoordinated electrical impulses in the left atrium (LA), which could induce lasting changes in the heart tissue or could be a consequence of underlying cardiac disease. This study aimed to assess the left atrial phasic function and deformation in paroxysmal AF (PAF) patients-who had not received radiofrequency ablation and had no signs of permanent AF-using the cardiovascular magnetic resonance (CMR) feature-tracking (FT) technique. Fifty subjects (27 PAF patients and 23 controls) were included and examined with CMR. Their LA volume, LA function, LA longitudinal strain (LS) and LA strain rate were assessed in the LA reservoir, conduit, and contractile phases. PAF patients exhibited higher LA volumes than controls, while their LA emptying fraction and LA LS was significantly lower in all three phases. In contrast, the corresponding emptying volumes (total, passive and active) were similar in both groups. The LA volumetric rates from CMR-derived volume curves differed significantly in PAF patients vs controls in the reservoir and contractile phases. In contrast, the equivalent LV volumetric rates were similar. This study suggests that assessing the LA phasic function could offer insight into early LA impairments for PAF patients.

• MeSH
• fibrilace síní * patologie   MeSH
• katetrizační ablace * MeSH
• lidé MeSH
• magnetická rezonanční spektroskopie MeSH
• srdce - funkce levé síně MeSH
• srdeční síně MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION: The randomized PRAGUE-17 trial demonstrated noninferiority of left atrial appendage closure (LAAC) to non-vitamin K anticoagulants (NOACs) for the prevention of major cardiovascular or cerebrovascular events. However, the left atrial appendage is an important source of natriuretic peptides and plays a role in left atrial reservoir function. Changes of heart failure (HF) biomarkers after LAAC compared to NOAC has not been studied. The aim of the study was to compare the changes in concentrations of HF biomarkers between LAAC and NOAC patients. METHODS: Of 402 patients randomized in the PRAGUE-17 trial, biomarkers were analyzed in 144 patients (73 in the NOAC and 71 in the LAAC group). Both groups had similar baseline characteristics. Serum concentration of NT-proBNP, NT-proANP, Galectin-3, and GDF-15 were measured at baseline (before the procedure in the LAAC group), at the 6-month (and at 24-month for NT-proBNP) follow-up timepoint. RESULTS: There were no significant differences in baseline, 6 month, and delta (δ = baseline - 6 month) concentrations of NT-proANP between the groups (NOAC: baseline 2.6 [0.5; 4.9], 6-month 3.1 [1.8; 4.8], p = .068; LAAC: baseline 3.3 [1.1; 4.6], 6-month 2.6 [0.9; 5.3], p = .51; p value for δ in concentrations between groups = 0.42). Similarly, there were no significant differences in baseline, 6, 24 months, and delta concentrations of NT-proBNP between the groups (NOAC: baseline 461.0 [113.5; 1342.0], 6 month 440.0 [120.5; 1291.5], 24 month 798 [274; 2236], p = .39; LAAC: baseline 421.0 [100.0; 1320.0], 6 month 601.0 [145.0; 1230.0], 24 month 855 [410; 1367], p = .28; p value for δ in concentrations between groups = 0.73 at 6 months, and 0.58 at 24 months). Finally, no significant differences were present in baseline, 6 month, and δ concentrations of Galectin-3 and GDF-15 between the two groups. CONCLUSION: LAAC did not significantly influence the levels of HF biomarkers 6 months after the procedure.

• Klíčová slova
• atrial natriuretic peptide, biomarkers, brain natriuretic peptide, left atrial appendage, left atrial appendage closure,
• MeSH
• antikoagulancia terapeutické užití   MeSH
• aplikace orální MeSH
• biologické markery MeSH
• cévní mozková příhoda * MeSH
• fibrilace síní * diagnóza   farmakoterapie   chirurgie   MeSH
• lidé MeSH
• síňové ouško * diagnostické zobrazování   chirurgie   MeSH
• srdeční selhání * diagnóza   farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• antikoagulancia MeSH
• biologické markery MeSH

BACKGROUND: Left atrial (LA) fibrosis begets atrial fibrillation (AF). Cardiovascular magnetic resonance (CMR) using the late gadolinium enhancement (LGE) technique might visualize the LA fibrosis and thus help to choose an appropriate strategy for treatment of AF. In this regard, we investigated whether the extent of preablation LA LGE would predict AF recurrence after ablation in a non-selected patient population. METHODS: CMR was performed in 95 patients before radiofrequency ablation of AF. An interpretable scan was available in 73 patients (age, 59 ± 8 years; men, 71%; persistent/paroxysmal AF, 55/45%). The extent of LA LGE was quantified by three established thresholding techniques. In addition, CMR was used to quantify LA volume and reservoir function. The patients were followed for AF recurrence for 1.3 ± 0.8 years. RESULTS: The arrhythmia recurred in 29 (40%) of the patients. The extent of LA LGE did not differ between paroxysmal and persistent AF and it did not predict the AF recurrence. Moreover, the extent of LA LGE did not correlate with LA volume, reservoir function and bipolar voltage. CONCLUSIONS: Our data indicate a limited value of a routine assessment of LA LGE before ablation of AF. Further experimental and clinical researches should be done before applying the method to a wide clinical practice.

• Klíčová slova
• Ablation, Atrial fibrillation, Fibrosis, Magnetic resonance imaging,
• MeSH
• fibrilace síní diagnóza   chirurgie   MeSH
• gadolinium * MeSH
• katetrizační ablace * metody   MeSH
• kontrastní látky MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonance kinematografická metody   MeSH
• následné studie MeSH
• radionuklidy * MeSH
• senioři MeSH
• srdeční síně patologie   chirurgie   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
• Názvy látek
• gadolinium * MeSH
• kontrastní látky MeSH
• radionuklidy * MeSH

In patients with heart failure and preserved or mildly reduced ejection fractions (EF ≥40%), implantation of an interatrial shunt device (IASD) resulted in heterogenous changes of the left atrial (LA) volume. Baseline characteristics that correlate with a favorable decrease in LA volume are unknown. We hypothesized that a larger ratio of left to right atrial volume at baseline would correlate strongly with LA volume decongestion following IASD implantation. Reduce Elevated LA Pressure in Patients With Heart Failure was a multicenter study of the safety and feasibility of IASD implantation. Sixty-four patients with EF ≥40% underwent device implantation along with baseline conventional echocardiograms, speckle tracking echocardiography, and resting and exercise hemodynamics. Higher LA compliance (-4.2%, p = 0.048) and right atrial reservoir strain (-0.8%, p = 0.005) were independently associated with a percent decrease in the systolic LA volume index from baseline to 6-months. In conclusion, greater LA volume reduction following IASD implantation is associated with higher baseline compliance of the left atrium and higher reservoir strain of the right atrium.

• MeSH
• dopplerovská echokardiografie metody   MeSH
• dospělí MeSH
• funkce levé komory srdeční fyziologie   MeSH
• hemodynamika fyziologie   MeSH
• hodnocení rizik MeSH
• implantace protézy metody   MeSH
• kardiochirurgické výkony metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lineární modely MeSH
• míra přežití MeSH
• multivariační analýza MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• prospektivní studie MeSH
• protézy a implantáty * MeSH
• srdeční katetrizace metody   MeSH
• srdeční selhání diagnostické zobrazování   mortalita   chirurgie   MeSH
• srdeční síně patofyziologie   MeSH
• stupeň závažnosti nemoci MeSH
• tepový objem MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

AIMS: Identification of heart failure (HF) patients with secondary mitral regurgitation (SMR) that benefit from mitral valve (MV) repair remains challenging. We have focused on the role of left ventricular global longitudinal strain (LV-GLS) and reservoir left atrial longitudinal strain (LASr) for the prediction of long-term survival and reverse remodelling in patients with SMR undergoing endoscopic MV repair. METHODS AND RESULTS: The study population consisted of 110 patients (age 67 ± 11 years, 66% men) with symptomatic SMR undergoing isolated MV repair using a minimally invasive surgical approach. Speckle tracking-derived LV-GLS and LASr were assessed in apical views using vendor-independent software. Over a median of 7.7 years (IQRs 2.9-11.2), 64 patients (58%) died. Significant reverse LV (↓ LVESVI >10 mL/m2 ), LA (↓ LAVI >10 mL/m2 ) remodelling or both were observed in 43 (39%), 37 (34%) and 19 (17%) patients, respectively. LV-GLS (HR 0.68, 95% CI 0.58-0.79, P < 0.001) and LASr (HR 0.93, 95% CI 0.88-0.97, P < 0.01) but not LV ejection fraction (LVEF) and LA volume index (LAVi) emerged as independent predictors of all-cause mortality in Cox regression analysis. LV-GLS was the only independent predictor of LV reverse remodelling (OR 1.24, 95% CI 1.05-1.43, P < 0.001) whereas LAVi and LASr were both independent predictors of LA reverse remodelling (both P < 0.05). In patients with atrial fibrillation at baseline, only LASr was an independent predictor (P < 0.05) of LA reverse remodelling. CONCLUSIONS: In patients with SMR undergoing endoscopic MV repair, LV-GLS and LASr are independently associated with long-term survival and reverse remodelling and may be helpful in selecting SMR patients who may benefit from this procedure.

• Klíčová slova
• Endoscopic mitral valve repair, Reverse remodelling, Secondary mitral regurgitation, Strain, Survival,
• MeSH
• funkce levé komory srdeční MeSH
• kardiochirurgické výkony * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mitrální chlopeň diagnostické zobrazování   chirurgie   MeSH
• mitrální insuficience * diagnóza   chirurgie   MeSH
• senioři MeSH
• tepový objem 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

This paper describes a numerical model of the human cardiovascular system. The model is composed of 15 elements connected in series representing the main parts of the system. Each element is composed of a rigid connecting tube and an elastic reservoir. The blood flow is described by a one-dimensional time-dependent Bernoulli equation. The action of the ventricles is simulated with a Hill's three-element model, adapted for the left and right heart. The closing of the four heart valves is simulated with the aid of time-dependent drag coefficients. Closing is achieved by letting the drag coefficient approach infinity. The resulting system of 32 non-linear ordinary differential equations is solved numerically with the Runge-Kutta method. The results of the simulation (pressure-time and volume-time dependence for the atria and ventricles and pressure forms in the aorta at a heart rate of 70 beats per minute) agree with the physiological data given in the literature. The model's input aortic impedance is 31.5 dyn s cm-5 which agrees with literature data given for aortic input impedance in man 26-80 dyn s cm-5). Long-term stability of the system was achieved. The cardiovascular system presented here can also be simulated at higher and varying heart rates--up to 200 beats per minute. The results of calculations for some pathological changes (e.g. valvular abnormalities) are discussed.

• MeSH
• algoritmy MeSH
• aorta fyziologie   MeSH
• cévní kapacitance MeSH
• cévy fyziologie   MeSH
• krevní oběh * MeSH
• krevní objem MeSH
• krevní tlak MeSH
• lidé MeSH
• modely kardiovaskulární * MeSH
• reologie krve MeSH
• srdce - funkce komor MeSH
• srdce - funkce síní MeSH
• srdce fyziologie   MeSH
• srdeční chlopně fyziologie   MeSH
• srdeční frekvence MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Relaxin is a peptide hormone that may decrease circulatory congestion and improve kidney function. In this study, we conducted a double-blind, international, multicenter trial to test whether volenrelaxin, a long-acting form of human relaxin, can improve left atrial (LA) function, reduce congestion and improve kidney function in patients with heart failure and preserved ejection fraction (HFpEF). We randomly assigned patients with New York Heart Association (NYHA) class II-IV HFpEF and recent heart failure (HF) decompensation to 25-mg, 50-mg or 100-mg volenrelaxin or placebo administered subcutaneously once weekly. The primary outcome was the change in LA reservoir strain at 26 weeks, with key secondary endpoints including changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP), estimated glomerular filtration rate (eGFR) and safety. The trial was stopped early by the sponsor because of evidence for worsening congestion after 332 participants had been enrolled (mean age 74 years, 49% women, mean body mass index 30.6 kg m-2, 31.9% NYHA class III-IV). Compared to placebo, 25-mg volenrelaxin improved LA reservoir strain (+3.9%, 95% confidence interval (CI): 1.1-6.6, P = 0.006) but did not have effects on this outcome at 50-mg (+1.3%, 95% CI: -1.3 to 3.9, P = 0.332) or 100-mg (+0.9%, 95% CI: -1.8 to 3.6, P = 0.521) doses. At 26 weeks, volenrelaxin (pooling all dosages) increased NT-proBNP levels (+24.5%, 95% CI: 2.0-51.8) and had no significant effect on eGFR (+2.2 ml min-1 1.73 m-2, 95% CI: -1.8 to 6.3). Volenrelaxin was also associated with a non-significant increase in risk for HF hospitalization compared to placebo (hazard ratio = 2.64, 95% CI: 0.93-7.56, P = 0.070), along with signals for an increased number of cardiovascular and renal serious adverse events (odds ratio = 2.52, 95% CI: 0.95-6.68, P = 0.056). In conclusion, despite some evidence for improvement in LA function at a low dose, treatment with this long-acting form of human relaxin was associated with worsening congestion in patients with recently decompensated HFpEF. ClinicalTrials.gov identifier: NCT05592275 .

• Publikační typ
• časopisecké články MeSH