المؤلفون: Hayashi, Yusuke, Takagi, Masahiko, Kakihara, Jun, Sakamoto, Shogo, Tatsumi, Hiroaki, Doi, Atsushi, Iwata, Shinichi, Sugioka, Kenichi, Yoshiyama, Minoru

المصدر: Heart & Vessels; Mar2018, Vol. 33 Issue 3, p299-308, 10p

مصطلحات موضوعية: CARDIAC pacing, HEART diseases, LEFT heart ventricle, ELECTROCARDIOGRAPHY, LOGISTIC regression analysis

مستخلص: Several trials demonstrated that frequent right ventricular apical pacing (RVAP) was associated with cardiac dysfunction and an increased rate of heart failure hospitalization. However, there are few reports about the 12-lead electrocardiogram (12-ECG) parameters at the time of device implantation to predict deterioration of LVEF in patients with frequent RVAP. We retrospectively studied 115 consecutive patients undergoing pacemaker or implantable cardioverter-defibrillator implantation with RVAP, with rate of ventricular pacing ≥ 40% and LVEF ≥ 50% at the time of implantation. We compared the 12-ECG characteristics at the time of device implantation between patients with deterioration of LVEF (≥ 10% reduction) and those without. Twenty-nine patients (25%) had deteriorated LVEF with a decrease in mean LVEF from 59 to 40% during a median follow-up period of 8.9 [4.6–13.7] years. Multivariate logistic regression analysis showed that cumulative % of ventricular pacing [odds ratio (OR) 1.04 per 1% increase, 95% confidence interval (CI) 1.01–1.09, p = 0.04], notching of baseline paced QRS in limb leads (OR 5.04, 95% CI 1.59–19.6, p = 0.005) and the QS pattern in all precordial leads (OR 3.56, 95% CI 1.21–10.8, p = 0.02) were independently associated with deterioration of LVEF. The QS pattern of baseline paced QRS in all precordial leads had 58% sensitivity, 93% specificity for the RV lead position at the tip of RV apex. In conclusion, considering OR by multivariate analysis, notching of baseline paced QRS in limb leads and the QS pattern in all precordial leads at device implantation may be simple and useful predictors to identify patients who are at risk for deterioration of cardiac function during long-term RVAP. 12-ECG monitoring at device implantation and avoidance of the RVAP site showing a QS pattern may be important to prevent deterioration of cardiac function in patients with frequent RVAP. [ABSTRACT FROM AUTHOR]

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المؤلفون: Hoshi, Yoko, Nozawa, Yukinaga, Ogasawara, Makoto, Yuda, Satoshi, Sato, Shoko, Sakasai, Takuya, Oka, Makoto, Katayama, Harumi, Sato, Masaya, Kouzu, Hidemichi, Nishihara, Masahiro, Doi, Atsushi, Nishimiya, Takatoshi, Miura, Tetsuji

المصدر: Echocardiography; Feb2014, Vol. 31 Issue 2, p140-148, 9p

مصطلحات موضوعية: ECHOCARDIOGRAPHY, STROKE risk factors, ATRIAL fibrillation, CHI-squared test, CONFIDENCE intervals, EPIDEMIOLOGY, FISHER exact test, RESEARCH evaluation, STATISTICS, T-test (Statistics), LOGISTIC regression analysis, DATA analysis, INTER-observer reliability, CROSS-sectional method, RETROSPECTIVE studies, RECEIVER operating characteristic curves, DATA analysis software, DESCRIPTIVE statistics, DISEASE complications

مصطلحات جغرافية: JAPAN

مستخلص: Background A considerable number of patients with atrial fibrillation ( AF) develop cardioembolic stroke ( CE) despite low CHADS2 score. We examined the possibility that use of the atrial electromechanical interval ( AEMI) improves prediction of CE in patients with paroxysmal AF ( PAF), particularly those with low CHADS2 score. Methods We consecutively enrolled 108 patients with nonvalvular PAF and 52 healthy subjects as controls. The PAF patients were divided into 2 groups depending on presence (n = 36) or absence (n = 72) of the history of CE. Left atrial ( LA) volume index ( LAVI), peak myocardial velocity during late diastole (a'), and AEMI as time from onset of P-wave to onset of lateral a' were measured. Results Patients with PAF had significantly larger LAVI, longer AEMI, and lower lateral a' than those in controls. Area under the curves for LAVI, lateral a', and AEMI for identifying patients with PAF were 0.70, 0.69, and 0.88, respectively. Multivariate logistic regression analysis indicated that age, use of antiarrhythmic drugs, and AEMI, but not LAVI or a', were independently associated with history of CE in patients with PAF. PAF patients were categorized into low risk by CHADS2 score (i.e. CHADS2 score = 0 or 1, n = 60), those with prolonged AEMI (>82 msec) had significantly higher rates of CE than those with ≤82 msec (48% vs. 15%, P < 0.05). Conclusion As compared with echocardiographic parameters of LA size and LA function, AEMI appears to be more useful for identifying PAF patients. AEMI may enable to detect high risk PAF patients, especially those categorized into low risk by CHADS2 score. [ABSTRACT FROM AUTHOR]

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المؤلفون: Tamura, Soichiro¹ (AUTHOR), Iwata, Shinichi¹ (AUTHOR), Ishikawa, Sera¹ (AUTHOR), Kitada, Ryoko¹ (AUTHOR), Kawai, Yu¹ (AUTHOR), Nonin, Shinichi¹ (AUTHOR), Ito, Asahiro¹ (AUTHOR), Doi, Atsushi¹ (AUTHOR), Izumiya, Yasuhiro¹ (AUTHOR), Yoshiyama, Minoru¹ (AUTHOR)

المصدر: Circulation. 2018 Supplement, Vol. 138, pA10921-A10921. 1p.

مصطلحات موضوعية: *CEREBRAL infarction, *ATRIAL fibrillation, *DISEASE risk factors, *LOGISTIC regression analysis, *TRANSESOPHAGEAL echocardiography, *KIDNEY diseases, *STROKE

مستخلص: Introduction: Although silent brain infarction (SBI) is an independent risk factor for subsequent symptomatic stroke and dementia in patients with nonvalvular atrial fibrillation (NVAF), little is known regarding the differences in prevalence and risk factors of SBI between patients with paroxysmal and persistent NVAF. Methods: This study population consisted of 190 neurologically asymptomatic patients (mean age, 64 ± 11 years) with NVAF (119 paroxysmal and 71 persistent) who were scheduled for catheter ablation. All patients underwent brain magnetic resonance imaging to screen for SBI prior to the day of ablation. Comprehensive transthoracic and transesophageal echocardiography were performed to evaluate left atrial abnormalities such as left atrial enlargement, spontaneous echo contrast, or left atrial appendage emptying velocity (LAAEV) and complex plaques in the aortic arch defined as large (≥4mm), ulcerated, or mobile plaques. Results: SBI was detected in twenty-six (22%) paroxysmal and twenty-four (34%) persistent NVAF, and there were no significant difference between AF types (P = 0.09).In univariate analysis, CHA2DS2-VASc score and decreased estimated glomerular filtration rate (eGFR), e', and LAAEV were significantly associated with SBI in paroxysmal NVAF, whereas only CHA2DS2-VASc score and decreased e' were associated with SBI in persistent NVAF. Multiple logistic regression analysis indicated that presence of chronic kidney disease (eGFR < 60mL/min/1.73m2) was associated with the presence of SBI in paroxysmal NVAF (odds ratio, 3.42; 95% CI, 1.06-11.03; P < 0.05), whereas decreased e' predicted for SBI in persistent NVAF (odds ratio, 0.71; 95% CI, 0.52-0.98; P < 0.05). Conclusions: In paroxysmal NVAF, renal impairment, which represents microvascular disease, is associated with SBI independent of CHA2DS2-VASC score. In persistent NVAF, decreased e', which represents diastolic dysfunction carrying a greater risk of microembolism, is associated with SBI independent of CHA2DS2-VASC score. These findings, suggesting the different mechanism of SBI in paroxysmal (microvascular disease) and persistent (microembolism) NVAF, may be useful for risk stratification of the early stage of cerebral damage in patients with paroxysmal and persistent NVAF. [ABSTRACT FROM AUTHOR]