No abstract available.
Atrial Function, Left ; Sprains and Strains

BACKGROUND: Maze operation is aimed for the restoration of sinus rhythm. But restoration of atrial mechanical function has not been demonstrated in all patients converted to sinus rhythm. METHOD: From Apr. 1994 to Feb. 1996, maze operations were performed in 32 pts (M:F=13:19, mean age 47.1+/-9.0 years) combined with valvular surgery(n=26), CABG(n=3), and others(n=3). Presence of atrial mechanical function was serially examined before discharge, in 3mo, 6mo and 1 yr using Doppler echocardiography. RESULTS: In 22 patients(pts), sinus rhythm was maintained without antiarrhythmic agents. In 4 patients antiarrhythmic agent was required to maintain sinus rhythm while in another 4 patients showed paroxysmal Af despite of the treatment with antiarrhythmic agents. In 30 pts with sinus rhythm or paroxysmal Af, right atrial function was restored in all pts while left atrial function was restored in only 19/30(63%). Peak A velocity and A/E ratio were 0.38+/-0.12m/s, 0.74, respectively on tricuspid inflow(TI), and 0.46+/-0.14m/s, 0.40, respectively on mitral inflow(MI ). MI peak A velocity and A/E ratio were significantly lower than the 16 control postoperative pts (0.75<0.29, 0.80 : p+/-0.01). In pts with atrial mechanical function, the duration of Af was significantly shorter than patients without atrial function (1.9+/-2.9 yr vs 7.1+/-3.0 yr : p<0.01), but no significant differences in the LA size and volume. CONCLUSION: Maze operation is effective in restoring sinus rhythm. But restoration of sinus rhythm was not always associated with restoration of atrial mechanical function, and the restored atrial function was incomplete. The duration of Af could be a markker for predicting the restoration of atrial function.
Atrial Fibrillation ; Atrial Function ; Atrial Function, Left ; Atrial Function, Right ; Echocardiography, Doppler ; Humans

BACKGROUND: Maze operation is aimed for the restoration of sinus rhythm. But restoration of atrial mechanical function has not been demonstrated in all patients converted to sinus rhythm. METHOD: From Apr. 1994 to Feb. 1996, maze operations were performed in 32 pts (M:F=13:19, mean age 47.1+/-9.0 years) combined with valvular surgery(n=26), CABG(n=3), and others(n=3). Presence of atrial mechanical function was serially examined before discharge, in 3mo, 6mo and 1 yr using Doppler echocardiography. RESULTS: In 22 patients(pts), sinus rhythm was maintained without antiarrhythmic agents. In 4 patients antiarrhythmic agent was required to maintain sinus rhythm while in another 4 patients showed paroxysmal Af despite of the treatment with antiarrhythmic agents. In 30 pts with sinus rhythm or paroxysmal Af, right atrial function was restored in all pts while left atrial function was restored in only 19/30(63%). Peak A velocity and A/E ratio were 0.38+/-0.12m/s, 0.74, respectively on tricuspid inflow(TI), and 0.46+/-0.14m/s, 0.40, respectively on mitral inflow(MI ). MI peak A velocity and A/E ratio were significantly lower than the 16 control postoperative pts (0.75<0.29, 0.80 : p+/-0.01). In pts with atrial mechanical function, the duration of Af was significantly shorter than patients without atrial function (1.9+/-2.9 yr vs 7.1+/-3.0 yr : p<0.01), but no significant differences in the LA size and volume. CONCLUSION: Maze operation is effective in restoring sinus rhythm. But restoration of sinus rhythm was not always associated with restoration of atrial mechanical function, and the restored atrial function was incomplete. The duration of Af could be a markker for predicting the restoration of atrial function.
Atrial Fibrillation ; Atrial Function ; Atrial Function, Left ; Atrial Function, Right ; Echocardiography, Doppler ; Humans

Background: Atrial Septal Defect (ASD) is one of the most common congenital cardiac defects. Both surgical and catheter occlusion of the defect has been found effective and safe in eliminating interatrial shunting. However, knowledge of the response of the left side of the heart to ASD closure is incomplete. Objective: This study assessed the left side of the heart\u2019s response to ASD closure over a 6-month follow-up period. Subjects and method: 148 patients of ASD ostium secundum with an average age of 26.13 +/- 14.24 years (2-62 years) and the mean ASD size of 24.92 +/- 7.97 mm has been studied by echocardiography before and after atrial septal defect closure. Results: The right ventricular diameter and hemodynamics were improved after ASD closure (p<0.0001). The left ventricular end-diastolic diameter and volume increased significantly after ASD closure (p<0.0001). Conclusions: The left ventricular systolic function was unaffected by ASD closure. The right side of the heart\u2019s response to ASD closure over 6-month follow-up period decreased significantly (p<0.0001).
Atrial septal defect ; ASD ; left ventricular function

BACKGROUND: Analysis of mitral flow velocity pattern provides useful variables in the assessment of left ventricular diastolic dysfuntion, but are affected by loading conditions or presence of atrial fibrillation. Thus we assessed intraventricular diastolic flow velocity profile in order to assessment of left ventricular diastolic dysfuntion. METHODS: The study population consisted of 20 subjects with normal left ventricular function(including 7 patients with atrial fibrillation only), 15 patients with hypertensive heart disease, and 14 patients with dilated cardiomyopathy. The flow velocity pattern at the mitral tip was recorded simultaneously with regional pulsed Doppler diastolic velocity patterns at 1, 2, or 3 cm from the mitral tip toward the apex. RESULTS: Inteh normal subjects, early diastolic flow velocity at the mitral tip was maintained at the positions 1 to 3cm away from the tip into the left ventricular carvity. In patients with dilated cardiomyopathy or hypertensive heart disease, peak early diastolic flow velocity decreased form the mitral tip toward the apex more progressively than in the subjects with normal left ventricular function. The same findings were obtained in selected patients group with atrial fibrillation or a normalized mitral flow velocity pattern. CONCLUSION: The assessments of the intraventricular dispersion in peak early diastolic flow velocity may be useful in detecting left ventricular diastolic dysfuntion, particularly in patients with atrial fibrillation or a normalized mitral flow velocity pattern.
Atrial Fibrillation ; Cardiomyopathy, Dilated ; Heart Diseases ; Humans ; Ventricular Function, Left

BACKGROUND: Right ventricular apical (RVA) pacing induces left ventricular (LV) dyssynchrony, increases the risk of persistent atrial fibrillation in the long term. The aim was to investigate the effects of RVA pacing on left atrial (LA) function, which are unknown. METHODS: Echocardiographic evaluation including LV dyssynchrony based on conventional Doppler, tissue Doppler imaging and speckle tracking strain echocardiography was done before and after (12 months) single-chamber ventricular pacemaker implantation in 40 patients with sick sinus syndrome. Patients were divided to 2 groups, according to the RVA pacing frequency (group I had higher pacing rate of more than 50% and group II, less than 50%). RESULTS: There was no significant difference in LV ejection fraction, however, mean global LV strain, myocardial performance index, and parameters of LV dyssynchrony had shown significant changes after 12 months of RVA pacing. There were also significant increase in the LA volume index and the reduction of peak systolic LA strain and strain rate (SR), peak early and late diastolic SR after RVA pacing. Moreover, there was significant deterioration of LV dyssynchrony and both LA and LV longitudinal function in even group II. LA functional deterioration and LA volume was significantly correlated with the frequency of RVA pacing. CONCLUSION: LV dyssynchrony, induced by RVA pacing, significantly impaired active LA contraction and passive stretching, and these findings were shown in the patients with even less than 50% of RVA pacing. Impairment of LA strain/SR was significantly correlated with the frequency of RVA pacing.
Atrial Fibrillation ; Atrial Function ; Atrial Function, Left ; Contracts ; Echocardiography ; Humans ; Muscle Stretching Exercises ; Sick Sinus Syndrome ; Sprains and Strains ; Track and Field

BACKGROUND: Right ventricular apical (RVA) pacing induces left ventricular (LV) dyssynchrony, increases the risk of persistent atrial fibrillation in the long term. The aim was to investigate the effects of RVA pacing on left atrial (LA) function, which are unknown. METHODS: Echocardiographic evaluation including LV dyssynchrony based on conventional Doppler, tissue Doppler imaging and speckle tracking strain echocardiography was done before and after (12 months) single-chamber ventricular pacemaker implantation in 40 patients with sick sinus syndrome. Patients were divided to 2 groups, according to the RVA pacing frequency (group I had higher pacing rate of more than 50% and group II, less than 50%). RESULTS: There was no significant difference in LV ejection fraction, however, mean global LV strain, myocardial performance index, and parameters of LV dyssynchrony had shown significant changes after 12 months of RVA pacing. There were also significant increase in the LA volume index and the reduction of peak systolic LA strain and strain rate (SR), peak early and late diastolic SR after RVA pacing. Moreover, there was significant deterioration of LV dyssynchrony and both LA and LV longitudinal function in even group II. LA functional deterioration and LA volume was significantly correlated with the frequency of RVA pacing. CONCLUSION: LV dyssynchrony, induced by RVA pacing, significantly impaired active LA contraction and passive stretching, and these findings were shown in the patients with even less than 50% of RVA pacing. Impairment of LA strain/SR was significantly correlated with the frequency of RVA pacing.
Atrial Fibrillation ; Atrial Function ; Atrial Function, Left ; Contracts ; Echocardiography ; Humans ; Muscle Stretching Exercises ; Sick Sinus Syndrome ; Sprains and Strains ; Track and Field

BACKGROUND: Abnormalities in the left atrial (LA) structure and function may develop in patients with paroxysmal atrial fibrillation (AF). We sought to determine the contribution of LA mechanical function, including LA stiffness, to AF by comparing patients with paroxysmal AF with normal control subjects, and to evaluate whether LA mechanical function and stiffness are related with the structural changes of LA. METHODS: Sixty-four paroxysmal AF patients (57 +/- 13 years, 59% male) were studied, using a speckle tracking echocardiography, and were compared with 34 age-, gender-, and left ventricular (LV) mass-matched controls (53 +/- 14 years, 61% male). LA volume indices, expansion index for reservoir function, active emptying fraction for contractile function, mitral annular velocities, and global longitudinal LA strain were measured. The ratio of E/e' to LA strain was used as an index of LA stiffness. RESULTS: Patients with paroxysmal AF had similar LV volume indices, ejection fraction, and diastolic function, when compared with that of the normal controls. However, paroxysmal AF patients showed increased LA volume indices and decreased LA reservoir function, but similar contractile function. LA stiffness was increased in patients with paroxysmal AF than in the control subjects (0.40 +/- 0.25 vs. 0.29 +/- 0.10, p = 0.002), and was related with LA volume indices and reservoir function. CONCLUSION: Patients with paroxysmal AF have decreased LA reservoir function and increased stiffness, in comparison with that of the control subjects. LA stiffness was significantly related with LA volume indices and reservoir function. LA stiffness can be used for the assessment of LA function in patients with paroxysmal AF.
Atrial Fibrillation ; Atrial Function, Left ; Echocardiography ; Humans ; Sprains and Strains ; Track and Field

BACKGROUND: The current study was undertaken to investigate the results of a modification in the conventional Maze III Procedure devised by the authors. The aim of the technical modification was in improving the left atrial contractility. MATERIAL AND METHOD: Between July 1997 and December 1998, 34 patients with chronic atrial fibrillation for more than 1 year duration underwent a modified Maze III procedure. The assessment of the left atrial function was made by various echocardiographic measurements and SA nodal recovery was evaluated by HRV Holter monitoring. RESULT: All 34 patients were in sinus rhythm. On echocardiography, right atrial contraction was detected in 32 patients(94.1%) and left atrial contraction in 33 patients(97.1%). The echocardiographic A wave at 1, 6, and 12 months or more were 50.5+/-31.5, 62.1+/-25.1, 66+/-20.6 cm/sec, respectively, and the E wave measurements at the same time points were 152+/-31.1, 134.4+/-35.2, 133+/-27.5 cm/sec. The corresponding A/E ratios were 0.32+/-0.13, 0.48+/-0.18, 0.5+/-0.15, showing a rising trend. Treadmill evaluation at 6 months showed a mean 82% increase in heart rate after excising, and the SDNN and SDANN upon HRV Holter at 1 and 3 months postoperatively were 65.3+/-28.1/87.8+/-27.2 ms, and 60.0+/-24.1/83.4+/-25.7 ms, respectively, showing a predoinant autonomic recovery in the parasympathetic system(PSDNN = 0.01, PSDANN =0.015). CONCLUSION: The results of our data suggest that the current modification in the conventional Maze III Procedure was efective in enhancing the postoperative left atrial contractility.
Atrial Fibrillation ; Atrial Function, Left* ; Echocardiography ; Electrocardiography, Ambulatory ; Heart Rate ; Humans

OBJECTIVE: Longstanding hypertension lead to left ventricular diastolic dysfunction with a development of a left atrial enlargement (LAE) which may result in vulnerability to atrial fibrillation (AF). Paroxysmal AF is usually unrevealed in the acute period of ischemic stroke, but is crucial for anticoagulation to prevent recurrent stroke. This study was aimed to investigate the frequency of LAE and the predictors of paroxysmal AF during the hospitalization of acute ischemic stroke. METHODS: A total 1,643 consecutive patients with acute ischemic stroke were registered in between January 2005 and December 2014. The subjects who had AF before index stroke or at admission were excluded. The clinical and echocardiographic findings of all patients were reviewed. Paroxysmal AF were detected on electrocardiography of Holter monitoring during hospitalization. LAE were defined as LA diameter larger than 44 mm in echocardiography. We compared the frequency of LAE between the patients with or without AF. Logistic regression analysis were performed to determine the echocardiographic parameters for prediction of paroxysmal AF. RESULTS: The mean age was 67.3 and the male was 55.6%. AF were detected in 123 (11.4%) of LAE(-) group but were detected in 102 (49.0%) in LAE(+) group. In logistic regression analysis, LAE significantly predicted for newly detected AF during hospitalization after adjusting covariates (odds ratio, 5.698; 95% confidence interval, 3.799-8.546; P<0.001). CONCLUSION: LAE was an independent predictor for AF during hospitalization in patients with acute ischemic stroke. Prolonged electrocardiography monitoring should be meticulously indicated for acute ischemic stroke with LAE to detect paroxysmal AF.
Atrial Fibrillation* ; Atrial Function, Left ; Echocardiography* ; Electrocardiography ; Electrocardiography, Ambulatory ; Hospitalization ; Humans ; Hypertension ; Logistic Models ; Male ; Stroke*