Abstract Introduction To explore how to measure LAP Eq accurately and quantitatively, that is, the left atrial pressure (LAP) measured and calculated by equation method using mitral regurgitation spectrum. Methods The mitral regurgitation spectrum, pulmonary arteriolar wedge pressure (PAWP) and invasive arterial systolic pressure of radial artery of 28 patients were collected simultaneously, including 3 patients with rheumatic heart disease, 15 patients with mitral valve prolapse and 10 patients with coronary artery bypass grafting, patients with moderate or above aortic stenosis were excluded. LAP Bp (Doppler sphygmomanometer method), LAP Eq (Equation method) and LAP C (Catheter method) were measured synchronously, and the measurement results of the three methods were compared and analyzed. A special intelligent Doppler spectrum analysis software was self-designed to accurately measure LAP Eq . This study had been approved by the ethics committee of the Northern Theater General Hospital (K-2019-17), and applied for clinical trial (No. Chictr 190023812). Results It was found that there was no significant statistical difference between the measurement results of LAP C and LAP Eq ( t = 0.954, P = 0.348), and significant correlation between the two methods [ r = 0.908(0.844, 0.964), P < 0.001]. Although the measurement results of LAP C and LAP BP are consistent in the condition of non-severe eccentric mitral regurgitation, there are significant differences in the overall case and weak correlation between the two methods [ r = 0.210, (−0.101, 0.510), P = 0.090]. In MVP patients with P1 or P3 prolapse, the peak pressure difference of MR was underestimated due to the serious eccentricity of MR, which affected the accuracy of LAP BP measurement. Conclusions It was shown that there is a good correlation between LAP Eq and LAP C , which verifies that the non-invasive and direct quantitative measurement of left atrial pressure based on mitral regurgitation spectrum is feasible and has a good application prospect.
Abstract Objective Atrial electromechanical coupling time (AEMCT) can be used to evaluate atrial electrical remodeling and early structural remodeling. This study explores the predictive role of AEMCT in postoperative new-onset AF (POAF) after off-pump isolated coronary artery bypass grafting (OPCAB). Methods Atotal of 116 patients who underwent OPCAB and left atrial diameter (LAD)<44mm were analyzed. According to 7-day continuous telemetry and Holter monitoring after OPCAB, the patients were divided into POAF group and non- POAF group. Results There was no significant difference in LAD between two group. Multivariate analysis found that P-ALA, TLA and HbA1c in POAF group were significantly higher than that in non-POAF group, that is, higher HbA1c, prolonged P-ALA and TLA were independent risk factors for POAF after OPCAB. P- ALA had the highest diagnostic predicting value. The AUC of HbA1c, P-ALA and TLA with Cut -off was 0.766, 95% CI: 0.67–0.86, P < 0.001. Conclusion In OPCAB patients without significant LAD enlargement, when P-ALA ≥ 96. 50 ms, there is more than 90% probability of POAF. The combination of HbA1c, P-ALA and TLA has the highest predictive value of POAF. AEMCT measured with TDI has the advantages of low cost and high repeatability.
Abstract To explore how to measure LAP Ep accurately and quantitatively, that is, the left atrial pressure (LAP) measured and calculated by equation method using mitral regurgitation spectrum. Methods The mitral regurgitation spectrum, pulmonary arteriolar wedge pressure (PAWP) and invasive arterial systolic pressure of radial artery of 28 patients were collected simultaneously, including 3 patients with rheumatic heart disease, 15 patients with mitral valve prolapse and 10 patients with coronary artery bypass grafting, patients with moderate or above aortic stenosis were excluded. LAP Bp (Doppler sphygmomanometer method), LAP Eq (Equation method) and LAP C (Catheter method) were measured synchronously, and the measurement results of the three methods were compared and analyzed. We designed a special intelligent Doppler spectrum analysis software to accurately measure LAP Eq . Results Found that there was no significant statistical difference between the measurement results of LAP C and LAP Eq (t = 0.954, P = 0.348),and significant correlation between the two methods [r = 0.908(0.844,0.964), P < 0.001]. Although the measurement results of LAP C and LAP BP are consistent in some patients, there are significant differences in the overall case and weak correlation between the two methods [r = 0.210, (−0.101, 0.510), P = 0.090]. In MVP patients with P1 or P3 prolapse, the peak pressure difference of MR was underestimated due to the serious eccentricity of MR, which affected the accuracy of LAP BP measurement. This study had been approved by the ethics committee of the northern theater general hospital ( K-2019-17), applied prospectively for clinical trial (No. Chictr 190023812) and invention patent application (No. 202210711862.X). Conclusions This study shows that there is a good correlation between LAP Eq and LAP C , which verifies that the noninvasive and direct quantitative measurement of left atrial pressure based on mitral regurgitation spectrum is feasible and has a good application prospect.
Objective: Postoperative atrial fibrillation (PoAF) is a common complication after surgical mitral valve replacement. Late PoAF is independently associated with long-term mortality. This study aimed to test the utility of preoperative left atrial mechanical function as a predictor of early and late PoAF in clinical practice. Methods: Patients (N = 150) with a rheumatic mitral valve who underwent mitral valve replacement with or without tricuspid valvuloplasty and who were in stable sinus rhythm were included. Baseline characteristics and transthoracic echocardiographic assessment information on the day before surgery were collected. Em, Em´, and Ei´ indicate early diastolic peak velocity of the mitral valve, early diastolic velocity at the lateral wall of the mitral annulus, and early diastolic velocity at the interventricular septal annulus, respectively. Results: Early PoAF was present in 59 of 150 patients (39.3%), and 32 of 150 patients (21.3%) developed late PoAF within 1 year after surgery. Among all of the variables examined, age, diabetes, early mitral filling velocity (Mitral E), left atrial mechanical function (Mitral A), Em/Em´, Em/Ei´, and mitral transvalvular gradient showed a significant correlation with PoAF. Only age, Mitral A, and mitral transvalvular gradient showed strong, significant correlations with the occurrence of late PoAF. In a multivariate analysis, predictors of late PoAF recurrence included early PoAF and Mitral A. Conclusion: Routine evaluation of Mitral A is feasible and useful to predict early and late PoAF in patients with a rheumatic mitral valve undergoing surgical mitral valve replacement.
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