Christina Luong

Right Atrial Volume Is Superior to Left Atrial Volume for Prediction of Atrial Fibrillation Recurrence After Direct Current Cardioversion

BACKGROUND The value of right atrial volume as a predictor for recurrence of atrial fibrillation (AF) after direct current cardioversion (DCCV) is unknown. METHODS We sought to compare the performance of right atrial volume indexed to body surface area (RAVI), left atrial diameter, left atrial volume indexed to body surface area (LAVI), and biatrial volume index (BAVI) for the prediction of AF recurrence at 6 months after DCCV. This study included the first 95 consecutive patients from the AF Clinic at a large tertiary care hospital who underwent DCCV and who had an echocardiogram available within 6 months before DCCV. Maximal LAVI, RAVI, and BAVI were determined from the echocardiogram before DCCV. Electrocardiographic and clinical data were acquired at baseline, before cardioversion, and at each clinic visit. RESULTS Of the 95 patients (64 male; mean age, 63 ± 12 years), history of systemic hypertension, diabetes mellitus, heart failure, and transient ischemic attack/stroke was present in 60 (63%), 14 (15%), 27 (28%), and 5 (5%) patients, respectively. Mean duration from AF diagnosis to DCCV was 3.5 ± 5.0 years. At 6 months after DCCV, 53 (56%) had reverted to AF. RAVI had superior predictive ability (area under the receiver operator characteristic curve: RAVI, 0.77; left atrial diameter, 0.54; LAVI, 0.64; and BAVI, 0.70). RAVI ≥ 42 mL/m(2) provided the best accuracy for prediction of recurrence (76% accuracy, 71% sensitivity, 83% specificity, 90% positive predictive value, and 56% negative predictive value). Best accuracy for LAVI was ≥ 48 mL/m(2) (70% accuracy, 53% sensitivity, 79% specificity, 85% positive predictive value; 43% negative predictive value). CONCLUSIONS RAVI is superior to LAVI for the prediction of AF recurrence at 6 months after DCCV.

Clinical presentation of patients with spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is an infrequent but important cause of myocardial infarction (MI) especially in younger women. However, the clinical presentation and the acuity of symptoms prompting invasive management in SCAD patients have not been described. Understanding these presenting features may improve SCAD diagnosis and management.

Atrial Fibrillation and Heart Failure: Cause or Effect?

Atrial fibrillation (AF) and heart failure (HF) are two epidemics of the century that have a close and complex relationship. The mechanisms underlying this association remain an area of ongoing intense research. In this review, we will describe the relationship between these two public health concerns, the mechanisms that fuel the development and perpetuation of both, and the evolving concepts that may revolutionize our approach to this dual epidemic.

Focused Cardiac Ultrasonography: Current Applications and Future Directions: Focused Cardiac Ultrasonography, a Cardiology Perspective

Focused cardiac ultrasonography is performed by clinicians at the bedside and is used in time‐sensitive scenarios to evaluate a patients cardiovascular status when comprehensive echocardiography is not immediately available. This simplified cardiac ultrasonography is often performed by noncardiologists using small, portable devices to augment the physical examination, triage patients, and direct management in both critical care and outpatient settings. However, as the use of focused cardiac ultrasonography continues to expand, careful consideration is required regarding training, scope of practice, impact on patient outcomes, and medicolegal implications. In this review, we examine some of the challenges with rapid uptake of this technique and explore the benefits and potential risk of focused cardiac ultrasonography. We propose possible mechanisms for cross‐specialty collaboration, quality improvement, and oversight.

Echocardiographic Assessment of Patients with Fabry Disease

&NA; Fabry disease is an X‐linked lysosomal storage disorder that results from a deficiency of &agr;‐galactosidase A. Increased left ventricular wall thickness has been the most commonly described cardiovascular manifestation of the disease. However, a variety of other structural and functional abnormalities have also been reported. Echocardiography is an effective noninvasive method of assessing the cardiac involvement of Fabry disease. A more precise and comprehensive characterization of Fabry cardiomyopathy using conventional and novel echocardiographic techniques may lead to earlier diagnosis, more accurate prognostication, and timely treatment. The aim of this review is to provide a comprehensive overview of the structural and functional abnormalities on echocardiography that have thus far been described in patients with Fabry disease and to highlight potential areas that would benefit from further research. HighlightsEchocardiography can effectively identify cardiac manifestations of Fabry disease.Increased ventricular wall thickness has been the most commonly described finding.Abnormalities in the atria, valves, aorta, and papillary muscles can also be seen.Advanced techniques such as strain imaging can detect subclinical cardiomyopathy.More research is needed to determine how these findings can best inform management.

Automatic Detection of Patients with a High Risk of Systolic Cardiac Failure in Echocardiography

Heart disease is the global leading cause of death. A key predictor of heart failure and the most commonly measured cardiac parameter is left ventricular ejection fraction (LVEF). Despite available segmentation technologies, experienced cardiologists often rely on visual estimation of LVEF for a swift assessment. In this paper, we present a direct dual-channel LVEF estimation approach that mimics cardiologists’ visual assessment for detecting patients with high risk of systolic heart failure. The proposed framework consists of various layers for extracting spatial and temporal features from echocardiography (echo) cines. A data set of 1,186 apical two-chamber (A2C) and four-chamber (A4C) echo cines were used in this study. LVEF labels were assigned based on risk of heart failure: high-risk for \(\text {LVEF}\le 40\%\) and low-risk for \(40\%<\text {LVEF}\le 75\%\). We validated the proposed framework on 237 clinical exams and achieved a success rate of 83.1% for risk-based LVEF classification. Our experiments suggests the fusion of the two apical views improves the performance, compared to single-view networks, especially A2C. The proposed solution is promising for segmentation-free detection of high-risk LVEF. Direct LVEF estimation eliminates ventricle segmentation, and can hence be a useful tool for formal echo and point-of-care cardiac ultrasound.

NATURAL HISTORY OF MITRAL ANNULUS REMODELING IN PERMANENT ATRIAL FIBRILLATION

Atrial fibrillation (AF) is associated with progressive atrial enlargement, and mitral annular diameter (MAD) is closely related to the left atrial size. The natural history of mitral annulus remodeling in the context of AF has not been assessed. We aimed to determine the rate of change in MAD over