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Background Left atrial (LA) enlargement is associated with adverse events in heart failure with preserved ejection fraction (HFpEF). However, the role of LA mechanics (i.e., LA strain measures) in HFpEF has not been well studied. We hypothesized that in HFpEF, reduced (worse) LA strain is a key pathophysiologic abnormality and is a stronger correlate of adverse events than left ventricular (LV) or right ventricular (RV) longitudinal strain. Methods and Results We evaluated baseline LA function in 308 patients with HFpEF who were followed longitudinally for adverse outcomes. All patients underwent speckle-tracking echocardiography for measurement of LV longitudinal strain, RV free wall strain, and LA booster, conduit, and reservoir strains. The clinical and prognostic significance of LV, RV, and LA strain measures was assessed by regression analyses. The mean age was 65±13 years; 64% were female; 26% had atrial fibrillation; and LA enlargement was present in the majority (67%) of patients. Decreased LA reservoir strain was associated with increased pulmonary vascular resistance (P<0.0001) and decreased peak oxygen consumption (P=0.0001). Of the LV, RV, and LA strain measures, LA reservoir strain was the strongest correlate of adverse events, and was independently associated with the composite outcome of cardiovascular hospitalization or death (adjusted HR per 1-SD decrease in LA strain = 1.54; 95% CI = 1.15–2.07; P=0.006). Conclusions Abnormal indices of LA mechanics (particularly LA reservoir strain) are powerful clinical and prognostic factors in HFpEF. Unloading the LA and/or augmentation of LA function may be important future therapeutic targets in HFpEF. Registration Information URL: http://www.clinicaltrials.gov. Unique identifier: NCT01030991.

IMPORTANCE Psoriasis is a chronic inflammatory skin disease associated with increased coronary plaque burden and cardiovascular events. Biologic therapy for psoriasis has been found to be favorably associated with luminal coronary plaque, but it is unclear whether these associations are attributable to direct anti-inflammatory effects on the coronary arteries. OBJECTIVE To investigate the association of biologic therapy with coronary inflammation in patients with psoriasis using the perivascular fat attenuation index (FAI), a novel imaging biomarker that assesses coronary inflammation by mapping spatial changes of perivascular fat composition via coronary computed tomography angiography (CCTA). DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study performed from January 1, 2013, through March 31, 2019, analyzed changes in FAI in patients with moderate to severe psoriasis who underwent CCTA at baseline and at 1 year and were not receiving biologic psoriasis therapy at baseline. EXPOSURES Biologic therapy for psoriasis. MAIN OUTCOMES AND MEASURES Perivascular FAI mapping was performed based on an established method by a reader blinded to patient demographics, visit, and treatment status. RESULTS Of the 134 patients (mean [SD] age, 51.1 [12.1] years; 84 [62.5%] male), most had low cardiovascular risk by traditional risk scores (median 10-year Framingham Risk Score, 3% [interquartile range, 1%-7%]) and moderate to severe skin disease. Of these patients, 82 received biologic psoriasis therapy (anti-tumor necrosis factor α, anti-interleukin [IL] 12/23, or anti-IL-17) for 1 year, and 52 did not receive any biologic therapy and were given topical or light therapy (control group). At baseline, 46 patients (27 in the treated group and 19 in the untreated group) had a focal coronary atherosclerotic plaque. Biologic therapy was associated with a significant decrease in FAI at 1 year (median FAI −71.22 HU [interquartile range (IQR), −75.85 to −68.

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Early AF recurrence peaks within the first few weeks after PVI, but continues at a lower level until the completion of monitoring. A blanking period of 3 months is justified to identify patients with AF recurrences that do not portend procedure failure. Freedom from AF in the first 2 weeks following ablation significantly predicts long-term AF freedom.