Postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with increased morbidity, mortality, and prolonged hospital stay. Speckle tracking echocardiography (STE) has been applied recently for evaluation of LA function. The purpose of this study was to examine whether left atrial longitudinal strain measured by STE is a predictor for the development of POAF following mitral valve surgery for severe mitral regurgitation. We studied 53 patients undergoing mitral valve surgery in sinus rhythm at the time of surgery. Echocardiography with evaluation of LA strain by STE was performed. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization. Patients who did not develop POAF were taken as group 1 and those who had POAF constituted group 2. The echocardiographic and clinical predictors of POAF were investigated. POAF occurred in 28.3% of subjects. Mean age, LAVi and BNP were found higher in group 2 while peak atrial longitudinal strain (PALS) (13.9 ± 3.8% vs. 24.8 ± 7.3%; P < 0.001), peak atrial contraction strain (PACS) (7.6 ± 1.95% vs. 11.3 ± 3.5%; P < 0.001) were significantly lower. By multivariate logistic regression analysis, PALS and LAVi were independent predictor of POAF development. LA longitudinal strain was found to predict POAF in patients undergoing mitral valve surgery. It could be used to better identify patients at greater risk of developing POAF, and thus to guide in risk stratification and to take appropriate intensive prophylactic therapy.

Volume overload in chronic severe mitral regurgitation (MR) causes left atrial (LA) remodeling. Volume overload generally diminishes after mitral valve surgery and LA size and shape are expected to recover. The recovery of LA functions named as reverse remodeling is said to be related with prognosis and mortality. A few clinical and echocardiographic parameters have been reported to be associated with LA reverse remodeling. In this study, we investigated the relationship between LA peak longitudinal strain (reservoir strain) assessed with 2-dimensional speckle tracking echocardiography (2D STE) and LA reverse remodeling. 53 patients (24 females and 29 males, mean age: 45.7 ± 13.5 years) with severe MR and preserved left ventricular systolic function were included in the study. All patients had normal sinus rhythm. The etiology of MR was mitral valve prolapse (MVP) in 37 patients and rheumatic valvular disease in 16 patients. Mitral valve repair was performed in 30 patients while 23 underwent mitral valve replacement. Echocardiography was performed before the surgery and 6 months later. LA peak atrial longitudinal strain (PALS) was assessed with speckle tracking imaging. LA reverse remodeling was defined as a percent of decrease in LA volume index (LAVI). Left atrial volume index significantly decreased after surgery (58.2 ± 16.6 vs. 43.9 ± 17.2 ml/m2, p ≤ 0.001). Mean LAVI reduction was 22.5 ± 27.2%. There was no significant difference in LAVI reduction between mitral repair and replacement groups (22.1 ± 22.6 vs. 23.1 ± 32.8 %, p = 0.9). Although the decrease in LAVI was higher in MVP group than rheumatic group, it was not statistically significant (24.4 ± 26.8 vs. 18.2 ± 28.9%, p = 0.4). Correlates of LAVI reduction were preoperative LAVI (r 0.28, p = 0.039), PALS (r 0.36, p = 0.001) and age (r -0.36, p = 0.007). Furthermore, in multivariate linear regression analysis (entering models), preoperative LAVI, age and PALS were all significant predictors of LA reverse remodeling (p ≤ 0.001, p = 0.04, p = 0.001 respectively). Left atrial peak longitudinal strain measured by 2D STE, in conjunction with preoperative LAVI and age is a predictor of LA reverse remodeling in patients undergoing surgery for severe MR. We suggest that in this patient population, PALS may also be used as a preoperative prognostic marker.

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Impaired diastolic function in STEMI affects LA and increased LAEF is one of its manifestations. LAEF may also have diagnostic importance in diastolic dysfunction, but these findings should be confirmed by further studies.

A B S T R A C TBackground: Right Ventricular (RV) functions are known to have an impact on determining the prognosis of patients with Non-Ischemic Dilated Cardiomyopathy (NICMP). Objectives: This study aimed to investigate the echocardiographic determinants of RV systolic dysfunction in patients with NICMP. Patients and Methods: This cross-sectional study was conducted on 79 patients with angiographically normal coronary arteries (mean age: 50.5 ± 12, mean Ejection Fraction (EF): 31 ± 4%) selected through purposive sampling The patients were divided into two groups based on their RV systolic function determined by tissue Doppler systolic velocities (RV-Sm): group A (RV-Sm ≥ 10 cm/s, N = 48) and group B (RV-Sm < 10 cm/s, N = 31). The two groups were compared regarding clinical, demographic, and echocardiographic variables using independent t-test and chi-square test. Results: The patients with RV systolic dysfunction were found to have higher Brain Natriuretic Peptide (BNP) values (P = 0.006) and worse functional status (New York Heart Association (NYHA) III-IV, P = 0.04) compared to group A. Besides, univariate analysis of the echocardiographic parameters revealed that the patients in group B had significantly (all P values < 0.05) higher Left Atrial Volume Index (LAVI), higher degree of left ventricular diastolic dysfunction (represented by LV-E/Em), higher degree of Functional Mitral Regurgitation (FMR), higher estimated Pulmonary Artery Systolic Pressure (PASP), and higher degree of RV diastolic dysfunction (represented by RV-E/ Em) Moreover, multivariate logistic regression analysis showed that severe FMR (P = 0.006) and RV-E/Em (P = 0.016) predicted RV systolic dysfunction independently. Conclusions: Advanced FMR and worse RV diastolic functions emerged as the independent predictors of RV systolic dysfunction in NICMP correlating to functional status and BNP levels.