UNASSIGNED: Two-dimensional speckle tracking echocardiography (2D-STE) and three-dimensional echocardiography (3DE) may overcome many limitations of the conventional 2D echocardiography (2DE) in assessing right ventricular (RV) function. We sought to determine whether characteristics of the right atrium and right ventricle as measured by 2D-STE and 3DE are associated with cardiac mortality in patients with ischemic heart failure, over a 6-year follow-up.
UNASSIGNED: The inclusion criteria were ischemic cardiomyopathy with left ventricular ejection fraction of <40% diagnosed using standard 2DE, 2D-STE, and 3DE examination. Patients were followed for 6 years, and cardiac mortality was recorded.
UNASSIGNED: The study sample comprised a total of 54 participants. During the period of follow-up, 24% (13/54) died. The 2DE models showed that being older, having a higher body mass index (BMI), having higher systolic pulmonary artery pressure (SPAP), and a lower RV global longitudinal strain were associated with cardiac mortality in our cohort after 6-year follow-up. Finally, the 3DE models showed that in addition to being older, having higher BMI, having a higher SPAP baseline, lower baseline 3DE RV stroke volume, and larger 3DE RV end-diastolic volume and 3DE RV end-systolic volume were associated with cardiac mortality over 6-year follow-up.
UNASSIGNED: This study provides evidence that RV dysfunction as seen on 2D-STE and 3DE could be associated with increased risk of cardiac-related mortality in patients with heart failure over 6 years.

BACKGROUND: Recent studies have shown that right atrial (RA) function are important predictors of cardiovascular morbidity and mortality. However, the study data about RA phasic function in obstructive sleep apnea syndrome (OSAS) patients are scarce, especially based on the left ventricular geometry. So, we aimed to assess the influence of left ventricular geometry on RA phasic function in OSAS patients via a multimodal echocardiographic approach.
METHODS: Total of 235 OSAS patients were enrolled in this cross-section study and underwent complete clinical, polysomnography, and echocardiography examinations. The OSAS patients were divided into four groups based on left ventricular mass index (LVMI) and relative wall thickness (RWT): normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). RA phasic function was evaluated via multimodal echocardiography approach (two-dimensional echocardiography biplane method [2DE]; two-dimensional speckle-tracking echocardiography [2D-STE]; and three-dimensional echocardiography [3DE]). The multiple linear regression analysis was used to determine the relationship between left ventricular geometry and RA phasic function.
RESULTS: The RA volume and indices increased from NG to CR to EH to CH. RA total emptying fraction and RA strain during systole decreased from NG to CR to EH to CH. RA passive emptying fraction and RA strain during early diastole similarly decreased. RA active emptying fraction and RA strain during late diastole also gradually increased similarly. In analyses that adjusted for gender, age, body mass index, systolic blood pressure, apnea-hypopnea index, LVMI, systolic pulmonary artery pressure, and right ventricular free wall thickness, CH was associated with RA reservoir and conduit function via 2DE area-length method, whereas CH and EH were associated with RA reservoir and conduit function via 2D-STE and 3DE method. Further, CH was associated with RA booster pump function via 2DE area-length method, 2D-STE, and 3DE method.
CONCLUSIONS: The RA volumes and phasic function varied with left ventricular geometry via multimodal echocardiography approach. CH had the apparent negative effect on RA phasic function.

Background and Objectives: Left atrial (LA) remodelling and dilatation predicts atrial fibrillation (AF) recurrences after catheter ablation. However, whether right atrial (RA) remodelling and dilatation predicts AF recurrences after ablation has not been fully evaluated. Materials and Methods: This is an observational study of 85 consecutive patients (aged 57 ± 9 years; 70 [82%] men) who underwent cardiac magnetic resonance before first catheter ablation for AF (40 [47.1%] persistent AF). Four-chamber cine-sequence was selected to measure LA and RA area, and ventricular end-systolic image phase to obtain atrial 3D volumes. The effect of different variables on event-free survival was investigated using the Cox proportional hazards model. Results: In patients with persistent AF, combined LA and RA area indexed to body surface area (AILA + RA) predicted AF recurrences (HR = 1.08, 95% CI 1.00-1.17, p = 0.048). An AILA + RA cut-off value of 26.7 cm2/m2 had 72% sensitivity and 73% specificity for predicting recurrences in patients with persistent AF. In this group, 65% of patients with AILA + RA > 26.7 cm2/m2 experienced AF recurrence within 2 years of follow-up (median follow-up 11 months), compared to 25% of patients with AILA + RA ≤ 26.7 cm2/m2 (HR 4.28, 95% CI 1.50-12.22; p = 0.007). Indices of LA and RA dilatation did not predict AF recurrences in patients with paroxysmal AF. Atrial 3D volumes did not predict AF recurrences after ablation. Conclusions: In this pilot study, the simple measurement of AILA + RA may predict recurrences after ablation of persistent AF, and may outperform measurements of atrial volumes. In paroxysmal AF, atrial dilatation did not predict recurrences. Further studies on the role of RA and LA remodelling are needed.

BACKGROUND: Persistent atrial fibrillation (PerAF) is often associated with right atrial (RA) enlargement. We investigated the efficacy of RA intervention in patients with PerAF and RA enlargement.
METHODS: Patients with PerAF and RA enlargement were randomised (1:1) to receive adjunctive RA ablation (left atrial [LA] + RA group; n = 60) or to receive LA ablation alone (LA-only group; n = 60). In the LA + RA group, RA ablation was performed if LA ablation failed to terminate AF. The primary end point was freedom from AF/atrial tachycardia (AT) recurrence at 12 months after a single ablation procedure without antiarrhythmic drug therapy.
RESULTS: In the LA + RA group, 40 patients (67%) required RA ablation. The LA + RA group had a higher rate of acute AF termination than the LA-only group (63.3% vs 36.7%; P = 0.003). At the end of 12-month follow-up, 42 patients (70%) in the LA + RA group were free of AF/AT recurrence, compared with 31 (51.7%) in the LA-only group (log rank P = 0.034; hazard ratio 0.549, 95% confidence interval 0.310-0.974). The rate of freedom from AF recurrence was also higher in the LA + RA group than in the LA-only group (81.7% vs 63.3%; log rank P = 0.019). The 2 groups had similar rates of adverse events (5% vs 3.3%; P = 0.648).
CONCLUSIONS: Adjunctive RA ablation increased the success rate of a single ablation in patients with PerAF and RA enlargement.
UNASSIGNED: ChiCTR220056844.

UNASSIGNED: Surgical treatment of kidney cancer with a tumor thrombus spreading through the inferior vena cava (IVC) up to the right atrium remains a challenge.The aim of this article was to 1. assess the safety and feasibility of four transdiaphragmatic surgical approaches to the right atrium from the abdominal cavity; 2. to evaluate the feasibility of palpation and displacement of thrombi below the diaphragm.
UNASSIGNED: Four cadaveric specimens preserved with the Thiel method to assess each surgical access: 1) extrapericardial T-shaped diaphragmotomy, 2) extrapericardial T-shaped + circular diaphragmotomy, 3) transpericardial T-shaped diaphragmotomy with longitudinal pericardiotomy, 4) transpericardial T-shaped + circular diaphragmotomy with longitudinal and circular pericardiotomy.Different diameters and density of tumor thrombus simulators, placed at various levels from the cava-diaphragm junction, were used to evaluate the palpation and displacement of the thrombus. Two surgeons performed each assessment independently.
UNASSIGNED: Approaches 2, 3 and 4 were significantly better than approach 1, regarding the feasibility of palpation, according to both surgeons (surgeon 1 Chi-square 21.56, p = 0.001; surgeon 2 Chi-square 27.83, p <0.0001). Approach 1 also showed a significant higher number of impossible displacements recorded by both surgeons (surgeon 1 Chi-square 19.02, p = 0.004; surgeon 2 Chi-square 20.01, p = 0.003). Only surgeon 1 recorded a significant lower number of easy palpations at 4 cm from the cava-diaphragm junction (Chi-square 14.10, p = 0.007). There were no high-risk complications in any approach.
UNASSIGNED: The transdiaphragmatic access to the right atrium from the abdominal cavity is feasible using three of the four surgical approaches. They are an adequate alternative to sternotomy.

UNASSIGNED: Early onset of cardiomyopathy represented by myocardial volumetric and deformation properties is a major concern for patients with type 1 diabetes mellitus (T1DM). Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a novel methodology with capability of 3D assessment of the right atrium (RA) via virtual models. The present study was designed for detailed comparative analysis of T1DM-associated RA volumetric and functional abnormalities to those of matched healthy controls to be examined by 3DSTE.
UNASSIGNED: The present study comprised of 17 patients with typical features of T1DM (mean age: 36.4 ± 13.0 years, 59% males). Their results were compared to those of 31 age- and gender-matched healthy controls (mean age: 35.0 ± 2.9 years, 61% males).
UNASSIGNED: 3DSTE-derived RA volumes respecting the cardiac cycle and RA stroke volumes and emptying fractions did not show differences between young T1DM patients and matched controls. From peak RA strains representing RA reservoir function, mean segmental RA 3D strain proved to be significantly increased. Some regional basal/midatrial end-systolic peak RA strains were found to be significantly increased as well in T1DM patients as compared to controls. T1DM duration and HbA1c correlated with certain RA strains and RA volume-based functional properties.
UNASSIGNED: In young patients with T1DM, preserved RA volumes respecting the cardiac cycle are accompanied with increase in certain regional end-systolic peak RA strains, which seems to be associated with T1DM duration and HbA1c.

BACKGROUND: This study aims to examine the prevalence and related factors of pulmonary hypertension (PHT) in patients on hemodialysis (HD) at the only referral institution in Somalia. A total of one hundred and forty-three patients  who had received regular HD therapy for at least three months and underwent transthoracic echocardiography (TTE) were included in the study. Patients with a systolic pulmonary artery pressure (sPAP) value > 35 mmHg at rest on TTE were considered having PHT. The relationship of TTE parameters, demographic, and clinic characteristics of participants with PHT were evaluated.
RESULTS: The number of patients with PHT was 73 (51%). The mean age was 54.2 ± 18.4 years. The majority of patients were 65 years of age or older. (n: 46, 32.2%) and 65 (45.5%) were male. Median sPAP was found to be 35 mmHg. Systolic pulmonary artery pressure was positively correlated with right atrium (RA) diameter (r: 0.6, p < 0.001) and negatively correlated with left ventricular ejection fraction (LVEF) (r: - 0.4, p < 0.001). In addition, LVEF, RA diameter, presence of pericardial effusion (PE) were found to be independent predictors of PHT.
CONCLUSIONS: Pulmonary hypertension has a relatively high prevalence in end-stage renal disease (ESRD) patients on regular HD. Besides, the presence of PE and certain right and left heart parameters were independently associated with PHT.

Evidence suggests that changes in left ventricular systolic and diastolic functions may affect right atrial (RA) phasic functions. We aimed to evaluate RA phasic functions in the presence of anterior ST-elevation myocardial infarction (ASTEMI) as an acute event and to compare the findings with those in a control group.
We recruited 92 consecutive ASTEMI patients without accompanying significant stenosis in the proximal and middle parts of the right coronary artery and 31 control subjects, matched for age, sex, diabetes, and hypertension. RA phasic functions were evaluated concerning their longitudinal 2D speckle-tracking echocardiography-derived markers. The ASTEMI group was followed up for all-cause mortality or reinfarction.
In the ASTEMI group, RA strain was reduced during the reservoir (33.2% ± 4.3% vs 30.5% ± 8.1%; P = 0.021) and conduit (16% [12-18%] vs 14% [9-17%]; P = 0.048) phases. The other longitudinal 2D speckle-tracking echocardiography-derived markers of RA phasic functions were not different between the 2 groups. RA strain and strain rate during the contraction phase were predictive of all-cause mortality or reinfarction (hazard ratio = 0.80; P = 0.024 and hazard ratio = 0.39; P = 0.026, respectively).
Based on 2D speckle-tracking echocardiography, in the ASTEMI group, compared with the control group, RA reservoir and conduit functions were reduced, while RA contraction function was preserved. RA contraction function was predictive of all-cause mortality or reinfarction during the follow-up period.

BACKGROUND: In dextro-transposition of the great arteries (dTGA), the aorta and the pulmonary artery are transposed. The present study aimed a three-dimensional speckle-tracking echocardiography-derived determination of volumetric and functional features of the atrium being on the morphologic right side [\'right atrium (RA)] in adult patients with dTGA.
METHODS: The present study comprised 18 adult dTGA patients, four of whom were excluded due to inferior image quality. From the remaining 14 patients (mean age: 29.7 ± 8.1 years, 9 males), 7 cases underwent Mustard-procedure, while another 7 subjects underwent Senning-procedure. Their results were compared to that of 28 age- and gender-matched healthy subjects (28.8 ± 1.4 years, 20 males).
RESULTS: Increased RA volumes respecting the cardiac cycle could be demonstrated in dTGA patients compared to controls. RA stroke volumes (SVs) for reservoir and conduit function were reduced together with impaired RA emptying fractions (EFs) featuring all phases of RA function. Mustard-operated patients showed tendentiously lower RA volumes and increased SVs and EFs respecting the cardiac cycle compared to those of Senning-operated patients suggesting beneficial results for Mustard-procedure. Reduced RA global and mean segmental peak RA strains and RA strains at atrial contraction could be detected in dTGA patients compared to those of controls with tendentiously lower values in Mustard-operated patients compared to those of Senning-operated subjects.
CONCLUSIONS: Significant RA volumetric and functional abnormalities could be detected in adult dTGA patients following atrial switch repair. While RA volumetric data proved to be better in Mustard-operated patients, RA strains were enhanced in Senning-operated subjects.

Atrial septal defects (ASD) are associated with atrial arrhythmias, but the arrhythmia substrate in these patients is poorly defined. We hypothesized that bi-atrial fibrosis is present and that right atrial fibrosis is associated with atrial arrhythmias in ASD patients. We aimed to evaluate the extent of bi-atrial fibrosis in ASD patients and to investigate the relationships between bi-atrial fibrosis, atrial arrhythmias, shunt fraction, and age.
Patients with uncorrected secundum ASDs (n = 36; 50.4 ± 13.6 years) underwent cardiac magnetic resonance imaging with atrial late gadolinium enhancement. Comparison was made to non-congenital heart disease patients (n = 36; 60.3 ± 10.5 years) with paroxysmal atrial fibrillation (AF). Cardiac magnetic resonance parameters associated with atrial arrhythmias were identified and the relationship between bi-atrial structure, age, and shunt fraction studied. Bi-atrial fibrosis burden was greater in ASD patients than paroxysmal AF patients (20.7 ± 14% vs. 10.1 ± 8.6% and 14.8 ± 8.5% vs. 8.6 ± 6.1% for right and left atria respectively, P = 0.001 for both). In ASD patients, right atrial fibrosis burden was greater in those with than without atrial arrhythmias (33.4 ± 18.7% vs. 16.8 ± 10.3%, P = 0.034). On receiver operating characteristic analysis, a right atrial fibrosis burden of 32% had a 92% specificity and 71% sensitivity for predicting the presence of atrial arrhythmias. Neither age nor shunt fraction was associated with bi-atrial fibrosis burden.
Bi-atrial fibrosis burden is greater in ASD patients than non-congenital heart disease patients with paroxysmal AF. Right atrial fibrosis is associated with the presence of atrial arrhythmias in ASD patients. These findings highlight the importance of right atrial fibrosis to atrial arrhythmogenesis in ASD patients.