OBJECTIVE: To assess the ability of left atrial (LA) strain parameters to discriminate patients with elevated left atrial pressure (LAP) from patients with atrial fibrillation (AF).
RESULTS: A total of 142 patients with non-valvular AF who underwent first catheter ablation (CA) between November 2022 and November 2023 were enrolled in the study. Conventional and speckle-tracking echocardiography (STE) were performed in all patients within 24 h before CA, and LAP was invasively measured during the ablation procedure. According to mean LAP, the study population was classified into two groups of normal LAP (LAP < 15 mmHg, n = 101) and elevated LAP (LAP ≥ 15 mmHg, n = 41). Compared with the normal LAP group, elevated LAP group showed significantly reduced LA reservoir strain (LASr) [9.14 (7.97-11.80) vs. 20 (13.59-26.96), p < .001], and increased LA filling index [9.60 (7.15-12.20) vs. 3.72 (2.17-5.82), p < .001], LA stiffness index [1.13 (.82-1.46) vs. .47 (.30-.70), p < .001]. LASr, LA filling index and LA stiffness index were independent predictors of elevated LAP after adjusted by the type of AF, EDT, E/e\', mitral E, and peak acceleration rate of mitral E velocity. The receiver-operating characteristic curve (ROC) analysis showed LA strain parameters (area under curve [AUC] .794-.819) could provide similar or greater diagnostic accuracy for elevated LAP, as compared to conventional echocardiographic parameters. Furthermore, the novel algorithms built by LASr, LA stiffness index, LA filling index, and left atrial emptying fraction (LAEF), was used to discriminate elevated LAP in AF with good accuracy (AUC .880, accuracy of 81.69%, sensitivity of 80.49%, and specificity of 82.18%), and much better than 2016 ASE/EACVI algorithms in AF.
CONCLUSIONS: In patients with AF, LA strain parameters could be useful to predict elevated LAP and non-inferior to conventional echocardiographic parameters. Besides, the novel algorithm built by LA strain parameters combined with conventional parameters would improve the diagnostic efficiency.

Cardiac power output (CPO) is a powerful predictor of adverse outcomes in heart failure (HF). However, the original formula of CPO included the difference between mean arterial pressure and right atrial pressure (RAP). The prognostic performance of RAP-corrected CPO (CPORAP) remains unknown in heart failure with preserved ejection fraction (HFpEF). We studied 101 HF patients with a left ventricular ejection fraction > 40% who had pulmonary hypertension due to left heart disease. CPORAP was significantly more discriminating than CPO in predicting outcomes (Delong test, P = 0.004). Twenty-five (24.8%) patients presented with dis-concordantly high CPORAP and low CPO when stratified by the identified CPORAP threshold of 0.547 W and the accepted CPO threshold of 0.803 W. These patients had the lowest RAP, and their cumulative incidence was comparable with those with concordantly high CPO and CPORAP (P = 0.313). CPORAP might identify patients with right ventricular involvement, thereby providing better prognostic performance than CPO in HFpEF.

Echocardiographic assessment of diastolic function during atrial fibrillation (AF) remains challenging due to the irregular cardiac cycle length. We sought to assess whether the index-beat method, the beat following two preceding cardiac cycles of equal duration, could provide a more reliable measurement of E/e\' (mitral E wave/diastolic tissue Doppler velocity) than the conventional averaging of consecutive beats and hence facilitate the noninvasive estimation of elevated left atrial pressure (LAP) in patients with AF.
We prospectively studied 35 patients with persistent AF who had preserved left ventricular ejection fraction and underwent radiofrequency ablation. LAP was measured in conjunction with transseptal puncture during catheter ablation. Echocardiography was performed 24 h before ablation and E/e\' was determined using the recommended averaging of 10 beats and the index-beat method, with the observers blinded to the clinical details and LAP measurements.
Correlation analysis showed a strong positive correlation between two methods in terms of both septal E/e\' (r = 0.841, p < 0.001) and lateral E/e\' (r = 0.930, p < 0.001). Bland-Altman analysis also showed a good agreement between the two measurement methods in terms of E/e\'. E/e\' determined using both conventional averaging and the index-beat method was significantly correlated with LAP (p < 0.05). After Fisher Z transformation, we found that the index-beat septal E/e\' had a better correlation with LAP than did the conventional averaging E/e\' (r = 0.736 vs. r = 0.392, Zr = -2.110, p = 0.035). Furthermore, the index-beat method took significantly less time to measure E/e\' (mean 33.6 s; 95% confidence intervals [CIs]: 32.1 s-36.2 s) than did conventional averaging method (mean 96.2 s; 95% CI: 90.2 s-102.3 s; p < 0.001). Receiver operating characteristic curve analysis revealed that the optimal cut-off for predicting mean LAP >12 mm Hg was 11 (sensitivity 100%; specificity 77.3%) for index-beat septal E/e\' and 16 (sensitivity 61.5%; specificity 95.5%) for index-beat lateral E/e\'.
Good correlations were found between E/e\' and LAP in patients with AF, particularly with the index-beat method. Moreover, the index-beat method can easily measure E/e\' at an accuracy similar to that for the conventional averaging of consecutive beats, which can therefore be applied to assess the diastolic dysfunction and potentially improve the diagnosis of heart failure in patients with AF.

BACKGROUND: To explore how to measure LAPEq 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. LAPBp (Doppler sphygmomanometer method), LAPEq (Equation method) and LAPC (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 LAPEq. 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 LAPC and LAPEq (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 LAPC and LAPBP 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 LAPBP measurement.
CONCLUSIONS: It was shown that there is a good correlation between LAPEq and LAPC, 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.

UNASSIGNED: Heart failure is a global health problem, and elevated left atrial pressure (LAP) is a precursor to identifying decompensated heart failure. At present, out-of-hospital monitoring of patients with heart failure is mostly based on the patient\'s symptoms and signs, and the use of non-invasive technology is scarce. In this study, a non-invasive ballistocardiography (BCG) device was used to collect thoracic vibration signals generated by heartbeat. We collected these signals from more than 1,000 adults, including those with different heart diseases, and used a sensor system and a composite index related to LAP recognition named the LAP-index, to analyze them. This study aimed to verify the reliability and accuracy of the LAP-index in identifying elevated LAP within heart failure patients.
UNASSIGNED: We prospectively included 158 patients with various extent of diastolic function, some of whom had various underlying diseases, and collected BCG and echocardiographic data using a cross-section methodology. The BCG signal was recorded from multiple optical fiber vibration sensors placed on the back of each patient. We adopted the 2016 ASE/EACVI echocardiography guideline as the standard for determining LAP level from echocardiography parameters. To evaluate the diagnostic efficacy of the LAP-index, we drew a receiver operating characteristic (ROC) curve and calculated the area under the ROC curve (AUC).
UNASSIGNED: The LAP-index of the 158 patients ranged from 6 to 32. Of them, 39 were diagnosed as high LAP by echocardiography, and 119 cases had normal or slightly elevated LAP. Comparison of the LAP-index results and echocardiographic results revealed the ROC c-statistic of the LAP-index for identifying high LAP was 0.86 (95% CI: 0.79-0.93; P<0.0001). When the LAP-index was at the best cut-off value of 15.5, the positive agreement rate between it and echocardiography LAP was 0.85, the negative agreement rate was 0.80, and the overall agreement rate was 0.81.
UNASSIGNED: The sensor system and the LAP-index, a composite index derived from BCG, have high reliability and accuracy in identifying elevated LAP, which provides a novel possibility for the non-invasive detection of hemodynamic congestion in heart failure patients.

BACKGROUND: Due to a high prevalence and morbidity rate, heart failure (HF) constitutes an immense economic burden on the global health care system. An increase in left atrial pressure (LAP) precedes the occurrence of any HF symptoms. In this study, we applied a novel non-invasive method of ballistocardiography (BCG) to extract early diastolic ventricular vibration waves [the BCG-B3 index, which corresponds to the third heart sound (S3) at the end of the rapid filling phase of diastole]. This study evaluated the predictive value of the BCG-B3 index for LAP in HF patients.
METHODS: A total of 83 HF patients and 20 patients with underlying diseases were prospectively enrolled, and their cross-sectional BCG and echocardiography (ECHO) data were collected. BCG obtains a signal through a high-precision fiber-optic sensor placed on the patient\'s back. LAP or pulmonary capillary wedge pressure (PCWP) was estimated by the ratio of mitral inflow peak early diastolic velocity to the early diastolic velocity of the mitral annulus (E/e\') or the Nagueh equation (LAP = 1.24 × E/e\' + 1.9). To evaluate the diagnostic efficacy of the BCG-B3 index, a receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was calculated. The best cutoff value for the BCG-B3 index was determined by the maximum Youden index.
RESULTS: The correlation coefficient between the BCG-B3 index and E/e\' ratio was 0.51 (P<0.01). Under an optimal cutoff value of 55.13, the BCG-B3 index showed a positive consistency value of 0.93, a negative consistency value of 0.53, and an overall consistency value of 0.82 for identification of significantly elevated LAP.
CONCLUSIONS: The BCG-B3 index derived by noninvasive BCG using a built-in fiber-optic sensor has important diagnostic value for identifying significantly elevated LAP in HF patients with high accuracy. BCG examination is not limited by place or the doctor\'s experience. Therefore, BCG can provide timely assessments for HF patients, enabling early diagnosis and treatment.

OBJECTIVE: The aim of this study was to compare radial arterial catheter-derived pressure with oscillometric blood pressure in women with severe peripartum hypertension undergoing urgent treatment with intravenous nicardipine at a maternal intensive care unit.
METHODS: We obtained patients\' paired values of systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). All of the measurements were divided into four groups based on the levels of SBP and MAP measured using the oscillometric method.
METHODS: We assessed agreements of the paired values using the Bland-Altman method. The clinical relevance of differences between the two methods was assessed by error grid analysis.
RESULTS: A total of 337 paired SBP and DBP values and 305 paired MAP values were obtained for 89 patients. The values of intra-arterial SBP were higher than those of oscillometric SBP. The values of intra-arterial MAP were higher than those of oscillometric MAP except for the women with MAP ≥ 125 mm Hg. Bland - Altman analysis showed acceptable agreement for DBP and MAP measured by intra-arterial method and oscillometric method. Error grid analysis showed the proportions of measurements in risk zones A to E were 83.22%, 16.46%, 0.32%, 0%, and 0% for SBP, and 97.81%, 2.19%, 0%, 0%, and 0% for MAP, respectively.
CONCLUSIONS: Intra-arterial MAP can be used reliably to monitor the effect of intravenous nicardipine for treating severe hypertension. Intra-arterial SBP may trigger moderate-risk treatment decisions in the women with oscillometric SBP ≤ 160 mm Hg.

Despite numerous reports documenting an important role of hypertension in the development of atrial fibrillation (AF), the detailed mechanism underlying the pathological process remains incompletely understood. Here, we aim to test the hypothesis that diastolic sarcoplasmic reticulum (SR) Ca2+ leak in atrial myocytes, induced by mechanical stretch due to elevated pressure in the left atrium (LA), plays an essential role in the AF development in pressure-overloaded hearts.
Isolated mouse atrial myocytes subjected to acute axial stretch displayed an immediate elevation of SR Ca2+ leak. Using a mouse model of transverse aortic constriction (TAC), the relation between stretch, SR Ca2+ leak, and AF susceptibility was further tested. At 36 h post-TAC, SR Ca2+ leak in cardiomyocytes from the LA (with haemodynamic stress), but not right atrium (without haemodynamic stress), significantly increased, which was further elevated at 4 weeks post-TAC. Accordingly, AF susceptibility to atrial burst pacing in the 4-week TAC mice were also significantly increased, which was unaffected by inhibition of atrial fibrosis or inflammation via deletion of galectin-3. Western blotting revealed that type 2 ryanodine receptor (RyR2) in left atrial myocytes of TAC mice was oxidized due to activation and up-regulation of Nox2 and Nox4. Direct rescue of dysfunctional RyR2 with dantrolene or rycal S107 reduced diastolic SR Ca2+ leak in left atrial myocytes and prevented atrial burst pacing stimulated AF.
Our study demonstrated for the first time the increased SR Ca2+ leak mediated by enhanced oxidative stress in left atrial myocytes that is causatively associated with higher AF susceptibility in pressure-overloaded hearts.

BACKGROUND: The 2016 guidelines for left ventricular diastolic dysfunction diagnosis has been simplified from previous versions; however, multiparametric diagnosis approach still exists indeterminate left ventricular diastolic dysfunction category. Left atrial (LA) strain was recently found useful to predict elevated left ventricular (LV) filling pressures noninvasively. This study aimed to (1) analyze the diagnostic value of LA strain for noninvasive assessment of LV filling pressures in patients with stable coronary artery disease (CAD) with preserved LV ejection fraction (LVEF), using invasive hemodynamic assessment as the gold standard, and (2) explore whether LA strain combined with conventional diastolic parameters could detect elevated LV filling pressures alone.
METHODS: Sixty-four patients with stable CAD having LVEF > 50% and 30 healthy controls were enrolled. Two-dimensional speckle-tracking echocardiography was used to measure LA strain during the reservoir (LASr), conduit, and contraction phases. LV end-diastolic pressure (LVEDP), as a surrogate for LV filling pressures, was invasively obtained by left heart catheterization. Logistic regression was used to calculate the odds ratio to predict LV filling pressures. Pearson\'s correlation was used to analyze associations between echocardiographic parameters and LVEDP. The area under the receiver-operating characteristic curve was calculated to determine the capability of the echocardiographic parameters to detect elevated LVEDP. Inter-technique agreement was analyzed by contingency tables and tested by kappa statistics.
RESULTS: LASr and the ratio of early-diastolic transmitral flow velocity (E) to tissue Doppler early-diastolic septal mitral annular velocity (E/E\'septal) significantly predicted elevated LV filling pressures. LASr was combined with E/E\'septal to generate a novel parameter (LASr/E/E\'septal). LASr/E/E\'septal had the best predictive ability of elevated LV filling pressures. LVEDP was negatively correlated with LASr and LASr/E/E\'septal but positively correlated with E/E\'septal. The area under the receiver-operating characteristic curve of LASr/E/E\'septal was higher than that of LASr alone (0.83 vs. 0.75), better than all conventional LV diastolic parameters. Inter-technique agreement analysis showed that LASr/E/E\'septal had good agreement with the invasive LVEDP measurement, better than the 2016 guideline (kappa = 0.63 vs. 0.25).
CONCLUSIONS: LASr provided additive diagnostic value for the noninvasive assessment of LV filling pressures. LASr/E/E\'septal had the potential to be a better single noninvasive index to predict elevated LV filling pressures in patients with stable CAD and preserved LVEF.

OBJECTIVE: We aimed to investigate the prevalence of iron deficiency (ID) in congenital heart disease associated with pulmonary arterial hypertension (CHD-PAH) and to explore the influence of ID on CHD-PAH patients. What was associated with ID in these patients was also looked into.
METHODS: One hundred and fifty-three patients who were newly diagnosed with CHD-PAH were enrolled. Patients were divided into iron-deficient and iron-replete groups according to the following criteria. ID was defined as transferrin saturation <20% in male and transferrin saturation <25% in female. Clinical data of all participants were collected and compared. Logistic regression was performed to explore factors associated with ID in CHD-PAH.
RESULTS: Thirty-nine percent of 153 CHD-PAH patients were founded with ID. Iron-deficient group had greater proportion of female patients, shorter six minutes walking distance (6-MWD), higher N-terminal pro-brain natriuretic peptide levels, lower creatinine levels, greater ratio of diastolic right ventricle diameter to left ventricle diameter. Female (OR = 15.44, 95%CI 4.91-48.54, p < .01), 6-MWD (OR = 0.99, 95%CI 0.98-1.00, p = .02) and mean right atrial pressure (OR = 1.13, 95%CI 1.02-1.26, p = .02) were independently associated with ID in the overall CHD-PAH patients. Menstruation was independently associated with ID in the female subgroup (OR = 3.88, 95%CI 1.09-13.84, p = .04).
CONCLUSIONS: ID was highly prevalent in CHD-PAH patients. Worse exercise tolerance and right heart function were observed in iron-deficient patients with CHD-PAH. Female, 6-MWD, mean right atrial pressure and menstruation are important variables indicating the presence of ID in CHD-PAH.