Echocardiography/methods – ABC CARDIOL

IJCS

Original Article

Prevalence of Critical Congenital Heart Disease Detected in the Pulse Oximetry Test in Asymptomatic Newborns, ≥35 Gestational Weeks, in a Maternity in Southern Brazil

Sandra Mara Witkowski et al. Rafael Bertoldi Torres Aline Fernanda Pereira Carolina Marchi Guerra … Marco Otílio Rodrigues Wilde Leonardo Fonseca Sene Marcelo França Soares Thor Ferreira da Cruz

Abstract

Background

Congenital heart diseases (CHD) are one of the most prevalent malformations, and the screening tests to identify critical congenital heart disease (CCHD) is the pulse oximetry test, with subsequent investigation and treatment.

Objective

To quantify positive pulse oximetry tests and verify the prevalence of CCHD detected by it in asymptomatic newborns, ≥35 gestational weeks, in a Brazilian maternity hospital.

Methodology

This is an observational, retrospective, quantitative, analytical and cross-sectional study, conducted from October 2020 to May 2022, in a maternity hospital in southern Brazil, through the collection of records of positive oximetry pulse tests, following the norms of screening CCHD test of the Brazilian Society of Pediatrics (SBP), after they were evaluated with echocardiography for confirmation or exclusion of CHD.

Results

A total of 5,667 newborns were evaluated in this study, according to the inclusion criteria; 0.17% (n = 10) had a positive pulse oximetry test. Regarding the results of the echocardiography of the neonates with a positive test, two were normal, seven were cases of patent foramen ovale (PFO), and one was a case (0,017%) with interatrial communication (IAC) diagnosis. In the same period, five neonates with CCHD were born, symptomatic, diagnosed by physical examination, and referred to neonatal intensive care units (NICU) before taking the neonatal cardiac screening (< 24 hours of life).

Conclusion

The prevalence of positive pulse oximetry tests was 0.17% and none CCHD was detected. Five cases of CCHD were born in this period, but they were diagnosed before the recommend time to perform the screening test.

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IJCS

Original Article

Echocardiogram in Critically ill Patients with COVID-19: ECOVID Study

Bruno Ferraz de Oliveira Gomes et al. Armando Luis Cantisano Iliana Regina Ribeiro Menezes Anny de Sousa Azevedo … Thiago Moreira Bastos da Silva Valdilene Lima Silva Giovanni Possamai Dutra Suzanna Andressa Morais de Paula Barbara Ferreira da Silva Mendes Plinio Resende do Carmo Junior Basilio de Bragança Pereira Joao Luiz Fernandes Petriz Glaucia Maria Moraes de Oliveira

Abstract

Background

Literature is scarce on echocardiographic characteristics of COVID-19 patients admitted to the intensive care unit (ICU).

Objectives

To describe echocardiographic characteristics of ICU COVID-19 patients and associate them with clinical signals/symptoms, laboratory findings and outcomes.

Methods

Patients with RT-PCR-confirmed COVID-19, admitted to the ICU, who underwent echocardiography were included. Clinical characteristics associated with an abnormal echocardiogram (systolic ventricular dysfunction of any degree — left and/or right ventricle — and/or high filling pressures and/or moderate to severe pericardial effusion) were analyzed. Groups were compared using the Student’s t-test, chi-square, and logistic regression. A p < 0.05 was considered statistically significant.

Results

A total of 140 patients met inclusion criteria, and 74 (52.9%) had an abnormal echocardiogram. A low number of left and right ventricular systolic dysfunction was observed, and 35% of the population had a normal diastolic function. In the univariate analysis, characteristics associated with abnormal echocardiogram were age, chronic kidney disease, elevated troponin, previous heart failure, and simplified acute physiology score 3 (SAPS 3). In the regression model, troponin and SAPS3 score were independent markers of abnormal echocardiogram. An abnormal echocardiogram was associated with a higher prevalence of in-hospital death (RR 2.10; 95% CI 1.04-4.24) and orotracheal intubation (RR 2.3; 95% CI 1.14-4.78).

Conclusions

COVID-19 has little effect on ventricular function, but it is common to find increased filling pressures. Elevated serum troponin level and SAPS3 score were the independent markers of an abnormal echocardiogram. In addition, the prevalence of in-hospital death and need for mechanical ventilation were higher in patients with abnormal echocardiogram.

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IJCS

Original Article

Subclinical Systolic Dysfunction during Chemotherapy for Breast Cancer

Geanne Maria Holanda de Menezes Barroso et al. Júlio César Oliveira Costa Teles Paulo Victor de Jesus Silva Karin Yasmin Santos Fonseca … Vinícius Antônio Santos Aragão Marília Marques Aquino Enaldo Vieira de Melo Karina Oliveira Ferreira Ronnei José Feitosa de Assis Michel Fabiano Silva Alves Antônio Carlos Sobral Sousa Joselina Luzia Menezes Oliveira

Abstract

Background

Cardiotoxicity is the main complication related to cancer therapy. Studies indicate that global longitudinal strain is an early detector of subclinical dysfunction of the left ventricle, preceding the decline in ejection fraction (EF). However, the reproducibility of such methodology has not been tested outside specialized centers.

Objectives

To assess the frequency of subclinical cardiotoxicity and to compare global longitudinal strain and EF measurements during the clinical course of patients undergoing chemotherapy for breast cancer.

Methods

This was an observational prospective study of 78 adult women who underwent serial echocardiograms (baseline and 1, 3, and 6 months after the beginning of chemotherapy), to evaluate biplane and 3D EF and global longitudinal strain. Cardiotoxicity and subclinical dysfunction were defined according to American Society of Echocardiography/European Association of Cardiovascular Imaging criteria. Statistical significance was set at p < 0.05.

Results

The mean age of the patients was 50.1 ± 11.48 years. The frequency of subclinical cardiotoxicity (defined by global longitudinal strain) was 14.9% after 30 days of chemotherapy, 16.7% after 3 months, and 19.7% after 6 months, compared to 4.5%, 3%, and 6.6%, respectively, when clinical cardiotoxicity was determined according to EF. The group that developed subclinical cardiotoxicity by 30 days (group A) had a higher frequency of clinical cardiotoxicity at 3 months (p=0.028) and a lower mean biplane EF after 30 days (p= 0.036) than the group that showed no evidence of subclinical cardiotoxicity (group B).

Conclusion

Subclinical cardiotoxicity was frequent and began early, being associated with a drop in EF during the clinical course.

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IJCS

Editorial

The Importance of Early Diagnosis and Treatment for Pericardial Effusion and Cardiac Tamponade

Carlos Aurélio dos Santos Aragão et al. Vera Maria Cury Salemi

Pericardial effusion has several etiologies, such as primary pericardial diseases, cardiac surgery, trauma and systemic conditions, including hypothyroidism, renal failure, chronic neoplastic infiltration, autoimmune inflammation, systemic lupus erythematosus, and rheumatoid arthritis.’ Queiroz et al., published an interesting paper on 254 patients with pericardial effusion at a quaternary institution, 40.4% with severe pericardial effusion and 44.1% with cardiac tamponade. Retrospective cohorts of critically ill patients are rare in the literature. The most frequent etiology was idiopathic, but postoperative, neoplasia, and postinterventional procedures were also common. Although the main etiology is idiopathic in developed countries, infectious causes are prominent in developing countries, such as tuberculosis, which reaches a frequency above 60%. During the current COVID-19 pandemic, SARS-CoV-2 is of great importance in etiological investigation.

In Queiroz et al., pericardial effusion was diagnosed by echocardiography, a widely available and inexpensive method that can be performed at bedside. In addition to clinical and epidemiological aspects, Doppler echocardiography, magnetic resonance imaging, nuclear medicine tests, and laboratory analysis of the pericardial fluid could provide additional information about the etiology. However, the gold standard diagnostic exam is pericardial biopsy, which is indicated for diagnostic investigation in patients with persistent pericarditis refractory to clinical treatment and no definitive diagnosis.

[…]

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IJCS

Original Article

Analysis of Diastolic Left Ventricular Function in Adolescents with Juvenile Systemic Lupus Erythematosus

Talita Nolasco Loureiro et al. Cristina Ortiz Sobrinho Valete Marcia Bueno Castier Maria de Fatima Monteiro Leite Flavio Roberto Sztajnbok

Abstract

Background

Juvenile systemic lupus erythematosus (JSLE) is a chronic inflammatory disease that affects the heart in 50% of cases. The behavior of diastolic function in adolescents and the predictors of its occurrence by conventional echocardiography are poorly established.

Objectives

This study aimed to evaluate diastolic function in adolescents with JSLE and to identify possible predictors of its occurrence by conventional echocardiography.

Methods

Cross-sectional, observational, control group study in a tertiary hospital of 49 adolescents with JSLE and 49 controls, using the EACVI 2016 guideline classification. Statistical methods used were Fisher and Mann-Whitney tests. Multivariate logistic regression models were constructed. A significance level of 5% was adopted.

Results

Among 98 patients, the JSLE group had higher indexed left atrial volume (p <0.001), lower lateral E' value (p<0.001) and lower E/A ratio value (p<0.001). The diagnosis of JSLE was associated with a higher chance of increased left atrial index volume (OR 3.3; p value 0.03).

Conclusions

Based on the 2016 guideline, no diastolic dysfunction was found in JSLE. However, differences in the analyzed echocardiographic parameters were found in these adolescents.

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IJCS

Case Report

Complete Pericardial Agenesis in a Pregnant Patient: A Clinical Dilemma

Carolina de Souza Galvão et al. Sterffeson Lamare Lucena de Abreu Magda Luciene de Sousa Carvalho Gardenia Nogueira e Silva … Júlio Cezar Uchoa Serra Ana Bárbara Silva dos Santos Leite

Abstract

Pericardial agenesis is a rare congenital anomaly found predominantly in men, and its complete form is extremely rare and difficult to diagnose. This report describes the case of a pregnant patient with complete pericardial agenesis in which mode of delivery and sterilization raised debate among specialists.

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IJCS

Original Article

Echocardiographic and Ultrasonographic Parameters Associated with Protein-losing Enteropathy in Patients with Fontan Physiology: a Systematic Review with Meta-analysis

Marianna Freitas Mourato et al. Felipe Alves Mourato Sandra da Silva Mattos Juliana Rodrigues Neves

Abstract

Background:

Fontan circulation can be associated with significant morbidity, especially Protein-Losing Enteropathy (PLE). Echocardiographic parameters can provide valuable diagnostic information about a patient’s risk of developing PLE after Fontan surgery.

Objectives:

To describe echocardiographic/ultrasonographic parameters associated with PLE in patients after Fontan surgery through a systematic review with meta-analysis.

Methods:

A literature search was performed in electronic databases to identify relevant studies about echocardiographic parameters and PLE prediction in children after Fontan surgery. The search terms used were: “echocardiography”, “ultrasonography”, “Fontan,” and “protein-losing enteropathy”. A p < 0.05 was considered statistically significant.

Results:

A total of 653 abstracts were obtained from electronic databases and bibliographic references. From these, six articles met criteria to be included in the qualitative analysis and three in the quantitative (meta-analysis). The resistance index in the superior mesenteric artery was described in three studies, and the quantitative analysis showed statistical significance (p < 0.001). Other echocardiographic and ultrasonographic parameters were also described, albeit in single studies not allowing a meta-analysis.

Conclusion:

This systematic review with meta-analysis identified echocardiographic and ultrasonographic parameters related to PLE in patients with Fontan physiology. Vascular ultrasonography seems to play a prominent role in this aspect, but additional studies are needed to increase the degree of evidence.

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IJCS

Editorial

Epicardial Fat Thickness: a Promising Cardiovascular Risk Factor that Requires in-Depth Studies

Roberto M. Saraiva et al. Andréa Rodrigues da Costa

This issue of the International Journal of Cardiovascular Sciences presents a paper by Castanheira et al. that addresses epicardial fat (EF) thickness in an elderly Portuguese population. They describe the mean values of EF thickness and its correlation with anthropometric, echocardiographic, and clinical variables in these individuals.

EF is the visceral adipose tissue located between the myocardium and the visceral pericardium, and commonly found in the atrioventricular and interventricular grooves. EF has several physiological roles, including local effects on the heart, in a paracrine manner.^– EF can be measured non-invasively by echocardiography, and the measurement of EF thickness by 2D echocardiography has been proposed as a surrogate for visceral fat, since it is easier to perform as compared with direct measures such as computed tomography and magnetic resonance imaging (MRI). In addition, a significant correlation between EF and visceral fat measurements by MRI was demonstrated.

[…]

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IJCS

Case Report

Double-lumen Aortic Arch: Persistence of the Fifth Aortic Arch?

Nathalia Mussi Monteze et al. Adriana Furletti Machado Guimarães Fatima Derlene da Rocha Araujo

Abstract

Double-lumen aortic arch is a rare congenital anomaly related to persistence of the fifth aortic arch. It may be found alone or in association with other anatomical changes of the heart. We report a case of double-lumen aortic arch associated with coarctation of the aorta and patent ductus arteriosus in a child with a congenital malformation known as the VACTERL association (vertebral defects, imperforate anus, cardiopathy, tracheoesophageal fistula, renal abnormalities and limb anomalies).

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IJCS

Original Article

Correlation between Epicardial Fat Thickness and Clinical and Anthropometric Variables in an Elderly Population

Joaquim Castanheira et al. Cristiana Nunes Telmo Pereira

Abstract

Background

Epicardial fat (EF) thickness is a marker of visceral adiposity and consequently considered an important predictive marker of cardiovascular and metabolic risk.

Objective

To describe echocardiographic features of the heart in an elderly population and to study the correlation between EF thickness and clinical and anthropometric variables.

Methods

A sample of 34 individuals (25 women) aged between 65 and 92 years, who attended a private institution in the central region of Continental Portugal, was analyzed. A standardized sociodemographic questionnaire was applied, and anthropometric assessment, echocardiography and blood pressure measurement were performed in all subjects. A correlational analysis of EF thickness with anthropometric and clinical parameters was performed. The association between variables was tested by Pearson’s correlation and point-biserial correlation. A value of p < 0.05 was defined as statistically significant.

Results

EF thickness was higher in males (6.0 ± 1.4 mm vs 5.2 ± 0.9 mm in females), and ranged from 4 to 9 mm. There were statistically significant correlations between EF thickness and weight (r = 0.4; p = 0.02), body surface area (r = 0.4; p = 0.02), lean mass (r = 0.4; p = 0.03), calf circumference (r = 0.5; p = 0.01) and left ventricular end-diastolic diameter (r = 0.3; p = 0.04).

Conclusion

EF thickness was higher in males and was significantly correlated with anthropometric parameters of adiposity and left ventricular end-diastolic diameter. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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IJCS

Review Article

Translational Approach for Percutaneous Interventions for the Treatment of Cardiac Arrhythmias

Angelo Amato Vincenzo de Paola

Abstract

New translational concepts on cellular and tissue substrate of cardiac arrhythmias have been responsible for the development of non-pharmacological interventions, with important achievements compared to the conventional approach with antiarrhythmic drugs. In addition, the increasing knowledge of anatomical and electrophysiological studies, sophisticated mapping methods, special catheters, and controlled clinical trials have favored the progression of ablation of tachyarrhythmias, particularly of ventricular tachyarrhythmias and atrial fibrillation.

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IJCS

Case Report

Coxiella Burnetti Infective Endocarditis – Detection and Cure

Manuel Martins Barbosa et al. Carla Dias Elsa Araújo Raquel Costa

Introduction

Infective endocarditis (IE) is one of the first diagnostic hypotheses for patients admitted for acute heart failure and evidence of infection. Blood samples are collected for culture, and empiric, broad-spectrum antimicrobial therapy is initiated. Emergent cardiac surgery may be required depending on the severity of the case.

These procedures reduce bacteremia and improve clinical condition, which, in turn, may lead to discontinuation of diagnostic investigation in the presence of blood culture-negative endocarditis. Some of these patients, however, will have another episode of endocarditis.

[…]

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IJCS

Viewpoint

PARAGON-HF: Lessons Learned and Perspectives

José Francisco Kerr Saraiva et al. Isadora de Oliveira

An estimated 6.5 million Americans aged 20 and over have heart failure (HF) and projections show that the prevalence of HF will increase by 46% from 2012 to 2030, resulting in over 8 million people with HF.

Patients with HF can be stratified into different categories of left ventricular ejection fraction (LVEF), presenting different phenotypes in terms of demographics, clinical presentation, etiology and outcomes. The current classification comprises HF with reduced ejection fraction (EF) [EF ≤ 40% (HFrEF)], with intermediate EF [EF 40-50% (HFiEF), and preserved EF [EF ≥ 50% (HFpEF).^,

[…]

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IJCS

Original Article

Diagnostic and Prognostic Role of Liver Elastography in Heart Failure

Diane Xavier Ávila et al. Priscila Abreu Matos Gabriel Quintino Wolney de Andrade Martins … Dalmo Machado Claudio Tinoco Mesquita Humberto Villacorta Junior

Abstract

Background:

Hepatic congestion is a frequent finding in patients with heart failure (HF). Physical examination has limitations in quantifying systemic congestion and requires correlation with echocardiographic and laboratory data (usually B-type natriuretic peptide, BNP, or N-terminal pro-B type natriuretic peptide, NT-proBNP). Hepatic elastography evaluates liver stiffness using a transducer that transmits low-frequency vibrations (50 Hz), and the speed of shear waves propagating through the tissues is measured by ultrasound. The faster the vibrations propagate in the hepatic parenchyma, the stiffer the liver, which, in case of HF, can be correlated with hepatic congestion.

Objective:

In this systematic review, case-controls, cohort studies, and randomized clinical trials were searched in MEDLINE, LILACS and Cochrane Database of Systematic Review, to evaluate the use of elastography in the detection of hepatic congestion in patients with HF.

Methods:

From the 49 articles retrieved, seven were selected for review, according to the inclusion and exclusion criteria. The most used methods for the diagnosis and evaluation of HF were echocardiography combined with BNP and NT-proBNP measurements.

Results:

Elastography performed at bedside was able to establish a significant correlation between increased liver stiffness and increased venous capillary pressure. In addition, liver elastography performed at hospital discharge was able to predict rehospitalization and mortality.

Conclusion:

Liver elastography is a non-invasive method that can be useful in predicting prognosis and mortality of individuals with HF, contributing to the clinical management of these patients.

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IJCS

Original Article

Coarctation of The Aorta: A Case-Series from a Tertiary Care Hospital

Joaquim Barreto et al. Juliana Roda Carlos Wustemberg Germano Ana Paula Damiano Thiago Quinaglia

Abstract

Background:

Coarctation of the aorta is a congenital segmental narrowing of the aortic arch with severe hemodynamic repercussions and increased cardiovascular mortality. Early surgical correction and life-time echocardiographic follow-up must be performed to improve prognosis. However, this goal has been challenged by high rates of underdiagnosis, which delay surgical correction, and by recoarctation in up to one third of operated patients.

Objectives:

The objectives of this study were: (i) to register the frequency of common clinical signs at diagnosis of coarctation of the aorta; (ii) to describe the course of echocardiographic parameters before and during the follow-up of coartectomized subjects; (iii) to analyze the clinical prognosis of patients according to baseline characteristics, occurrence of recoarctation and associated malformations.

Methods:

Case-series of 72 patients coarctectomized between June 1996 and November 2016 in a tertiary care hospital. Clinical, echocardiographic and surgical variables were considered. All patients were submitted to coarctectomy by posterolateral thoracotomy and end-to-end anastomosis. Data were classified as parametric or non-parametric by Kolmogorov-Smirnov test. Parametric data were expressed as mean and standard deviation, and non-parametric data as median and interquartile range. Continuous variables were analyzed using paired t-tests, and categorical variables were compared by chi-square test. For all analysis, a p-value of less than 0.05 was considered statistically significant. Statistical analysis was performed using SPSS, version 20.0 (IBM, Chicago, IL, USA).

Results:

The mean follow-up time was 5.8 years (range: 0-20 years). At diagnosis, most patients had heart murmur (88%), non-palpable pulse in the lower limbs (50%), left ventricular hypertrophy (78%), and bicuspid aortic valve (33%), with a mean aortic peak gradient of 55 mmHg. After surgical correction, those without recoarctation were less symptomatic (60 vs 4.5%; p < 0.001), had lower aortic peak gradient (54 ± 3.8 vs 13 ± 0.8; p = 0.01) and left ventricle mass (95 ± 9.2 vs. 63 ± 11; p = 0.01), and the most common complications were late hypertension (39.2%), and recoarctation (27.6%). Recoarcted patients did not show improvement of neither clinical nor echocardiographic variables. Age at repair and bicuspid aortic valve groups had comparable results with controls. Surgical procedure was safe; mean time of hospitalization was 10 days and mean surgery time 2.3 hours.

Conclusions:

Coarctectomy improves cardiac symptoms and left ventricular hypertrophy, with a slight effect on the incidence of hypertension. Recoarctation occurs in one-third of patients and draws attention for the need of lifelong surveillance by echocardiography.

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IJCS

Original Article

Influence of ACE Polymorphism on Echocardiographic Data of Patients with Heart Failure

Silene Jacinto da Silva et al. Salvador Rassi Alexandre da Costa Pereira

Abstract

Background:

Angiotensin converting enzyme (ACE) polymorphism has been associated with different clinical and echocardiographic parameters in patients with heart failure (HF). However, no studies have been investigated such association with HF caused by Chagas disease.

Objectives:

To perform a genetic study to evaluate the frequency of ACE polymorphism in patients with HF caused by Chagas disease attending a university hospital in the central-west region and its association with echocardiographic findings.

Methods:

Descriptive study of ACE polymorphism (I/D) and echocardiographic data of 103 patients with HF caused by Chagas disease. Echocardiographic parameters were compared between the genotypes using the ANOVA test.

Results:

Genotypic distribution of the ACE polymorphism was 16.5% DD, 57.3% DI and 26.2% II. There was no statistically significant difference in the distribution of genotypes between men and women. The echocardiographic findings were: left ventricular ejection fraction: 43.8 ± 14.8 (DD) vs. 42.3 ± 11.6 (ID) vs. 44.9 ± 13.0 (II), p = 0.664; left ventricular diastolic diameter: 59.2 ± 9.7 (DD) vs. 60.3 ± 7.6 (ID) vs. 59.7 ± 78.1 (II), p = 0.879; left ventricular systolic diameter: 48.6 ± 12.8 (DD) vs. 50.6 ± 9.7 (ID) vs. 49.3 ± 11.9 (II), p = 0.753; and left atrial volume: 44.9 ± 10.1 (DD) vs. 40.9 ± 9.6 (ID) vs. 38.2 ± 7.8 (II), p = 0.068. Significant correlation coefficients were found for gender, age, ethnicity, heart rate and dyslipidemia.

Conclusion:

ACE polymorphism was not associated with echocardiographic findings in patients with HF caused by Chagas disease.

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IJCS

Original Article

Correlation between Exercise Stress Test and Echocardiographic Parameters in Elderly Individuals

Liz Andréa Villela Baroncini et al. Camila Varotto Baroncini Juliana Ferreira Leal

Abstract

Background:

Maximum oxygen consumption (VO₂ max) in healthy individuals decreases approximately 10% per decade of life, and such decrease is more pronounced after the seventh decade.

Objectives:

To assess functional capacity of individuals aged 75 years or older, submitted to ergometric test and transthoracic echocardiogram exam, by means of metabolic equivalent (MET) and VO₂ max measurements.

Methods:

A total of 381 patients (205 women; 79 ± 3.7 years) were evaluated. Exclusion criteria were: presence of left ventricular (LV) systolic dysfunction, LV diastolic dysfunction grade II and III, significant valve disease, or coronary artery disease with systolic LV dysfunction or dilatation. Associations between quantitative variables were analyzed by Pearson and Spearman correlation coefficients, and comparisons of quantitative data by Student’s t-test for independent samples.

Results:

Increasing age was associated with a progressive decrease in the distance covered (p = 0.021), in the expected increase in HR (p < 0.001), in VO₂ max (p < 0.001), and METs (p < 0.001) in both genders. There was no correlation of exercise test parameters with the echocardiographic parameters.

Conclusions:

Relatively healthy older individuals, with global systolic and diastolic functions of the left ventricle preserved, presented a progressive decrease in their functional capacity due to their natural aging process, comorbidities related to their age range and physical deconditioning.

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IJCS

Editorial

To Occlude or not to Occlude. That is the Question

Wilson Mathias Junior

In this issue of the International Journal of Cardiovascular Sciences, Madeira et al. evaluated the influence of percutaneous left atrial appendage (LAA) occlusion device on left atrial (LA) function. They assessed several parameters of atrial function, including LA strain and strain rate by speckle-tracking echocardiography (STE) of 16 patients, 75% with permanent atrial fibrillation, undergoing percutaneous LAA closure. No differences were found in maximum and minimum LA volume or LA emptying fraction before and 3 months after the procedure. Similarly, no differences were noted in LA strain (13.7 ± 11.1 vs. 13.0 ± 8.8%; p = 0.63) or strain rate (1.06 ± 0.26 vs. 1.13 ± 0.34 s^-1; p = 0.38) in the reservoir phase. Based on those results, the authors concluded that LAA occlusion had no impact on LA function.

This is among the first studies to examine the effect of this procedure on LA function, for which the authors should be congratulated.

[…]

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