PubMed İndeksli Yayınlar Koleksiyonu

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Author: search.filters.author.Muderrisoglu, HaldunSubject: search.filters.subject.atrial fibrillation

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    Left Atrial Mechanics For Secondary Prevention From Embolic Stroke Of Undetermined Source
    (2022) Sade, Leyla Elif; Keskin, Suzan; Can, Ufuk; Colak, Ayse; Yuce, Deniz; Ciftci, Orcun; Ozin, Bulent; Muderrisoglu, Haldun; https://orcid.org/0000-0003-3737-8595; 33206942; AAQ-7583-2021
    Aims Anticoagulation is not justified unless atrial fibrillation (AF) is detected in cryptogenic stroke (CS) patients. We sought to explore whether left atrial (LA) remodelling is associated with embolic stroke of undetermined source (ESUS). Methods and results In this prospective study, we evaluated consecutively 186 patients in sinus rhythm who presented with an acute ischaemic stroke (embolic and non-embolic) and sex- and age-matched controls. We performed continuous electrocardiogram (ECG) monitoring to capture paroxysmal AF episodes as recommended by the guidelines. After 12 months of follow-up, continuous ECG monitoring was repeated in patients with undetected AF episodes. We quantified LA reservoir and contraction strain (LASr and LASct) by speckle-tracking, LA volumes by 3D echocardiography. Out of 186 patients, 149 were enrolled after comprehensive investigation for the source of ischaemic stroke and divided into other cause (OC) (n = 52) and CS (n = 97) groups. CS patients were also subdivided into AF (n = 39) and ESUS (n = 58) groups. Among CS patients, LA strain predicted AF independently from CHARGE-AF score and LA volume indices. ESUS group, despite no captured AF, had significantly worse LA metrics than OC and control groups. AF group had the worst LA metrics. Moreover, LASr predicted both CS (embolic stroke with and without AF) and ESUS (embolic stroke with no detected AF) independently from LAVImax and CHA(2)DS(2)-VASc score. LASr >26% yielded 86% sensitivity, 92% specificity, 92% positive, and 86% negative predictive values for the identification of ESUS (areas under curve: 0.915, P < 0.0001, 95% confidence interval: 0.86-0.97). Conclusion Echocardiographic quantification of LA remodelling has great potential for secondary prevention from ESUS.
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    Determinants of New-Onset Atrial Fibrillation in Patients Receiving CRT Mechanistic Insights From Speckle Tracking Imaging
    (2016) Sade, Leyla Elif; Atar, Ilyas; Ozin, Bulent; Yuce, Deniz; Muderrisoglu, Haldun; 26684972
    OBJECTIVES The aim of this study was to investigate the factors associated with the development of atrial fibrillation (AF) and to examine the impact of these factors for long-term outcome after cardiac resynchronization therapy (CRT). BACKGROUND The effect of CRT on the development of new AF is under debate. METHODS Clinical assessment, 12-lead electrocardiogram, echocardiography with speckle tracking strain imaging, and device interrogation before implantation and every 6 months thereafter were performed regularly over a 5-year follow-up. The primary endpoint was new-onset AF. Pre-specified outcome events were transplantation, assist device implantation, and death. RESULTS During follow-up, AF occurred in 29 of 106 patients. Parameters of left atrial (LA) mechanics including mitral annular (A') velocity, left atrial volume index (LAVI), LA ejection fraction, active emptying fraction, LA mean systolic strain (Ss) and late diastolic strain (Sa) improved at 6 months only in patients who remained free of AF. The change in LA Ss and Sa from baseline to 6 months after CRT had the highest accuracy to predict new-onset AF (area under the curve [AUC] = 0.793, 0.815, respectively, p < 0.0001 for both vs. left ventricular [LV] reverse remodeling AUC = 0.531; p < 0.01 for both). In addition, the change in LA Ss and Sa predicted outcome events independently from new-onset AF and LV volume response. CONCLUSIONS LA functional improvement is essential for AF-free survival after CRT and is an independent predictor of AF-free survival. The improvement in LA Ss and Sa as a means of LA mechanical reserve also predicts long-term event-free survival after CRT independently from LV volume response and new-onset AF. (C) 2016 by the American College of Cardiology Foundation.