Multimodality Quantitative Assessment of Left Atrial Remodeling Characteristics Using Echocardiography and LGE-CMR in Isolated Degenerative Mitral Regurgitation: Association With Atrial Fibrillation

Prediction of Left Atrial Appendage Dysfunction by Atrial Strain Imaging in Patients with Rheumatic Mitral Stenosis in Sinus Rhythm

In severe rheumatic mitral stenosis with sinus rhythm, left atrial appendage (LAA) dysfunction increases thromboembolic risk, yet clinical guidelines provide no recommendations, and its assessment via transesophageal echocardiography is not feasible for routine or repeated use. This study assessed whether left atrial (LA) strain imaging could noninvasively predict LAA contractile dysfunction. We prospectively enrolled 138 patients with severe rheumatic MS in sinus rhythm who underwent transthoracic and transesophageal echocardiography. LAA inactivity was defined as LAA emptying velocity <25 cm/s. LA reservoir (LASr), conduit, and contractile strain were quantified using speckle-tracking echocardiography. Multivariable logistic regression and receiver-operating characteristic (ROC) analyses were performed to evaluate predictors of LAA inactivity. LAA inactivity was observed in 108 patients (78.2%), and LAA thrombus was detected in 8 patients (5.8%)—all in sinus rhythm. In multivariate analysis, LASr was the strongest independent predictor of LAA inactivity (OR 0.61 per 1% increase; 95% CI: 0.50–0.75; p < 0.0001). LASr yielded an AUC of 0.950 (95% CI: 0.911-0.989), with a threshold of ≤22.95% showing a sensitivity of 93.5%, and specificity of 90% for predicting LAA inactivity. Impaired LA strain identified patients with elevated fibrinogen, D-dimer, and the presence of LAA thrombus. LA strain imaging provides a robust noninvasive predictor of LAA dysfunction in severe rheumatic MS patients in sinus rhythm. These findings support the potential clinical utility of LA strain in improving risk stratification and guiding anticoagulation decisions in this under-recognized high-risk population.

Association of Cardiovascular Magnetic Resonance-Derived Papillary Muscle Abnormalities with Non-Sustained Ventricular Tachycardia in Hypertrophic Cardiomyopathy

Background: Risk stratification for ventricular arrhythmias in hypertrophic cardiomyopathy (HCM) remains challenging, particularly in patients who do not fulfill conventional high-risk criteria. This study aimed to investigate the association between cardiovascular magnetic resonance (CMR)-derived phenotypic characteristics and non-sustained ventricular tachycardia (NSVT) in patients with HCM. Methods: A total of 69 consecutive patients with HCM who underwent comprehensive CMR imaging and 24 h Holter monitoring were retrospectively analyzed. CMR assessment included phenotypic characteristics of the left ventricle, mitral valve apparatus, and papillary muscles, as well as late gadolinium enhancement (LGE). Ventricular arrhythmic events were defined as the presence of a premature ventricular complex burden >10%, NSVT, and/or sustained ventricular tachycardia. Univariable logistic regression and multivariable Firth penalized logistic regression analyses were performed to identify variables associated with NSVT. Results: The study population had a mean age of 57.5 years, and 23 patients (33.3%) were female. Ventricular arrhythmic events were detected in 16 patients (23.1%), all of whom had NSVT. Median LGE burden was 4%. LGE was present in 43 patients (62.3%), including papillary muscle (PM)-LGE in 13 patients (19.0%). Anterolateral PM–septum systolic contact was observed in 7 patients (10.0%). In univariable analysis, maximal left ventricular wall thickness (OR 1.29, 95% CI 1.09–1.53; p = 0.004), abnormal chordal attachment (OR 5.56, 95% CI 1.09–28.19; p = 0.039), anterolateral PM mobility (OR 1.45 per 0.1-unit increase, 95% CI 1.10–1.91; p = 0.009), anterolateral PM–septum systolic contact (OR 31.20, 95% CI 3.38–288.0; p = 0.002), and PM-LGE (OR 9.60, 95% CI 2.50–36.84; p < 0.001) were associated with NSVT. In the four-variable Firth penalized logistic regression model, abnormal chordal attachment (OR 9.09, 95% CI 1.18–67.42; p = 0.036), anterolateral PM–septum systolic contact (OR 23.08, 95% CI 2.18–385.17; p = 0.008), and PM-LGE (OR 17.26, 95% CI 2.37–176.64; p = 0.004) remained associated with NSVT. Given the limited number of events, these multivariable findings should be considered exploratory. Conclusions: CMR-derived PM abnormalities were associated with NSVT in patients with HCM. In particular, PM-LGE, abnormal chordal attachment, and anterolateral PM–septum systolic contact emerged as exploratory CMR characteristics that warrant further evaluation in larger prospective studies.

Quantitative MRI assessment of left ventricular filling: associations with left atrial and pulmonary artery dimensions in a population-based study

In individuals free of overt cardiovascular disease, MRI-derived LV filling dynamics were associated with structural alterations of the left atrium and pulmonary vasculature, suggesting that changes across the cardiopulmonary axis may already be detectable by whole-body MRI before clinical disease becomes apparent.

Left Atrium and Left Atrial Appendage Remodeling Assessed by Echocardiography Predict Atrial Fibrillation Recurrence After Radiofrequency Catheter Ablation

ABSTRACT Purpose The aim of this study is to evaluate left atrium (LA) and left atrial appendage (LAA) remodeling using two‐dimensional speckle tracking echocardiography (2D‐STE) and investigate its predictive value for atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA). Methods One hundred patients with AF underwent TTE and TEE before undergoing RFCA. LA and LAA strain and strain rate values obtained by 2D‐STE. Logistic regression analysis was used to analyze independent contributors for AF recurrence after RFCA. The prediction efficiency of clinical ultrasound parameter models associated with the presence of AF recurrence was evaluated by the receiver operating characteristic (ROC) curve with area under curve (AUC). Results ①During the 1‐year follow‐up, 33% of patients experienced AF recurrence. ②The recurrent group had significantly higher NLR, NT‐proBNP, and LAVImin values compared to the non‐recurrent group (p < 0.05). ③The recurrence group had significantly lower LAEF, LAEI, LAA‐EV, LAS, LASR, LAAS, LAASR values than the non‐recurrent group (p < 0.05). ④LAAS and LAASR were potential factors contributing to AF recurrence (p < 0.05). In addition, incorporating LAAS and LAASR into predictive models can provide extra valuable information to identify patients at a higher risk of AF recurrence. Conclusion LAAS and LAASR, as obtained by 2D‐STE, are potential predictors of AF recurrence after RFCA. By incorporating these 2D‐STE parameters into preoperative clinical data along with TTE and TEE, it may be possible to identify impaired LA/LAA function in AF patients early. This could aid in choosing suitable patients and improving the benefit ratio of RFCA.

Diagnostic Value of Left Atrioventricular Coupling Index and Left Atrial Stiffness Index for Left Ventricular Diastolic Dysfunction in Patients with Chronic Kidney Disease: A Comparative Study Based on the 2025 ASE Guidelines.

Resting Tissue Doppler Imaging for Detecting Coronary Artery Disease in Patients with Preserved Ejection Fraction and No Wall Motion Abnormalities

Background and Objectives: Coronary artery disease may be difficult to detect by resting echocardiography when left ventricular ejection fraction is preserved and regional wall motion abnormalities are absent. This study aimed to assess whether resting Tissue Doppler Imaging-derived mitral annular velocities can help identify CAD in patients with suspected angina pectoris. Materials and Methods: We conducted a cross-sectional observational study of 92 patients hospitalized with suspected angina pectoris who underwent elective coronary angiography at the Institute of Cardiovascular Diseases in Timișoara (January 2025–February 2026). Patients with conditions known to affect TDI-derived parameters were excluded, including previous acute coronary syndrome or myocardial revascularization, significant valvular disease, cardiomyopathies, relevant arrhythmias or conduction abnormalities, permanent pacing, reduced ejection fraction, and pericardial disease. Laboratory and echocardiographic data were collected. ROC curve analysis, univariable logistic regression and multivariable logistic regression were performed to evaluate the diagnostic performance of TDI-derived parameters and their independent association with coronary artery disease. Results: Patients with CAD had significantly lower average E′ values (7.4 ± 1.9 vs. 8.9 ± 1.8 cm/s, p < 0.001) and average S′ values [7.0 (IQR 6.0–7.5) vs. 9.0 (IQR 8.1–10.0) cm/s, p < 0.001], together with higher E/E′ ratios [9.33 (IQR 8.23–11.15) vs. 7.87 (IQR 5.93–9.51), p = 0.002]. Average S′ showed the highest discriminative ability for coronary artery disease, with an AUC of 0.899 (95% CI: 0.819–0.952, p < 0.0001). The optimal Youden-derived cut-off was ≤7.5 cm/s, yielding 77.42% sensitivity and 93.33% specificity. After adjustment for age, male sex, body mass index, diabetes, smoking status, hypertension and LVEF, dichotomized S′ remained an independent predictor of coronary artery disease (OR = 45.49, 95% CI: 8.03–257.68, p < 0.0001), with an adjusted model AUC of 0.92 and 88.04% correct classification. Conclusions: TDI, particularly S′ velocity, may be a useful resting echocardiographic parameter for identifying CAD in selected patients with preserved LVEF and no resting regional wall motion abnormalities. Rather than serving as a universal diagnostic marker, S′ should be considered a complementary, easily obtainable parameter that may improve non-invasive assessment in this specific clinical setting.