Carilion Clinic -Virginia Tech, Roanoke, VA Purpose: Two separate studies by Morris et al. in 1964 and then He at al. in 2017 were able to show a direct relationship between P wave analysis and valvular heart disease and ischemic stroke, respectively. We hope to continue this progress by establishing a relationship between P wave morphology, duration, PR interval, and P wave terminal force with the severity of Heart Failure with Reduced and Preserved Ejection Fraction in our patient population. Methods: We retrospectively analyzed a specific subset of patients who were admitted to the hospital for decompensated heart failure. These patients were classified into either the Heart failure with preserved ejection fraction (HFpEF) or the heart failure with reduced ejection fraction (HFrEF) group after transthoracic echos were reviewed, with Syngo, using the current ASE guideline for diastolic dysfunction. Their admission ECGs were also reviewed, using MUSE, with specific attention paid to P wave analysis. We manually measured their p wave duration in sec, PR interval in sec, P wave morphology, and P wave height. The P wave terminal force was then calculated for each patient. All these patients were then compared to patient without any systolic or diastolic dysfunction. Results: Our analysis showed a statistically significant correlation with specific P wave analysis in the each subgroup of heart failure patients, when compared to our control group. Patient's with HFpEF had a higher incidence of a parabolic p wave shape (p=0.04), while patient's with HFrEF had a higher incidence of bifid p wave shape (p=0.045). We also noted a significantly higher terminal force by over 11% in both our analysis group compare to control (HFpEF 11.9% vs HFrEF 11.3%; p=0.05). The terminal force cut off for each subgroup was higher than previously noted in prior studies. Subanalysis also yielded a direct correlation with terminal force and severity of heart failure in both HFpEF and HFrEF with a strong, positive, relative linear relationship (Pearson Correlation of 0.609 and r of 0.63) likely suggesting more severe remodeling of the atria as LV function declines. Conclusion: Our retrospective analysis suggests another noninvasive diagnostic tool via P wave analysis from an EKG to help diagnose different forms of heart failure, such as HFpEF and HFrEF. Concurrently, calculation of the p wave terminal force can also help determine the severity of both systolic and diastolic heart failure.Background: Impaired left atrial (LA) function in heart failure with preserved ejection fraction (HFpEF), defined by worse LA reservoir strain, is linked to adverse clinical outcomes. The characteristics of HFpEF patients who have LA myopathy out of proportion to left ventricular (LV) myopathy remain unclear. Methods: In the Prevalence of Microvascular Dysfunction in HFpEF (PROMIS-HFpEF) study (n=241), we defined 3 phenotypes based on degree of LA myopathy (LA reservoir strain) compared with LV myopathy (global longitudinal strain) ( Figure 1) and evaluate...
Background Post-operative atrial fibrillation (POPAF) following cardiac surgery is a common arrhythmia associated with an increased morbidity and mortality. There is little data evaluating the safety and effectiveness of anticoagulation (AC) in POPAF patients. We investigated the occurrence of 30-days POP major bleeding or embolic events and their timing in relation to the index cardiac surgery, the initiation of the arrhythmia and of anticoagulation in patients who developed new onset POPAF. Methods 4,073 consecutive patients undergoing cardiac surgery from September 2010- December 2016 were evaluated. Patients with history of AF/Aflutter were excluded. POPAF was confirmed by ECG or telemetry. Major post-operative bleeding that occurred after AF was defined using PLATO criteria or the BARC scale (any ≥3). Results 3,230 patients were included (37% CABG, 69% valve surgery). The incidence of POAF was 24%. The median time (IQR) of POPAF was 3 (2) days after the index surgery. 64% of POAF patients were male and 14% had a history of stroke. The mean (SD) age was 72 (9) years old. The average (SD) CHA2DS2-VASc score was 3.9 (1.5). The initial postoperative AC was full dose heparin, lovenox or argatroban in 58% of patients. The rest of patients had low dose heparin/lovenox for DVT prophylaxis and/or were started on oral anticoagulation without a bridge. The median (IR) time of POPAF to anticoagulation was 1 (2) days. There were 15 (1.9%) major bleeding events; 88% of which occurred in patients receiving full anticoagulation. Major bleeding events occurred a median of 15 (9) days after the index surgery and 9 (6) days after anticoagulation. Independent predictors of major bleed were history of PAD (P<0.01) and pre-operative use of b-blockers (P=0.04). There were 11 (1.4%) POP strokes which occurred a median of 5 (16) days after the index surgery, and 2 (13) days after POPAF. 63% of strokes happened in patients that received anticoagulation. The mean CHA2DS2-VASc score were 3.9 (1.5) and 4.7 (1.7), P=0.1 for patients without and with strokes, respectively. Stroke history (P<0.01) was the only independent stroke predictor. Both strokes and bleeding events were associated with significantly longer ICU and hospital length of stay. 86% of POPAF patients received amiodarone during hospitalization and 2.1% electric cardioversion. Upon discharge, 2.3% of patients were in in atrial fibrillation and 0.8% in atrial flutter. Conclusion The post-operative course of major bleeds and stroke in patients with POPAF after cardiac surgery is different. Bleeding events are delayed and appear related to anticoagulation. The relative benefit of perioperative anticoagulation remains unclear. FUNDunding Acknowledgement Type of funding sources: None.
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