Transient symptomatic episodes of AF, often responsible for impaired quality of life, are unpredictable in frequency and timing, but amenable to effective contemporary treatments, and infrequently progress to permanent AF. AF is not a major contributor to heart failure morbidity or a cause of arrhythmic sudden death; when treated, it is associated with low disease-related mortality, no different than for patients without AF. AF is an uncommon primary cause of death in HCM virtually limited to embolic stroke, supporting a low threshold for initiating anticoagulation therapy.

Background: For over 50 years, surgical septal myectomy has been the preferred treatment for drugrefractory heart failure symptoms in patients with obstructive hypertrophic cardiomyopathy (HCM). Over this time in the United States, the majority of myectomy operations have been performed in a small number of select referral centers. Methods:We have taken the opportunity to report results from the relatively new Tufts HCM Center and surgical program, incorporated 13 years ago, during which 507 myectomies (52±14 years of age; 56% male) were performed by one cardiothoracic surgeon, Dr. Hassan Rastegar.Results: Resting left ventricular (LV) outflow gradients were reduced from 56±42 mmHg preoperatively to 1.2±6.8 mmHg on most recent echocardiogram 2.0±2.5 years after surgery, and 94% of patients showed clinical improvement to NYHA functional class I or II. The first 200 myectomies were performed without mortality or major complications. Among all patients, 30-day mortality rate was 0.8%. Over follow-up of 3.2±2.8 years, 11 patients died (four due to HCM causes) with long-term survival after myectomy of 94% at 5 years (95% CI: 89-96%) and 91% at 10 years (95% CI: 84-95%), which did not differ from the age-and gender-matched general U.S. population (log-rank P=0.9).Conclusions: This experience demonstrates that, with the appropriate support, new HCM surgical programs can provide patients successful relief of outflow obstruction, extended longevity and restored of quality of life.

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Key PointsQuestionAre lower (worse) left atrial (LA) function and greater LA size associated with increased risk of subsequent dementia?FindingsIn this retrospective cohort study that included 4096 participants, there were statistically significant associations between measures of lower LA function and incident dementia comparing the lowest vs highest quintile for LA reservoir strain (HR, 1.98), conduit strain (HR, 1.50), contractile strain (HR, 1.57), emptying fraction (HR, 1.87), and active emptying fraction (HR, 1.43). Measures of LA size were not significantly associated with incident dementia.MeaningThe findings suggest that impaired LA function may be a risk factor associated with dementia.

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