Atrial function analysis after percutaneous umbrella device and suture-mediated patent fossa ovalis closure: a prospective study

Background

Suture-mediated patent fossa ovalis (PFO) closure is a new technique, achieving closure of the PFO by means of a simple suture. The difference between traditional occluders and a simple suture might have different impact on atrial structure, geometry and function.

Purpose

Aim of this study was to evaluate bi-atrial function after closure of PFO by direct suture and traditional occluders.

Methods

We studied 40 age and sex matched patients, 20 undergoing PFO closure by device and 20 by suturing. Only patients with no residual right-to-left shunt, assessed by contrast-enhanced echocardiography, were included. Left and right atrial function was evaluated by using speckle-tracking analysis assessing the following parameters: strain values of the reservoir (r-ED), conduit (cd-ED) and contraction phase (ct-ED). All patients underwent transthoracic echocardiographic examination the day before and 1 year after the procedure. All exams and measurements were conducted by two echocardiographers and validated with common consent by two other expert operators.

Results

Compared with values baseline PFO closure, at one year follow-up, patients underwent occluder implantation had significantly worst indices of left (LA) and right (RA) atrial reservoir function (LA r-ED p<0.001; RA r-ED p<0.001), conduit function (LA cd-ED p<0.001; RA cd-ED p<0.001) and contraction function (LA ct-ED p<0.05; RA ct-ED p<0.05).

In patients underwent suture-mediated PFO closure, no significant differences were observed in the same indices of reservoir (LA r-ED p=0.848; RA r-ED p=0.183), conduit (LA cd-ED p=0.156; RA cd-ED p=0.419) and contraction function (LA ct-ED p=0.193; RA ct-ED p=0.375).

Conclusions

Suture-mediated PFO closure does not alter atrial function. Conversely, PFO closure by metallic occluders is associated with worse atrial function. This detrimental effect on atrial function could favor the development of atrial arrhythmias.

Funding Acknowledgement

Type of funding sources: None.

A comprehensive and easy-to-use ECG algorithm to predict the coronary occlusion site in ST-segment elevation myocardial infarction

Background

Several electrocardiogram (ECG) criteria have been proposed to predict the location of the culprit occlusion in specific subsets of patients presenting with ST-segment elevation myocardial infarction (STEMI).

Purpose

The aim of this study was to develop, through an independent validation of currently available criteria, a comprehensive and easy-to-use ECG algorithm, and to test its diagnostic performance and reliability in real-world clinical practice.

Methods

We analyzed ECG and angiographic data from 408 consecutive STEMI patients submitted to primary percutaneous coronary intervention, dividing the overall population into derivation (306 patients) and validation (102 patients) cohorts. In the derivation cohort, we tested >60 previously published ECG criteria, using the decision-tree analysis to develop the algorithm that would best predict the infarct-related artery (IRA) and its occlusion level. We further assessed the new algorithm diagnostic performance and reliability in the validation cohort.

Results

In the derivation cohort, the algorithm correctly predicted the IRA in 91% of cases and both the IRA and its occlusion level (proximal vs. mid-distal) in 73% of cases. When applied to the validation cohort, the algorithm resulted in 90% and 69% diagnostic accuracies, respectively. In a real-world comparative test, the algorithm performed significantly better than expert physicians in identifying the site of the culprit occlusion (p=0.026 vs. best cardiologist and p<0.001 vs.best emergency medicine doctor). The algorithm showed almost perfect reliability (Cohen's kappa 0.86) between a cardiologist and an ambulance paramedic.

Conclusions

Derived from an extensive literature review, this comprehensive and easy-to-use ECG algorithm can accurately predict the IRA and its occlusion level in all-comers STEMI patients.

Funding Acknowledgement

Type of funding sources: None.