OBJECTIVES: Left atrial fibrosis (LAF) and left atrial volume index (LAVI), assessed via cardiac magnetic resonance (CMR), are emerging biomarkers for atrial cardiomyopathy and stroke risk. Their roles in the embolic str...OBJECTIVES: Left atrial fibrosis (LAF) and left atrial volume index (LAVI), assessed via cardiac magnetic resonance (CMR), are emerging biomarkers for atrial cardiomyopathy and stroke risk. Their roles in the embolic stroke of undetermined source (ESUS) remain unclear. This study evaluates LAF and LAVI in ESUS and explores whether age modifies these outcomes. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO CRD42024615479), we searched eight databases (inception-October 2024) for studies evaluating LAF or LAVI via CMR in ESUS, compared to atrial fibrillation (AF) without stroke, cardioembolic stroke (CES), non-cardioembolic stroke (NCE), and healthy controls. We performed a Bayesian network meta-analysis to estimate mean differences (MD) with 95 % credible intervals (CrI). Node-splitting tested consistency, and a meta-regression examined the effect of age. RESULTS: Ten observational studies with 1285 patients (mean age 65.1 ± 12.1 years) were included, demonstrating a generally low risk of bias. ESUS patients had significantly higher LAF than healthy controls (MD 9.86 %, 95 % CrI 3.05 %-16.62 %). No significant LAF differences were found between ESUS and AF without stroke, CES, or NCE. LAVI did not differ significantly between ESUS and any comparator groups. Node-splitting indicated no inconsistencies. Age was not significantly associated with LAF or LAVI. CONCLUSION: ESUS patients show increased LAF compared to healthy individuals, suggesting a key role of LAF in ESUS pathogenesis. Nonetheless, the application of CMR-detected LAF as a prognostic biomarker requires prospective validation to confirm its clinical utility in predicting stroke recurrence.
Recognizing individuals with stage B heart failure (HF) is important to prevent or delay its progression to symptomatic HF. Unfortunately, no study at present describes the prevalence of stage B HF in Indian patients. Th...Recognizing individuals with stage B heart failure (HF) is important to prevent or delay its progression to symptomatic HF. Unfortunately, no study at present describes the prevalence of stage B HF in Indian patients. This study involved 227 consecutive patients (mean age 56.3 ± 12.1 years, 60 % were men) undergoing echocardiography at a referral center in North India. Overall, 13 % of patients had increased left atrial volume index, 7 % had elevated ratio of early diastolic mitral inflow to mitral annular velocity, and 47 % had reduced left ventricular global longitudinal strain. Based on these findings, stage B HF was diagnosed in 119 (52.4 %) subjects. The patients with stage B HF had significantly lower left atrial reservoir strain. In conclusion, this study shows a high prevalence of stage B HF in a general clinical setting in India. Further, larger studies are needed to overcome the current study limitations and better define stage B HF's prevalence and clinical implications in Indian patients.
BACKGROUND: Cardiovascular complications are a significant cause of morbidity and mortality in patients with end-stage liver disease (ESLD) undergoing liver transplantation (LT). Dobutamine stress echocardiography (DSE)...BACKGROUND: Cardiovascular complications are a significant cause of morbidity and mortality in patients with end-stage liver disease (ESLD) undergoing liver transplantation (LT). Dobutamine stress echocardiography (DSE) is a commonly used tool for cardiac risk stratification, but its predictive utility in this population remains controversial. OBJECTIVE: To evaluate the role of DSE in predicting 30-day cardiac morbidity and mortality in ESLD patients undergoing LT. METHODS: This was a prospective observational study conducted at a tertiary care centre from June 2020 to November 2021. Ninety-four patients aged ≥40 years with ≥2 cardiovascular risk factors underwent DSE as part of their pre-LT evaluation. Patients were categorized based on DSE results as ischemic, non-ischemic, or indeterminate. Outcomes measured included 30-day mortality, major adverse cardiac events (MACE), ICU stay, and inotrope requirement. RESULTS: The study included 94 patients (mean age 53.4 ± 7.8 years; 81 males). DSE results were non-ischemic in 83 (88.3 %), indeterminate in 9 (9.6 %), and ischemic in 2 (2.1 %) patients. Both ischemic and indeterminate cases had non-significant coronary disease. There were 10 deaths (10.6 %) in 30 days, one attributed to cardiac cause. Two MACES were recorded in DSE-negative patients (ACS, HF). Sensitivity of DSE for mortality prediction was 0 %, specificity 97.4 %, and NPV 89.2 %. CONCLUSION: DSE demonstrated high specificity but limited sensitivity in predicting short-term cardiac events in ESLD patients undergoing LT. The utility of DSE as a sole screening in this population appears limited.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) procedures frequently require a second arterial access to perform aortic root angiography. In recent times, there has been an increase in the use of unilateral ac...BACKGROUND: Transcatheter aortic valve replacement (TAVR) procedures frequently require a second arterial access to perform aortic root angiography. In recent times, there has been an increase in the use of unilateral access, however, the outcomes data are conflicting. METHODS: A systematic database search was conducted to retrieve studies comparing unilateral to bilateral access in TAVR. Risk ratios (RR) with 95 % confidence intervals (CI) were pooled using the Mantel-Haenszel random-effects model. Outcomes of interest included minor vascular complications, major vascular complications, 30-day stroke, and 30-day all-cause mortality. RESULTS: Three studies with a total of 2,181 patients undergoing TAVR (unilateral 368, bilateral 1813) were included in this meta-analysis. Unilateral access was comparable to bilateral access for minor vascular complications (RR: 0.88; 95 % CI: 0.48-1.62), major vascular complications (RR: 0.61, 95 % CI: 0.14-2.75), stroke (RR: 0.95; 95 % CI: 0.42, 2.17) and all-cause mortality (RR: 0.52; 95 % CI: 0.04, 6.93). CONCLUSION: Unilateral access for TAVR was associated with similar short-term outcomes and safety profiles compared to bilateral access for TAVR.
Meshram II, Sunu PV, Sreeramakrishna K
… +10 more, Neeraja G, Stephen GL, Narasimhulu D, Sengupta S, Kurpad A, Raman R, Yajnik C, Sachdev HS, Laxmaiah A, Chandak G
BACKGROUND: Lifestyle and epidemiological transition have resulted in increasing burden of diet-related chronic diseases among the population, which are contributing to increasing morbidity and mortality. OBJECTIVE: To a...BACKGROUND: Lifestyle and epidemiological transition have resulted in increasing burden of diet-related chronic diseases among the population, which are contributing to increasing morbidity and mortality. OBJECTIVE: To assess the prevalence of overweight and obesity, hypertension, diabetes, and dyslipidemia and their associated risk factors among the adults. METHOD: A Multistage random sampling procedure was adopted for this community-based cross-sectional study carried out in eight states in urban, urban slum, and rural adult (≥18 years) populations of India. Household socioeconomic and demographic particulars, anthropometric, blood pressure measurements, and blood collection were done from all the selected subjects. Data analysis was done using SPSS version 23. RESULTS: The prevalence of overweight and obesity was 23.5 % (CI = 22.1-25) and 6.7 % (CI = 5.8-7.6) respectively, and was higher among women (25.8 %; CI = 23.7-27.9) and among urban (28.6 %; CI = 26-31.3) adults. The prevalence of hypertension and diabetes was 44 % (CI = 42.3-45.7) and 21 % (CI = 19.8-22.6) respectively; and was higher among the elderly (62 % and 29.7 %) and among urban (46.7 % and 25 %) population. Hypertriglyceridemia and high LDL was observed among 15 % (M: 15.5 %; F: 14.5 %) and 43 % (M: 40 %; F: 46.8 %) of subjects, and was higher in urban compared to rural areas. The odds of hypertension and diabetes were higher among men, among the elderly, among the overweight and obese individuals, with abdominal and truncal obesity, and among increased CRP levels. CONCLUSIONS: The burden of cardiometabolic risk factors is substantial among adults in the eight states evaluated. The risk factors are greater among men, the elderly and in urban areas.
The challenges and rigors of the modern-day health care systems demand a critical reappraisal of our training paradigms in cardiology. Today, modern day DM and DNB Cardiology training needs to seamlessly amalgamate tradi...The challenges and rigors of the modern-day health care systems demand a critical reappraisal of our training paradigms in cardiology. Today, modern day DM and DNB Cardiology training needs to seamlessly amalgamate traditional teaching methodologies with the rapidly evolving technology based educational tools now available to us for personalized and adaptive learning. The contemporary cardiology curricula need to incorporate ALL components of clinical competency including cognitive, psychomotor and affective skills to enable the next generation of cardiologists to provide truly holistic care to their patients. In addition, a greater focus on impactful cardiology research with an intent to publish it while in training, is likely to encourage at least some of the young trainees to pursue careers in academia. Most importantly, the exit examination patterns need to be restructured. We need to decide whether we need cardiologists who simply follow textbooks and are trained in procedures -or we need those who have the ability to themselves write the next chapters in cardiology, have the precision of thought, the depth of empathy, and the courage to question.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is defined as clinical evidence of myocardial infarction (MI) without significant obstruction (<50 % stenosis) in coronary angiography, making it a cl...Myocardial infarction with non-obstructive coronary arteries (MINOCA) is defined as clinical evidence of myocardial infarction (MI) without significant obstruction (<50 % stenosis) in coronary angiography, making it a clinically distinct and heterogeneous disorder. Unlike MI associated with obstructive coronary artery disease (MICAD), MINOCA is more common in younger women and often involves microvascular dysfunction or vasospastic conditions. Despite recent advancements in understanding MINOCA, its prognosis and predictors remain uncertain, necessitating further research into its pathogenesis. The diverse underlying causes of MINOCA mean that traditional treatment of the "one-size-fits-all" approach used for MICAD may not be appropriate, emphasizing the need for individualized treatment strategies based on accurate diagnosis. There is an urgent need to raise awareness among healthcare providers, implement standardized diagnostic protocols, and conduct targeted research to improve patient outcomes. Multi-centered studies and clinical trials are essential to establish evidence-based therapies and optimize management strategies for MINOCA, ensuring better long-term outcomes.
BACKGROUND: Evaluate the effect of mavacamten on echocardiographic parameters and cardiac biomarkers in patients with hypertrophic cardiomyopathy (HCM). METHODS: We searched PubMed, SCOPUS, Web of Science, and Cochrane L...BACKGROUND: Evaluate the effect of mavacamten on echocardiographic parameters and cardiac biomarkers in patients with hypertrophic cardiomyopathy (HCM). METHODS: We searched PubMed, SCOPUS, Web of Science, and Cochrane Library until November 2023. Results were reported as mean difference (MD) and Risk Ratio (RR) with 95 % confidence intervals (CI). RESULTS: Seven studies with 524 patients (456 with obstructive HCM and 59 with non-obstructive HCM) were included. Mavacamten significantly improved septal early diastolic mitral annular velocity (e') (MD 0.78, 95 % CI [0.51 to 1.05]) and left ventricular mass index (LVMI). It reduced left ventricular outflow tract (LVOT) gradient, NT-proBNP (MD -557.14, 95 % CI [-685.59 to -428.68]), and troponin levels. Improvements were also seen in left atrial volume index (MD -6.26, 95 % CI [-8.88 to -3.63]) and E/e' ratios, particularly in obstructive HCM patients. CONCLUSION: Mavacamten enhances echocardiographic and cardiac biomarker outcomes in HCM patients on short-term follow-up. Limited data on non-obstructive HCM require cautious interpretation.
This retrospective, hospital-based observational study was aimed to examine the indications for PPM implantation, risk factors, demographics, and microbiological profiles of PPM infections (PPMI). The study included pati...This retrospective, hospital-based observational study was aimed to examine the indications for PPM implantation, risk factors, demographics, and microbiological profiles of PPM infections (PPMI). The study included patients presenting with local inflammatory signs and excluded those under 18 years old. Of the 716 patients who underwent Cardiac Implantable Electronic Device (CIED) implantation, 37.7 % received single-chamber devices and 52.8 % received double-chamber devices. PPMI was identified in 15 patients (2.09 %), with infections more prevalent in devices implanted over 12 months prior. Diabetes (36.11 %) and hypertension (32.56 %) were the most common comorbidities. Culture-negative infections (53.33 %) predominated, followed by methicillin-resistant Staphylococcus aureus (MRSA) (33.33 %).
INTRODUCTION: Aortic valve neocuspidization (AVNeo) using fixed autologous pericardium, also known as the Ozaki technique, is an effective therapy for treating aortic valvulopathies. It serves as an alternative to comple...INTRODUCTION: Aortic valve neocuspidization (AVNeo) using fixed autologous pericardium, also known as the Ozaki technique, is an effective therapy for treating aortic valvulopathies. It serves as an alternative to complex aortic valve repair, offering better hemodynamics compared to biological or mechanical valve replacement, without the need for lifelong anticoagulation. OBJECTIVES: To evaluate the immediate and early outcomes of our initial experience with the AVNeo procedure in a spectrum of aortic valve diseases. METHODS: In this retrospective cohort study, seventeen AVNeo procedures were performed between March 2023 and October 2023 at our center. All patients completed one year of follow-up. Outcomes were assessed by echocardiographic evaluation postoperatively and at one year, including complications and mortality. RESULTS: Patient age ranged from 7 to 77 years (mean 35.2 ± 22.4 years), with 3 females among the 17 patients. Aortic valve morphology was bicuspid in 6 (35.3 %) and tricuspid in 11 (64.7 %) patients. Twelve patients had aortic stenosis as the primary pathology, and five had moderate to severe aortic regurgitation. In aortic stenosis patients, the preoperative mean peak gradient was 82.3 ± 20.3 mmHg, and mean gradient was 48.9 ± 18.5 mmHg. Postoperatively, mean peak gradient reduced to 9 ± 5.3 mmHg, and mean gradient to 16.7 ± 9.1 mmHg. Two patients required conversion to prosthetic valve replacement for progressive aortic regurgitation. There was no mortality at one year, though one patient developed severe aortic regurgitation. CONCLUSION: AVNeo is a feasible, reproducible procedure with favorable early outcomes, low pressure gradients, and mild regurgitation at one year. It is a cost-effective option, particularly in resource-limited settings like India.
BACKGROUND: The Core Cardiology Training Symposium (COCATS) guidelines, endorsed by the American College of Cardiology (ACC) emphasize competency-based training and establish milestones to be met during cardiology traini...BACKGROUND: The Core Cardiology Training Symposium (COCATS) guidelines, endorsed by the American College of Cardiology (ACC) emphasize competency-based training and establish milestones to be met during cardiology training. However, India lacks such guidelines for training cardiology fellows. OBJECTIVES: The study aimed to evaluate the self-declared competencies of cardiology fellows across multiple preselected domains as per the COCATS-4 recommendations. METHODS: The study was conducted at three premier institutions across India between June 2022 and December 2024. A total of 52 cardiology fellows who had recently completed their 3-year core cardiology training course were included in the study. These candidates completed a questionnaire that included a checklist assessing different levels of competency in various preselected aspects of cardiovascular medicine. Candidates were also asked about their awareness of COCATS-4 standards and cardiology training in India. RESULTS: While all trainees reported Level 1 competency in cardiac catheterization, heart failure, and adult congenital heart disease, a significantly lower percentage of trainees achieved Level 1 competency in nuclear medicine (1.9 %), cardiac MRI (3.8 %), and cardiac CT (17.3 %). At Level 2, cardiac catheterization (73.1 %) and echocardiography (63.5 %) had the highest self-declared competencies, whereas nuclear medicine (3.8 %), cardiac MRI (0 %), and cardiac CT (0 %) had the lowest. Only 23.1 % of trainees were aware of COCATS-4, and 82.7 % believed that standardized guidelines would improve cardiology training in India. CONCLUSIONS: The results emphasize the wide variability in self-reported competencies of cardiology trainees across India and highlight the deficiencies in certain core areas like cardiovascular imaging.
OBJECTIVE: Intravenous anaesthetics induce loss of consciousness in one arm-brain circulation time. As the circulatory transit time in patients with mitral stenosis (MS) and aortic stenosis (AS) is increased, the deliver...OBJECTIVE: Intravenous anaesthetics induce loss of consciousness in one arm-brain circulation time. As the circulatory transit time in patients with mitral stenosis (MS) and aortic stenosis (AS) is increased, the delivery of anaesthetics to the brain may be prolonged and consequently the onset of hypnosis. This study aimed to compare the induction time in patients with and without valvular heart disease (VHD). DESIGN: Prospective, single-center, open-label analytical study. SETTING: It was conducted in adult patients undergoing elective cardiac surgery. PARTICIPANTS: The patients (n = 144) were segregated into three groups; Group 1 - Stenotic VHD (MS, AS), Group 2 - Regurgitant VHD (Mitral Regurgitation, Aortic Regurgitation), and Group 3 - Control (coronary artery disease). METHOD: General anaesthesia was induced with intravenous thiopental 4mg kg bolus over 20s. The time to induction was noted as loss of eyelash reflex. Bispectral Index (BIS) values were recorded over 2 min. Statistical analysis was performed using SPSS software version 25.0. A p value < 0.05 was considered significant. MAIN RESULTS: Patients in Group 1 (n = 48) had significantly prolonged induction time (99.6 ± 12.9s; p < 0.001) compared to the other two groups (n = 48 each) (68.5 ± 9.6s in Group 2 and 70.4 ± 11.8s in Group 3). Time required for BIS to fall below 60 was significantly longer in Group 1 (139.4 ± 24.6s; p < 0.001) compared to Group 2 (90.4 ± 6.3s) and Group 3 (92.1 ± 12s). CONCLUSION: The induction time was prolonged in patients with stenotic VHD compared to patients with regurgitant VHD or those without VHD.
OBJECTIVE: Low cardiac output syndrome (LCOS) is the leading cause of death after cardiac surgery. Studies have shown that 24% of postoperative mortality in patients undergoing pericardiectomy is attributed to LCOS. It i...OBJECTIVE: Low cardiac output syndrome (LCOS) is the leading cause of death after cardiac surgery. Studies have shown that 24% of postoperative mortality in patients undergoing pericardiectomy is attributed to LCOS. It is necessary to explore the risk factors of LCOS after pericardiectomy in patients with tuberculous constrictive pericarditis (CP). METHODS: Patients undergoing pericardiectomy for tuberculous CP were included in the study. The personal and clinical data of these patients with LCOS and without LCOS were collected and compared. Logistic regression analyses were conducted to identify the risk factors of postoperative LCOS. ROC curve analysis was used to check the accuracy of each risk factor to predict LCOS. RESULTS: A total of 175 patients with tuberculous CP were included in this study, of which 35 cases developed LCOS postoperatively, resulting in an incidence rate of 20%. The independent predictors of LCOS were preoperative NYHA class III/IV, decreased left ventricular mass index (LVMI), and hypoalbuminemia in these patients (p < 0.05). When albumin (ALB) < 30.35 g/L, it had the highest diagnostic value in predicting postoperative LCOS, with sensitivity and specificity of 59.4% and 86.9%, respectively (p < 0.01). CONCLUSIONS: For patients with tuberculous CP, preoperative NYHA class III/IV, lower LVMI, and hypoalbuminemia are independent risk factors for LCOS following pericardiectomy. Clinically, these risk factors should be identified as early as possible, and early pericardiectomy should be performed when the patient's cardiac function remains well-preserved to avoid the occurrence of cardiac cachexia, myocardial atrophy and severe hepatic insufficiency.
BACKGROUND: Pulmonary congestion detected by lung ultrasound (LUS) has emerged as a valuable prognostic marker in acute heart failure (AHF). This systematic review and meta-analysis aimed to evaluate the prognostic signi...BACKGROUND: Pulmonary congestion detected by lung ultrasound (LUS) has emerged as a valuable prognostic marker in acute heart failure (AHF). This systematic review and meta-analysis aimed to evaluate the prognostic significance of residual B-lines identified by LUS before hospital discharge. METHODS: A comprehensive literature search of PubMed, Cochrane Library, ScienceDirect, and ClinicalTrials.gov was conducted up to October 4, 2024. Studies assessing the association between residual B-lines and adverse clinical outcomes in hospitalized AHF patients were included, while studies involving ambulatory assessments were excluded. The primary outcome was a composite of all-cause mortality and heart failure (HF) rehospitalization. Secondary outcomes included all-cause mortality and HF rehospitalization individually. Pooled hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated. RESULTS: Fifteen studies were included. Residual B-lines were significantly associated with an increased risk of composite outcomes (HR: 2.32; 95 % CI: 1.91-2.82), all-cause mortality (HR: 3.01; 95 % CI: 1.91-4.73), and HF readmission or cardiovascular events (HR: 4.01; 95 % CI: 2.22-7.24). Risk increased with greater B-line burden. Prognostic impact was stronger in short-term follow-up (<6 months; HR: 3.57) than in longer-term follow-up (≥6 months; HR: 1.96). CONCLUSIONS: Residual pulmonary congestion assessed by LUS at discharge is a strong independent predictor of adverse outcomes and may guide therapy decisions in AHF management.
BACKGROUND: Post myocardial infarction ventricular septal rupture (MI-VSR) is a devastating complication after acute myocardial infarction (AMI); lacks uniform treatment recommendations and carries poor outcomes. OBJECTI...BACKGROUND: Post myocardial infarction ventricular septal rupture (MI-VSR) is a devastating complication after acute myocardial infarction (AMI); lacks uniform treatment recommendations and carries poor outcomes. OBJECTIVES: To evaluate the outcomes of post MI-VSR, stratify based on management strategy and determine the predictors of survival. METHODS: All cases of VSR hospitalized in a tertiary referral cardiac care center over 11 years were retrospectively evaluated for various parameters and stratified based on the modality of treatment, either conservative, surgical or transcatheter closure. RESULTS: Among a total of 131 cases of VSR with a median age of 65 years, hospitalized from January 2013 to December 2023, 47(35.9 %) had surgical closure, 25(19.1 %) had transcatheter closure and the rest were managed conservatively. 11(8.4 %) cases alone underwent primary percutaneous coronary intervention (PCI). Apex was the commonest (79.3 %) site. Older patients and patients in higher stages of shock at the time of VSR diagnosis were often managed conservatively. Two-thirds of surgical patients were in SHOCK stage A or B; three-fourths of transcatheter group were in stage C or D. Overall mortality was 71 % with 100 % in conservative, 68 % in transcatheter closure and 36.2 % in surgical group. Younger age, lower shock stage, VSR closure, and delayed closure were predictors of survival. CONCLUSIONS: Post MI VSR outcomes were poor, based on the hemodynamic status. Closure of VSR is essential for survival. Surgical closure had lower mortality than transcatheter closure possibly contributed by a selection bias.
OBJECTIVE: Drug-eluting stents (DES) are a normative care of coronary stenosis. However, their efficacy was limited by stent thrombosis and in-stent restenosis especially in small vessel coronary artery disease (SvCAD)....OBJECTIVE: Drug-eluting stents (DES) are a normative care of coronary stenosis. However, their efficacy was limited by stent thrombosis and in-stent restenosis especially in small vessel coronary artery disease (SvCAD). The aim of this study was to assess angiographic efficacy and clinical outcomes of drug coated balloons (DCB) as compared with DES in SvCAD setting. METHODS: A total of 100 SvCAD patients with percutaeous angioplasty of culprit coronary arteries <3 mm diameter and >70 % stenosis were enrolled in this study. The patients were categorized into DES arm and DCB arm. One year clinical outcomes were assessed. The primary endpoint was in-lesion late lumen loss (LLL). The secondary endpoints were vessel thrombosis, major bleeding, all-cause death and major adverse cardiac events (MACEs). RESULTS: One year clinical follow-up revealed that in-lesion LLL was significantly lower in DCB arm as compared with DES arm (p = 0.004). Composite MACE was significantly higher in DES group compared to DCB group (p < 0.001). Non-fatal myocardial infarction (MI), target lesion revascularization (TLR), and major bleeding in DES group were significantly higher than DCB group (p = 0.04 & p < 0.001 & p = 0.03, respectively). However, there was a numerically; but not significantly, higher incidence of cardiac death (p = 0.65), and vessel thrombosis (p = 0.18) in DES arm compared to DES arm. CONCLUSION: In SvCAD setting, DCB has favourable angiographic and clinical outcomes; as evidenced by lower LLL and composite MACE at one year follow up, compared to DES.
OBJECTIVES: Left atrial appendage (LAA) dysfunction is a risk factor for stroke. Evidence shows that frequent premature ventricular complexes (PVCs) are associated with embolic stroke. Whether left atrial dysfunction is...OBJECTIVES: Left atrial appendage (LAA) dysfunction is a risk factor for stroke. Evidence shows that frequent premature ventricular complexes (PVCs) are associated with embolic stroke. Whether left atrial dysfunction is the bridging link between frequent premature ventricular complexes and stroke is unknown. MATERIALS AND METHODS: Patients with a structurally normal heart undergoing elective electrophysiology study were included. Transoesophageal echo was used to measure LAA flow velocities. To simulate PVCs in bigeminal rhythm, single paced beats were delivered from the right ventricle with a coupling interval of QT + 10 % RR interval after each sinus beat. LAA flow doppler velocities were acquired at baseline, after 5 min of pacing and again 5 min after cessation of pacing. RESULTS: Ten patients were included in the study. Late diastolic emptying velocity decreased significantly after 5 min of PVCs (55.68 ± 16.33 cm/s, p = 0.01) compared to baseline (68.01 ± 10.34 cm/s). This almost returned to baseline after a rest period of 5 min (63.13 ± 16.16 cm/s, p = 0.277). The left atrial appendage filling velocity exhibited a statistically non-significant trend toward a decrease after 5 min of PVCs (45.70 ± 10.85 cm/s, p = 0.129), compared to the baseline value of 51.31 ± 14.11 cm/s. CONCLUSIONS: Premature ventricular complexes in bigeminal pattern for 5 min resulted in an acute decrease in the late diastolic emptying velocity. This is a possible mechanism for the increased risk of strokes in patients with frequent PVCs.