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PubMed2004

Comparison of left atrial volume and function after linear ablation and after cardioversion for chronic atrial fibrillation.

Several techniques for treatment of atrial fibrillation (AF) have been developed, including the direct placement of radiofrequency for lesions at open heart surgery. Detailed evaluation of left atrial (LA) function has not been performed after these procedures and has not been compared in patients with chronic AF. We compared the atrial function of patients with sustained sinus rhythm (SR) after linear ablation with a group who underwent direct-current cardioversion and a group of normal controls to investigate the measurable deleterious effects, if any, on atrial function after the surgical procedure. Twenty-one consecutive patients who had maintained SR for >6 months after a linear radiofrequency ablation (LRFA) procedure were studied. As control subjects, we examined 33 patients with chronic AF successfully restored to SR by cardioversion who maintained SR for >6 months and 42 age-matched normal subjects. LA function was decreased in both the LRFA and cardioverted AF groups compared with normal controls. The parameters of LA function, atrial fraction, LA ejection fraction, and the A' velocity were lowest in the LRFA group, intermediate in the cardioverted AF group, and highest in the normal controls (LA function: 15.8 +/- 10%, 26 +/- 10%, 33 +/- 7%; p = 0.0001; LA ejection fraction: 31 +13%, 41 +/- 12%, 51 +/- 9%; p = 0.0001; A' velocity: 4.2 +/- 1.4, 7.6 +/- 2.2, 9.5 +/- 1.9 cm/s; p = 0.0001). LA volumes were increased in the LRFA and cardioverted AF groups compared with normals (62.8 +/- 22 vs 70.6 +/- 17 vs 38.7 +/- 9.8 ml; p = 0.0001). Thus, although LA function is restored and maintained after LRFA has been performed during open heart surgery, LRFA use is associated with a measurable decrease in LA function over and above that found after conventional cardioversion.

Aged↗
PubMed2002

[The relationship of the left atrial spontaneous echo contrast integrated backscatter with left atrial appendix function and tissue doppler characteristics].

OBJECTIVE: Integrated backscatter (IBS) is an objective method to measure spontaneous echo contrast (SEC) quantitatively. The purpose of this study was to investigate the relationship between the quantitative values of left atrial SEC measured by using IBS with its qualitative gradation as well as the left atrial appendix (LAA) functions and LAA tissue Doppler characteristics (TD). METHODS: Thirty-two patients (23 female, 9 male) with various diseases undergoing transesophageal echocardiography (TEE) were included. Mean age was 52 + 13 years. Left atrial SEC was graded as no SEC (n = 12), mild (n = 12) or severe SEC (n = 8) in patients underwent TEE. LAA peak emptying and LAA apical and basal TD velocities were measured. LAA ejection fraction was assessed by standard means. RESULTS: Between no SEC and mild SEC groups, left atrium IBS and LAA apical TD values were found statistically significant. But there were no differences between two groups regarding LAA emptying velocities, LAA ejection fraction values and LAA basal TD values. All of these parameters were found statistically different between severe and mild SEC groups. The left atrial IBS values were found to be correlated positively with the qualitative SEC grade. The left atrial IBS values correlated negatively with LAA emptying, apical TD velocities and LAA ejection fraction values. CONCLUSION: Integrated backscatter provides an objective quantitative measure of SEC that correlates well with LAA apical TD velocities and the other parameters of LAA.

Atrial Appendage↗
PubMed2005

New parameters for left ventricular function in atrial fibrillation: based on the relationship between RR interval and performance.

This study was designed to obtain new parameters representing left ventricular (LV) function independent of irregular RR intervals in atrial fibrillation (AF). AF patients were divided into Normal (n=9) and LV Dysfunction (n=9) groups. The relations between LV outflow peak ejection velocity (Vpe) and preceding (RR-1) or prepreceding RR intervals (RR-2) were obtained using logarithmic equations, from which the squared correlation coefficient (r2), slope, Vpe at RR-1 or RR-2=1 sec (Vpe-1), and the ratio of slope to Vpe-1 (Slope/Vpe-1) were calculated. Among the parameters between RR-1 and Vpe, Slope/Vpe-1 was higher in LV Dysfunction group than in Normal group (p=0.05). When only coordinates with RR-1 from 0.6 to 1 sec were included, Slope/Vpe-1 (p=0.001) was higher in LV Dysfunction group than in Normal group. Among the parameters between RR-2 and Vpe, Slope/Vpe-1, slope, and r2 were different between the two groups. In multivariate analysis, Slope/Vpe-1 between RR-2 and Vpe was only independent parameter. However, Slope/Vpe-1 between RR-1 and Vpe in the coordinates with RR-1 from 0.6 to 1 sec had the highest discriminating power. New parameters derived from the relations between RR intervals and LV performance might be useful to evaluate LV function quantitatively in AF.

Age Factors↗
PubMed2005

Assessment of cardiac structure and left atrial appendage functions in primary antiphospholipid syndrome: a transesophageal echocardiographic study.

BACKGROUND AND PURPOSE: Although thromboembolic events are the major complication of primary antiphospholipid syndrome (PAPS), cardiac involvement is commonly present. Left atrial appendage (LAA) is recognized as an important source for thrombus formation and thromboembolism. The purpose of the study was to assess the structure and function of LAA with transesophageal echocardiography (TEE) in PAPS patients. METHODS: Thirty-one PAPS patients (22 women, mean age 36+/-9 years) in sinus rhythm and 31 (17 women, mean age 37+/-7 years) controls with normal TEE examination were investigated. RESULTS: Eighty-four percent of the PAPS patients had functional and structural valvular defect predominantly in the mitral valve. Valvular lesions were especially frequent in PAPS patients with a history of cerebrovascular events, patients with history of arterial thrombosis (91.6%), and patients with high titers of IgG anticardiolipin antibodies (100%). Intracardiac thrombus was present in 5 patients and in 1 of them it was located in LAA. The structure of LAA was similar between groups. Left atrial appendix ejection fraction (51.8+/-4 versus 48.6+/-5.5%; P<0.05) and LAA peak outflow velocity (87+/-10.9 versus 80.6+/-10.3 cm/s; P=0.02) was significantly higher in PAPS group compared with controls. In PAPS patients with mitral regurgitation (MR), LAA outflow peak velocity (84.3+/-10 versus 98.6+/-6.5 cm/s; P=0.002) and LAA inflow peak velocity (67.8+/-10.5 versus 80.8+/-8.6 cm/s; P=0.009) were significantly lower compared with PAPS patients without MR. CONCLUSIONS: It was concluded that disease process in PAPS frequently involved cardiac valves especially mitral valve but spared LAA function. LAA function was normal, but intracardiac thrombus was present in 5 patients and 1 of them was located in LAA. MR in PAPS patients seems to impair LAA function.

Adolescent↗
PubMed1992

[Left atrial booster pump function in patients with hypertrophic cardiomyopathy and essential hypertension: evaluations based on left atrial pressure-volume relationship].

In patients with hypertrophic cardiomyopathy (HCM) and essential hypertension (HT), left ventricular dysfunction in early diastole which is associated with left atrial contraction plays an important role in left ventricular filling. To evaluate left atrial booster pump function, we analyzed left atrial preload (left atrial pressure at the end of diastasis; LAPd, left atrial volume index at the end of diastasis; LAVd), left atrial afterload (left ventricular end-diastolic pressure; LVEDP, left ventricular chamber stiffness constant; K), and left atrial ejection indices (left atrial ejection fraction during atrial contraction; LAEF, left atrial ejection volume index during atrial contraction; ACVI). The study subjects consisted of control subjects (n = 5), HT patients (n = 6), and HCM patients (n = 11). The left ventricular wall was significantly thicker in the HT and HCM groups. The left ventricular rapid filling volume index was less in the HT group, and significantly less in the HCM than in the control group. LAPd and LAVd were greater in the HT group than in the control group, and greater in the HCM group than in the HT group. LVEDP and K were greater in the HT group than in the control group, and significantly greater in the HCM group than in the other 2 groups. ACVI was greater in the HT group than in the control group, but in the HCM group, ACVI was significantly less than in the HT group and did not differ significantly from that in the control group. LAEF was significantly less in the HCM group than in the other 2 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Left atrial and left ventricular function in healthy children and young adults assessed by three dimensional echocardiography.

OBJECTIVE: To establish normal values of left atrial and left ventricular volumes and function in children and young adults using three dimensional echocardiography (3DE). METHODS: 169 healthy subjects aged 2 to 27 years were studied by digitised 3DE. 3DE was achieved using rotational acquisition of planes at 18 degrees intervals from the parasternal view for the left atrium and from the transthoracic apical view for the left ventricle with ECG gating and without respiratory gating. Left atrial and left ventricular volumes could be calculated throughout the heart cycle, and the respective time-volume curves were reconstructed in each subject. RESULTS: For the analysis the subjects were divided into five groups according to body surface area: 0.5-0.75 m2, 0.75-1.0 m2, 1.0-1.25 m2, 1.25-1.5 m2, and over 1.5 m2. Mean (SD) left atrial maximum volume/body surface area was 19.6 (3.5), 21.7 (3.7), 22.0 (4.7), 24.5 (4.8), and 27.4 (6.4) ml/m2; left ventricular maximum volume/body surface area was 50.1 (8.8), 54.9 (10.1), 56.4 (9.9), 58.7 (11.0), and 64.4 (10.3) ml/m2. Left atrial active emptying increased from 19% to 35% with age (r = 0.34, p < 0.001) and with decreasing heart rate (r = -0.28, p < 0.001). CONCLUSIONS: Transthoracic 3DE is well suited for studying the phasic changes in left atrial and left ventricular volumes in young children as well as in adults. The data obtained from 169 healthy subjects will serve as a reference for further studies in patients with various cardiac abnormalities.

Adolescent↗
PubMed2005

Left atrial appendage function analyzed by tissue Doppler imaging in mitral stenosis: effect of afterload reduction after mitral valve commissurotomy.

BACKGROUND: This study sought to investigate the relative load dependence of left atrial appendage (LAA) tissue Doppler velocities in patients with mitral stenosis after percutaneous mechanical mitral commissurotomy (PMMC). METHODS: LAA tissue Doppler velocities were obtained in 34 patients with mitral stenosis (20 with sinus rhythm and 14 with atrial fibrillation) before and after PMMC by transesophageal echocardiography. Standard ultrasound studies were also performed for mitral valve orifice area, transmitral pressure gradient, and LAA blood flow velocity measurements. RESULTS: PMMC resulted in a significant increase in mitral valve area (P < .001) and decrease in mean transmitral pressure gradient (P < .001). LAA tissue Doppler velocities consisted of a triphasic velocity profile: SLAA and ELAA occurring during left ventricular contraction and relaxation, respectively, and ALAA occurring after the atrial contraction. After PMMC, ELAA and ALAA velocities consistently increased (4.8 +/- 1.2 to 7.9 +/- 2.6 cm/sec [P < .001] and 6.6 +/- 2.9 to 8.1 +/- 4.2 cm/sec [P < .05], respectively). The mean transmitral pressure gradient was significantly correlated with ALAA before and after PMMC (r = .65). CONCLUSIONS: In mitral stenosis, tissue Doppler velocities illustrated improvement of regional LA function after PMMC, in relation to decreased transmitral pressure gradient.

Atrial Function, Left↗
PubMed2001

Influence of age on left atrial appendage function in patients with nonvalvular atrial fibrillation.

BACKGROUND: Age is an independent risk factor for thromboembolism in nonvalvular atrial fibrillation (NVAF). An association between low left atrial appendage (LAA) Doppler velocities and thromboembolic risk in NVAF has been reported. HYPOTHESIS: The study was undertaken to identify age-related differences in LAA function that may explain the higher thromboembolic rates in older patients with NVAF. METHODS: Forty-two consecutive patients (age 69+/-2 years [range 42-92], 24 [57%] men) with NVAF underwent transthoracic and transesophageal echocardiography. The following were compared in 22 patients younger and 20 older than 70 years: left ventricular (LV) diameter, mass and ejection fraction, left atrial (LA) diameter and volume, LAA area and volume, LAA peak emptying (PE) and peak filling (PF) velocities, presence and severity of spontaneous echo contrast (SEC) and mitral regurgitation (MR). RESULTS: Left atrial diameter (4.6+/-0.1 vs. 4.5+/-0.2 cm), LA volume (105+/-10 vs. 92+/-8 ml), LAA area (6.8+/-0.6 vs. 5.2+/-0.8 cm2), and LAA volume (5.6+/-0.9 vs. 3.9+/-1.0 ml) were similar (p>0.05) in both groups. Older patients had lower LAA PE (26+/-2 vs. 34+/-3 cm/s, p = 0.02) and PF (32+/-2 vs. 41+/-4 cm/s, p = 0.04) velocities, lower LV mass (175+/-13 vs. 234+/-21 gm, p = 0.02), higher relative wall thickness (0.52+/-0.02 vs. 0.43+/-0.03, p = 0.02), smaller LV diastolic diameter (4.3+/-0.1 vs. 5.2+/-0.2 cm, p < 0.001), and higher LV ejection fraction (62+/-2 vs. 55+/-2%, p = 0.025). Frequency and severity of SEC and MR were similar in both groups. Multivariate analysis identified older age as the only significant predictor of reduced LAA velocities. CONCLUSION: Compared with younger patients, older patients with NVAF have lower LAA velocities despite higher LV ejection fraction, smaller LV size, and similar LA and LAA volumes. These findings may explain the higher thromboembolic rates in older patients with NVAF.

Adult↗
PubMed2000

Effect of inotropic stimulation on left atrial appendage function in atrial myopathy of chronic atrial fibrillation.

Atrial fibrillation (AF) leads to remodeling of the left atrium (LA) and left atrial appendage (LAA), resulting in atrial myopathy. Reduced LA and LAA function in chronic AF leads to thrombus formation and spontaneous echo contrast (SEC). The effect of inotropic stimulation on LAA function in patients with chronic AF is unknown. LAA emptying velocity (LAAEV) and maximal LAA area at baseline and after dobutamine were measured by transesophageal echocardiography in 14 subjects in normal sinus rhythm (NSR) and 6 subjects in AF. SEC in the LA was assessed before and after dobutamine. LAAEV increased significantly in both groups. However, the LAAEV at peak dobutamine in patients with AF remained significantly lower than the baseline LAAEV in patients who were in NSR (P = 0.009). Maximal LAA area decreased significantly with dobutamine in both groups, but LAA area at peak dose of dobutamine in patients with AF remained greater than baseline area in those in NSR (P = 0.01). Despite the increase in LAAEV, SEC improved in only two of five patients. We conclude that during AF, the LAA responds to inotropic stimulation with only a modest improvement in function.

Atrial Appendage↗
PubMed2006

Left atrial appendage function in patients with systemic embolism in spite of in sinus rhythm.

OBJECTIVE: We sought to investigate whether left atrial (LA) appendage (LAA) function was impaired in patients with systemic embolism in sinus rhythm. METHODS: Transesophageal echocardiography was performed in 7 patients within 5 days after embolism (early group) and in 32 patients, more than 5 days after embolism (late group). We searched intracardiac thrombus and determined LAA area and LAA flow velocity, and the grade of spontaneous echocontrast. RESULTS: LA thrombus could be detected in 2 of the 39 patients only in early group (P = .028). The patients of early group, as compared with late group, had lower LAA flow velocity (28 +/- 16 vs 60 +/- 26 cm/s, P = .007) and higher grade of spontaneous echocontrast score (1.14 +/- 1.46 vs 0.25 +/- 0.62, P = .013). LA dimension and LAA area were not statistically different. CONCLUSION: LAA function may be impaired early after embolism even in sinus rhythm.

Aged↗
PubMed2000

Maternal cardiac systolic and diastolic function: relationship with uteroplacental resistances. A Doppler and echocardiographic longitudinal study.

OBJECTIVE: To test the hypothesis of the existence of a relationship between central and peripheral hemodynamic parameters by the longitudinal evaluation of maternal echocardiographic and uteroplacental resistance modifications during normal pregnancy. METHODS: Forty-three healthy normotensive primigravidae were evaluated at 12 +/- 1, 21 +/- 1, and 33 +/- 1 weeks of gestation with uterine artery color Doppler and maternal echocardiographic examinations to identify morphologic, systolic, and diastolic variables. RESULTS: Cardiac output and stroke volume significantly increased during pregnancy. Uterine resistance index (RI) decreased from the first to the second trimesters (0.72 +/- 0.10 versus 0.54 +/- 0.09, P < 0.001). Left atrial dimensions increased during pregnancy (33.8 +/- 1.9 cm, 38.1 +/- 1.8 cm, 39.3 +/- 2.1 cm, P < 0.001). Left atrial function also increased. Left ventricular mass increased (132 +/- 18 g, 162 +/- 16 g, 174 +/- 27 g, P < 0.001). Diastolic function parameters showed significant modifications: E wave velocity and E/A ratio decreased; A wave velocity and deceleration time of the E wave (DtE) increased; the left ventricular isovolumetric relaxation time (IVRT) decreased significantly (88.7 +/- 6.7 ms, 75.6 +/- 7.7 ms, 71.1 +/- 5.0 ms, P < 0.001) showing a correlation with left atrial dimensions and RI (r = -0.38, r = 0.47, respectively; P < 0.001). CONCLUSIONS: Diastolic cardiac function varies during pregnancy. A relationship between preload (left atrial enlargement), afterload (RI reduction), morphologic, and diastolic function modifications (IVRT reduction, DtE prolongation) appears to exist as a consequence of the hemodynamic modifications which occur during physiologic pregnancy. Diastolic function analysis maybe useful to identify women who fully adapt to pregnancy, and to understand the mechanisms that might be involved in women who show abnormal uterine artery Doppler waveforms.

Adult↗
PubMed1992

[Evaluation of the diagnostic effectiveness of the indicators of left atrial myocardial function in intraoperative cardiac weakness in patients with mitral valve defects].

Excursions of the left-atrial myocardium were recorded by tensiometric transducers in patients with mitral valvular disease. The structural features of myocardial excursions were evaluated as symptoms. Myocardial shortening in P-Q interval was considered a negative symptom in relation to heart weakness, shortening in T-Q interval as an indefinite symptom, and shortening in Q-T interval as a positive symptom. Appraisal of the sensitivity and specificity of these symptoms revealed their high diagnostic efficacy.

Adolescent↗
PubMed1995

[The influence of electrical time interval indices and aging on the left atrial systolic time intervals].

The influence of aging and heart rate on left ventricular systolic time intervals is well known, but the effects on left atrial systolic time intervals, a new index of left atrial function, remain unknown. The influence of aging and heart rate on left atrial systolic time intervals was investigated in 43 normal subjects (13-72 years of age) by Doppler echocardiography. Atrial pre-ejection period, atrial ejection time, and corrected atrial pre-ejection period were obtained by transmitral Doppler echocardiography. Simple regression analysis showed atrial pre-ejection period significantly correlated with P wave duration (PP; r = 0.78), and PR interval (PR; r = 0.60), but not with RR interval (RR). However, multiple regression analysis showed atrial pre-ejection period significantly correlated only with PP. Simple regression analysis found atrial ejection time significantly correlated with PP (r = 0.38), and PR (r = 0.39), but not with RR. However, multiple regression analysis found atrial ejection time did not correlate with any factor significantly. Aging was significantly correlated with corrected atrial pre-ejection period (r = -0.37), but not with corrected atrial ejection time and atrial pre-ejection period. Atrial ejection time significantly correlated with corrected atrial pre-ejection period (r = -0.37), but not with atrial pre-ejection period. Corrected atrial pre-ejection period is a clinically useful index of left atrial systolic function.

Adolescent↗
PubMed2001

Effect of left atrial size and function on P-wave dispersion: a study in patients with paroxysmal atrial fibrillation.

BACKGROUND: Paroxysmal atrial fibrillation (PAF), a common arrhythmia, is caused by the fractionated and nonhomogeneous propagation of sinus impulse. HYPOTHESIS: This study was undertaken to examine the effect of left atrial (LA) dimension and function on P-wave dispersion (deltaP) in unselected patients with PAF and health controls. METHOD: In this study, 62 consecutive patients with PAF (32 men, 30 women, mean age 55+/-11 years) and 62 age- and gender-matched healthy controls (33 men, 29 women, mean age 52+/-13 years) were studied to compare the effect of LA size, volume, and function on deltaP (difference between maximum and minimum P-wave duration on 12-lead electrocardiogram). RESULTS: P-wave dispersion in patients with PAF and normal LA diastolic diameter (LAD) was longer than that in controls with normal LA size (53+/-8 vs. 34+/-8 ms, p < 0.001). P-wave dispersion increased in patients with PAF (62+/-12 vs. 53+/-8 ms, p = 0.003) and controls (40+/-7 vs. 34+/-8 ms, p = 0.005) with increased LAD. Presence or absence of PAF did not interact with LAD for their effect on deltaP (2 x 2 analysis of variance test p = 0.20). In the PAF group, deltaP correlated with LAD (r = 0.43, p = 0.002), LA diastolic volume (r = 0.6, p < 0.001), and LA ejection fraction (AEF) (r = - 0.33, p = 0.05). The AEF was preserved when LAD increased in the patients without PAF (0.52+/-0.07 vs. 0.57+/-0.10, p = NS), however was significantly decreased in the PAF group (0.37+/-0.12 vs. 0.49+/-0.10, p = 0.01). On multivariate logistic regression analysis, only deltaP retained significance on development of PAF. CONCLUSION: It was concluded that deltaP increased in patients with PAF and normal LA size. In controls with increased LA size, deltaP increased but did not reach the levels attained in patients with PAF. The AEF was decreased in patients with PAF but was preserved in those without PAF. These findings can be explained by the changes in LA microarchitecture which concurrently decreased atrial myocardial contraction, increased deltaP, and predisposed to PAF.

Adult↗
PubMedDate not supplied

Relationship between left ventricular wall thickness and left atrial size: comparison with other measures of diastolic function.

We postulated that in patients with essential hypertension and normal left ventricular (LV) systolic function, left atrial (LA) size correlates with LV wall thickness by better reflecting the chronicity and duration of LA hypertension than the commonly used hemodynamic and Doppler measures of LV diastolic function. Accordingly, hemodynamic, Doppler, and two-dimensional echocardiographic measurements were performed in 30 subjects with no cardiovascular abnormalities other than essential hypertension (mean systolic blood pressure of 150 +/- 29 mm Hg). The mean LV wall thickness was 0.57 +/- 0.14 cm/m2 and the mean LV ejection fraction was 0.62 +/- 0.12. Hemodynamic and Doppler measures including pulmonary capillary wedge and LV end-diastolic pressures, isovolumic LV pressure relaxation, LV chamber elastic stiffness, and E/A ratio (E and A waves on the pulsed Doppler signal of the mitral valve) correlated poorly (r = 0.01 to -0.52) with LV wall thickness. Both E/A ratio and isovolumic LV pressure relaxation correlated better (p = 0.05) with patient age than with LV wall thickness. In contrast, LA area (in the apical four-chamber view) had a good correlation (r = 0.77 for LA area in atrial diastole and r = 0.86 for LA area in atrial systole) with LV wall thickness. Multiple regression analysis revealed LA area in atrial systole to be the best correlate of LV wall thickness. We conclude that because the left atrium is a thin-walled structure, its size may increase with an increase in LA pressure. In the absence of mitral valve disease and atrial fibrillation, LA size may reflect the chronicity and duration and thus the history of LA hypertension. LA size in the apical four-chamber view may, therefore, provide a simple noninvasive assessment of the degree of LV diastolic dysfunction.

Adult↗
PubMed2002

Comparison of left ventricular geometry and left atrial size and function in patients with aortic stenosis versus those with pure aortic regurgitation.

Chronic aortic valve disease can result in distinct adaptive left ventricular (LV) geometric patterns, which has different effects on LV function and left atrial (LA) performance. In this study we assessed the effect of LV geometry on LA size and function, and we verified the relation between LA size and LV mass in patients with distinct LV overload subsets. We analyzed 183 patients with aortic valve disease who underwent a complete echocardiographic evaluation. Based on the type of valvular dysfunction, patients were classified into 2 groups: 141 patients with aortic stenosis (group AS) and 42 patients with pure aortic regurgitation (group AR). Each of these 2 groups were then divided into those with a concentric LV pattern and those with an eccentric pattern. Both LA size and LA ejection force were significantly greater in group AS than group AR, particularly in patients with a concentric LV pattern. The degree of LA enlargement depended on LV mass in the patients with a concentric LV pattern (group AS r = 0.61, p <0.00001; group AR r = 0.38, p = 0.04). In contrast, no relation was found between LA size and LV mass in the patients with an eccentric pattern, independently of the type of valve dysfunction. Our results indicate that the influence of LV geometry on LA size and function in patients with aortic valve disease is relevant. A concentric LV pattern is associated with greater LA size and higher ejection than an eccentric pattern, suggesting that chronic LV pressure overload more than volume overload has a greater effect on stimulating increases in LA performance. The degree of LA enlargement depends on LV mass in patients with a concentric LV pattern, whereas it was unpredictable in those with an eccentric LV pattern.

Adult↗
PubMed1993

Left atrial volume and function in valvular aortic stenosis.

To assess left atrial volume and function in aortic stenosis, 20 patients with this condition and 10 normal controls were studied. Atrial volumes were measured by echocardiography at mitral valve opening (maximal), onset of atrial systole (P wave of the electrocardiogram) and mitral valve closure (minimal), using biplane techniques. The maximal volume was greater in those patients with aortic stenosis as compared to the controls (74.8 +/- 26.4 cm3 vs. 46.4 +/- 11.9 cm3, p < 0.005), and was directly related to left ventricular mass (r = 0.77). The passive emptying volume (maximal minus onset of atrial systole) was similar in the two groups (21 +/- 8 cm3 vs. 18.7 +/- 5.9 cm3, p = NS), while active emptying volume (onset of atrial systole minus minimal) was higher in aortic stenosis (16.8 +/- 5.2 cm3 vs. 10.2 +/- 2.5 cm3, p < 0.001). The total emptying volume (sum of passive and active) was slightly higher amongst those with aortic stenosis (37.4 +/- 10.2 cm3 vs. 28.9 +/- 7.5 cm3, p < 0.05). The passive emptying fraction (passive emptying volume/maximal) was lower in the aortic stenosis group (0.28 +/- 0.08 vs. 0.40 +/- 0.05, p < 0.001), while the active emptying fraction (active emptying volume/volume at onset of atrial systole) was similar between the two groups (0.33 +/- 0.09 vs. 0.37 +/- 0.05, p = NS). Increased left atrial size in aortic stenosis is directly related to left ventricular mass and restores left atrial total emptying volume, despite the depressed passive emptying fraction. Left atrial dilatation thus represents an important compensatory mechanism, contributing to the maintenance of left ventricular stroke volume and cardiac output in severe aortic stenosis.

Aortic Valve↗
PubMed1995

Left atrial volumes and function in orthotopic cardiac transplantation.

Early ventricular filling and therefore passive left atrial emptying may be impaired in patients with cardiac transplantation. As a result, left atrial function may be an important factor in maintaining stroke volume in recipients of orthotopic cardiac transplants. Left atrial volumes maximal (mitral valve opening), minimal (mitral valve closure), and onset of atrial systole (P wave on electrocardiogram) were determined by echocardiography using the biplane area-length method in 12 patients after cardiac transplantation and 12 control subjects. Maximal and minimal left atrial volumes and left atrial volumes at onset of atrial systole were larger in patients who had cardiac transplantation than in control subjects (89.8 vs 41.8 cm3, 48 vs 15.2 cm3, and 70.4 vs 27.0 cm3, respectively; p < 0.01). In patients undergoing cardiac transplantation, good correlations were found between left atrial maximal volume and left ventricular mass (r = 0.56) and between left atrial maximal volume and mean pulmonary capillary wedge pressure (r = 0.81). Left atrial passive emptying volume (maximal minus volume at P wave), was not statistically different between the two groups (19.3 in patients receiving transplants vs 14.7 cm3 in control subjects), but left atrial stroke volume (beginning atrial systole to minimal) was larger in patients receiving transplants than in control subjects (22.4 vs 11.8 cm3, respectively; p < 0.001). Thus left atrial contraction contributed 42% to the left ventricular stroke volume in patients who had cardiac transplantation but only 17% in control subjects (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Function, Left↗