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At least 685 records · Page 38Linked to original sources
PubMed1994

Left atrial-volume determination by echocardiography. Validation by biplane angiography in the setting of mitral balloon valvuloplasty.

To validate echocardiographic left atrial volume measurements, 25 patients with mitral stenosis were studied before and after mitral balloon valvuloplasty. Seven normals served as controls. The modified Simpson's rule was used for echocardiographic and angiographic left atrial volume determination from two orthogonal planes. Left atrial antero-posterior diameter was measured from parasternal long axis view and supero-inferior and medio-lateral diameters from apical four-chamber view. Transthoracic echocardiographic left atrial volume correlated well, but systematically underestimated angiographic left atrial volume (y = 0.4x + 27, r = 0.92). Monoplane transesophageal echocardiography did not improve correlation, nor the underestimation. Out of the several left atrial diameters, antero-posterior dimension showed the closest correlation with angiographic volume (r = 0.91), which persisted after exclusion of patients with atria > 400 ml (r = 0.84). Furthermore, relative changes of antero-posterior diameter after mitral valvuloplasty were closely related to the relative changes observed in left atrial volume (r = 0.82). Our results suggest that, in spite of a consistent underestimation, bidimensional, transthoracic echocardiographic and angiographic left atrial assessment correlate closely. Moreover, it is suggested that the mere antero-posterior diameter from transthoracic two-dimensional image is sufficient in clinical practice for routine follow-op of left atrial volume.

Adult↗
PubMed1996

Atrial Mechanical Function Before and After Electrical or Amiodarone Cardioversion in Atrial Fibrillation: Assessment by Transesophageal Echocardiography and Pulsed Doppler.

In some patients with atrial fibrillation (AF), it has been suggested that left atrial mechanical dysfunction can develop after successful electrical cardioversion, justifying postcardioversion anticoagulant treatment. The purpose of this study was to investigate differences in left atrial appendage peak flow velocities and the incidence of left atrial spontaneous echo contrast in patients with AF before and after electrical cardioversion or intravenous amiodarone, studied using transesophageal echocardiography (TEE) and pulsed Doppler. We performed a control TEE in 7 patients in the electrical group and 6 in the amiodarone group, with no significant clinical differences between both groups. A second TEE was performed immediately in the 7 patients with successful electrical cardioversion. The peak flow velocities in the appendage before and after the procedure were: filling 43.3 +/- 22 vs 27.7 +/- 28 cm/sec (P = 0.01) and emptying 35.5 +/- 22 vs 23.6 +/- 17 cm/sec (P = 0.01), respectively. The spontaneous echo contrast increased in 4 of the 7 patients. In 4 patients of the amiodarone group, the peak flow velocities in the appendage during AF and within the first 24 hours after restoration of sinus rhythm were: filling 37.4 +/- 12 vs 37.8 +/- 18 cm/sec and emptying 36.4 +/- 18 vs 35.9 +/- 18 cm/sec, respectively (P = NS). There was no change in spontaneous echo contrast. In conclusion, patients with AF reverted to sinus rhythm using amiodarone did not show changes in left atrial mechanical function; however, patients with electrical cardioversion showed mechanical dysfunction. Further investigations on the effects of amiodarone and other drugs on the mechanical function of the atria are needed to determine if patients reverted pharmacologically require anticoagulation post reversion. (ECHOCARDIOGRAPHY, Volume 13, March 1996)

Journal Article↗
PubMedDate not supplied

Comparison of velocity and volumetric indexes of left ventricular filling during increased heart rate with exercise and amyl nitrite.

Physiologic variables, such as heart rate, affect the noninvasive indexes of left ventricular filling, complicating the interpretation of these indexes for clinical assessment of diastolic function. We compared the effect in normal subjects of increased heart rate provoked by both exercise and amyl nitrite on noninvasive velocity and volumetric indexes of left ventricular filling. Velocity indexes were affected in a different pattern with exercise compared with amyl nitrite because peak E wave velocity and relative atrial contribution to filling increased with exercise. In contrast, the volumetric index of rapid left ventricular filling increased similarly with both mechanisms. These findings demonstrate the importance of recognizing the different effects on indexes of left ventricular filling when heart rate is increased by different methods.

Adult↗
PubMedDate not supplied

Predictors of failure to cure atrial fibrillation with the mini-maze operation.

BACKGROUND: Maze-III is a complex surgical procedure designed to treat chronic atrial fibrillation. A reduction in the number of right and left atrial incisions could decrease the operative time. The aim of this study was to assess the results of a mini-maze operation and to define predictors of its failure. METHODS: Between 1995 and 2000, 72 patients (mean age 64 +/- 9 years) undergoing cardiac surgery had a concomitant mini-maze operation for symptomatic chronic atrial fibrillation. Three and 12 months post-operatively, heart rhythm and left atrial transport functions were assessed by electrophysiology, echocardiography, and magnetic resonance imaging. Multivariate analysis was performed to identify predictors of failure of the mini-maze operation. RESULTS: Operative mortality was 1.4% (1/72). Death during follow-up occurred in 5.6% of patients (4/71), in one due to chronic heart failure. After 1 year, 80% of patients (48/60) were either in sinus rhythm (n = 43; 72%) or had a pacemaker (n = 5; 8%) implanted due to sick sinus syndrome. Intermittent and chronic atrial fibrillation was found in 20% of patients (12/60). Preoperative duration of atrial fibrillation (p = 0.05), preoperative left atrial diameter (p = 0.001), preoperative right atrial diameter (p = 0.02), a reduced left ventricular ejection fraction (p = 0.03), an increased left ventricular end-diastolic diameter (p = 0.04), and the presence of mitral valve stenosis (p = 0.001) were found to be univariate predictors of failure of the mini-maze operation 1 year postoperatively. Multivariate analysis defined preoperative diagnosis of mitral valve stenosis (p = 0.005; OR 117.5), longer duration of preoperative atrial fibrillation (p = 0.01; OR 1.33), and increased preoperative left ventricular end-systolic diameter (p = 0.02; OR 1.2) as incremental independent risk factors for failure of the mini-maze operation to cure chronic atrial fibrillation. CONCLUSION: The mini-maze operation is a safe procedure with similar results to that of Cox's Maze-III operation. The less-invasive mini-maze operation could be applicable even to patients with severely reduced left ventricular function, in whom complex cardiac surgery has to be performed concomitantly as well as in those presenting severe comorbidities.

Adult↗
PubMed2004

Quantification of atrial tachyarrhythmia burden with an implantable pacemaker before and after pulmonary vein isolation.

Long-term efficacy of pulmonary vein (PV) ostial isolation for paroxysmal atrial fibrillation is difficult to assess. We evaluated the net duration of atrial tachyarrhythmia episodes (burden), atrial tachyarrhythmia episode frequency, and quality-of-life (QOL) before and after PV isolation in patients with an existing pacemaker featuring extensive diagnostic capabilities. Due to frequent recurrences of paroxysmal atrial fibrillation, PV isolation was performed 21 +/- 10 months following pacemaker implantation on 12 patients (57 +/- 5 years) with normal left ventricular function. Atrial tachyarrhythmia burden (ATB) and episode frequency were monitored daily by the device both pre- and postablation. QOL questionnaires were collected at ablation and 1, 3, and 6 months thereafter. Patients were followed for 20 +/- 9 and 11 +/- 9 months pre- and postablation, respectively. Membrane-active antiarrhythmic medications were discontinued after ablation in 8 of 12 patients. PV isolation resulted in a significant reduction of ATB from a median of 3.2 hours/day (preablation) to 0.2 hours/day (postablation, P < 0.01, Wilcoxon signed-rank test). The median tachyarrhythmia frequency was 6.4 episodes/day (preablation) and 0.3 episodes/day (postablation, P = 0.09). QOL measures significantly improved over the data collection intervals (P < 0.05). Tachyarrhythmia burden was positively associated with Symptom Checklist frequency and severity (P < 0.01). Significant long-term reductions in total ATB (symptomatic and asymptomatic) were observed. Furthermore, reductions in ATB were associated with improvements in QOL measures. Extensive monitoring capabilities in implantable devices help provide complete disclosure on the effect of PV isolation in paroxysmal atrial fibrillation patients.

Atrial Fibrillation↗
PubMed1994

Directionally opposite left atrial and ventricular volume changes during lower body suction.

In animals, sympathetic responses to orthostasis are regulated in part by cardiopulmonary afferents arising from atrial and ventricular baroreceptors. To determine the relative importance of these baroreceptor regions in the cardiopulmonary baroreflex of normal humans, simultaneous measurements of left atrial and right and left ventricular volumes (cine computed tomography), invasive hemodynamics, forearm vascular resistance (plethysmography), and efferent sympathetic nerve activity to muscle (microneurography) were obtained under control conditions and with nonhypotensive lower body negative pressure (-10 mmHg, LBNP-10) in nine normal human subjects. LBNP-10 did not alter heart rate or mean systemic arterial pressure, but it did produce significant decreases in pulmonary artery diastolic and right atrial pressures. This reduction in cardiac filling pressures resulted in efferent sympathoexcitation evidenced by increases in forearm vascular resistance and efferent sympathetic nerve activity to the muscle. LBNP-10 did not alter end-diastolic volume of the left or the right ventricle. Similarly, ventricular stroke volume was unchanged during LBNP-10, as assessed by cine computed tomography or thermodilution techniques. In contrast, LBNP-10 resulted in a significant decrease in left atrial volume. Thus, LBNP produced a significant decrease in cardiac filling pressures and left atrial volumes with resultant reflex sympathoexcitation, whereas ventricular volumes were unchanged. These observations suggest an important role for left atrial (nonventricular) baroreceptor afferents in the cardiopulmonary baroreflex of normal humans.

Atrial Function, Left↗
PubMed2004

Tachycardia during the valsalva maneuver: a sign of normal diastolic filling pressures.

Alteration of the loading conditions during the Valsalva maneuver is a helpful ancillary method in the noninvasive assessment of diastolic filling of the heart by Doppler echocardiography. When tachycardia is induced by the maneuver, mitral inflow velocity curves may become uninterpretable because of E velocity (the initial early diastolic velocity on the transmitral flow velocity curve) and A velocity (the velocity at atrial contraction on the transmitral flow velocity curve) wave fusion. To determine the clinical significance of the E velocity and A velocity wave fusion, our study assessed the relation between the heart rate response induced by the Valsalva maneuver and the left ventricular filling pressures measured during cardiac catheterization. In all, 77 patients performed the maneuver during continuous hemodynamic and electrocardiographic monitoring. The ratio between the baseline R-R interval and the shortest R-R interval during the maneuver was calculated. A ratio value higher than 1.1 was predictive of a pre-A pressure of less than 18 mm Hg (94% positive predictive value). Reflex tachycardia during the Valsalva maneuver and subsequent fusion of the E velocity and A velocity waves on the mitral velocity curves is a sign of normal left ventricular filling pressures.

Atrial Function, Left↗
PubMed1999

Prolongation of left atrial augmentation after handgrip stress in coronary artery disease: observation using pulsed Doppler flowmetry.

Although alterations in left ventricular diastolic filling dynamics have been observed during myocardial ischemia, few data exist regarding temporal changes in left ventricular filling during recovery. Therefore, the authors evaluated transmitral inflow pattern during and after handgrip exertion in coronary artery disease (CAD) by using Doppler echocardiography. The study population consisted of 18 normal (N) subjects and 47 patients with CAD. Of the CAD patients, 17 had coronary lesions associated with a limited area of underperfused myocardium (seven with good collateral circulation and 10 with distal lesions) (MILD), 15 patients exhibited a proximal lesion in a single vessel (SVD), and 15 patients had significant multivessel disease (MVD). Transmitral inflow velocities were continuously recorded at baseline, during handgrip exercise (50% of maximal for 1 minute), and for 5 minutes of recovery. Mean blood pressure, heart rate, early diastolic (E) and late atrial (A) inflow velocities, A/E ratio, and percent changes in E, A, and A/E from baseline were measured. In N and MILD, respectively, left ventricular inflow pattern returned to baseline at 3 minutes after handgrip (%E: 0.7 +/- 7.6%, 6.4 +/- 13.7%; %A: -0.2 +/- 7.9%, 3.1 +/- 6.5%; %A/E: -0.1 +/- 9.7%, -1.7 +/- 12.9%). In SVD and MVD, respectively, change in left ventricular inflow pattern was continued at 3 minutes after handgrip (%E: 7.2 +/- 9.4%, -4.3 +/- 17.2%, %A: 15.4 +/- 11.7%, 20.4 +/- 14.6%, %A/E: 7.9 +/- 10.0%, 29.2 +/- 25.6%). Increases in A and A/E in SVD and MVD were significantly higher than in N and MILD. Impaired left ventricular inflow pattern was observed at 3 minutes after handgrip in CAD, which may be reflected from prolonged impairment of diastolic function produced by ischemia. Therefore, temporal observation of left ventricular inflow pattern using the handgrip stress Doppler method may be useful for detection or follow-up of CAD.

Aged↗
PubMed1991

Clinical study of left atrial compliance and left atrial volume in mitral stenosis.

We studied left atrial compliance and left atrial volume in 21 patients with mitral stenosis showing a normal sinus rhythm. 1) A significant (p less than 0.001) negative linear correlation of r = 0.72 was found between the mitral valve area (MVA) and left atrial mean pressure (LAm). 2) A significant (p less than 0.005) positive linear correlation of r = 0.60 was found between MVA and left atrial compliance (delta V/delta P). 3) A significant (p less than 0.001) hyperbolic correlation of r = 0.73 was found between LAm and delta V/delta P. 4) A significant (p less than 0.001) hyperbolic correlation of r = 0.65 was found between left atrial specific compliance (delta V/delta P/LAVmax. LAVmax: left atrial maximum volume) and left atrial mean volume. 5) These findings led to the conclusion that in patients with mitral stenosis showing a normal sinus rhythm, left atrial compliance was decreased in patients whose left atrial volume was increased, and the decrease of left atrial compliance was related to narrowing of the mitral valve area and elevation of the left atrial pressure.

Adult↗
PubMed1986

The effect of bicycle exercise and atrial pacing on left ventricular volume and function in healthy persons and in patients with coronary artery disease. An echocardiographic study.

The haemodynamic response to submaximal exercise and atrial pacing in 30 healthy subjects and in 30 patients with coronary artery disease was investigated by M-mode echocardiography. In healthy subjects, the cardiovascular function after atrial pacing was not altered substantially. Exercise, however, caused a marked improvement in haemodynamics, which was due to increased myocardial contractility and diminished afterload. On the other hand, in patients with coronary artery disease, both after exercise and after atrial pacing a significant deterioration of left ventricular function was observed.

Adult↗